Center for Global Health R&D Policy Assessment

Previously, we wrote about this year’s annual Global Health Council Conference and its focus on non-communicable diseases (NCDs). We mentioned the profound global economic impact of NCDs and asked the global health research and development (R&D) community what we can do to address the issue of NCDs.

We decided to take a closer look at NCDs—to understand the basics of NCDs and to explore opportunities that exist for R&D. Phillip Baker, organizer of the NCD Action Network, a civil society movement advocating to increase resources and to inspire action to address the global NCD epidemic participated in a Q&A.:

Edith Han, R4D: When we are talking about non-communicable diseases (NCDs), what diseases are these and what are the major risk factors for NCDs? Why have NCDs become such a glaring problem on the global health agenda?

Phillip Baker, NCD Action Network: NCDs, also known as non-communicable or chronic diseases, include cardiovascular disease, chronic respiratory diseases, diabetes, cancers, and mental illnesses. These diseases have four common risk factors: tobacco use, unhealthy diets, alcohol and physical inactivity. Generally thought of as diseases that affect rich countries, NCDs are severely impacting low- and middle-income countries (LMICs). Cardiovascular disease, for example, is now the leading cause of death in Africa amongst those 30 years and older. Global economic and social transition is fueling this epidemic as more people are being exposed to unhealthy environments and health depleting products: tobacco, unhealthy foods, alcohol and unsafe exercise environments are increasingly common. NCDs contribute to poverty–sickness from diabetes, for example, can burden poor families and communities with catastrophic health care bills.

Han: What is NCD Action Network?

Baker: The mission of NCD Action Network is to connect, inform, empower and inspire young people, students and young professionals to take action against the injustice of NCDs and to ultimately achieve a healthier and more equitable global society. The Network was launched in April 2011 in anticipation of the United Nations High-Level Meeting on NCDs which will take place on September 19-20, 2011. This is the second ever UN Summit on health and of great importance (the first in 2001 mobilized global political support for action on HIV/AIDs). All are welcome to join us.

Han: Many issues seem to revolve around health education, systems strengthening, and prevention. Is there much R&D that still needs to be done for NCDs (for treatments, diagnostics, vaccines)? What is the major barrier to treating NCDs? Lack of access to existing drugs and technologies? Appropriate drugs and technologies for resource-poor settings?

Baker: What you have listed are all important, but to truly address NCDs, we must prevent them. It is the changing economic and social environments that are driving this pandemic, and it is to these environments where the changes must be made. We must ensure access to health promoting rather than health depleting foods, remove tobacco smoke and air pollution, and ensure access to education, healthcare, and essential medicines. These are social issues that must be addressed through sound policy development from the global to the local level.

In terms of R&D, recent drafts of the NCD Summit Outcomes Document specify an urgent need for R&D for NCDs. Providing entire populations with access to cardiovascular disease drugs is actually quite cost-effective, but when we look at cancer as an example, the cost of medicines can be very high. Scaling up production and reducing the cost of such medicines will benefit millions of people around the world.

Also, there is a huge need for heat-stable formulations for temperature-sensitive drugs, such as insulin for diabetes treatment, since refrigeration is a luxury the majority of the world’s population cannot afford. We also need to expand low-cost technologies such as blood pressure and glucose monitoring machines and other basic diagnostic machinery.

We also need to look at who does R&D and how to develop effective capacity. We must ensure that LMICs have the capacity to develop their own R&D capacities. For this to be successful and sustainable, we will need to develop stronger South-South and South-North partnerships.

One aspect to emphasize is the importance of information & communication technologies in many countries for e- and m-health. Given the ubiquity of global cell phone use, we can develop effective health education, training, and patient and health systems management platforms using mobile technologies, which can partly alleviate the need for very expensive traditional infrastructure projects.

Han: How should global health policy makers think about the problem of NCDs? Considering the fact that there is still a significant amount of money going towards treating infectious diseases and other basic needs issues, what would you say to people who argue that global health financing is already under pressure and that we should not further dilute our efforts by moving into new areas?

Baker: Tough question. If you are thinking in terms of silos–disease driven programs–well then yes, it is easy to think of how when a country (or donor country) has finite resources, funding for diabetes mellitus (DM) might deplete funding for tuberculosis (TB) for example. But this is an outdated mode of thinking. In reality, we see a confluence of infectious diseases and NCDs in many countries. Take India for example. In 2000, approx one fifth of TB cases were attributable to DM. Drug resistance, symptoms, treatment outcomes and mortality rates for TB are all affected by DM. When you consider that approximately 30 million Indians have DM and almost 2 million have TB, the numbers are mind-boggling. Vertical programs do not make sense in these instances.

A buzz word we are hearing is ‘integration’–integrating NCD prevention and control into pre-existing primary health care programs. Integrated approaches mean that investments are building on pre-existing structures, and therefore more cost-effective. We know that NCD programs can be highly scalable and can potentially piggy-back off existing NTD, HIV/AIDS, and tuberculosis (TB) programs (diagonal, cross-cutting programs). We can also ‘learn-by-doing’ here.

There are also many low-hanging fruits that are highly cost-effective and can even generate, rather than deplete, national income. For example, taxes and import tariffs on tobacco, alcohol and unhealthy foods can produce substantial income for countries. Thailand is a great example of this, as funds from tobacco taxes are reinvested into health promoting programs.

Overall, we are seeing some positive changes. Nugent and colleagues have recently shown development assistance for health to developing countries specifically targeting NCDs increased by 618% between 2001 and 2008, with the majority coming from non-state donors. Unfortunately however, this accounts for less than 3% of total development assistance for health, and is dismally inadequate. We still need more engagement from public donors.