As infectious disease falls, chronic disease increases; possible solutions emerge

A patient in Kenya undergoes a full physical exam as part of an attempt to detect and treat non-communicable disease supported by Novartis Access. Photo: Bedad Mwangi

This was originally published on Global Health TV on January 31, 2017.

As 2017 begins, we celebrate the fact that many diseases of developing countries have been significantly weakened. The numbers of people suffering from HIV, malaria and tuberculosis are in decline. Children are healthier and living longer.

But as these communicable diseases wane, non-communicable diseases (NCDs) wax (like cancer, diabetes, cardiovascular and chronic respiratory diseases).

This was hammered home by the Institute for Health Metrics and Evaluation (IHME) of the University of Washington which, just in the last two months, released three new reports that provide further evidence of this trend:

• Almost 20% of global deaths in 2015 were linked to elevated blood pressure, according to the latest Global Burden of Disease study. The number of people in the world with high blood pressure, including hypertension, has doubled in the past two decades, putting billions at increased risk for heart disease, stroke and kidney disease.
• Cancer is growing almost everywhere in the world but the greatest increase between 2005 and 2015 occurred in the poorest countries that are least equipped to deal with it, according to a new analysis.
• 30% of all deaths from diabetes worldwide occur in the poorest countries bringing a double burden of disease – from communicable and non-communicable disease – to many countries in Africa, according to a new IHME report. Women often bear most of the burden.

Of course, NCDs are not a new problem. However, they are increasing both in scale and visibility because of the transition from low-income to middle-income status, the influence of globalization on diet and consumption patterns and greater longevity as people increasingly survive childhood illness and communicable disease, according to an analysis by the Kaiser Family Foundation.

Despite the rising tide of NCDs, though, little money has been invested to prevent and treat them. In Financing Global Health 2014, IHME said that development assistance for health (DAH) directed towards NCDs is one of the smallest health focus areas they estimate and was only $611 million in 2014, just under 2% of total DAH. The first graph on page two of this brief shows just how little NCDs are funded compared to communicable disease and child health.

“The productivity loss for NCDs is estimated to be $500 billion annually yet almost no donor funding is being deployed against them,” said Dr. Harald Nusser, global head of Novartis Access and Novartis Malaria Initiative. “We need robust funding for both communicable and non-communicable disease, and more robust health systems in general to start turning our efforts towards NCDs while not relenting in the fight against AIDS, malaria and tuberculosis.”

“NCDs share all the ideological and social justice issues of HIV but cause 30 times more deaths and receive 17 times less funding,” writes Luke N. Allen and Andreas B. Feigl in a new commentary in The Lancet Global Health.

Even communicable disease experts see how the disease burden is shifting to NCDs. Charles Nelson, chief executive of the Malaria Consortium, talks about how malaria death have fallen between 2000 and 2015. Nelson said disability-adjusted life years (DALYs), which is a measure of overall disease burden, coming from communicable maternal, perinatal and nutritional diseases is decreasing while DALYs from NCDs is increasing, said Nelson. This is true globally, as well as in Africa and Southeast Asia.

Kenya seems to be the focus of the research as well as some of the first attempts to deal with NCDs in Africa.

A report on the burden of disease in Kenya found that the country has made tremendous progress in dealing with communicable disease and maternal and child health but that the burden of NCDs was growing, with the health loss from NCDs growing from 19% in 2000 to almost 30% in 2013. 

Three new efforts, all led by pharmaceutical companies, are trying to address NCDs in Kenya:

• In 2015, Nusser helped launch Novartis Access which makes 15 on- and off-patent medicines available to treat NCDs at $1.00 per treatment per month.
• AstraZeneca’s Healthy Heart Africa program conducted one million hypertension screenings in Kenya, opened over 250 health facilities, trained over 2,600 health care workers, diagnosed close to 150,000 patients with high blood pressure and started treatment for 25,000 patients in its first year.
• Novo Nordisk is expanding its Base of the Pyramid Project, a sustainable initiative rolled out in 2010 to facilitate access to diabetes care for the working poor in low- and middle-income countries. The project has screened more than 20,000 people for diabetes.

And a major initiative involving 22 biopharmaceutical companies just launched Access Accelerated, a global initiative to increase access to NCD prevention and care in low- and lower-middle income countries, at the World Economic Forum on Jan. 18. Access Accelerated is supported by $50 million in funding and a pledge of increased individual company programs focused on NCDs.

The NCD movement has long been hobbled by its unwieldy name – non-communicable diseases. “A name that is a longwinded non-definition, and that only tells us what this group of disease is not, is not befitting of a group of diseases that now constitute the world’s largest killer,” writes The Lancet Global Health, which calls for a change in terminology (and offers a few suggestions) to bring needed and deserved attention to these diseases.