That’s the conclusion of a long-awaited estimate by the World Health Organization in the war against the world’s latest enemy: “noncommunicable diseases.”
Who will pay?
Many unanswered questions linger, however. The biggest are: Who’s going to foot the bill? And is the world really ready for another global campaign against disease?
The price tag for the “best buys” in prevention was unveiled Sunday on the eve of a two-day meeting at the United Nations to discuss the growing epidemic of these ailments, principally heart attacks, strokes, cancer, diabetes and chronic lung conditions such as emphysema and asthma. Together they account for 63 percent of deaths each year.
Despite their stereotype as being “diseases of affluence,” the vast majority occur in the developing world. People in the poorest countries — sub-Saharan Africa and parts of Central and Southeast Asia — are three times as likely to die of them before age 60 than are Americans and Europeans.
While their global importance is undisputed, the viability of a campaign against “the NCDs,” as they’re called in epidemiological parlance, is clouded in doubt.
Bringing optimal AIDS treatment to people in poor countries and reducing deaths associated with childbirth are the high priorities on the global health agenda. A new campaign might also distract from the “Millennium Development Goals,” eight economic, environmental, social and health targets that U.N. member states pledged to reach by 2015.
More important, wealthy nations don’t want to be expected to pay for the treatment and prevention of chronic illnesses in poor countries, especially not in the middle of an economic downturn. That is why no hard targets appear in the draft of the “political declaration” circulating here.
No target set
The WHO suggested a goal of reducing national NCD mortality rates by 25 percent by 2025. But the United States, the European Union and Canada opposed it, so no target was set and discussion of the matter will be deferred until 2012.
“The fear is that if you commit to something there will be the expectation that wealthy countries are going to finance this,” J. Stephen Morrison, director of global health policy at the Center for Strategic and International Studies in Washington, said in advance of the meeting here. “It just shows you how we’ve become habituated to simply expecting that donors are going to pay the bills.”
Others are more optimistic.
“One of the myths out there is that this is going to be expensive to put right, and that is not correct,” said Ann Keeling, head of the International Diabetes Federation in Brussels, who helped organize a consortium of similar advocacy groups called the NCD Alliance.
In particular, she said, low-income countries can raise money for the work immediately by raising taxes on cigarettes and alcohol. Smoking is responsible for 9 percent of deaths worldwide.
There’s consensus that reducing tobacco use is the most important step, and that raising cigarette prices through taxes is the most powerful way to do it.
There are many other impediments, too.
Higher prices for tobacco and alcohol, as well as moves to reduce the salt and fat in food, may encounter opposition from consumers and commercial interests. Better medical treatment of people with cardiovascular disease (or at high risk of it) requires drugs and expertise in short supply in some places.
Although the medicines named in the WHO package are cheap and generic — aspirin, statins, the diabetes drug metformin among them — pharmaceutical companies worry that they may be pressured to provide patented ones at discounted prices, or to let offshore companies make them without paying royalties, as is the case with some AIDS drugs.
Remaking the urban landscape so that people walk more and drive less as a strategy for getting people to burn more calories also won’t be easy. It requires cooperation from branches of government not usually involved in public health.
While diverse in the organs they attack and misery they cause, the chronic illnesses have much in common. Four behaviors — smoking, excessive drinking, inactivity and an unhealthy diet — contribute to them. Four medical conditions — high blood pressure, high cholesterol, high blood sugar and obesity — do, too. Consequently, these ailments are a tempting package to target together, as many countries have been doing for decades.
The U.N. meeting, however, shows that it takes a public event to make the leaders of many countries pay attention to a national health problem and, rhetorically at least, commit to addressing it.
That’s what happened in June 2001 at a U.N. General Assembly meeting on AIDS, which most observers believe played an important part in the coordinated response to the epidemic, in particular the effort to bring anti-retroviral treatment to Africa.
The declaration from that meeting named the amount of money poor countries needed by 2005 and noted that the global community should “take measures to ensure that needed resources are made available, particularly from donor countries.” Such language is absent from the proposed declaration here.
As investments go, however, the ones laid out by the WHO are bargains.
The $11.4 billion needed per year to put them into effect in low- and middle-income countries is less than the $15.9 billion spent from all sources (donor and domestic) for HIV/AIDS prevention and treatment in 2009. Even that sum left 9 million people with HIV without treatment. A successful campaign to prevent or defer deaths from noncommunicable diseases would save far more lives.