The NCD Alliance has called the millions of avoidable deaths due to noncommunicable disease (NCDs) a “collective failure”, as new WHO data shows NCDs now constitute 7 of the top 10 causes of death globally, up from 4 of 10 top causes of death in 2000.

According to WHO’s new Global Health Estimates released Wednesday, the top 10 causes of death amounted to half of the total 55 million deaths worldwide last year. But deaths from NCDs are increasing the most rapidly and dramatically, according to the report, which also looks at trends over the past twenty years, from 2000 to 2019.

More and more low- and middle-income countries (LMICs) are suffering from rising NCD rates, associated with poor diets, environmental conditions and unhealthy lifestyles.

In the past 20 years, for instance, deaths from diabetes more than doubled in WHO’s Eastern Mediterranean region, which has been beset by an epidemic of obesity, while diabetes deaths rose globally by 70%.

Heart disease retained its position as the leading cause of death, causing some 9 million deaths last year – up by 2 million since the turn of the millennium. Alzheimer’s and other forms of dementia ranked as the 3rd highest cause of death in the Americas and Europe.

The data highlights the need to focus much more intensely on the prevention and treatment of cardiovascular diseases, cancer and chronic respiratory diseases, among others, WHO said.

“These new estimates are another reminder that we need to rapidly step up prevention, diagnosis and treatment of noncommunicable diseases,” said Dr Tedros Adhanom Ghebreyesus, Director General of WHO.

“The WHO report depicts a devastating toll on human life that could have and should have been prevented,” said Katie Dain, CEO of the NCD Alliance.

“If governments are serious about preventing both avoidable death on a massive scale and better preparing the world for future pandemics, then they have to invest in the health of their citizens and promote healthy environments by tackling the common risk factors.”

The “collective failure to” address alcohol, tobacco and substance abuse, unhealthy diets and lifestyles, and air pollution, she said, “has got us to an unsustainable position”.

⚠️ #NCDs now make up 7 of the world’s top 10 causes of death according to @WHO today ⚠️

CEO @katiedain1 said, "this report depicts a devastating toll on human life that could have and should have been prevented." 🚨

Read more here 👉https://t.co/orccCt1UQU #ActOnNCDs pic.twitter.com/JDKZMc0k5I

— NCD Alliance (@ncdalliance) December 9, 2020

LMICs Still Struggling with Communicable Disease Despite Global Decline

Even as the number of NCDs in the top 10 causes of death globally increased by 3, and WHO noted a global decline in deaths caused by communicable diseases like HIV/AIDS and tuberculosis (TB), LMICs are still strapped by both.

For example, TB left the global top 10, falling from 7th place 13th and seeing a 30% reduction in deaths worldwide. But in low-income countries, TB remains at a much higher 8th place. Similarly, HIV/AIDS dropped from 8th to 19th globally, but sits at 9th place in low-income countries.  Groups in countries where undernutrition is still prevalent also now are seeing pockets of obesity and malnutrition, as a result of increasingly unhealthy diets, including too many fat-rich fast foods and processed foods.

Speaking at a press conference on Wednesday as the report was published, Dr Samira Asma, WHO Assistant Director-General, Division of Data, Analytics and Delivery for Impact, said: “It is important to acknowledge the progress we have made in addressing communicable diseases, such as HIV/AIDS and TB.

“This reflects sustained investments made to bring down the burden of these diseases. It is, however, very important to underscore the need to stay vigilant and to avoid backsliding.”

In recent years, WHO has cited a plateauing of progress against infectious diseases like HIV and TB. Available resources for HIV dropped by US$1 billion in 2018, marking the first time global HIV funding declined since 2000.

While the global AIDS response was off track before the COVID-19 pandemic, the onset of lockdowns and travel restrictions created additional setbacks, WHO and UNAIDS said on World AIDS Day in December.

26 million people living with HIV/AIDS today are now regularly using antiretroviral therapies, falling short of the 30 million target for 2020, that was set before the COVID pandemic began.

UNAIDS warned that the world may still see up to 293,000 more HIV infections and up to 148,000 AIDS-related deaths by 2022, despite treatment services having successfully “rebounded” from the pandemic, as WHO stated.

“There are many chronic conditions which commonly occur together, such as HIV and cervical cancer, TB and diabetes, or hypertension, diabetes and chronic kidney disease – and now COVID-19,” NCD Alliance’s Director of Policy and Advocacy Nina Renshaw told Health Policy Watch.

