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Friday, November 18, 2011

Non-Communicable Diseases: The Sword of the Damocles for developing countries

Siddharth Chatterjee, MPP ’11
Dr. Ayham Alomari

Thanks to the excellent work done by the United Nations Children’s Fund (UNICEF), the World Health Organization (WHO), the Global Alliance for Vaccines and Immunization (GAVI), the International Federation of Red Cross and Red Crescent Societies (IFRC), the Bill and Melinda Gates Foundation, governments, and other institutions to ramp up immunization for vaccine-preventable diseases, it is having the desired effect in reducing infant and child mortality. This important initiative has to be kept up and would contribute greatly to achieving the UN’s Millennium Development Goals by 2015.

But there is another threat that looms like the Sword of the Damocles: non-communicable diseases (NCDs) such as cardiovascular, cancer, diabetes, and lung diseases. To some extent, of course, the increasing prevalence of NCDs is an arithmetic consequence of reducing morbidity and mortality from communicable diseases. If people do not suffer and die from communicable diseases, they typically will die from an NCD. The tragedy, however, is that humans around the world suffer and die from NCDs prematurely, long before the natural limit to which modern medicine and non-medical interventions, including community-based efforts, can push the onset of suffering and the occurrence of death. In addition, the high burden of NCDs makes them a laden threat to health and development. NCDs are barriers to poverty reduction, health equity, economic stability, and human security.

A recent issue of the Economist states: “Indeed, of the 36m people killed by NCDs [annually], some 80% live in low- and middle-income countries. These diseases are associated with increased prosperity and longevity, and the results are costly. The World Economic Forum estimates that NCDs will cost low- and middle-income countries $7 trillion over the next 15 years.”

The most striking feature of NCDs is that, contrary to what most people think, it’s not just the rich that are feeling the damaging effects of physical inactivity, obesity, and poor diets. Far from it, the poor and middle class within the developing world are facing NCDs-related deaths exponentially. According to the statistics above, each day there are 100,000 deaths from NCDs, with 80% occurring in the world’s poorest countries. And unless we act collectively and with conviction the future looks ominous. According to WHO, NCD deaths are projected to increase by 15% globally between 2010 and 2020.

With the lives of 36 million people annually at stake, we all know what it takes to prevent NCDs – healthy lifestyles. NCDs could be preventable by eliminating shared risk factors such as tobacco use, unhealthy diet, physical inactivity, and harmful use of alcohol. Those risk factors are the main contributors to the magnitude and scale of NCDs worldwide. But many hurdles stand in our way, most stemming from a lack of urgency as well as political will to deal with this growing scourge.

To find ways to engage broader community involvement in NCDs, prevention through dialogue and concrete action were the topic of an event co-hosted by the IFRC and the International Federation of Pharmaceutical Manufacturers Association (IFPMA) at this year’s UN General Assembly in September. The panelists – who represented leaders among Red Cross Red Crescent National Societies, WHO, the private sector, and academia (including the active participation of two prominent members of Princeton University) – reinforced the call for integrated multi-sector and multi-partner NCD prevention initiatives.

Greg Vickery, President of the Australian Red Cross, shared his experience in working with Indigenous Australians, who are among the most vulnerable to NCDs. “Our response is threefold – through the ‘Save-a-Mate’ resuscitation and education program tackling the alcohol problem they face; breakfast clubs that teach school children healthy eating habits; and the ‘Food Cents Programme’ that shows families how to eat healthily on a tight budget, i.e. simple strategies to support healthy eating habits.” Professor Uwe Reinhardt, James Madison Professor of Political Economy at the Woodrow Wilson School, reminded the audience that part of this community-based effort must be to make the individual be both able and willing to play an active role in the management of his or her own health.

So basically, the message we want to stress is simple. Says IFRC’s Secretary General, Mr. Bekele Geleta, “Humanitarian organizations such as the Red Cross Red Crescent, whose staff and close to 13 million active volunteers world-wide work closely with local communities, play an enormous role in bringing about changes in behavior and attitudes towards health and lifestyle.” We at the IFRC strongly believe that including NCDs in our health programs is consistent with our Red Cross Red Crescent Strategy 2020 to enable healthy and safe living. Our Framework for NCDs focuses on prevention, innovation & research, monitoring & evaluation, partnership, and advocacy.

But we cannot do it in silos or on our own. To make a real difference for those who are not on a health services radar screen, it is critical that we forge robust partnerships not only with governments, the UN, and NGOs but also with important thought leaders and opinion leaders like Princeton University. This has to be a collective and well-orchestrated endeavour to prevent what the UN has called “a public health emergency in slow motion” from spreading. Simple lifestyle change is the key. Resources – intellectual and financial, as well as partners from the public and private sectors alike – need to come together.

The IFRC is keen to move forward on this important initiative. In the words of Professor Reinhardt, “One thinks of the Red Cross Red Crescent more in connection with earthquakes, tsunamis, and other spectacular and sudden natural disasters. I was surprised and encouraged to learn how much the organization is doing in response to another, albeit slowly developing, natural disaster, the growing burden of premature deaths due to NCDs, much of that burden the result of people’s inability or unwillingness, or both, to manage their own health better.”

The actions, then, appear to be simple, and the outcomes desirable. But it will take a significant investment of time and money to strengthen the ties that bind the Sword above us.

Siddharth Chatterjee is the Chief Diplomatic Officer and Head of International Relations at the IFRC. Dr. Ayham Alomari is a Senior Health Officer, Community Based Health and First Aid, NCDs at the IFRC.


  1. Indeed a timely reminder of a major health problem that has already started to snap at our heels. 345 million cases of diabetes, 80% of these are in the developing world.

  2. Interesting. Hope the Red Cross can work to ensure prevention. Healthy options and lifestyles will be important.

  3. "_Siddharth Chatterjee" makes a compelling case.