Do you think that HIV/AIDS, malaria and TB are the world's top killers? Many people do, but they are also wrong. By far and away the globe's most potent causes of death, according to the World Health Organization (WHO), are chronic illnesses, including cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. These together kill more than 35 million people every year, approximately 60 percent of all deaths worldwide. By comparison, in 2009, the infectious disease AIDS killed far too many -- approximately 1.8 million, TB killed about 1.7 million and malaria 800,000.
Deaths from so-called "non communicable diseases" (NCDs) are not limited to wealthy or heavily-industrialized countries. An increasing fraction, perhaps 80 percent, occur in low and moderate income countries. And the burden of these diseases is only going to become heavier. According to WHO, NCD deaths will increase by 17 percent over the next ten years, with the greatest increases in Africa (27 percent) and the Eastern Mediterranean region (25 percent). Overall, the highest absolute number of deaths from NCDs will occur in the Western Pacific and South-East Asia. Global changes in lifestyle, including an accelerated movement away from rural and toward urban living, are exacerbating this trend.
The sad fact is that many of these deaths are preventable. WHO estimates that with adequate action, four out of five deaths from heart disease, stroke, and type 2 diabetes, as well as a third of all cancers, could be averted by eliminating or reducing tobacco and alcohol use, eating a healthful diet, and maintaining appropriate levels of physical activity. The costs of inaction are staggering, not only because of the skyrocketing price tag of treating those with chronic illnesses, but also because of the billions in productivity that NCDs sap from economies large and small. Yet a recent study by the Center for Global Development indicated that donor spending for NCDs averages only about 3 percent of all development assistance spent on health, itself just a portion of what is spent on foreign assistance.
In order to counter these alarming trends, the United Nations will convene a High Level Session in September 2011 devoted to raising awareness about the global threat from NCDs. Over a day and a half, heads of state and others will come to New York to talk about how NCDs are affecting the world's productivity, and how caring for millions of affected people is draining health budgets around the globe. The WHO is preparing a report for the special session, which will contain a great deal of useful information for advocates who want their governments to act. And the United Nations itself is convening a special "listening session" in June 2011 to gather information from civil society members around the world to feed into the process.
Already a global alliance of interested organizations (NGOs, academics, and others) has formed and is producing much useful information about NCDs. In addition, the US-based Global Health Council has formed a roundtable on NCDs, composed of non-profit and for-profit partners committed to global and US-based advocacy on the subject. The WHO has a website on the subject of NCDs, and the UN General Assembly President's office has a website devoted to the UN High Level Session, to be held over September 19-20. The subject is even percolating into the World Economic Forum meetings this week in Davos, Switzerland, and the upcoming G-20 meeting in Paris on February 18-19.
There is enormous scope for U.S. leadership on reducing the global burden of NCDs, given the wealth of experience we have in preventing NCDs and caring for those who have them. Before the High Level Session, the United States should commit publicly to the goal of educating people the world over on simple steps that can prevent illness, death and massive loss of productivity. We should commit, as well, to building proven principles of NCD prevention into all of our foreign assistance, including that related to global health, especially when nations request this of us. We should demand the highest-level participation by U.S. government representatives at the UN High Level Session, and press for the inclusion of qualified NCD experts on the U.S. delegation. At the High Level itself, our delegation should call for measurable and realistic targets for reducing the burden of NCDs globally. And after the High Level Session, the United States should work actively with other donor and recipient nations to measure NCD incidence, and ensure the WHO and other agencies implement data collection, capacity-building, and locally-relevant interventions for integrated approaches to prevention, treatment and care of NCDs.
Will any of this matter? In 2001, the United Nations held another High Level Session to deal with the epidemic of HIV/AIDS. That meeting led to a critical agreement among nations to tackle the problem head on, and pushed leaders to agree to the creation of the Global Fund for HIV/AIDS, Malaria and Tuberculosis, which has thus far raised more than $10 billion to fight these killer illnesses, and saved millions of lives. Is it time now for the world to take stock in a similar way of the greater numerical threat of NCDs? Only time will tell.