Developing a Global Strategy to Combat Noncommunicable Diseases
WHO'S commitment to addressing the impact of 4 common noncommunicable diseases will ultimately lead to improvements for patients with a broad range of chronic conditions.
Chronic illnesses account for 63% of deaths worldwide and 70% in the United States.1 More than 800,000 people die from cardiovascular disease in a given year in this country, 570,000 die from cancer, and diabetes contributes to more than 230,000 deaths.2-4
If no action is taken to combat these and other noncommunicable diseases (NCDs), the World Health Organization (WHO) expects chronic conditions to increase 15% worldwide in the next 10 years, with much of the increase occurring in Africa, the Middle East, and Southeast Asia.
In April 2011, WHO convened a meeting of 100 ministers of health and 150 government delegations from around the world to deliberate on NCD issues and the need for policies to ensure the most effective responses to these diseases. The US delegation was led by Secretary of Health and Human Services Kathleen Sebelius, and included representatives from 2 patient advocacy organizations: John Seffirn, CEO, American Cancer Society,and Larry Hausner, CEO, American Diabetes Association.5
The Moscow conference was a precursor to a United Nations (UN) high-level September 2011 meeting in New York City initiating the development of a global strategy to combat cardiovascular diseases, cancer, diabetes, and respiratory diseases. The UN conference represented a significant opportunity to highlight the impact of NCDs on global health and generate widespread recognition of the challenge the world is facing. The focus of the conference was to gain political commitment to investing the necessary resources to prevent and tackle the growing threat of NCDs to public health.
Cardiovascular diseases, cancer, diabetes, and respiratory diseases, the 4 NCDs selected by WHO as a starting point, are connected by common modifiable risk factors: tobacco use, unhealthy diet, physical inactivity, and the misuse of alcohol. WHO believes that if we can take action both nationally and globally to address and halt the negative health and socioeconomic consequences of these 4 NCDs and their risk factors, we can have a major impact on a wide range of chronic conditions.
However, a number of patient advocacy organizations are legitimately concerned that by limiting the definition to 4 disease areas, some conditions will become less of a priority for decision makers. It is imperative that when we talk about NCDs, we do not forget the many other chronic conditions with which people live. Consequently, some patient advocacy organizations and professional associations—including the World Health Professions Alliance, whose membership includes the International Pharmaceutical Federation—are actively advocating for a more inclusive definition of NCDs, while supporting a global commitment to implement a WHO strategy.
One such patient advocacy organization is the International Alliance of Patients’ Organizations (IAPO), a patient-led global alliance that promotes patient-centered healthcare around the world. IAPO has committed itself to ensuring that chronic conditions in a broader sense are addressed in the NCD strategy, while not undermining the opportunity to have (for the first time) a high-level global initiative to address the NCDs identified by WHO.6 When the greater patient community understands the objectives of the WHO campaign and its potential impact on a broad range of conditions, IAPO believes advocacy organizations will then support the WHO’s strategy as it rolls out the NCD program in the coming year.
Closely related to the need for broad patient engagement in the development of an NCD strategy is the need for health literacy promotion. The WHO campaign must recognize the need to give people the skills to help prevent chronic conditions as well as manage the conditions they have in order to combat NCDs. As we have seen in this country, people with limited health literacy skills are more likely to skip important preventive health measures, have chronic conditions, and make greater use of services designed to treat complications of a disease and less use of services designed to prevent complications.7 Creating health-literate citizens is essential to enabling patients to effectively manage their health.
In addition, the success of any action on NCDs must be measurable, both in terms of how it strengthens the ability of healthcare systems to prevent and treat NCDs and how it results in better health outcomes. As the Nobel Prize—winning economist Joseph Stiglitz aptly said, “What you measure affects what you do. If you don’t measure the right thing, you don’t do the right thing.”8
The global fiscal pressure of NCDs is already obvious, and the cost of inaction will be even greater—resulting in lost economic productivity in all countries.9 Evidence-based and cost-effective interventions exist to prevent and control NCDs.10 Although high blood pressure kills 4 times as many people around the world as HIV/AIDS, it costs only one one-hundredth as much to treat.1
The commitment of WHO to initiating and strengthening action at national and global levels to halt and address the impact of NCDs will ultimately lead to improvements for patients with other chronic diseases, so long as the broader healthcare environment is considered in the decision making. A patient-focused and measurable approach to prevention and management of the 4 identified conditions is an important first step in order to meet the needs of people worldwide.