Here is a question that we should all know the answer to:
What is the world’s greatest opportunity to save and improve lives by 2030?
The answer may surprise you - it’s preventing and treating noncommunicable diseases, or NCDs. The most common ones include cardiovascular disease, diabetes, chronic respiratory disease, cancers, and mental health conditions. But there are hundreds of others like eye health conditions, oral health diseases, chronic kidney disease (CKD) and thyroid conditions.
Together, they account for 41 million deaths each year - that’s 74% of all deaths in the world - and 15 million of these are occurring in people between the ages of 30 and 70. They also cause 80% of disability in the world, and take a catastrophic toll on the economies of countries and households. And the toll of NCDs is rising fast - most of all in low- and middle-income countries (LMICs). Why?
It’s because most NCDs share a common denominator: the risk factors that provoke and aggravate them.
The main NCD risk factors are tobacco and alcohol use, unhealthy diets, physical inactivity and air pollution.
As exposure to these risk factors rises, so does the prevalence of NCDs.
This has been especially visible in LMICs, where these risk factors began commonly appearing just three to four decades ago. Now, they are a part of life for most people in the world. In all countries regardless of income status, the poorest and most marginalized communities are the most exposed to NCD risk factors - and therefore, the most at risk of NCDs and their consequences.
This higher exposure is not usually the result of individual choice, but rather the result of social and structural determinants. For instance, physical inactivity is often the result of not having safe or appealing outdoor areas, an unhealthy diet may be due to the prohibitively high cost of fresh foods compared to ultra-processed ones, and exposure to air pollution often comes from using unsafe cooking fuels in poorly ventilated areas, a common practice in developing countries. Health-harming industries, like those producing tobacco, alcohol, ultra-processed foods and breastmilk substitutes, also seek out marginalized groups with aggressive marketing tactics, in relentless pursuit of “new markets” to be exploited.
The good news is that these risk factors can be modified through collective action - and progress is being made all the time. You’ll hear about it in this podcast series, where advocates and activists share their struggles and triumphs as they work towards a world where everyone enjoys an equal right to health.
Small island developing states intensify efforts to fight NCDs
Small island developing states (SIDS) are being battered by noncommunicable diseases (NCDs). In response, a series of events were organised in recent years to examine SIDS’ current situation and needs. The latest of these was the SIDS Ministerial Conference, held in Barbados in June. Strategic guidance for the Conference was provided by a policy expert group co-chaired by Sir George Alleyne and Sir Collin Tukuitonga. In our new episode we speak to the co-chairs about the Ministerial Conference and the events that pre-dated it as well as about the Bridgetown Declaration generated by the Ministerial Conference, and what it will take to achieve its calls to action. While recognising that making progress on NCDs prevention and care will require constant, long-term effort, both men are optimistic and already see signs of progress.
Hospital innovates funding and care
Since we recorded this episode in June, Bayalpata Hospital management has learned that its funding for the current fiscal year, which started in July, is in doubt. Management signed a five-year agreement with the provincial government in 2022 but now officials say that there is no legal mechanism to transfer money to the hospital. A committee has been set up to look into this and a report is expected in early August. Meanwhile, the hospital is delaying signing staff contracts.
Bayalpata Hospital has been working to provide universal health coverage — care that is accessible and affordable to everyone — since it started running as a non-profit project in Nepal’s Far West region 15 years ago. COVID-19 disrupted the initiative, for example by cutting patient numbers by more than half, to below 50,000 per year. A couple of years earlier Nepal’s transition to a federal governance system meant that the hospital was suddenly working most closely with a provincial government not the Ministry of Health in Kathmandu. Despite these disruptions, Bayalpata is developing as an alternative healthcare model, one that provides free healthcare to people in the most disadvantaged part of the country while developing innovative service delivery tools, funding sources and collaborations.
The Moment for Caring: Global Week for Action on NCDs 2023
The Global Week for Action on NCDs is a major event on the annual calendar of the NCD community worldwide. In 2023 it takes place from 14 to 21 September. This year’s theme is Bridging the care gap, and in this episode of Voices of the Health Revolution, Grace Dubois from NCD Alliance explains why this year’s event is all about care. Universal Health Coverage (UHC) is key to the approach: the UN High-level Meeting on UHC takes place on 21 September, and for the NCD community it as an opportunity to build on progress to date and to advance UHC policy and implementation ahead of the target date of 2030.
That means the Global Week is ideally situated to call on governments to accelerate action on NCD prevention and care policies globally across the three UHC dimensions: financial, service, and population coverage. Fair and effective solutions will support every person, every family and every community affected by NCDs as well as their costs for care and treatment.
Spotlighting commercial drivers of health
In recent decades growing attention has been paid to how the social and environmental conditions in which we live — such as air quality (environmental) and income (social) — affect our health. These are known as social and environmental determinants of health. Now a spotlight has been turned on commercial determinants of health, thanks to a new series in The Lancet. Today we’re chatting with three contributors to that series to learn more about commercial determinants: how the products made by commercial actors, and the processes they use in making them, affect people’s health, and how we might start to reduce those impacts.
