Since 2014, the United States has been looking at health and healthcare as a security issue. The Global Health Security Agenda (GHSA) is a partnership of 64 nations and other stakeholders to help build countries’ capacity to help create a world safe and secure from infectious disease threats and elevate global health security as a national and global priority. GHSA was set up at the beginning of the 2014 Ebola crisis but can be looked at through the prism of NCDs. The US Centers for Disease Control (CDC) identifies three ways in which NCDs relate to global health security.
The first is susceptibility to infectious disease outbreaks: “Uncontrolled diabetes increases the risk and severity of infectious diseases like dengue and malaria, and makes tuberculosis even harder to treat. Tobacco smoking is a risk factor for all leading NCDs and also increases risk and severity of influenza, tuberculosis, pneumonia, and hospital-acquired infections.”
The reality is that some NCDs like diabetes and CVDs can lead to an impaired immune function. This makes the fight against infectious diseases much more difficult and because the double burden tends to take place in low- and middle-income countries, they are often accompanied by unhealthy exposures and environments. Experts, institutions and policies need to start supporting the prevention and control of these two overarching disease categories. Patients with NCDs have an increased susceptibility to infectious diseases. This means that the infrastructure that needs to be developed to support one burden could very well support both.
The second is health system strength: “A health delivery system that ordinarily addresses NCDs can be a first line of defense when a communicable disease emergency occurs. For example, Brazil’s strong system for managing NCDs helped the country respond to the Zika virus epidemic. Additionally, reducing the rate of NCDs keeps health systems from being overburdened when large outbreaks happen.”
Thirdly, combating NCDs is a key element in meeting global goals: “NCD initiatives contribute to international development goals by reducing the economic burden of illness and death and improving overall capacity for emergency response.”
The 2030 Agenda for Sustainable Development adopted by the United Nations in 2015, recognises NCDs as a major challenge for sustainable development. This is why the Third High Level Meeting on NCDs was held in September 2018 and a political declaration was signed. The ultimate hope is to reduce by one third premature mortality from NCDs. According to The Lancet half of the countries that have signed up to these goals will not be meeting them by 2030.
“Despite clear commitments, international aid agencies and national governments are doing too little to reduce deaths from cancers, heart and lung diseases and diabetes. Progress is even slower for other diseases that are not a part of an SDG target, meaning that the true health of people in most countries is even more dire,” says Professor Majid Ezzati, Imperial College London, UK. The authors of this research emphasised that though there were 12.5 million premature deaths from the four major NCDs in people aged 30-70 years in 2016, there were 27.3 million deaths from all NCDs in all people aged less than 80. And it will be countries in sub-Saharan Africa and some countries in the Middle East and North Africa that are most likely to be left behind.
It is not just weak health systems that are at fault for these numbers. In a number of low-income countries where the International Committee of the Red Cross, (ICRC) operates, the prevalence of diabetes among the population above 18 years is higher than 10%. The growing burden of NCDs in humanitarian emergencies is a concern that aid actors have been emphasising in recent years. In those countries, diabetes is the cause of more than 25% of amputations in one-third of the centres in the cohort of amputees in ICRC’s Physical Rehabilitation Centres.
“There can be no security without making NCDs fundamental to the vision for universal health coverage,” according to Richard Horton, writing in The Lancet. “Access to medicines for NCDs should be a decisive matter of human rights.”