Friday, September 16, 2011

U.S. committed to fighting NCDs, but not financially

Non-communicable diseases (NCDs) are now the leading cause of deaths in the world, killing more than 36 million people in 2008 (63% of the total). Cardiovascular diseases were responsible for 48% of these deaths, cancers 21%, chronic respiratory diseases 12% and diabetes 3%, according to a report published this week by the World Health Organization. 

But NCDs are definitely not “rich country”  diseases anymore: 80% of those deaths took place in low- and middle-income countries. 

And it is getting worse. This week the Washington Post reported

“The world is facing a growing avalanche of death from heart attack, stroke, cancer, emphysema and diabetes, with many of the victims working-age people in poor countries. Governments and individuals could intervene to prevent up to half those deaths, but no country is doing all it could.”

The economic impact of all that death and disability is profound. Just take cancer, the second leading cause of NCD deaths. Last year, the American Cancer Society reported that the total economic impact of premature death and disability from cancer worldwide was $895 billion, representing 1.5% of the world’s gross domestic product. That’s enormous, and it’s just one of the four main NCDs.

What to do about the newly-discovered worldwide epidemic in a time of fiscal austerity and, in the U.S., hostility to new social spending, was one of the main issues discussed at an event last week at the Center for Global Development “U.S. Outlook for the Non-Communicable Disease Summit.” 

The Center had wisely anticipated the lack of appetite for major new spending on a major new global health challenge and had just published “Affordable Interventions to Prevent Noncommunicable Disease Worldwide.” In the middle of all of this bad news, the Center found a bit of good: Much of the NCD burden can be prevented through interventions that are low-cost or no-cost:

    * End tariff-reducing trade practices for tobacco.
    * Partner with public and private donors.
    * Leverage U.S. influence in multilateral development institutions.
    * Exploit synergies between disease control and other development projects.
    * Encourage evidence-informed budget allocation.

So what is the U.S. role in this fight against NCDs?

Clearly, it will not be financial. All four U.S. government speakers emphasized the U.S. commitment to fighting NCDs and to the process leading up the U.N. High-Level Meeting to take place next week. But none of them promised new funds.

“Many were hoping to replicate the High-Level Meeting on AIDS 10 years ago [which opened the door to major funding for HIV/AIDS],” said Holly Wong of the U.S. Department of Health and Human Services. “We now recognize that will not happen.”

Wong represented the U.S. in the negotiations over the political declaration on NCDs recently concluded in New York, and which will be ratified at the HLM.

“We were pretty happy with it,” she said. “We got in some of our language on the Framework Convention on Tobacco Control, including tax measures to reduce consumption and accelerated implementation of the Framework.”

The NCD Alliance acknowledged the importance of that language but was critical on other issues in their official reaction: “The language on curbing the harmful use of alcohol is particularly weak, with no reference at all to essential measures on the price and availability of alcohol. Regrettably, Member States have ignored calls from the NCD Alliance to agree measures to protect children from the marketing of alcohol but have committed to implement WHO recommendations to restrict the marketing to children of foods high in fats, sugar and salt; and to reverse the rising trends of obesity in children, youth and adults.”

Patricia Simone of the U.S. Centers for Disease Control and Prevention (CDC) said that in NCDs, the CDC emphasizes improving health policy “as that is the most cost-effective way of improving health.” She listed a number of examples all over the world where CDC was addressing NCDs (for example, in expanding its malaria surveillance to NCDs) but when pressed to give the financial value of this assistance, she admitted it is “quite small” and mostly in the form on in-kind staff time.

The speakers were clear that there will be no new U.S. money for NCDs in this economic and political climate: Instead, Wong said that the U.S. government’s focus at the HLM next week will be to show how the U.S. will build on existing initiatives.”

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