Trends in Global Health: The Rising Burden of Noncommunicable Diseases

Vidya Swaminathan, Ph.D.HVO  board member and Senior Director of Inhalation Product Development at AstraZeneca, authored this installment of Trends in Global Health, highlighting the rising prevalence of noncommunicable diseases (NCDs) in resource-scarce countries, as well as opportunities for HVO to contribute to the fight against NCDs. 

Asthma affects 315 million people globally, making it one of the most common chronic diseases in the world. Every year, asthma results in an estimated 345,000 deaths and the loss of 22 million disability-adjusted life years.

The global prevalence of chronic obstructive pulmonary disease (COPD) is estimated to be 329 million people. COPD is predicted to become the third leading cause of death worldwide by 2030.

These statistics on the burden of respiratory disease are ones with which I am intimately familiar in my current area of work—developing devices to deliver medicines by inhalation. I use these facts when communicating with my teams to frame our work in the larger context of global health, and to foster a heightened sense of urgency in getting our medicines to patients.

The statistics are a sliver of a snapshot of the global burden of chronic or non-communicable diseases (NCDs), such as cardiovascular disease, cancer, chronic lung diseases and diabetes.  The World Health Organization attributes 70% of all deaths – nearly 40 million deaths in 2015 – to NCDs. The majority of NCD-related deaths, 78% in 2015, occur in low- and middle- income countries, and 43% of deaths occur before the age of 70.  Chronic diseases and NCDs are now a major focus of the WHO, and reducing premature NCD deaths by a third by 2030 is a Sustainable Development Goal.  Toward this goal, the WHO has defined a list of nine health targets to reduce NCDs by 2025, together with a list of 25 indicators to monitor progress toward these targets.

NCDs share these modifiable risk factors: physical inactivity, unhealthy diet, smoking and alcohol use.  Economic growth and the accompanying shift out of poverty and scarcity, and the movement of populations from rural areas to towns and cities have been predictably accompanied by a rapid change in dietary preference to fast and processed foods. In many countries, these foods are associated with a modern lifestyle and social status, but consumptions of such foods has led to a rise in obesity, a risk factor for diabetes and hypertension, which in turn are risk factors for heart attacks and stroke, health outcomes that claim a high toll of lives.

The burden of NCDs goes beyond morbidity and mortality to include the high economic cost of managing chronic conditions, and the loss of productivity that results when individuals drop out of the workforce due to death or disability. An increased awareness and recognition of the significant NCD burden—including the economic burden on individuals, families, communities, and public health services—and its potential to slow down future socioeconomic growth has prompted action by governments, with the backing and support of the WHO and organizations such the Global Alliance for Chronic Diseases (GACD) founded by the NIH, that is investing in exploring and testing research strategies to stem this looming public health crisis.

Examples of regional initiatives include Thailand’s national program to promote physical activity. This program has been implemented through a combination of political support at the highest level, and regional economic investment in better environments for people of all ages and abilities to be more physically active, such as parks, and running and cycling trails. A social movement helped by social media promotion and celebrity endorsements has also aided in the success of the program.

The HEARTS pilot project in the Philippines is another example of a national effort to step up prevention, detection and treatment of cardiovascular diseases, through standardizing and strengthening primary health care for NCDs. This project has increased the availability of and access to medicines and diagnostic kits, and strengthened the capacity of health workers to counsel patients and families on healthful life choices.  Pilots are also ongoing in India, Kenya, and Tanzania where researchers with support from GACD are using smart phone technology to diagnose and monitor patients with hypertension, and test whether interventions by local health care workers are effective.

What can HVO do to step up its contribution toward addressing this critical global health need? HVO’s mission and core competencies fit this challenge spot on. The organization is about building resilience after all – a key component of any sustained solution to the NCD problem. HVO is in the business of skill-building and capacity-strengthening through education, and has been for over three decades, since the inception of the organization. HVO has deep and long standing relationships with regional and local health care agencies and governments in parts of South East Asia, Africa, and Central and South America, and a track record of delivering high quality training and teaching through a dedicated corps of volunteers.

HVO’s leadership has invested in relationship building based on trust, understanding of partner needs and constraints, sensitivity to local culture and mores, and above all consistent engagement over several years to sustain the gains realized and continue to build on the momentum gained. The organization has a broad network of volunteers and, more critically, through this network, the means to tap into a broad range of expertise in areas relevant to NCDs. This ability can be leveraged to expand HVO’s reach and impact. HVO’s proven ability to establish and maintain effective international partnerships across a diverse range of cultures and medical specialties complements the needs of the WHO and other organizations seeking to reduce the global burden of NCDs. For this reason, HVO can be an asset in the global fight against NCDs and chronic diseases.

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