Meeting the Challenge of Non-Communicable Diseases Dr. Jeffrey L. Sturchio President & CEO Global Health Council Journalist to Journalist Training National Press Foundation June 12, 2011

Globalization and health In an age of globalization and growing insecurity, health is everybody’s business With the impact of global transportation and communications networks, a SARS outbreak in China can reverberated rapidly from Canada to Cairo “In an interconnected and interdependent world, bacteria and viruses travel almost as fast as e-mail messages and money flows.” Gro Harlem Brundtland, former Director-General, World Health Organization (2005)

Global health matters Global health affects everyone – disease knows no borders Infectious diseases such as avian influenza, tuberculosis, SARS and West Nile Virus can spread from one country to another Other health challenges such as HIV/AIDS have a major global political and economic impact  Good health is the foundation for building a stable economy Poor health hinders one’s ability to take advantage of educational opportunities or hold a job Poor health undermines countries’ development and trade and can reinforce the cycle of poverty and political instability.

Impact of global crises on health “Equitable access to health care, and greater equity in health outcomes are fundamental to a well-functioning economy….Health had no say in the policies that led to the financial crisis or made climate change inevitable. But the health sector will bear the brunt of the consequences.....A world that is greatly out of balance in matters of health is neither stable nor secure.” Margaret Chan, “The impact of global crises on health: money, weather and microbes,” Address at the 23rd Forum on Global Issues, Berlin, Germany, March 18, 2009. http://www.who.int/dg/speeches/2009/financial_crisis_20090318/en/

Non-communicable diseases Non-communicable diseases (NCDs) are the leading cause of death and disability worldwide; they account for 60 percent of all deaths globally People living in developing countries are more likely to develop and die prematurely from chronic disease Have limited access to comprehensive health services for NCDs Live in countries that do not have effective policies for NCDs (tobacco, alcohol, air pollution, etc.) In addition to their devastating impact on health, NCDs have a major socio-economic impact on individuals, families, communities, and countries There is an urgent need to raise the profile of NCDs on the international development agenda The burden of chronic disease will account for over 75 percent of deaths by 2030

Ten leading causes of burden of disease, world, 2004 and 2030

The World Economic Forum named NCDs the third largest economic risk facing the globe in 2010

Many of the risk factors associated with NCDs are related to modifiable behaviors

SOURCE: Geneau R, Stuckler D, McKee M, et al SOURCE: Geneau R, Stuckler D, McKee M, et al. Raising the priority of preventing chronic diseases: a political process. Lancet 2010; 376: 1689-98.

Cardiovascular Diseases The leading cause of death worldwide, accounting for 17 million deaths in 2005 Of these, 7.2 million were due to heart attacks and 5.7 million due to stroke Include coronary heart disease (heart attacks), cerebrovascular disease, raised blood pressure (hypertension), peripheral artery disease, rheumatic heart disease, congenital heart disease, and heart failure If current trends continue, WHO estimates that 23.6 million people will dies from cardiovascular disease by 2030

Chronic respiratory diseases (CRDs) Include asthma, respiratory allergies, chronic obstructive pulmonary disease (COPD), occupational lung diseases, sleep apnea syndrome and pulmonary hypertension Collectively, CRDs account for 4 million deaths per year; COPD is the fourth leading cause of death worldwide Many CRDs are preventable, although they often fail to receive adequate attention from the health care system

Cancers A leading cause of death group worldwide, accounting for 7.4 million deaths in 2004 The global cancer burden has doubled in the past 30 years; by 2020, the cancer burden of 2000 is expected to double again More that 70 percent of cancers occur in low- and middle-income countries The leading type of cancer is lung cancer, accounting for 1.3 million deaths per year In less developed countries, the leading type of cancer for men is lung cancer, followed by liver cancer; the leading type for women is breast cancer followed by cervical cancer

Diabetes Worldwide, over 220 people had diabetes in 2004 Nearly 80 percent of diabetes deaths occur in low- and middle-income countries WHO estimates that diabetes deaths will double between 2005 and 2030 Causes kidney failure, diabetic retinopathy, and diabetic neuropathy; increases the risk of heart disease and stroke 43 million pre-school children worldwide are obese or overweight

60 per cent of the world’s total deaths are due to non-communicable diseases, many of which are preventable

90 per cent of people dying prematurely from NCDs live in developing countries

NCDs are among the top ten causes of causes of death in every income group

Without action, Africa will witness the largest increase in deaths from NCDs in 2015 (compared to 2004). South East Asia and the Western Pacific will have the highest absolute number of deaths.

