“Where you live shouldn’t determine whether you live.” With that simple statement Nancy G. Brinker, CEO of Susan G. Komen for the Cure, focused attention on the non-communicable disease burden the big four (cardiovascular and chronic respiratory disease along with cancer and diabetes, commonly referred to as NCDs) place on countries and citizens as the UN convened for the second time around global health issues.
UN Opening Week, among other things, presents an opportunity for a myriad of initiatives and global challenges to take the stage. And while frustrating politics from the General Assembly can be discouraging, there are also moments of hope. Despite the difficult challenges facing the world due to the NCD epidemic, the week’s events could also be viewed through the lens of confidence flowing from the progress that has been made with HIV, tuberculosis and malaria over the last decade. Further positivity flows from infrastructure and platforms supporting that progress.
An example of such a platform is the U.S. Global Health Initiative. Their mission is clear: “The U.S. will promote country ownership and align our investments with country-owned plans, including improved coordination across U.S. agencies and with other donors, with the aim of making programs sustainable.”
The Global Health Council along with Management Sciences for Health (MSH), one of USAID’s significant partners, convened a session called “Tackling NCDs: How Can Existing Platforms be Leveraged?” to showcase leaders from USAID, NGOs (Path and psi), corporations (Medtronic and Novo Nordisk), universities and others to discuss possible pathways to multi-disease platform capabilities.
How would the jockeying for position affect each organization’s advocacy? For the most part it did not. Leaders from each cause seemed to get this was an opportunity to lift all boats and avoided putting their own concerns ahead of the overall effort.
This cooperation also may have been driven by the recognition that in the current global crisis, no amount of leadership will result in a new global fund for NCDs. Flowing from this reality, a second theme emerged: countries, NGOs, companies and innovators of all stripes will need coordinated and aggressive innovation, behavior change, policy commitments and funding to minimize loss of life and costs. Without all of the above, the world will face significant trade-offs, especially in low-income countries.
Many of the challenges were openly discussed. The list below is only a partial one. If you have others, feel free to add them in the comment section below.
Spend now or pay later
“The World Health Organization identified strategies to prevent and treat cancer, heart disease and lung disease that would cost $11.4 billion a year to implement in low- and middle- income countries, the UN agency said in a separate report today. Without action, those nations could suffer $7 trillion in losses, the World Economic Forum and Harvard study said.”
These are the diseases that break the bank. Left unchecked, these diseases have the capacity to devour the benefits of economic gain. According to Dr. Margaret Chan, WHO Director General, treatment of diabetes in some countries already consumes as much as 15% of the national health care budget.
Government intervention or lifestyle freedom?
According to Her Royal Highness Dina Mired, “In poor countries a lifestyle choice will instead become a life sentence.”
Why must this responsibility fall on heads of state? According to Dr. Chan, the problem is too big and too broadly based to be addressed by any single government ministry.
The rise of these diseases is being driven by powerful, borderless forces that affect everyone—in particular rapid urbanization and a globalization of unhealthy lifestyles. These trends require top-level attention to command protective policies across all sectors of government.
For example, full implementation of the WHO Framework Convention on Tobacco Control could bring the single biggest blow to heart disease, cancer, diabetes and respiratory disease.
“I call on heads of state and heads of government to stand rock-hard against the despicable efforts of the tobacco industry to subvert this treaty,” said Chan. “Increases in tobacco taxes and prices are the most effective measure. They not only protect health. They bring in considerable revenue. The same is true for taxes on alcohol.”
Corporations as partners, innovators or pariahs?
Whether Dr. Chan’s comment above could – and should – also be applied to the food and beverage industries was central to the debate which lead the UN to unanimously adopt a 13-page document on Prevention and Control of Non-communicable Diseases. More of the behavior change innovation in this fight must come from corporate leadership and through offering healthier products to all populations. Changes in both behavior and products will require companies to be more open in sourcing ideas, products, marketing innovations and business models. Continued partner recognition will depend to a great extent on corporate success in these reinvention efforts.
