Health expert says a ‘moral imperative’ is growing to face noncommunicable disease epidemic in poor countries

September 14, 2011

A “moral imperative” is emerging to prevent and treat noncommunicable diseases in poor countries that is similar to the one that developed during the AIDS epidemic a decade ago, a leading health expert said Wednesday.

That people in rich countries taking AIDS drugs could expect long lives while Africans, lacking them, died quickly was an injustice that eventually led to 6 million people in poor countries getting access to antiretroviral therapy, said Julio Frenk, former health minister of Mexico, during a meeting of experts and advocates in Washington, D.C..

A similar but largely unrecognized gulf exists with the treatment for noncommunicable diseases such as cancer, heart attacks, diabetes and emphysema, he said.

Only 10 percent of children with acute leukemia in low-income countries are cured, compared with 90 percent in Canada. In Mexico, only 10 percent of women with breast cancer are diagnosed at the earliest, most curable stage, compared with 60 percent in the United States. There are places in the world where insulin, which children with type 1 diabetes need to survive, is essentially unavailable.

“This gives many of these diseases that same moral imperative that we have with AIDS,” said Frenk, who is now the dean of the Harvard School of Public Health. “We are witnessing a new frontier of equity.”

Noncommunicable diseases — NCDs in epidemiological parlance — account for 63 percent of deaths worldwide. About 80 percent occur in low- and middle-income countries. People who contract cancer, suffer heart attacks or develop diabetes in low-income countries such as Cambodia, Haiti and Kyrgyzstan are three times more likely to die before age 60 than similar patients in wealthy, industrialized nations.

Frenk and other experts spoke at a public, daylong conference on noncommunicable diseases sponsored by The Washington Post and underwritten by the pharmaceutical company Lilly. The session was held in advance of a two-day meeting scheduled next week at the United Nations on the same subject.

Speakers at the conference described the fast-rising incidence of many of the illnesses and the strategies to prevent or control them.

Ann Keeling, head of the International Diabetes Federation based in Brussels, said new statistics estimate there are 366 million people with diabetes and 280 million with pre-diabetes in the world today. In a generation, a half-billion people will have the disease.

“We are terrified by the numbers,” she told the gathering. “We want you to be terrified by the numbers. If we don’t pay attention to this, the world is sleep-walking into a terrible future.”

Prevention strategies include convincing people to eat less, eat better, exercise regularly, drink in moderation and not smoke. They also encompass action only governments or large corporations can take, such as designing cities that encourage walking and biking, removing harmful fats and excessive salt from processed foods, and restricting smoking.

Asked to name the most important prevention tool, several speakers pointed to high taxes on cigarettes. The World Health Organization recommends tobacco taxes that amount to 75 percent of the price of the product.

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