The document discusses the growing threat of non-communicable diseases (NCDs) like heart disease, diabetes and cancer to development, especially in low and middle income countries. It outlines the scale of NCDs globally and in developing nations, highlighting their social and economic impacts. Potential responses are examined, including priorities identified by the UN like implementing multi-sectoral national NCD plans with a focus on prevention, primary care, community health workers, and making patients central to care.

1. Non-Communicable Disease and the future
of development
Richard Smith
Director, UnitedHealth Chronic Disease Initiative

3. Ban Ki-moon on NCDs
• “Non-communicable
diseases are a threat
to development. NCDs
hit the poor and
vulnerable particularly
hard, and drive them
deeper into poverty.”
• Ban Ki-moon

4. Ban Ki-moon on NCDs
• More than a quarter of all people
who die from NCDs succumb in the
prime of their lives. The vast
majority live in developing
countries. Millions of families are
pushed into poverty each year
when one of their members have
become too weak to work. Or when
the costs of medicines and
treatments overwhelm the family
budget. Or when the main
breadwinner has to stay home to
care for someone else who is sick.

5. Agenda
• Definitions
• Scale of the problem
• Causes
• The UN meeting
• How best to respond ?

6. Non-communicable disease
• WHO defines non-communicable disease (NCD) as
cardiovascular disease, diabetes, chronic respiratory
disease, and certain cancers.
• All of these have in common that they are caused
predominantly by tobacco use, poor diet, physical
inactivity, and the harmful use of alcohol.
• Doesn't include mental health and many other chronic
conditions
Source: World Health Organization, 2005

7. Burden of disease

8. Leading Causes of Mortality and Burden of Disease
world, 2004
Mortality DALYs
% %
• Ischaemic heart disease 12.2 • Lower respiratory infections 6.2
• Cerebrovascular disease 9.7 • Diarrhoeal diseases 4.8
• Lower respiratory infections 7.1 • Depression 4.3
• COPD 5.1 • Ischaemic heart disease 4.1
• Diarrhoeal diseases 3.7 • HIV/AIDS 3.8
• HIV/AIDS 3.5 • Cerebrovascular disease 3.1
• Tuberculosis 2.5 8. Prematurity, low birth weight 2.9
9. Trachea, bronchus, lung cancers 2.3 • Birth asphyxia, birth trauma 2.7
• Road traffic accidents 2.2 • Road traffic accidents 2.7
11. Prematurity, low birth weight 2.0 • Neonatal infections and other 2.7
8

9. Deaths from chronic disease are displacing deaths from
infectious disease even in rural Bangladesh

10. NCDs are commonest among the poorest in
rural Bangladesh

11. Ten leading causes of burden of disease,
world, 2004 and 2030
11

12. We can make a difference: death rates in the
US, 1900-1996
Decline

13. Yet only 3% of global
health aid ($21 billion)
goes to NCDs and mental
health.

14. Causes of NCDs

15. In September 2011 the UN held a high level meeting on
NCDs
• Only the second high level meeting of the UN on
health
• The first in 2001 led to the Global Fund for AIDS,
TB, and malaria
• Led to a flurry of activity and a raising of
consciousness (although not among ordinary
people)
• 130 countries spoke; 200 civil society
representatives attended; 40 side meetings

16. Future commitments with target dates
• 2012: work with WHO and all stakeholders to
set targets
– Currently arguments over targets
– Can targets be sensibly set?
– Will they set some countries up to fail?
• 2013: review of the MDGs; integrate NCDs
• 2014: UN review of progress

18. What was achieved?
• On global agenda: meeting was a step change
• Understanding that a response must go well
beyond health sector: “Whole of society, whole
of government”
• Development issue
• Civil society movement important: NCD
Alliance

19. What didn't happen
• Nothing on mental health. Should there be another high level meeting?
• No new funding apart from Russia and Australia
• NCD Alliance had issues with best buys—major omissions
• Alcohol weak
• Little on children
• No champion countries
– China and India not very visible; too few G8 champions
– Not many LMIC stepping forward
• Yet to engage the public—must do by 2014

20. How best to respond?

21. Priorities of the UN Secretary General
• Complete government wide action on risk factors
• Sustained primary health care with prioritised
packages plus palliative and long term caregivers
• Surveillance and monitoring
• Learning from and integration with AIDS, TB, and
malaria programmes
• Governments, private sector, civil society, and
international organisations must all work together

22. How best to respond?
• “We need a whole
of government and
a whole of society
response”
• Margaret Chan,
director general,
WHO

23. Which is the best level at which to intervene?

24. WHO calculations of cost effectiveness of priorities for
preventing and controlling NCDs
• Depends on geography and disease patterns in each
country/region
• Looked at 500 single or combined interventions
• Costs: resources needed multiplied by unit price
(varies widely), in $Int, which takes account of
purchasing power
• Benefits: DALYs averted
• “Highly cost effective” if cost per DALY below GDP per
person

25. Interventions that cost less than GDP per head:
SubSaharan Africa
• Cardiovascular disease, diabetes and tobacco: 8
– Preventive multidrug treatment at 35% risk of CVD event
– Increased taxation on tobacco
– Retinopathy screening, 80% coverage
• Cancer: 6
– Cervical cancer, pap smear at age 40, lesion removal plus cancer
treatment, 50% coverage
– Colorectal cancer: surgery/chemotherapy/radiotherapy
• Respiratory disorders: None
• Sensory disorders: 8
• Mental disorder: 8
• Injuries (road traffic): 3

26. Cost effectiveness of different interventions for
preventing and controlling NCDs in Mexico

27. Interesting question
What might an entirely new system for
preventing and controlling NCDs in a low
income country look like?

28. Best system for responding to NCDs in LMIC
• High level task force that is whole of government and whole
of society
• Emphasis on public health and prevention with an
emphasis on structural changes
• Patients TRULY in charge
• Extensive use of community health workers
• Extensive standardisation and use of protocols
• Emphasis on primary care
• Few hospitals and specialists—to avoid capture of
resources