Could NCD Advocacy Hurt Global Health Funding?

Donors, including governments and international institutions, have been notoriously stingy in funding non communicable disease (NCD) programs related to global health.  Economist Rachel Nugent has estimated that less than three percent of all donor assistance for global health is for work on NCDs like cancer, cardiovascular disease, chronic obstructive pulmonary disease and diabetes, while Dr. Chris Murray at the the University of Washington's Institute for Health Metrics and Evaluation figures NCDs as representing less than one percent of all global health funding.

Why is this so?  There are probably many reasons, but one of the most important is that donors have chosen to see NCDs as individual illnesses that affect at most nation states, and not transnational issues that can affect the global economy.

In the run up to the UN High Level Meeting on NCDs, advocates have continually stressed the need to increase resources for NCDs.  Some have gone to great lengths to show that these dollars must be additional to, and not subtractions from, overall funding for global health, now at all-time high water marks mainly to fight infectious diseases, including HIV/AIDS, TB, and malaria. In part, the funding for preventing and treating the infectious diseases has grown from a realization that these illnesses represent direct threats to the security and economic prosperity of donor nations, including the United States, as well as recipient nations. Consequently, development assistance for health increased 400 percent from $5.59 billion in 1990 to more than $21.7 billion in 2007, a good deal of which represented increases in funding for HIV/AIDS.

However, a new analysis by David Fidler indicates that there is a risk in seeking to force global health funders, including the US Government, to dramatically increase funding for NCD prevention and treatment along the same lines.  Fidler, professor of law at Indiana University, says that this could be damaging, not just because it might not work, but because it also might accelerate what he sees as a worrying recent trend in declining attention to and resources for global health funding overall, because the argument for funding NCDs is weaker. 

Fidler's new report, the "Rise and Fall of Global Health as a Foreign Policy Issue," notes that the recent and unprecedented build up in the importance of and funding for global health work, based upon concern about infectious diseases, is already under strain. However, he says, infectious illnesses at least illustrate a strong case for the interdependence of nations. In contrast, he says, "pushing foreign policy deeper into NCDs, health systems reform and social determinants of health could exacerbate" the decline in global health's prominence in foreign policy matters.  "Despite warnings about the NCD problem," he says, "these diseases [NCDs] tend to reflect interconnectedness, rather than interdependence between states..." And interconnectedness, he says, "even as intensified by globalization, produces weaker common interests and often reflects divergence in foreign policy priorities."  Fidler says that "U.S. security, economic power, and development objectives are not affected by smoking or obesity prevalence rates in rival powers, other high-income states, or middle- and low-income countries." If Fidler is right, then advocates continuing to insist on action to combat NCDs in foreign countries without making a case for its effect upon the United States could unwittingly be speeding the decline in global health's importance in U.S. foreign policy, and therefore its funding.

United States Government representatives are in a difficult position when it comes to this issue. There is no question that NCDs are increasingly straining budgets of health ministries all over the globe.  And it is also undeniable that these same NCDs are sapping economic vitality from some of the most productive citizens in developing nations.  Yet U.S. government representatives, echoing their colleagues on Capitol Hill, are equally clear that there are no new resources with which to combat this rising tide of illness and death. 

If advocates are to successfully argue for more funding for NCD prevention and treatment, it will have to be based upon interdependence -- the success of the U.S. economy depends upon the health and well-being of citizens from all over the world. If not, we could see the ship of global health founder on the shores of good intentions.  

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