A commitment to know the truth
As Dr. Chan, HRH Dina Mired, Dr. Jonathan Quick and many others pointed out, meeting these challenges requires coordinated and aggressive collaboration, innovation and policy to envision positive outcomes and bring them to pass.
As important as this set of meetings are in launching and enabling that effort, their greater importance may lie in an increased obsession to understand how bad things really are today and communicating that reality to and with the government, NGO, corporate and social enterprise leaders who must respond.
A lesson for what is needed can be learned from a contagious disease containment success story. William Foege, author of House on Fire and leading expert in the eradication of smallpox, spoke at the International Conference on Global Health recently. Foege embodies the self-effacing and yet tenacious approach needed to deal with complex global problems. Referring to his long battle to eliminate smallpox, his advice is wise counsel for any and all health initiatives: “You have to be able to consistently envision the end result while aggressively seeking the actual data, no matter how bad it is.”
From his book, House on Fire:
“One had to be an optimist with a feel for numbers to be ecstatic at the same time that Bihar had over 5,000 known smallpox outbreaks and had just reported over 11,600 new cases of smallpox in a single week.”
While small pox spreads like fire, country after country has been lulled into inaction by the “slow-motion disaster” represented by the big four’s building cumulative impact. Unhealthy lifestyles that fuel these diseases are spreading with stunning speed and sweep.
During several meetings last week, the case was made that new efforts in primary care and research are needed for early detection and lifestyle education. Sir Peter Gluckman, Chief Science Advisor for New Zealand and Programme Director for Growth, Development and Metabolism at the Singapore Institute of Clinical Sciences brought research to the table emphasizing the importance of early interventions—particularly for pregnant women and their newborns. The Singapore Institute’s advances in understanding the propensities of different Asian populations around NCDs is also an important example of knowing the risks.
Communicating the non-communicable
Ten years ago the UN convened its focus on HIV. It was a critical juncture for garnering support and moving forward in a cohesive way and resulted in a global fund and a 10-fold increase in funding to tackle HIV, tuberculosis and malaria. Of those three diseases, only AIDS was a killer in the developed world at the time.
NCDs are different. The big four are indiscriminant killers globally. And while drugs play a critical part in every circumstance, their role with the big four can be deceptive. Drugs that reduce blood pressure, lower cholesterol and improve glucose metabolism only bring a progressive problem under control: they do not return a person to full health. Unfortunately the big four are lifestyle choices before they are diseases. New approaches must be taken regarding prevention, policy, harmful behaviour, corporate malfeasance and government failure.
Action requires more than advocacy. Some next steps are straightforward. Dr. Chan spoke powerfully about increasing taxes and the price of tobacco and alcohol, and methods for reducing salt intake. Low-cost regimens for cardiovascular disease, cancer screening, drug therapy and vaccination against hepatitis B were also brought forward.
As each organization seeks funding and directs its investments into innovation, platform development, education, behaviour change and policy prescriptions, better mechanisms are needed to find the best ideas and scale them. As an advocate for social innovation, I would argue the other players – NGOs, corporations and governments – need to be much more aggressive in seeking ideas from outside their silos and in moving resources so that research, idea testing and data collection are accomplished as part of integrated programs.
In the “How Can Existing Platforms be Leveraged?” session mentioned earlier, there were examples of this type of integrated capacity building. One is MSH and the Gates Foundation’s efforts in Tanzania to enhance how informal village drug sellers support community health workers and provide safe prescriptions for some diseases. Healthpoint Services in Punjab, India is building clean water and village clinics that provide telemedicine, diagnostics and generics at base of the pyramid prices. They plan to start offering chronic disease packages next year, which can be subscribed to and the costs shared between individuals, insurers and governments. Most importantly, both these sustainable efforts will improve early detection and lower the overall cost.
Many more examples are needed. The success of these approaches will depend greatly on funds flowing to the most innovative participants no matter their size and then scaling the successes to achieve more innovative and sustainable models and systems.
Note: This article first appeared on CSRWire.