Norway will contribute an additional 133 million USD (1.2 billion NOK) to reduce the burden of non-communicable diseases (NCDs) in low-income countries from 2020 to 2024, the Ministry of International Development announced today. 

The announcement comes in the wake of last year’s path-blazing strategy for how to tackle the growing NCD burden in LMICs, “Better Health, Better Life”. The strategy was the first by an  international donor country to address health risks that are an increasing factor in deaths and disease in poor countries – where poor diets and degraded, unhealthy environments combine with a lack of access to standard NCD prevention and treatments. More than 15 million people under the age of 70 die every year from NCDs, with most of those under-70 deaths in low- and middle-income countries where people have less access to treatment.

Despite the growing burden, most donor assistance to developing countries remains focused on infectious diseases, including vaccine preventable diseases. While those risks can’t be discounted either, too many health programmes are often organized “vertically” so that even basic NCD services, like cervical cancer screening, are ignored. The intricate link between NCDs and infectious diseases has also become more apparent during the COVID-19 pandemic –  where NCD conditions increase the risk of becoming seriously ill or dying from the SARS-CoV-2 virus. 

“Norway is the first donor country with a strategy focusing on NCD-action in developing countries. I hope other donor countries will follow,” said Dag-Inge Ulstein. “There is a huge need for funding. Despite the enormous death burden in low- and middle- income countries, NCD efforts only receive between one and two per cent of all global health-related development aid. The funding gap comes with a consequence, and too often the victims are the most vulnerable.” 

World Health Assembly Discussion on Healthier Lives and Wellbeing 

The announcement coincides with discussions at the World Health Assembly gathering of its member states on a third pillar of the WHO’s strategy that aims to promote – Healthier Lives and Wellbeing. 

However, those discussions covering strategies for healthy ageing, food safety and nutrition… also are at risk of being eclipsed by the highly-politicized debates over the COVID-19 pandemic response and WHO reform.  

“We applaud Norway for prioritising NCD prevention and control within its poverty alleviation and sustainable social development priorities,” says Katie Dain, CEO of the NCD Alliance, in responding to the announcement.

 “Norway is walking the talk on the Sustainable Development Goals and has recognised the urgency for action on the global tsunami of NCDs. It is setting an important precedent for other OECD countries to follow.”  

Nina Renshaw, NCD Alliance Policy and Advocacy Director also adds: “Financing has long been the Achilles heel of the NCD response. The emphasis on ensuring sustainable financing for NCD prevention and control is particularly welcome. 

“We’ve been hearing throughout this week’s World Health Assembly that countries have the will to achieve Universal Health Coverage, (UHC) but need to mobilise the means, in increasingly challenging financial circumstances. That Norway is offering countries support to develop sustainable financing models and calling on other donors to join in to act on NCDs as a major cause of poverty, is a strong signal for others to invest.”

NCDs, including heart disease and hypertension, cancers, lung disease, diabetes, and mental health disorders cause more than 70% of all deaths worldwide. This means that far more people die from non-communicable diseases than from infectious diseases such as malaria, tuberculosis, polio, HIV/AIDS, and Ebola. And in developing countries, NCDs are a large and growing proportion of the disease burden. 

‘Worldwide, 41 million people die each year as a result of respiratory disease, cancer, cardiovascular disease, diabetes, mental disorders and other non-communicable diseases. This cannot continue,” said Ulstein when the Norwegian NCD strategy was first launched a year ago in Oslo.  

“The NCD crisis has been ongoing for several decades. The death toll is rising year by year. NCDs are often chronic diseases, resulting in high health costs for individuals, families and societies. As is often the case, people in vulnerable situations bear the heaviest burden,” said Ulstein. 

And moreover, 86% of “premature” NCD-related deaths occur in low- and middle-income countries, where there is lack of awareness about prevention, and lack of access to diagnosis and treatment. These deaths will cost $7 trillion in economic losses over the next two decades.

Currently about 1-2% of global health-related assistance goes towards combating NCDs, or around $US 611 million. Bilateral donors (national governments or their development agencies) are the dominant source of funding in global health, but have been relatively absent in the field of NCDs until recently. 

Between 2010-2015, non-governmental organizations (NGOs) collectively provided more than twice as much aid for NCDs than bilateral donors, and considerably more than multilateral organizations such as the World Bank and the WHO. 

LMICs have been left to respond to increasing burdens of NCDs with their own scarce resources. Large-scale global efforts have the potential to save millions of lives and contribute to healthier populations and economic growth in LMICs. 

The Norwegian assistance will help fund activities around its three-point strategy: Strengthening primary health care; prevention targeting leading risk factors for NCDs, such as air pollution, tobacco and alcohol consumption, as well as unhealthy diets; and strengthening health information systems and other global public goods for health. 

Strengthening Primary Healthcare Services 

At the primary healthcare level, many NCD interventions can be delivered effectively and affordably, benefiting patients and savings for health systems. This can include checks for hypertension, diabetes, prevention of cervical cancer with HPV vaccination, as well as capacity for prevention and early diagnosis and treatment of mental health disorders in primary health services. Norway will support strengthening health services so that primary health care services are well-equipped to support NCD prevention, early diagnosis, and treatment.

Prevention Targeting Risk Factors for NCDs

Norway will support countries requesting assistance to improve taxation and regulation and regulation of products that are harmful to health through its Tax for Development Programme (Skatt for utvikling). These measures can be effectively used to discourage consumption of health-harmful products such as tobacco, alcohol, and sugary drinks. Pollution taxes and regulations can encourage shifts to clean energy and transport. All these are key risk factors that contribute to NCDs. 

Strengthening Health Systems 

The aim is to aid countries in developing better health information systems to improve access to health data critical for early stage NCD diagnosis treatment, supporting NCD-related health norms and standards, and will improve access to medical equipment and medication, especially in areas hit by crises and conflict. 

Together, these three points support the WHO Sustainable Development Goals (SDG) of reducing premature deaths from NCDs (SDG 3.4) by one-third by 2030 and Universal Health Coverage (SDG 3.8), and includes targets of reducing deaths from air pollution, strengthening tobacco control, and preventing harmful use of alcohol. 

Image Credits: icd 10/Flickr, Stine Loe Jenssen, John Campbell/Flickr, Sven Petersen/Flickr.