Chronic noncommunicable diseases such as cancer, diabetes and heart disease are the world's emerging pandemic. Guest columnists David Watkins and Jim LoGerfo write that world political, medical and philanthropic leaders, including those in Seattle, have an important role to play.
WHAT thoughts go through your mind when you hear the term “global health”?
For many Seattleites, the acronym “AIDS” immediately comes up. Or perhaps mental images of starving African children, or statistics of millions of people dying of malaria or tuberculosis. It is time to add other images. The landscape of global health has changed. A new pandemic has emerged and is beginning to overshadow all others.
New cases of chronic noncommunicable diseases (NCDs) such as heart disease, stroke, cancer, diabetes and chronic lung disease are exploding throughout the world, even in the poorest countries. These conditions account for 63 percent of deaths globally, and 80 percent of those deaths are occurring in low- and middle-income countries. Chronic diseases are also incredibly disabling and have a major negative impact on economic development, as they occur at a much earlier age and rob families of their breadwinners.
Historically, these diseases were thought only to affect the rich, the elderly and men, and would not affect poorer regions lacking access to the plagues of the Western world — obesity, sedentary lifestyle, tobacco smoking and harmful alcohol use. But changing local practices and globalization have created a deadly synergy.
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For example, tobacco use in low- and middle-income countries accounts for 4.8 million deaths per year. In some countries, governments even own tobacco production. Smoking is considered fashionable, and most are unaware of its effects on individual and public health.
Similarly, cases of unrecognized and untreated high blood pressure and diabetes are rapidly increasing in developing countries, where most affected lack access to medications that can prevent heart attacks and stroke.
In addition to providing cost-effective medicines for hypertension, diabetes and high cholesterol, the prevention of cases will be our greatest challenge. Chronic diseases require large public-health interventions and improvements to primary health-care systems. There are a few countries with success stories. And unfortunately, less than 3 percent of all global aid money per year is spent on these chronic-disease programs.
Cries for action have fortunately reached the very top. The United Nations will hold a high-level meeting on chronic diseases next week in New York, and heads of state will come together to develop long-term solutions.
Could chronic diseases be the next generation’s HIV/AIDS? The U.N. meeting will set the stage for future work. Action- and outcome-oriented resolutions will be essential. Political and philanthropic leaders need to hear from the public that they should take these diseases seriously.
Unfortunately, there are already many tensions between representatives of developing countries and U.S. and European stakeholders, who are balking at demands for firm goals and commitments. Language around “equitable access to medicines” is being watered down, even before the summit. What is needed is a shared sense of responsibility that spans resource-rich to resource-poor nations, from public to private sectors, from industry to consumer.
What is the role of the global-health community in Seattle? This city is full of global-health leaders, both in academia and nongovernmental organizations. Students, medical residents and faculty at University of Washington started a chronic disease working group to catalyze partnerships for chronic-disease research, training and disease-treatment programs worldwide. We look forward to working with civil society, the private sector, philanthropic organizations and government to address high-priority areas in chronic-disease control.
The chronic-disease pandemic will be the “face” of global health in the coming decades. It will be an insidious pandemic for those who are affected, causing slow and subtle declines in health over years. Seattle can play a leading role in the fight against premature death and disability from chronic diseases.
Dr. David Watkins, left, is a resident physician in the Department of Medicine and the Internal Medicine Global Health Pathway at the University of Washington. Dr. Jim LoGerfo is a professor of Medicine and Global Health at the University of Washington.