U.S. Government Committed to Fighting NCDs, but Not Financially

[David J. Olson]

Those of us who have been working this year on non-communicable diseases (NCDs) know all too well that despite our relative success in getting NCDs on the global health agenda, there is no new money for fighting them, certainly not in the U.S. (see Jeff Meer’s blog below).

It doesn’t matter that NCDs are now the leading cause of deaths in the world, killing more than 36 million people in 2008 (63%), according to a report published this week by the World Health Organization, cardiovascular diseases being responsible for 48% of those deaths, cancers 21%, chronic respiratory diseases 12% and diabetes 3.

It doesn’t matter that the Washington Post reported that it is only going to get worse: “The world is facing a growing avalanche of death from heart attack, stroke, cancer, emphysema and diabetes, with many of the victims working-age people in poor countries. Governments and individuals could intervene to prevent up to half those deaths, but no country is doing all it could.”

No new money.

Anticipating the lack of appetite for major new spending on a major new global health challenge, the Center for Global Development this week published “Affordable Interventions to Prevent Noncommunicable Disease Worldw... In the middle of all of this bad news about NCDs, the Center found a bit of good: Much of the NCD burden can be prevented through interventions that are low-cost or no-cost. They focused on these five:

* End tariff-reducing trade practices for tobacco.
* Partner with public and private donors.
* Leverage U.S. influence in multilateral development institutions.
* Exploit synergies between disease control and other development projects.
* Encourage evidence-informed budget allocation.

What to do about the newly-discovered worldwide epidemic in a time of fiscal austerity and, in the U.S., hostility to new social spending, was one of the main issues discussed at an event this week at the Center, “U.S. Outlook for the Noncommunicable Disease Summit.”

So what is the U.S. role in this fight against NCDs? All four U.S. government speakers emphasized the U.S. commitment to fighting NCDs and to the process leading up the U.N. High-Level Meeting next week. But none of them promised new funds.

“Many were hoping to replicate the High-Level Meeting on AIDS 10 years ago [which opened the door to major funding for HIV/AIDS],” said Holly Wong of the U.S. Department of Health and Human Services. “We now recognize that will not happen.”

Wong represented the U.S. in the negotiations over the political declaration on NCDs recently concluded in New York, and which will be ratified at the HLM.

“We were pretty happy with it,” she said. “We got in some of our language on the Framework Convention on Tobacco Control, including tax measures to reduce consumption and accelerated implementation of the Framework.”

The NCD Alliance acknowledged the importance of the tobacco language but was critical on other issues in their reaction:

“The language on curbing the harmful use of alcohol is particularly weak, with no reference at all to essential measures on the price and availability of alcohol. Regrettably, Member States have ignored calls from the NCD Alliance to agree measures to protect children from the marketing of alcohol but have committed to implement WHO recommendations to restrict the marketing to children of foods high in fats, sugar and salt; and to reverse the rising trends of obesity in children, youth and adults.”

George Herrfurth of the Fogarty Center at the National Institutes of health also criticized the declaration for having “no reference whatsoever to the importance of research.” He said NIH has 900 research grants in Africa, mostly for infectious diseases, but increasingly for NCDs as well.

Patricia Simone of the U.S. Centers for Disease Control and Prevention (CDC) said that in NCDs, the CDC emphasizes improving health policy “as that is the most cost-effective way of improving health.” She listed a number of examples all over the world where CDC was addressing NCDs (for example, in expanding its malaria surveillance to NCDs) but when pressed to give the financial value of this assistance, she admitted it is “quite small” and mostly in the form on in-kind staff time.

The speakers were clear that there will be no new U.S. money for NCDs in this economic and political climate: Instead, Wong said that the U.S. government’s focus at the HLM next week will be to show how the U.S. will build on existing initiatives.”

[Jeff Meer]

While the type of money the US Government is putting into the global fight on NCDs is not large, it is also not zero.  Some advocates were pleased this week that the Obama Administration announced an additional new contribution to fighting cervical cancer through the President's Emergency Plan for AIDS Relieve (PEPFAR).  At a news conference in Washington, Ambassador Eric Goosby, who leads the PEPFAR program at the State Department's Office of Global AIDS Control, announced an additional $10 million contribution over the next five years -- which adds to an existing $20 million commitment for this purpose.  This is part of the "Pink Ribbon Red Ribbon" initiative, announced at the George W. Bush "Summit to Save Lives," September 13-14, 2011, and flows directly from the President Obama's Global Health Initiative..