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K M Venkat Narayan: Global non-communicable diseases—a series of reflections

30 Apr, 14 | by BMJ

Non-communicable diseases (NCDs)—such as diabetes, cardiovascular diseases, cancers, chronic obstructive pulmonary disease, and poor mental health—are major and growing public health threats for all regions of the world—rich and poor, urban and rural. Left unchecked, the impact of these conditions on the health and economies of nations, families, and individuals can become devastating.

Rightly, therefore, the public health advocacy community has raised the alarm of a coming crisis through a large number of publications and high profile meetings, such as the UN high level summit on NCDs in September 2011. In the words of Margaret Chan, director general of the World Health Organization, “We must act now with a sense of urgency.” John Seffrin, chief executive officer of the American Cancer Society, also noted about NCDs: “If we don’t intervene, that [NCDs] will be calamitous. The cumulative economic output loss over the next few years could be as much as $47 trillion.”

The growing momentum and passion to tackle global NCDs is encouraging and laudable. At the same time, it is important to allow facts and evidence to guide action, and not get carried away by hyperbole and the notion that we know what to do. As the famous scientist Stephen Hawking said, “The greatest enemy to knowledge is not ignorance; it is the illusion of knowledge.” In a series of blogs, I wish to share eight personal reflections about NCDs, and why I think we need to be reframing the debate on solutions to the problem of global NCDs. Here is the first:

Keep the growth of NCDs in perspective by acknowledging the incredible positive changes in life expectancy and economic wellbeing the world over—thanks to development and mechanization

It has become fashionable to blame the rise of NCDs on globalization, industrialization, and urbanization. Yes, it is undoubtedly true that the rise of NCDs has coincided with these major trends. However, we also need to start acknowledging that some major health gains have occurred, and will continue to do so, thanks to these very same processes.

A huge public health success of the past century has been the major gains in life expectancy—gains that are now occurring rapidly even in the poor countries of the world. Life expectancy in the USA moved from 49.3 years in 1900 to 77.4 in 2000 and is projected to be 81.2 in 2030. Mexico, with a life expectancy of <30 years in 1900 is almost catching up with the USA, with a life expectancy of 74.9 in 2000 and a projection of 80.1 years in 2030. Life expectancy for China was 30 in 1900, 40.8 in 1950, 65.5 in 1980, 72.0 in 2000, and is projected to be 77.4 in 2030. The figures for India are <25, 37.4, 56.6, 62.9, and 72.6, respectively. Even the least developed countries of the world have shown dramatic increases from an average life expectancy of 40.8 in 1950 to 64.1 in 2000, with this projected to reach 71.5 in 2030.

These impressive gains in life expectancy have come from processes that have led to better food production and distribution, improvements in hygiene and sanitation, and also medical innovations—notably immunization against killer diseases. Many of these advances would not have been possible without economic development, technological progress, and global cooperation. This is something we need to acknowledge before demonizing industrialization and globalization for “causing” NCDs.

The past few decades have also witnessed rapid economic growth in countries that were traditionally regarded as poor or underdeveloped. The stellar example is China, which has come out of the abject poverty rate of 85% in 1981 to 13.1% in 2008, and now has a massive middle class and urban population. The economies of poor countries have grown widely, from India to Bangladesh, from South Africa to Botswana, and Brazil to Peru. In fact, several organizations project a massive shift in the global economy to emerging economies, and the International Monetary Fund forecasts that by 2030 five of the top 10 largest economies will be countries that have traditionally been regarded as poor and developing (namely China, India, Brazil, Indonesia, and Mexico). The impact of this global trend is that the size of the world’s middle class and urban populations will rise dramatically, and the numbers afflicted by poverty will drop substantially. These are reasons for celebration.

Yes, global NCDs have become a major problem and will continue to grow, and it is true that we need to act to contain them. At the same time, it is important to frame the debate not as globalization and development causing NCDs, but by acknowledging that globalization and development have fought and continue to help us fight dreaded poverty, undernutrition, and infectious diseases, liberating billions of people from hunger and inhuman living conditions. True, this comes with a price—that of the growth of NCDs. But the solutions to NCDs will likely be counterintuitive and may well reside within the innovative capacity of technology, industrialization, urbanization, agricultural reform, and more globalization, not less. It is a matter of creatively connecting the global health and global development agenda through realistic and pragmatic policy. Perhaps, it’s time to merge the World Health Organization and the World Economic Forum.

K M Venkat Narayan is Ruth and O.C. Hubert professor of global health and professor of epidemiology and medicine at Emory University Atlanta. He is a product of three continents, having lived and worked in India, United Arab Emirates, United Kingdom, and United States of America.

 

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