In our work in the United Nations to support global and national responses to non-communicable diseases (NCDs), we have found it alarmingly common for the importance of addressing NCDs, in the context of other health and development challenges, to be questioned. To our minds the covid-19 pandemic should remove any and all doubt as to why addressing NCDs is crucial for health and sustainable development. In different contexts worldwide, NCDs and their risk factors are increasing susceptibility to covid-19 infection and the likelihood of worse outcomes, including in younger people. One study in France suggests that the odds of severe covid-19 could be as much as 7 times higher in patients with obesity.  Yet we are concerned that NCDs continue to be neglected, constraining efforts to mitigate the pandemic’s immediate health, development and humanitarian impacts and diluting aspirations to build back better.
We must be clear on the issue. NCDs are the world’s leading source of premature death, disease and disability. Each year NCDs kill 15 million people between the ages of 30 and 69, with over 85 percent of these deaths in low- and middle-income countries, where covid-19 is most impacting health service delivery.  NCDs are now spiking the number of untimely deaths from covid-19. Almost one fourth (22%) of the global population is estimated to have an underlying condition that increases their vulnerability to covid-19, and most of these conditions are NCDs.  In many disadvantaged communities, covid-19 and NCDs are experienced as a “syndemic”, a co-occurring, synergistic pandemic that is interacting with and increasing social and economic inequalities.  NCDs and inequalities have aptly been called “a perfect storm.” 
For years the global community has not given NCDs the attention, investment and action they require, even though cost-effective solutions for NCDs have long-been available as have reports on the significant return on investment in prevention and control. NCDs represent over 60% of the global disease burden and account for 70% of deaths, yet receive less than two percent of development assistance for health.  Covid-19 is now exposing our collective shortcomings in addressing NCDs while exacerbating NCD burdens. For example, the pandemic and measures taken in response (e.g. lockdowns) have severely disrupted prevention and treatment services for people living with NCDs, in some cases led to increases in behavioural risk factors for NCDs such as physical inactivity, unhealthy diet, and harmful use of alcohol, and sowed the seeds of a major mental health crisis. 
Covid-19 must be the final wake up call for transformative action on NCDs. That is why WHO, UNDP and the wider United Nations Inter-Agency Task Force on the Prevention and Control of NCDs have issued Responding to NCDs during and beyond the COVID-19 pandemic.  The papers, developed with over 30 Task Force Members, are intended for governments, policymakers, UN agencies and development partners to address NCDs as an integral part of the covid-19 response and in broader efforts to restore and drive progress in achieving the 2030 Agenda for Sustainable Development, including the target to reduce premature mortality from NCDs.
As “build back better” has many possible interpretations, the papers paint a picture of exactly what this would look like in the context of NCDs and covid-19, while at the same time setting out immediate priorities.
In the first instance, the papers call for action to:
- integrate NCDs into national covid-19 response and recovery plans, in line with the UN Comprehensive Response to covid-19;
- rapidly assess essential services, including for NCDs, in the covid-19 pandemic;
- restore and scale up early diagnosis and care for people with NCDs as soon as feasible, and ensure that they are protected from exposure to covid-19 and considered in health and social protection;
- raise population awareness about the links between covid-19 and NCDs and how disadvantaged and vulnerable people can protect themselves; and
- identify opportunities to reduce NCD risk factors at population level, with attention to vulnerable communities, including in humanitarian settings.
It is important to make the most of digital technology to support these actions.
Building back better must also start now and include:
- involving people living with and affected by NCDs in knowledge-sharing, awareness-raising, service provision and decision making;
- increasing funding for NCD prevention and control at local, national and international levels, commensurate with the social and economic burden of these diseases, for example through the United Nations Multi-Partner Trust Fund to Catalyze Country Action for NCDs and Mental Health;
- addressing the social, economic, commercial and environmental determinants of NCDs and health, which includes implementing bold policy, legislative and regulatory measures, including fiscal measures, to minimize the impact of the main risk factors for NCDs and remove barriers to health services;
- advancing universal health coverage, ensuring that benefit packages include NCDs and that people with NCDs are not exposed to financial hardship when receiving care.
- collecting better data and making better use of data to “tell the story” in countries and communities of people with hypertension, cancer, diabetes and other NCDs, their risk factors and availability of treatment.
Before covid-19, the world was already off track to achieve many SDG targets, including that to reduce premature mortality from NCDs. The pandemic has made achievement of the SDGs even more challenging and has exposed the effects of insufficient progress in tackling NCDs and their risk factors. With NCDs amplifying the health, development and humanitarian impacts of covid-19, and with covid-19 exacerbating the burden of NCDs, particularly in already disadvantaged communities, there must be no doubt – addressing NCDs is crucial for health and sustainable development, now more than ever, and our requisite attention, investment and action are long-overdue.
Nick Banatvala (@un_ncd) is the Head of Secretariat of the WHO-led UN Inter-Agency Task Force on the Prevention and Control of NCDs.
Roy Small (@TheRealMcRoy) is a programme specialist at UNDP (@UNDP). His responsibilities include supporting countries to strengthen national capacity, leadership, governance, multisectoral action and partnerships for NCDs and health more broadly. Roy’s background is in law and global public health.
Competing interests: None declared.
Acknowledgment: The authors acknowledge the large number of colleagues across the United System that contributed to the development of the three papers described in this Opinion. They are listed in Responding to non-communicable diseases during and beyond the covid-19 pandemic.
Disclaimer: The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated.
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5] Schwalbe N, Lehtimaki S, Gutierrez JP. NCDs and COVID-19: a perfect storm. BMJ Opinion, 10 June 2020 (https://blogs.bmj.com/bmj/2020/06/10/noncommunicable-diseases-and-covid-19-a-perfect-storm/).
6] Exact figure is 1.81% for 2019 https://vizhub.healthdata.org/fgh/
7] Rapid assessment of service delivery for NCDs during the COVID-19 pandemic. Geneva: World Health Organization; 2020 (https://www.who.int/publications/m/item/rapid-assessment-ofservice-delivery-for-ncds-during-the-covid-19-pandemic).
8] WHO, UNDP. Responding to non-communicable diseases during and beyond the COVID-19 pandemic. 2020. (https://apps.who.int/iris/rest/bitstreams/1299990/retrieve), along with responding to non-communicable diseases during and beyond the COVID-19 pandemic. State of the evidence on COVID-19 and NCDs: a rapid review (https://apps.who.int/iris/rest/bitstreams/1299982/retrieve); and Responding to non-communicable diseases during and beyond the COVID-19 pandemic (https://apps.who.int/iris/rest/bitstreams/1299986/retrieve). Examples of actions being taken by selected members of the United Nations Inter-Agency Task Force of Non-communicable Diseases.