“But because of the imbalance in global health funding and programmes, someone living with HIV is likely to have access to affordable antiretrovirals – which is great – but they might die very young because of lack of access to insulin or to screening for cervical cancer or early treatment for heart disease.  We are hearing more and more stories like this.”

100 Million More Healthy Life-Years Lost in 2019 Than 2000

The WHO report also found that although people were living on average 6 years longer than in 2000, only 5 of those years were lived in good health.

Heart disease, diabetes, stroke, lung cancer and chronic obstructive pulmonary disease contributed to a total of nearly 100 million additional healthy-life years lost globally in 2019, compared to 2 decades earlier: the same diseases that are also causing the most deaths.

“We have seen that it is the people living with NCDs that have been most impacted from the pandemic,” Dr Bente Mikkelsen, director of WHO’s Department of Noncommunicable Diseases, said at a press conference. “Many have become severely ill and, of course, they have been untreated, undiagnosed and, to some extent, unprotected.”

The Americas region experienced a threefold increase in deaths from drug use: the only region to note this in its top 10 contributors to healthy life-years lost. In all other regions, drug use lies outside the top 25.

NCDs Are Now Diseases of Poverty

Mikkelsen said that the data counters the common “misconception” that NCDs are “the diseases of the wealthy and the high-income countries, given bigger risk appetites” related to tobacco, alcohol and diet.

“I think we see from this data that … health systems are not prepared to respond to [increasing cases of] heart disease, diabetes, cancer and lung disease,” she said. “The leading causes of death are draining resources.”

In a factsheet published alongside the new report, WHO notes that in most low-income countries “policy-makers still do not know with confidence how many people die and of what causes” – a data gap worsened by excess COVID deaths, also going unrecorded in some cases.

In a statement, Dr Tedros said that the report highlights “the urgency of drastically improving primary health care equitably and holistically. Strong primary health care is clearly the foundation on which everything rests, from combating noncommunicable diseases to managing a global pandemic”.

As one response, this week saw the launch of a new NCD Poverty Network, Alliance to improve NCD interventions and treatments in low – and middle income countries.

The new network includes some 20 low- and lower-middle-income countries (LLMICs) with large populations of people living in extreme poverty. The network will collaborate with the Lancet NCDI Poverty Commission to identify and advocate for effective evidence-based policies and services to combat NCDs in poor countries.

Collaborating countries will pass through a 4-phase system designed to introduce and expand the delivery of care that can be offered to people doubly affected by extreme poverty and NCDs.

• Phase 1: prioritize conditions and interventions.

• Phase 2: develop models for integrated delivery of priority interventions.

• Phase 3: establish training sites and national operational plans.

• Phase 4: build financial and technical partnerships to support scale-up.

Factors associated with both NCDs and poverty often include unhealthy housing and living environments, including excessive exposures to air pollution; unhealthy workplaces including exposures to chemicals or toxics in workplaces; unhealthy foods including an over-reliance on cheap starches, fast foods and processed foods; and a lack of physical activity associated with increased urbanization and a lack of safe outdoor spaces for leisure and exercise.

Treatment Can Cost One-Third of Household Income

NCDs are also extremely expensive to treat, and in countries like Jamaica, they can eat up one third of household income, said Jamaica’s Minister of Health and Wellness Christopher Tufton on Tuesday, at a press conference hosted by the NCD Alliance.

NCDs also lead to disability, which can mean joblessness and a loss of income, particularly said Tufton. These hit hardest at households in LMICs which may not have large disability and unemployment benefits in the first place.

In Caribbean countries like Jamaica where the brunt of chronic diseases is among the highest in the world, the NCD crisis accounts for 56% of total deaths every year, Tufton added. In 2015, 7 out of 10 Jamaicans died from four major NCDs, including cancers, cardiovascular disease, diabetes and chronic lower respiratory disease, he added.

He emphasized that access to healthcare must go beyond the “bare minimum”, and ensure that healthcare systems offer high-quality medicines that do not perish several months after they are purchased. He quoted surprising results from a Rwandan study that found that up to a fifth of antihypertensive formulations were of substandard quality at their time of purchase, and that 70% became substandard after six months in tropical conditions.

“Improving integration of NCD care and prevention into universal health coverage is an important step towards upscaling cost-effective solutions and implementing policies that ensure that those who cannot afford to pay the associated costs have access to care without suffering financial hardships,” warned Tufton on Tuesday.

Image Credits: WHO/INADI, The Lancet NCDI Poverty Commission.