by Jeremiah Norris – Senior Fellow, Hudson Institute
On November 1, the CGD and the Institute of Medicine (IOM) held a timely discussion under the heading of: What’s on the Agenda? Assessing the UN High-Level Meeting on Noncommunicable Diseases. The UN General Assembly will sponsor this Noncommunicable Diseases (NCD) Meeting in September, 2011.
The rapid acceleration of NCDs in the developing world is now a major development issue. CGD and IOM highlighted the findings of two recent reports: a new CGD report titled ‘Where Have All the Donors Gone? Scarce Donor Funding for NCDs’, and an IOM publication, Promoting Cardiovascular Health in the Developing World.
Both reports point to the high prevalence of chronic diseases in developing countries (see Table 2 below from CGD’s publication). Additionally, both publications note the lack of resources devoted to addressing NCDs in development.
In the CGD report, a recent assessment showed that official development assistance for health otherwise known as DAH was estimated at $21.8 billion in 2007, reaching $26.4 billion in 2008. Of the amount in 2007, CGD’s analysis revealed that only 3%, or $503 million, was dedicated to NCDs. In 2008, the amount rose to $686 million. In terms of the burden of disease, ODA donors provided about $0.78/DALY (disability-adjusted life year) for NCDs compared to $23.9/DALY attributable to AIDS, TB, and malaria.
So who spends what on NCDs? It seems that the private sectors contributions have grown the most between 2004 and 2008. As the CGD paper notes:
Official government funding from multilaterals and traditional bilateral donors has risen since 2004, but the largest growth comes from the private sector. The charitable arms of for-profit and not-for profit organizations together contributed over US$305 million in 2008, constituting a 1,200 percent increase since 2004. The total almost equaled funding from multilateral agencies, at 44 percent and 45 percent, respectively. This constitutes a major rebalancing of contributions in four years. In 2004, 10 percent of NCD funding came from private sources and 74 percent was from multilaterals.
The IOM publication focused specifically on cardiovascular health in the developing world and clearly made the point that this disease can no longer be confined to industrialized countries. Cardiovascular disease (CVD) now accounts for nearly 30%of deaths in low and middle income countries each year and is accompanied by significant economic repercussions. Yet, most governments, global health institutions and development agencies have largely overlooked CVD. The risk factors for CVD are well known, and the actions needed are deceptively simple: eat a healthy diet, be physically active, avoid tobacco, and seek care regularly. But the reality is much more complex.
The IOM convened a committee to assess current knowledge and strategies, and recommend promising ways to reduce the global burden of CVD. Its report is intended foremost as a guide to set goals and priorities in global CVD, including strategic partnerships with other U.S government agencies and international stakeholders. One primary goal outlined by the IOM is to create environments that promote heart healthy lifestyle choices and help reduce the risk of chronic diseases. An equally important goal is to build public health infrastructure and health systems with the capacity to implement programs that will effectively detect and reduce risk as well as manage CVD.
One of the panelists, Julian Schweitzer, a principal at the Results for Development Institute (R4D), commented on the importance of engaging ministers of finance in NCD program development because of the macroeconomic consequences, e.g., lost productivity, early retirements, and disabilities. Dr. Schweitzer also addressed the need to program interventions based on local conditions rather than trying to apply those that have worked in the West. An individual from Kenya in the audience responded to this comment by saying that in one area of her country the incidence rate of hypertension was over 50 percent of the population—but alcohol and sodium use were very limited. In this situation, she asked, what are the risk factors for CVD? Dr. Schweitzer responded: that’s why we have to program CVDs at the local level.
Both the CGD and IOM presentations resonated positively with the audience. They underscored the importance of preparing well-documented materials and data sets for the UN General Assembly in September 2011, thus permitting informed policy decisions to be reached on programmatic interventions. Perhaps this session at CGD will be seen as the initiator which set in train an understanding on the emerging significance of CVDs in the developing world.