Thanks as always to our guests:
- Sharon Friel - ARC Laureate Fellow, Professor of Health Equity, Australian National University
- Anna Gilmore - Professor of Public Health, Department for Health, University of Bath
- Jenn Lacy-Nichols - Research Fellow, Victorian Health Promotion Foundation, University of Melbourne
New fund to spark country action
NCDs account for 74% of all global deaths, 41 million people each year, yet they attract a miniscule fraction of global health financing. So situating them within other regional and global health movements, such as advocacy for Universal Health Coverage, is key to raising their profile and boosting support for NCD care and prevention, explains Dr. Douglas Webb in this episode. We also discuss how the new UN Health4Life Fund is designed to support national government initiatives in order to maximise their investments in NCDs and at the same time overcome the forces, such as Big Tobacco and Big Alcohol, trying to suppress such activity.
Health policy victory is sweet in Barbados
Sugary drinks are a major driver of the global epidemic of chronic conditions like obesity and diabetes. One way to keep consumption under control is through fiscal policies like taxes on these health harming beverages. Francine Charles from the Heart and Stroke Foundation of Barbados was at the frontline of the effort to move the Barbados sugary drinks tax increase forward. In this interview, she explains how they did it and how they are now working to see the implementation of diverse healthy food policies to reduce chronic disease and build a healthier population.
The worlds best ever investment opportunity?
Lack of resources and investment in NCD prevention and care is costing the world millions of lives and dollars each year. Yet, there are powerful and cost-effective actions that countries can take to turn the tide on NCDs. In this interview, NCD Alliance CEO Katie Dain shares her views and expertise on how we can close global health’s biggest funding gap. She reveals why investment in NCD prevention and control is the world’s biggest opportunity to save lives and money by 2030.
A landmark plan for chronic diseases in South Africa
South Africa recently launched The National Strategic Plan for the Prevention and Control of Non-Communicable Diseases, 2022-2027. Dr. Vicki Pinkney-Atkinson is Director of the South African NCD Alliance, which worked with the government over eight years to complete the document. In this interview she describes how difficult it was for people living with NCDs to have their voices heard when the new plan was being prepared and the challenges facing its implementation, including lack of resources. She also stresses that NCD activists were determined to followed the path made by the HIV/AIDs movement.
My NCD story, Our NCD story
People-centred healthcare occurs when people, not their conditions, are placed at the heart of health services, programmes and policies. In this episode, Johanna Ralston, CEO of World Obesity Federation, and former CEO of the World Heart Federation, speaks to her experiences of living with noncommunicable diseases for over 30 years. From being silent about her experience at the very beginning, to learning to speak and leverage the platforms around her, Johanna's journey has brought her to advocate for the meaningful involvement of the lived experience in decision-making. Johanna – a leader in the global NCD movement – talks about the improvements in resourcing and prioritisation of NCDs in the policy landscape, but she also knows we’ve still a long way to go.
Closing Global Health's Biggest Gap
Chronic diseases like cancer, diabetes and cardiovascular disease cause 41 million deaths per year, or 74% of all deaths globally. Out-of-pocket health costs are often catastrophic, driving millions of people into poverty every year. Yet they are the most underfunded global health issue. In this podcast, we hear from diverse NCD champions on the urgent need to close this funding gap - and solutions that can make it happen, like fiscal policies for health, innovative partnerships and integrated care. In the lead up to the Second Global NCD Financing Dialogue that will take place in 2023, the time is now to put our minds together and take a new approach to global health financing.
This podcast highlights five voices from NCDA's event: NCD financing as the foundation for healthy societies and economies.
- Rachel Nugent, RTI International
- Paul Fife, Director of the Department of Human Development, Norad
- Dr Omary Ubuguyu, Director for Curative Services, Ministry of Health, United Republic of Tanzania
- Dr Kelly Henning, Public Health Programme Lead, Bloomberg Philanthropies
- Dr Vuyiseka Dubula Majola, Director of the Africa Centre for HIV/AIDS Management, South Africa
Motivating a population to move
Efforts to make people worldwide more physically active have stumbled. Five years ago the world’s countries adopted the World Health Organization (WHO) Global Action Plan on Physical Activity (GAPPA). But putting it in place “has been slow and uneven, resulting in little progress towards increasing population levels of physical activity… and a reversal of progress in several key areas,” says a new WHO progress report . One of the main issues is that governments’ efforts often are not well coordinated, says Fiona Bull, Acting Director and Programme Manager in the Department of Prevention of NCDs, in this episode of Voices of the health revolution. Ways to get the GAPPA back on its feet include investing in “health-enabling environments” so that individuals aren’t left on their own to become more physically active, and supporting governments to take broad-based actions that encompass other ministries beyond those responsible for health and physical activity.
Unlocking the power of lived experience
Despite big advances on NCDs over the last decade, people living with NCDs worldwide have struggled to find platforms where their voices are heard, and where their experiences with health systems and policies contribute to shaping them. Our Views, Our Voices, an initiative launched by the NCD Alliance and people living with NCDs, was started five years ago with the aim of changing this. In this special anniversary podcast, you'll hear from Cajsa Lindberg and Bruno Helman, two lived experience advocates and members of the Our Views, Our Voices Advisory Committee. They reflect on all the initiative has been helping to drive change - even at global levels - and what they hope to achieve in the next five years to come.