Until recently, I thought I knew the definition of "noncommunicable disease." Then I attended "The Long Tail of Global Health Equity: Tackling the Endemic Non-Communicable Diseases of the Bottom Billion."
Held on the campus of Harvard Medical School in Boston, the 2-day conference was sponsored by Partners in Health, an international nonprofit organization that researches, advocates, and provides direct health care services for people living in poverty around the world. The "bottom billion" of the meeting’s title refers to the world’s poorest people living on less than $1 per day.
Photo: Courtesy Partners in Health
A cancer patient in Rwanda receives chemotherapy as her husband and physician discuss her treatment.
In a 2008-2013 action plan, the World Health Organization refers to "the four noncommunicable diseases (NCDs) – cardiovascular diseases, diabetes, cancers and chronic respiratory diseases – and the four shared risk factors – tobacco use, physical inactivity, unhealthy diets, and the harmful use of alcohol." Together, these conditions account for approximately 60% of all global deaths, of which 80% occur in low- and middle-income countries.
But, as I learned at the conference, among the bottom billion, rheumatic heart disease is often the result of an untreated streptococcal infection early in life, diabetes is frequently associated with malnutrition rather than overweight, and cervical cancer from human papillomavirus is far more common than in the developed world, where women routinely receive PAP screenings and a vaccine can now also prevent the infection.
Most startling: Among the world’s poorest populations, smoking is not the most common cause of chronic obstructive pulmonary disease. Cooking with biomass fuels is.
Individually, these and other so-called "endemic NCDs" including Burkitt’s lymphoma, sickle cell disease, and tropical diseases are far less common than are those within the WHO’s "four-by-four" definition. But together, that "long tail" of chronic conditions contributes to a great deal of suffering.
The United Nations announced that it would hold a General Assembly high-level meeting on NCDs in 2011, now set for Sept. 19-20. It will be only the second such disease-related meeting that the UN has ever held. The first one, the 2001 GA Special Session on HIV/AIDS, is credited with focusing global attention and obtaining public and private funding for that cause.
Speakers at the Partners in Health meeting stressed that the NCD movement should not be undertaken as an "us against them" competition with infectious disease for scarce resources. In a statement that will be presented to the heads of government at the UN summit, the group called instead for "strengthening and adjusting health systems to address the prevention, treatment, and care of NCDs, particularly at the primary health care level."
--Miriam E. Tucker. (on Twitter @MiriamETucker).