The NCD Slow Motion Disaster Requires a Long Term Solution

The prestigious New England Journal of Medicine's lead article this issue is about non communicable diseases (NCDs). Authors Lisa Rosenbaum and Daniela Lamas review the existing evidence, and agree with WHO Executive Director Margaret Chan that NCDs represent "a slow-motion disaster," based upon the virtual tidal wave of illness and death that are beginning to swamp health care budgets in many less developed countries, sapping productivity and economic progress from nations on every continent. There is no country on earth immune from cardiovascular disease, cancer, chronic lung disease, diabetes and mental illness, together responsible for at least two thirds of all deaths globally.

The article also singles out Tanzania as a nation that, on its own, is making some remarkable strides in building an NCD infrastructure to begin to address these transcendent problems.  Yet, the authors conclude that because of the nature of NCDs, there are no quick fixes.  Making changes in lifestyles are extraordinarily difficult to achieve on a national or global scale, and many of the interventions that seem to make sense in the long run -- promoting physical activity in schools and restricting market of unhealthy food and beverages to children -- are as yet to be assessed rigorously.

For these and other reasons, some in the global health community are determined to create a global coordinating platform for NCDs.  Among those advocating for this are Sania Nishtar, president of the Pakistani organization Heartfile, and Eva Jané-Llopis, who heads the Chronic Disease and Wellness program at the World Economic Forum. In a recent issue of the Journal of Health Communication, Nishtar and Jané-Llopis argue persuasively that "a mechanism for coordinating and synchronizing the contributions of a diverse range of stakeholders' efforts toward NCD prevention and control objectives appears to be a priority in terms of setting up a global response." The authors note that such a global mechanism would necessarily reach beyond the health sector and incorporate a broad range of actors, including "governments, the business community, academia and civil society."  Such a body might allow for sharing of information sharing, spotting programmatic gaps, and catalyzing collaboration among a bewildering set of international and national bodies to make best use of limited resources available at present. The authors do not postulate creating a new global fund (as in for HIV/AIDS, malaria and TB), but believe that this type of structure "can be accommodated with an existing multilateral institution with an appropriate mandate."

The bottom line that is no one nation -- donor or recipient -- possesses all of the tools to tackle the NCD crisis alone. Similarly, no UN agency or multilateral institution presently has the mandate to organize all of the necessary stakeholders to create concerted global action on NCDs. The good news is that not only the global health community is beginning to realize that the time for action is now. 




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