International Development Journalism Competition: Why non-communicable diseases hit the developing world so hard
Sitting in a doctor's room, a young man is answering questions about his lifestyle choices. How often do you eat fruit and vegetables? Smoke? Drink? What is your family medical history? This scene is one you might have experienced or can picture in the surgery practice down the road.
A familiar scene in high-income countries such as the UK, it has recently become the experience of hundreds of Kenyans and Nigerians as they take part in pilot projects aiming to tackle the rise of non-communicable diseases (NCDs) such as cardiovascular diseases (CVD), diabetes and cancer in developing countries.
The success of these projects, managed by Family Health International (FHI), have provoked calls to integrate CVD screening into Kenya's National AIDS strategy. It is a stepping stone in the movement of international health organisations to bring attention to the global burden of NCDs.
The facts and figures speak for themselves. Accounting for 60 per cent of global deaths NCDs are the largest causes of mortality worldwide. Of these deaths 80 per cent occur in low- and middle-income countries, making them an urgent development issue.
However, the Millennium Development Goals (MDGs) set out in 2000 by the United Nations outlined targets to combat infectious diseases such as HIV/AIDS, malaria and TB but did not include any references to NCDs such as heart disease, cancer, chronic respiratory disease or diabetes.
"It is a major problem", says Jo Hopkins, Director of Fundraising at World Child Cancer, a charity that is a member of the international campaign group NCD Alliance.
"It means that developing country governments have no incentive in terms of international funding to do anything for non-communicable diseases."
This helped to fuel a perception that cancer and heart disease were the burdens of affluent societies, whereas developing countries were associated with infectious diseases. However, with the urbanisation of many low-income countries this is increasingly not the case.
"Particularly as more people are adopting a western lifestyle and tobacco companies push their products on low- and middle-income countries, cancer is a major problem," says Hopkins.
However, in 2011 a UN High-Level Summit will be held in New York on September 16-19 to raise the profile of NCDs. This meeting has been likened to the 2001 UN conference on HIV/AIDS that sparked the formation of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which raised nearly $10bn.
Similar funding for NCDs could relieve the financial burden they create for developing countries. According to the World Health Organisation (WHO), 30 per cent of people dying from NCDs in low- and middle-income countries are under 60 years old and are in their most productive period of life. In conjunction with a WHO report on NCDs released in April, WHO Director-General Dr Margaret Chan said that the rise of NCDs presents an enormous challenge.
"In wealthy countries deaths from heart disease and strokes have declined significantly. But this gives a distorted picture," says Dr Chan. "For some countries, it is no exaggeration to describe the situation as an impending disaster; a disaster for health, for society, and most of all for national economies."
For those in lower socio-economic groups, who may have limited access to healthy food or places for physical activity, the risk is high and the financial burden of NCDs can be devastating. According to the World Heart Federation, parents can be forced to reduce basic consumption and children can be withdrawn from school to assist in care or to work. In China, expenses from strokes pushed 37 per cent of patients and their families below the poverty line. Research from the International Diabetes Federation in 2009 found that of 2300 people with type 2 diabetes one in six could not work because of their health, and more than half could not buy all the medicines they needed.
Dr Jothydev Kesavadev, a diabetes specialist in India outlines the financial burden of care for his patients.
"The average income of a person is less than $2000 a year," says Kesavadev.
"With the development of multiple combinations of diabetes the average cost of treatment would be more than $3000 per year. Incredible - how can they treat the disease?"
Following September's meeting it is hoped that more funding will be available for the prevention and treatment of NCDs. However, health programmes will require co-ordination between the health sector and non-health sectors such as agriculture, urban planning, and education. This co-ordination is also essential for the control of infectious diseases and, as the FHI projects indicate, some global health organisations believe that infectious and non-infectious health programmes can be successfully integrated.
Speaking in March a few days before an event held by NCD Alliance and Partners in Health (PIH) in Boston, co-founder of PIH and Professor at Harvard Medical School Paul Farmer suggested that health systems can be strengthened by NCD health programmes and by adapting existing programmes to new demands.
"A good cardiac surgery program would improve the quality of surgical care in general," Farmer said.
"If you have a good vaccination program for polio, measles, or tetanus, it is a delivery system for the cervical cancer vaccine, Gardasil."
Working in hospitals in developing countries, World Child Cancer see the impact that improving cancer care can have.
"Children with cancer need medical support such as blood tests and bone marrow tests so we often spend money on increasing standards in the pathology dept," explains Hopkins.
"This has a knock on effect with adult tests and other child diseases. Anecdotal evidence shows that when you start treating children with cancer in major hospitals it ups the game in other departments."
Broad health programmes and international co-ordination could help prevent further increase in NCD cases but during a recent speech in Moscow, Dr Chan warned that the time to act is now.
She said: "In the absence of urgent action, the rising financial burden of these diseases will reach levels that are beyond the capacity of even the wealthiest countries in the world to cope."
This feature was written for the Guardian International Development Journalism competition before 13 June 2011.