Health care aid must refocus on chronic disease

Aid programmes must be refocused to tackle non-communicable diseases and injuries, say Robyn Norton, Lalit Dandona and Yangfeng Wu.

Non-communicable diseases and injuries are undisputedly the leading causes of death and disability in developing countries, and projections suggest their frequency will continue to increase for the foreseeable future.

Cardiovascular disease, for example, is already the leading cause of mortality in these countries, and an article in the Journal of the American Medical Association predicted it will rise 120 per cent for women and 137 per cent for men between 1990 and 2020.

Recent studies in rural India support these predictions. Detailed reviews showed that diseases of the circulatory system are the leading causes of mortality, followed by injuries.

Africa and China are experiencing huge epidemics of diseases related to blood-pressure. Stroke is now the leading cause of death from vascular disease in both countries.

The China National Nutrition and Health survey in 2002 revealed that the number of overweight individuals had increased by 39 per cent in the previous 10 years. Even in the poorer, rural areas of western China, surveys show widespread under-nutrition in children is now being replaced by alarming levels of childhood obesity. This is likely to have significant implications for the chronic disease burden in adults over the coming years.

Minimal attention

Not surprisingly, a growing number of developing country governments recognise that the burden of disease from non-communicable diseases has already reached epidemic proportions. They are seeking cost-effective solutions. Arguably, such solutions already exist. Many high-income countries have made significant progress in reducing the burden of non-communicable diseases and injuries.

In contrast, many global philanthropic, nongovernmental and multilateral organisations — such as the Bill and Melinda Gates Foundation and the Global Health Council, as well as leading academic institutions involved in global health in high-income countries — pay minimal attention to these conditions in developing countries. Their focus remains almost exclusively on infectious diseases, nutritional deficiencies and maternal and child health.

 

Given that many developing countries rely heavily on resources from industrialised nations, it is not surprising that prevention and management of non-communicable diseases and injuries in the developing world is inadequate and underdeveloped. Health planners and workers in many developing countries know little about how to prevent, identify and manage these conditions. The existing health infrastructures and health systems have been designed to respond to acute, non-chronic conditions, and are poorly suited to managing these new epidemics.

This neglect by international and aid organisations is likely to have significant implications. The numbers of people with non-communicable diseases will continue to increase, as will the impact of poor health on them and their families. This in turn will have significant detrimental social and economic effects on their communities and countries as a whole.

This is ethically unjustifiable, especially since so much is known about how to prevent and manage these conditions, albeit in rich countries. Progress towards the Millennium Development Goals (MDGs) must continue, but given the double burden of both communicable and non-communicable diseases in many developing countries, those of us working in global health care planning must put pressure on international organisations and institutions to assist developing countries with cost-effective solutions to non-communicable diseases and injuries. The gains achieved in reaching the MDGs could easily be undermined if resources are not also directed towards non-communicable conditions.

Fortunately, some organisations and institutions are already changing their policies. A 2007 World Bank report, for example, called for action to reduce the growing increase in chronic diseases, and to prepare for the predicted heavy demand on healthcare budgets. The report said the Bank’s lending operations will be "demand driven". We suggest that developing country governments respond, and seize the opportunity to engage with the Bank.

Likewise, in July 2007, Ovations, a UnitedHealth Group company, issued a worldwide "request for proposals to create centres to counter chronic disease in developing countries", as a result of a commitment established at the 2006 Clinton Global Initiative. Although funds are available to establish only five such centres, 136 proposals were received from over 70 countries. This shows both that developing countries recognise non-communicable diseases as a priority, and that there is an urgent need for other global funders to follow suit.

 

We applaud these two initiatives. But change needs to be accelerated because we are in a race against time. Everyone committed to improving the health of populations in developing countries must take action. We must challenge and encourage global organisations and institutions to heed developing countries’ data and needs. We must support organisations in reorienting their work programmes so that high-profile initiatives on non-communicable diseases and injuries in developing countries become common.

Robyn Norton is principal director of The George Institute for International Health, Sydney, Australia. She is also professor of public health and associate dean (international) for the faculty of health at the University of Sydney.

Lalit Dandona is senior director of The George Institute, India, based in Hyderabad, and a professor and chair of international public health at the School of Public Health, University of Sydney, Australia.

Yangfeng Wu is director of The George Institute, China, based in Beijing, and a professor and director of clinical research at Peking University Health Science Centre, Beijing, China.