Steadily, the line between diseases of the rich (heart disease, diabetes, lung cancer) and those of the poor (HIV/AIDS, tuberculosis, malaria) has blurred. As citizens of developing nations get fatter and take up tobacco-smoking habits of the developed world they are also under increasing threat from the same chronic noncommunicable diseases (CNCD) that ail the wealthy.
Today CNCDs such as cardiovascular disease, stroke and cancer are responsible for about 44% of all premature deaths. Globally, twice as many people die from CNCDs as from infectious diseases, maternal and infant problems and malnutrition combined. "These disorders are becoming more and more important as we see better longevity and economic improvement around the world," says Abdallah Daar, a professor of public-health sciences at the University of Toronto.
If the spread of disease goes unchecked, researchers estimate that some 388 million people worldwide will die of one or more CNCDs over the next 10 years. The economic cost will be immense. There may be weeks or months of lost work per patient, along with expensive health care, before cardiovascular disease or cancer results in death. CNCDs are projected to cost China, India and Britain $558 billion, $237 billion and $33 billion, respectively, over the next decade.
To change the course of that fate, a coalition of major health agencies from Australia, Canada, China, Britain and the U.S., which together control 80% of the world's public health-research funding, announced today the formation of the Global Alliance for Chronic Diseases (GACD). "Our focus is on reducing the burden of chronic diseases in developing countries," says Leszek Borysiewicz, the chief executive of the U.K. Medical Research Council. "It's critically important to make these interventions now."
If one lesson can be learned from health care in the developed world, it's that chronic diseases are a lot less costly when they're prevented from the start: up to 80% of premature death from heart disease, stroke and diabetes can be avoided with basic behavioral changes and inexpensive drug treatments. But so far there has been little effort to tailor those interventions to low- and middle-income nations, such as China and Brazil, where chronic diseases are expected to take a serious toll in coming decades. "Avoiding tobacco, improving nutrition and getting more exercise we know this works," says Daar. "But the trick is how you get the public to change their behavior."
The GACD hopes to pool its members' experience and resources to identify, test and implement the best ways to slow the progress of chronic diseases both in developed and developing nations. That will be a tall order, particularly since no specific funding has been allocated for the GACD and because chronic diseases work slowly and frequently fall to the bottom of global health priorities. It's important to remember also that the rising rate of chronic diseases in developing nations does nothing to relieve the co-existing burden of infectious diseases like tuberculosis many such countries now face a "double burden" that can worsen the impact of each.
Ideally, public-health funding from governments will follow a more focused research agenda, which would help the GACD's case and that work could eventually be augmented by funding from private groups like the Gates Foundation. "This won't just be research for a publication at the end of the day," says Borysiewicz. "This is about producing better outcomes for real people."