Non-Communicable Diseases: Is the ‘New Normal’ Too Much Like The Old One?
The vast majority of people who died of COVID-19 had a non-communicable disease – yet investment in NCD prevention is pitiful.

More than two years after the novel coronavirus erupted into a global pandemic, the world is beginning to settle into a new normal. COVID-19 changed how we live and work in ways that will continue long after the pandemic subsides. Digital and automation technologies are here to stay, work is done remotely, and shopping and entertainment have gone online.

But the COVID-19 pandemic also laid bare an indisputable truth: the destructive path carved by the infectious SARS-CoV2 virus was only the tip of the iceberg. Studies have estimated that 60-90% of COVID-19 deaths have been of people living with one or more chronic conditions, like obesity, heart or kidney disease, or cardiovascular diseases. And people living with non-communicable diseases (NCDs) are still experiencing the collateral damage of the pandemic, due to severe disruptions to essential health services.

The lack of investment in NCD prevention and care over the years has vastly amplified the toll of the COVID-19 pandemic.

The bigger, long-term pandemic that we face  

Responsible for 74% of all deaths globally, NCDs are the even bigger, long-term pandemic that we face. Governments and global institutions have been learning many harsh lessons about the need to build back better, with more resilient health systems and more equitable access to quality, affordable treatment. But too often this has been a slogan without much substance behind it. We now need to see real changes taking hold.

Beyond COVID, there is a strong and urgent imperative for investment in NCDs, which now cause 15 million premature deaths of people between the ages of 30 and 70 each year, 85% of them in low- and middle-income countries.

This makes action and investment in NCDs a prerequisite for resilience, pandemic preparedness and health security, not to mention for meeting the most critical health challenges of the next decade in countries at all stages of development.

Yet financing for NCDs has stagnated at a pitiful 1-2% of development assistance for health for two decades. If we look at development assistance that has gone towards health system strengthening which also helps people living with NCDs we can add a further 5%, but that is simply inconsequential when compared to government handouts for fossils fuels and agriculture, which climb to $1.8 trillion annually – and more importantly, when compared to the magnitude of disease and economic burden of NCDs. 

 Still hope to see healthier populations by 2030

In 2015, all UN member countries committed to the Sustainable Development Goals (SDGs) to achieve a better and more sustainable future for all, including SDG target 3.4 to reduce NCD premature mortality by one-third by 2030. This and other NCD commitments should not lose priority because of the COVID-19 pandemic. They should actually gain priority.

Although the vast majority of countries are well off-track to meet SDG 3.4, a March 2022 paper published in The Lancet shows that there is still hope. All countries – and especially low- and middle-income countries (LMICs) – can achieve or nearly achieve SDG 3.4 to reduce premature NCD mortality by one-third by 2030 by introducing a cost-effective package of NCD prevention and treatment interventions.

Investment in the mitigation of NCDs boosts productivity by cutting the number of wasted lives.

The paper presents an NCD investment framework that aims to support LMICs in getting back on track towards achieving SDG target 3.4 in the wake of the COVID-19 pandemic. It is centred around a package of 21 cost-effective interventions; essentially, a feasible and pragmatic roadmap to healthier populations and more resilient health systems.

There are 15 clinical interventions, like screening and early detection for diabetes and cervical cancer, and cardiovascular disease prevention programmes. Many of these can be implemented at primary health care level. There are also six policy interventions, focused on taxing and regulating tobacco and alcohol, and measures to reduce intake of sodium and transfats. All of the interventions are aligned with WHO recommendations for NCD programmes, helping ensure a more coordinated NCD and pandemic response.

The paper provides guidance on the types of interventions that can best accelerate progress on NCDs in 123 LMICs, and the resources required to implement these interventions. While the clinical interventions are meant to be selected according to national needs and contexts, the policy interventions are crucial for all countries, accounting for nearly two-thirds of the health gains of any locally tailored NCD package. These actions could also generate significant revenue, which can then be reinvested in health.

The bottom line for NCD investment

 As the paper demonstrates, implementing the most efficient package of interventions in each world region would require $140 billion in new spending over 2023–30, equivalent to $18 billion per year. This investment could avert 39 million deaths and generate an average net economic benefit of US$2.7 trillion, or US$390 per capita. This means that benefits outweigh costs by 19 to one.

LMIC ministries of health would need to contribute around 20% of their budgets to the priority NCD interventions. Many countries would also need external support (bilateral, multilateral, philanthropy, private sector), particularly in light of the economic impacts of COVID-19.

For the first time, we have a price tag for tackling NCDs in LMICs – and it’s peanuts alongside current NCD treatment costs and economic losses due to premature death and disability. For instance, in 2021, health expenditure for diabetes reached $966 billion; the annual cost of obesity is projected to top $1.2 trillion globally by 2025; the total economic loss due to cardiovascular disease in LMICs was estimated at $3.7 trillion between 2011 and 2015.

The paper provides further evidence that underscores the urgent need to invest now in proven strategies to save lives and prevent and treat NCDs. Investments in NCDs are not only cost-effective, but they can also save money even within a short timeframe. The bottom line is that governments can reap substantial economic rewards, in both the short- and long-run, by taking bold action on NCDs and thus ensuring the security and fiscal sustainability of their health systems. This requires a view of health as an investment not a cost, and one that requires long-term thinking.

Trailblazing the road to recovery

Leaders must shift their priorities to achieving healthier populations, with impactful action for NCD prevention and care. Some countries are taking bold steps. India’s budget for 2021 more than doubled national healthcare and wellbeing spending from previous levels. The Philippines increased the taxation of tobacco products during the COVID-19 pandemic, with a share being earmarked to bolster capacity for universal health coverage to reach the poorest communities.

Meanwhile, Latin America has made big gains for healthy diets. Recognising a high number of COVID-19 cases among overweight children and adults, the Mexican states of Oaxaca and Tabasco banned the sale of junk food and sugary drinks to people under 18 in 2020, with more states planning to follow suit. 

Front of package labels in Mexico

A Mexican nationwide front-of-packaging warning labelling law also entered into effect in 2020, requiring black stop signs on packages of foods high in added sugar, fats, calories and sodium. Various Caribbean nations have implemented taxes on sugary beverages and made advances to control marketing of junk food in and near schools.

These are just a sample of the actions being taken around the world, and are reason for optimism that real progress can be made. What we need now to accelerate this progress is strong leadership that is committed to putting health and health security first. NCD action and investment must no longer be seen as an afterthought to infectious diseases and neglected within health services, but as fundamental to resilience, security, equity, and economic stability.

As Heads of State and Governments meet this week in Ghana for the International Strategic Dialogue on NCDs and the SDGs, we call on leaders to take the bold action so urgently needed. Whether NCDs and their prevention are addressed by future policy action will make or break the effectiveness of the pandemic response. 

Katie Dain is the Chief Executive Officer of the NCD Alliance.

David Watkins, University of Washington, is the lead author of a recent Lancet NCD 2030 Countdown series article on pathways and investments to accelerate NCDs progress.

Interactive map reproduced with permission from Politico Studio, based on data from WHO’s 2020 NCDs Progress Monitor.

Image Credits: WHO/A. Loke, World Health Organization , World Heart Federation / WHO.

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