Factors that contribute to the rise of NCDs Rapid urbanization has led to changes in diet, physical activity, and environmental exposure Decreases in the price of animal based products, sweeteners, and oils over the past two decades have contributed to dietary changes Increasing availability of tobacco products as a result of expanding markets and lack of protective trade policies Lack of knowledge about chronic disease and poor understanding of contributing risk factors Shifting patterns of behavior due to globalization and increased media exposure/marketing

Economic impact of NCDs NCDs reduce the economic productivity of individuals and cause many families to fall into poverty The long-term nature of treatment and care for chronic disease results in significant household expenditures over prolonged periods of time and inability of the household to accumulate savings Indian households that include a family member with a chronic disease are 40 percent more likely to fall into poverty The expense of treatment often deters individuals from seeking treatment In Nigeria, over 60 percent of cancer patients failed to complete their chemotherapy treatments because of the prohibitive cost of the drugs NCDs also have a severe impact on the economies of countries Over the next decade, China is estimated to lose over $550 billion in national income due to cardiovascular disease In Central Asia, chronic diseases may reduce workers’ labor effort by 7 to 30 percent

Why have NCDs been neglected? Common myths that surround NCDs – that people knowingly choose to engage in unhealthy behaviors (smoking, drinking, diet), or that chronic diseases related to aging are inevitable – may be detrimental to collective action Policies that aim to regulate individual behavior (taxes on soft drinks, cigarettes) may be seen as impinging on individual agency Weak health information systems prevent adequate surveillance of chronic disease in many developing countries; without data, it is difficult to argue for the prioritization of NCDs based on the burden of disease Although international advocacy for NCDs is growing, greater efforts are needed on the local level to raise the profile of NCDs on national agendas Another myth around NCDs is that low- and middle-income countries should give priority to infectious diseases. However, this approach does not align with the burden of disease in these countries.

Interventions for NCDs In 2007, a Lancet Series on NCDs identified three highly cost-effective interventions for preventing NCDs: tobacco control, salt reduction, combined drug treatment for people at high risk of cardiovascular disease Tobacco control and salt reduction could prevent almost 14 millions deaths over the next decade, at a cost of less than US $0.40 per person per year Aspirin and generic drugs to lower blood pressure and cholesterol could prevent 18 million deaths over the next decade, at a cost of approximately $1.10 per person per year National policies and legislation to limit the use of harmful substances, such as tobacco, alcohol, and unhealthy foods Behavior change campaigns to educate about the risks of chronic disease and encourage positive, healthy behaviors Strengthening of health systems and additional prevention, screening, treatment, and care services targeted to chronic disease

Funding for NCDs Funding for NCDs is severely lacking; in 2007, only 2.3 percent ($503 million) of overall development assistance for health was dedicated to NCDs Less than 15 percent of the WHO’s agenda is allocated to chronic disease Less than 2 percent of the total health budget of the Gates Foundation and the World Bank is allocated to chronic disease Currently, there is no OECD/DAC Reporting System code to track funds for NCDs In low- and middle-income countries, many governments are increasing domestic expenditures for health, but investment in chronic disease is lacking However, between 2001 and 2008 donor funding to developing countries for NCDs increased by over 600 percent. This suggests a growing recognition and willingness to address the increasing burden of NCDs.

Next steps for NCDs High-level Meeting of the United Nations General Assembly on the Prevention and Control of Non-communicable Diseases on September 19, 2011 UNGA will focus on three major themes related to chronic disease: The rising incidence, developmental and other challenges and the socioeconomic impact of NCDs and their risk factors; Strengthening national capacities, as well as appropriate policies, to address prevention and control of non-communicable diseases; Fostering international cooperation, as well as coordination, to address non-communicable diseases.

