Raising the priority accorded to diabetes in global health and development: A promising response…
Article Outline
On 13 May 2010, the United Nations General Assembly (UNGA) passed a resolution A/RES/64/265 on non-communicable diseases (NCDs). This step is of historic significance in global health and development, as the resolution recognizes the enormous human suffering, premature death and the seriously negative socioeconomic impact caused by NCDs [1].
These diseases, mainly diabetes, cardiovascular diseases, cancers and chronic lung diseases are emerging as a major threat to global development. Their magnitude is rapidly increasing, because of population ageing, unplanned urbanization and globalization of trade and marketing. These preventable problems, largely caused by unhealthy diet, physical inactivity, being overweight and obese, tobacco use and the harmful use of alcohol, are now causing an estimated 36 million deaths every year, including 9 million people dying prematurely before the age of 60 years [2]. Their major impact is on developing populations. Around 90% of deaths before the age of 60 occur in developing countries and economies in transition, in particular among the poorest and the most vulnerable people. NCDs are currently the second leading cause of death for women in low-income countries, and the leading causes of death for women in middle-income countries. Twice as many women die (per 1000 adults) from non-communicable diseases in Africa as in high-income countries [3].
Diabetes and other NCDs, which share the same risk factors, are a development issue because of the loss of household income from unhealthy behavior, from loss of productivity due to disease, disability and premature death, and from the high cost of health care which drives families below the poverty line. Additionally, the level of exposure of people in developing countries to unhealthy diets, physical inactivity, tobacco use and the harmful use of alcohol is higher than in high-income countries where a higher proportion of the population tends to be protected by comprehensive interventions aiming to promote healthier behavior. Also, affordable and accessible primary health care services for early detection, effective treatment and prevention of complications are often inadequate in developing countries [4].
NCDs and their risk factors are also closely related to poverty, and contribute to poverty at the household level. Studies in developing countries demonstrate how health care for a family member with diabetes can consume a considerable proportion of household income, and how treatment of heart disease and other cardiovascular complications greatly increases the likelihood of falling into poverty in developing countries, and due to “catastrophic” out of pocket expenditure and loss of income from ill-health [4]. NCDs are reported by the World Economic Forum to be a leading macroeconomic risk at a global level [5].
There is also evidence that diabetes and other NCDs are undermining the attainment of the Millennium Development Goals (MDGs). The links between smoking, diabetes and tuberculosis, the rising prevalence of high blood pressure and diabetes, and the increased exposure to NCD risk factors among women of child-bearing age in developing counties have direct consequences in terms of maternal health complications, pregnancy outcomes and child survival [6], [7]. As a result, the 63rd World Health Assembly urged Member States, international development partners and WHO, in a resolution on health-related Millennium Development Goals, to recognize the growing burden of NCDs [8].
Demographic and epidemiological transitions, together with unplanned urbanization and globalization, have brought about a deadly interplay between infectious diseases and NCDs like diabetes. Both are major challenges in many developing countries, and both need to be effectively addressed. This interplay must no longer remain nameless and faceless: it represents the health risks and disease profile of the twenty-first century, and it is emerging as a major socioeconomic risk. Addressing this phenomenon, from a health point view requires a more integrated and effective approach to prevention and treatment – one that is based upon strengthening health systems, rather than only peering through the keyhole of one specific disease or another. From the broader development perspective, preventing and minimizing the adverse socioeconomic impact requires the active engagement of all government sectors, the industry and civil society in reducing the level of diabetes risk factors and determinants. Many more gains can be achieved by influencing the policies of non-health sectors like finance, industry, trade, urban development and education than by changes in health policies alone.
