The Next Health Tsunami: Non-communicable Diseases

The emerging epidemic of non-communicable diseases is threatening to overwhelm healthcare systems worldwide unless action is taken now. Diabetes, cardiovascular disease, cancer and chronic respiratory diseases cause 60% of all deaths worldwide, with four in every five of these deaths occurring in low- and middle-income countries. NCDs are an under-appreciated cause of poverty and now present a serious barrier to economic development. They are estimated to reduce gross domestic product (GDP) by up to 5% in many low- and middle-income countries, dealing a double blow to fragile economies struggling in the global recession and its aftermath.

NCDs threaten all sectors of society and have been recognized as a serious and increasing global risk by the World Economic Forum (see Figure 6.1). NCDs hit workers in LMCs in their most productive years and if unchecked, will decimate the workforce in particular countries with catastrophic impact for both economic growth and the well being of families.

Although diabetes and the other NCDs account for 35 million deaths annually, they are seriously under-resourced. Most bilateral and multilateral funding organizations of Overseas Development Assistance (ODA) to low-income countries have little or no funding for NCD programmes. The International Diabetes Federation (IDF) strongly supports the UN Millennium Development Goals (MDGs) which include targets on maternal health, child health, and HIV/AIDS, tuberculosis and malaria. But the MDGs need indicators to measure progress on NCDs before the NCD burden undermines progress made on economic and human development.

Public and Private Partnerships

The World Health Organization (WHO), in its 2008—2013 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases, identifies international partnerships as paramount in the global struggle against NCDs. The WHO Action Plan calls for concerted action on a global scale from governments, non-governmental organizations, the international community and private sector.

In May 2009, IDF, International Union Against Cancer (UICC) and World Heart Federation (WHF) rose to the challenge and issued a joint statement timed to coincide with the meeting of the World Health Assembly in Geneva. The organizations highlighted their support for the WHO Action Plan and called for the international community to:

1. Ensure the availability of essential medicines for people living with NCDs in low- and middle- income countries  
2. Immediately and substantially increase financing for NCDs  
3. Integrate NCD prevention into national health systems and the global development agenda  
4. Create a Special Envoy of the UN Secretary-General for NCDs  
5. Support a UN General Assembly Special Session on NCDs

Simple, cost-effective solutions exist to take on the burgeoning epidemic of NCDs. With 10-12 essential NCD medicines — most of which are out-of-patent and cost pennies to produce — the world could save millions of lives in LMCs. Such action would bring the international community closer to achieving the UN Millennium Development Goals. Governments who invest in prevention now will be spared the overwhelming costs of chronic care later.

IDF is working to raise awareness of the growing diabetes burden and catalyse political action to reverse the epidemic. Statements from the high level UN Economic and Social Council (ECOSOC) and Caribbean Heads of Government meetings in July 2009 show clearly that political momentum is growing. 2009 may come to be seen as a landmark year in moving diabetes and the other NCDs higher up the global agenda.

Source: World Economic Forum, 2009 1 

Winning the Battle against Diabetes

The prevalence data in this edition of the IDF Diabetes Atlas demonstrate that we are losing the battle to contain diabetes. Diabetes is a disease that all countries have in common. The difference, however, is that people in low- and middle-income countries and disadvantaged communities all over the world often have no access to the essential diabetes medicines and care that their health depends on.

Unlike some other diseases, treatment exists for diabetes, and if managed correctly, is very effective in reducing complications such as heart attacks, amputations, blindness and kidney failure. Many of the essential medicines for diabetes and the other non-communicable diseases cost just pennies to produce. Despite this, essential NCD medicines are often not available to people living with diabetes in LMCs.

Call to fund essential medicines and technology

The current global economic crisis only exacerbates these problems. On a national level, the immediate impact of the economic downturn has been felt in reduced public health budgets and upon those individuals and families who struggle to fund their own care. The longer term impacts remains to be seen, but as many low-income countries depend on overseas development aid, a decrease in foreign aid will adversely affect healthcare budgets. Resources must be made available to healthcare systems in these countries to enable them to tackle chronic diseases, such as diabetes, HIV/AIDS and tuberculosis, the magnitude of which is hindering economic progress.

The International Diabetes Federation is thus calling on the international community to fund essential diabetes medicines and technology and respond to the requests from LMCs for support to strengthen their healthcare systems, in keeping with the goals of UN Resolution 61/225 on diabetes. The recent year has seen growing recognition at global level of the urgent need to take action on diabetes and the other non-communicable diseases. We have moved closer to the tipping point when financial and technical assistance will become available to low-income countries to address NCDs. IDF’s national member associations are working together with governments and other partners to ensure that when such resources do come on stream, they are used effectively to benefit people with diabetes.

Towards implementation of UN Resolution on diabetes

Going forward into the next triennium IDF will work towards the full implementation of UN Resolution 61/225 by all governments. The Federation will continue to raise awareness and knowledge about diabetes through key activities such as the UN-recognized World Diabetes Day since ignorance and misconception remain widespread. IDF will strengthen its alliances with international organizations representing heart disease and cancer, forge new ones and lead the way in global advocacy. It will support the WHO Noncommunicable Diseases Action Plan, 2008—2013, which recognizes diabetes as a development issue (see The Next Health Tsunami).

In addition, the framework to strengthen diabetes education to ensure that the person with diabetes is an essential member of the management team will be further enhanced. IDF will continue to establish global guidelines for diabetes treatment, and develop and pilot effective models for the integrated management of diabetes and related NCDs. Work will continue to produce authoritative epidemiological and economic evidence, such as the IDF Diabetes Atlas, to underpin global and national policy making. IDF will persist in putting the case for resources for diabetes and for the development of affordable and appropriate diabetes technology.

Above all IDF will work to strengthen its member associations since their work for people with diabetes connects the Federation’s global advocacy to reality on the ground and enable it to speak as the global voice of the diabetes community. Once again IDF will express outrage that children and adults are dying for lack of a life-saving drug, insulin, that was discovered more than 88 years ago. Governments, civil society and people with diabetes have to work together to ensure that accidents of geography and history do not determine who should live or die because of inadequate access to optimal care and treatment, and essential medicines.