NCD Alliance

NCD Alliance’s “10 Asks” for the UN NCDs Summit 1. Commit to a whole-of-government response through costed national plans for NCD prevention and treatment 2. Establish an NCDs Partnership, linked to WHO, to coordinate follow up action with member states, other UN and multilateral agencies, foundations, NGOs and private sector 3. Increase national and international resources for NCD prevention and treatment 4. Include NCDs in future global health and development goals 5. Accelerate implementation of Framework Convention on Tobacco Control (FCTC) 6. Reduce dietary salt, sugar, saturated and trans-fats and harmful use of alcohol 7. Implement strategies to encourage physical activity and improve diet 8. Strengthen health systems through integration of NCD prevention and treatment 9. Increase access to affordable, quality-assured essential medicines and technologies to prevent and treat cancer, cardiovascular disease, chronic respiratory disease and diabetes, including vaccines and palliative care 10. Establish a high level Accountability Commission on NCDs with cross sector representation to monitor Summit commitments.

Key dates WHO/ UNDESA Regional Summit Consultations South-East Asia (14-17 Feb, Dhaka, Bangladesh) Americas (24-25 February, Mexico City, Mexico) Western Pacific (25-27 March, Seoul, South Korea) Africa: TBD NCD Alliance Side Event: 55th Session of the Commission on the Status of Women, 22 Feb–4 Mar, New York Partners in Health / NCD Alliance Conference on NCDs of the Bottom Billion, 2-3 March, Harvard University Oxford Health Alliance Annual Meeting on NCDs, 14-15 April 2011, Oxford, UK NCDnet Global Forum, 27 April, Moscow Russia Ministerial Conference on NCDs, 28-29 April, Moscow 64th World Health Assembly, 16-25 May, Geneva Global Health Council Annual Conference (Theme: NCDs), 13-17 June, Washington, DC UN civil society consultation, June 16 UN High-Level Meeting, 19-20 September 2011 in New York Three Roundtable Sessions

A role for public/private partnerships Private sector companies can also make contributions to health and development by building partnerships to address these challenges Working together, we can achieve more than any single organization or country can do on its own Public/private partnerships offer an important mechanism that works to combine the complementary resources and expertise of the public and private sectors to achieve health goals

The value of collaboration “The marketplace is not the answer to all questions facing society. Likewise, the public sector cannot solve all social problems. But the combination of public and private efforts, when harnessed together, in an effort to achieve a clear and shared health objective, provides a powerful force that exceeds the sum of its separate efforts.” Dr. William H. Foege, in Ethics and the Pharmaceutical Industry (2005)

Health Promotion and Risk Prevention Health System Strengthening Framework for Corporate Pledges to Support NCD Prevention & Control Health Promotion and Risk Prevention Nutrition & healthy diets (A,H) Physical activity & sports (B,H) 3) Tobacco control (C,D,H) 4) Alcohol responsibility (C,D, H) 5) Health education & wellness initiatives (C,D, G, H, I) Reformulation Marketing Portion size Other School/youth Urban design Smoke free workplaces Cessation support Counsel/support Awareness Risk management Wellness incentives Health System Strengthening 6) Medicines & Vaccines (E) 7) Patient diagnosis & Treatment (E,F) 8) Healthcare professional training (D,F,G) 9) Patient monitoring & follow-up (D,G) 10) Governance (I) R&D for innovative medicines for NCD’s Affordable & accessible treatment Other Leveraging primary care infrastructure Innovative delivery models Building networks On-line training Internships Remote check-ups Disease management Self-regulatory codes Industry commitments Best practices A. Food/beverage, food service & agriculture B. Sporting Goods C. Employers D. Health Insurers & healthcare providers E. Pharmaceuticals F. Medical devices & diagnostics G. Information &/Communications Technologies (ICTs) H. Media I. Cross-industry J. Other

The way forward We need to find the best solutions and scale them up -- across borders, across sectors, and through collaboration and cooperation among all stakeholders Progress is possible -- and there have been encouraging developments in the past several years with respect to dealing effectively with major global health issues Continued partnerships in global health provide the best way to build on this momentum -- and offer the best hope for those living with both infectious and chronic diseases in the developing world