The challenge can be effectively addressed [9]. There is a sound global vision and a clear road map for global and national action. The vision is represented by the Global Strategy for the Prevention and Control of NCDs, which was endorsed by the World Health Assembly in 2000 [10]. The road map is guided by its six-year Action plan, which was developed with Member States and endorsed by the Assembly in 2008. The Action Plan has six objectives, with clear sets of actions under each objective for countries, the WHO and international partners. The World Health Assembly also endorsed specific global strategies and tools to reduce the exposure to the four key risk factors, such as the WHO Framework Convention on Tobacco Control, the Global Strategy on Diet, Physical Activity and Health, and the Global Strategy to Reduce the Harmful Use of Alcohol.
Objective one of the Action Plan for Global Strategy specifically focuses on integrating the prevention of diabetes and other NCDs into the global development agendas and related national initiatives. To support the implementation of this objective, evidence linking NCDs to socioeconomic development has been examined and discussed in several key events organized over the last two years, in close collaboration with Member States, the United Nations Department of Economic and Social Affairs (UNDESA) and relevant United Nations Regional Commissions. Proposals for addressing the NCDs burden and its developmental challenges were made in Ministerial consultations and the Meeting of the High-level Segment of the UN Economic and Social Council in July 2009. These have made a significant contribution to the consultations of countries that have led to the recent UNGA resolution.
The UNGA resolution is a major political event in the struggle against diabetes and other NCDs, and places them at the center of socioeconomic development. The resolution calls for a High-level Meeting of the United Nations General Assembly in September 2011 with the participation of Heads of State and Government to address the prevention and control of NCDs.
Establishing a global forum on the prevention of diabetes and other NCDs emphasizes the underlying social and environmental drivers of these health problems and their implications for poverty. It is also a clear recognition of the threat that NCDs pose to the economies of countries, leading to increasing inequalities between countries and populations, thereby threatening the achievement of internationally agreed development goals, including the Millennium Development Goals.
There is no doubt that the UNGA resolution has already made a major contribution to increasing the awareness of the need for global coordinated action to prevent diabetes and other NCDs, and there is now great hope that the High-level Meeting will focus on galvanizing action at global and national levels, so as to halt and address the health and socio-economic impact of diabetes and other NCDs through multi-sectoral approaches. However, the success of the Meeting will depend on the contribution that countries, the diabetes and NCDs community and other stakeholders will make in supporting the UN discussions over the coming months, and in providing technical guidance on challenges like integrating the surveillance of NCDs into national information systems, successful mechanisms and approaches for engaging non-health sectors in prevention initiatives and in strengthening health systems to deliver more effective care.
References
- United Nations General Assembly. Resolution 64/265. Prevention and control of noncommunicable diseases; 2010.
- World Health Organization. Global burden of disease 2004 update. <www.who.int/healthinfo/global_burden_disease/2004_report_update>.
- World Health Organization. Women and health: today’s evidence, tomorrow’s evidence. <http://www.who.int/gender/documents/9789241563857/en/index.html>.
- World Health Organization. Discussion paper: noncommunicable diseases, poverty and the development agenda (July 2009) ECOSOC high-level segment; 2009. <http://www.who.int/nmh/publications/discussion_paper_ncd_en.pdf>.
- World Economic Forum. Global risks 2010. A global risk network report; 2010. <http://www.weforum.org/pdf/globalrisk/globalrisks2010.pdf>.
- Gajalakshmi V, et al. Smoking and mortality from tuberculosis and other diseases in India. Retrospective study of 43,000 adult male deaths and 35,000 controls. Lancet 2003.
- World Health Organization. Equity, social determinants and public health programmes. WHO; 2010.
- World Health Organization. Resolution WHA63.15 monitoring of the achievement of the health-related Millennium Development Goals. WHO; 2010.
- Gaziano TA, Galea G, Reddy KS. Scaling up interventions for chronic disease prevention: the evidence. Lancet 2007;370:1939–46.
- World Health Organization. Resolution WHA53.17. Prevention and control of noncommunicable diseases. WHO; 2000.
PII: S1877-5934(10)00074-3
doi:10.1016/j.ijdm.2010.10.001
© 2010 Published by Elsevier Inc.
