Dr. Harvey Fineberg Speaks at CSIS
February 4, 2011
Fellow, Global Health Policy Center
Non-communicable diseases (NCDs) are on the rise globally and are an increasing factor in the burden of disease in low and middle income countries. Dr. Harvey Fineberg, President of the Institute of Medicine, spoke to a sizable crowd at CSIS this week as the first speaker in a series of events on NCDs hosted by the CSIS Global Health Policy Center leading up to the September United Nations High Level NCD Meeting. Dr. Fineberg began his talk by stepping back to look at the placement of chronic, or non-communicable diseases (NCDs), within the broader field of global health. He noted that there are five ways to frame and define global health issues: 1) as diseases unique to poor countries, 2) as diseases prevalent in poor countries, 3) as a comparison of diseases and health systems across regions or countries, 4) as a transnational problem, or 5) as a public health issue for which the population of interest is the global community. He proceeded to point out that if people view global health through frameworks 1 or 2, and focus on poor countries only, they often downplay the importance of NCDs because they perceive them to be problems for rich countries. This is false. Currently, the rise in NCDs is a global burden, and lower and middle income countries are in fact bearing the brunt of it. Of deaths due to NCDs, 80% occur in low to middle income countries. For example, the number of deaths due to NCDs in India and Pakistan combined is twice that of deaths due to infectious diseases in those two countries.
The impacts of NCDs are costly, but NCDs are avoidable with effective prevention programs. To illustrate this point, Dr. Fineberg highlighted the actions of Finland in the 1960’s as an example of effective prevention. Facing a high incidence of heart disease in the Finnish population, the country invested in a multisectoral approach, involving education and lifestyle change. This strategy resulted in an 85% decrease in heart disease among working men. Changes at the individual, community, and national level can have a real impact on the rates of morbidity and mortality due to NCDs and a preventative, versus curative, approach can save billions of dollars over time. Dr. Fineberg noted that between 2005 and 2015 China, India and Russia could lose $200-$550 billion of national income due to the effects of NCDs such as heart disease, stroke and diabetes on their populations.
Another incentive to invest in combatting NCDs is that often, interventions for one chronic disease also impact other NCDs. For instance, interventions to reduce tobacco use can also moderate the incidence of cancer and heart disease; and nutrition and exercise interventions to combat obesity simultaneously diminish rates of diabetes, joint diseases and blood pressure. Even limited interventions in diet, exercise and tobacco use can make a significant impact on the health, well-being and productivity of a population.
Although NCDs are a growing domestic problem that needs to be addressed, it is in the United States’ self-interest to invest in combatting NCDs globally. The US can reap the benefits of lessons learned from research and interventions abroad. Developed and developing nations share a common interest in preventing, mitigating and dealing with the impacts of NCDs in an effective and efficient way. Continuing to support the work of global players, such as the WHO, and actively involving the private sector is essential to a comprehensive approach that can mobilize institutions, individuals and society to promote a reduction in NCDs. Global collaboration and sharing of lessons learned can facilitate scale- up and dissemination of successful approaches and make the rising NCD epidemic a winnable war.
Looking ahead to the September UN NCD meeting, Dr. Fineberg noted that this high profile meeting has the potential to galvanize health advocates and the global public to mobilize on NCDs. With both Ministers of Health and Ministers of Finance in attendance, it is an opportunity to address the budgetary realities of moving ahead with a prevention response rather than a curative response to the emerging epidemic, and shine a light on the potential economic impacts of inaction.
The next session in the Global Health Policy Center’s speaker series leading up to the UN High Level Meeting on NCDs in September will be on February 16 and feature Jean-Luc Butel, Executive Vice President and Group President of International Operations at Medtronic. Find more information on the event here.