The globalization of non-communicable diseases

What will the future of health and healthcare look like? In a series of blog posts by the World Economic Forum’s Strategic Foresight and Health teams, a number of leading voices will present their own visions for the future. Contributions are linked to the Scenarios for Sustainable Health Systems project, the Workplace Wellness Alliance and the Healthy Living Initiative. In the following post, Julio Frenk, Dean of the Harvard School of Public Health, shares his perspective on the future of health.

The acronym NCD – non-communicable diseases – evolved as a way to draw a contrast between two epidemiological realities: the diseases that were the big killers in economically developed countries such as heart disease, diabetes and cancer; and the infectious diseases such as malaria, diarrheal diseases and tuberculosis that were on the whole limited to the developing world.

Today, however, NCDs are problems in the developed and the developing world. Low and middle-income countries now have the misfortune of sharing the compound burden of increasingly prevalent chronic diseases with a backlog of preventable infectious diseases.

Given this situation, I believe it makes sense to reframe our discussion of non-communicable diseases by suggesting that the acronym NCD stand for “new challenge diseases”. This is a far more useful concept for at least two reasons:

First, the old dichotomy is obsolete. Many diseases labelled as non-communicable but treated as chronic originate from an infectious agent (e.g. cervical cancer). Moreover, several diseases of infectious origin are now chronic, most notably HIV/AIDS.

Second, the term “new challenge diseases” dispenses with the notion that some diseases are best understood as what they are not, rather than what they are. The use of the word “non” pits one group against another – communicable versus non-communicable – and fails to focus on the common aspects of health system strengthening that are required to deal with the double burden of disease.

Looking ahead, if we are to effectively address the new challenge diseases, we will need to overcome four myths:

1. NCDs are not a major problem in developing countries.
2. Even if NCDs are important, there is little that developing nations can do to address them.
3. Even if there are effective interventions, developing countries cannot afford them.
4. Responding to the challenge of NCDs will siphon attention from more urgent priorities, mainly the health-related Millennium Development Goals.

Going forward, we must devote our energies more towards building strong, effective health systems that can prevent and treat communicable and non-communicable diseases alike, rather than creating fragmented programmes focused on addressing one particular disease or another.

During my years as Minister of Health in Mexico, we worked to do just that by pioneering a new generation of health promotion and disease prevention strategies, moving to guarantee universal access to high-quality care without fear of financial catastrophe, and incorporating innovations in the delivery of health services that make use of the technological and managerial revolutions of our times. Initiatives included the creation of a modern public health agency to protect the public from emerging risks like tobacco consumption, the introduction of a new insurance programme called Seguro Popular, which now covers 52 million people, and the active involvement of the private sector and civil society in a multistakeholder strategy to promote healthy living.

Progress in the battle against “new challenge diseases” will demand shared learning among countries, and the deployment of scientifically evaluated innovations that can be adapted to local resources and cultures in an increasingly global and interdependent world.  We will only be successful if we continually and rigorously measure the results of our efforts, and make use of that evidence to improve our health systems.

Author: Julio Frenk is Dean of the Harvard School of Public Health.

Image: A diabetes patient has her pulse checked by a diabetes specialist REUTERS/David Gray