U.N. Puts Non-communicable Diseases On the Map

Published on July 11, 2013
Positive effort by United Nations to curb non-communicable diseases falls short of setting targets and fails to address global emergency medicine development issues.

On September 19-20, 2011, the United Nations held a global summit that took an important step towards addressing non-communicable diseases (NCDs) such as cancer, heart disease, lung disease and diabetes. The summit was devoted to curbing, preventing, recognizing and treating these often-preventable problems that cause 63% of deaths worldwide.

The two-day general assembly meeting, attended by more than 30 heads of state and at least 100 other senior ministers and experts, adopted a declaration calling for a multi-pronged campaign by governments, industry and civil society. The plans address the need to curb the risk factors behind four major groups of NCDs – cardiovascular diseases, cancers, chronic respiratory diseases and diabetes – by the year 2013.

Secretary-General Ban Ki-moon noted that over a quarter of all people who die from NCDs succumb in the prime of their lives, the vast majority of them in developing countries. The overall annual death toll from NCDs is estimated at 36 million worldwide.

“Cancer, diabetes, and heart diseases are no longer the diseases of the wealthy,” said Ban Ki-moon. “Today, they hamper the people and the economies of the poorest populations even more than infectious diseases. This represents a public health emergency in slow motion.

“The prognosis is grim,” he continued. “According to the World Health Organization (WHO), deaths from NCDs will increase by 17 per cent in the next decade. In Africa, that number will jump by 24 percent.”

Noting that “the rising prevalence, morbidity and mortality” of NCDs can be largely prevented and controlled through collective and multi-sectoral action by all member states and other relevant stakeholders, the NCD declaration highlights the need for universal national health coverage and strengthened international cooperation to provide technical assistance and capacity-building to developing countries.

“This will be a massive effort, but I am convinced we can succeed,” Secretary-General Ban Ki-moon told the opening session of the landmark summit, only the second ever to deal with health (the first was HIV/AIDS in 2001).

What about emergency medicine, trauma and acute care?

This historic meeting brought together many national and international organizations. Most prominent was the NCD Alliance (ncdalliance.org), an organization of four international federations uniting a network of over 2000 organizations. These four organizations, namely the International Diabetes Foundation, the World Heart Federation, the Union for International Cancer Control, and the International Union Against Tuberculosis and Lung Disease, represent the four main NCDs outlined in the World Health Organization’s 2008-2013 Action Plan for NCDs – cardiovascular disease, diabetes, cancer, and chronic respiratory disease. These conditions share common risk factors (including tobacco use, physical inactivity and unhealthy diets) and also share common solutions, which provide a mutual platform for collaboration and joint advocacy.

Absent from the UN meeting were any major national or international organizations representing trauma and injury, or emergency medicine. Largely unnoticed in Europe and North America, trauma has become a rapidly expanding epidemic in the world’s low and middle-income countries. Every 5 seconds someone in the world dies as a result of an injury. In fact, injuries kill about 5.8 million people each year, more than malaria, tuberculosis and HIV/AIDS combined. Tens of millions more suffer injuries that lead to hospitalization, emergency treatment or other care. Among the causes of injury are acts of violence, traffic accidents, burns, drowning, falls and poisoning. Currently, trauma from road-traffic accidents alone is the 6th most common cause of death in middle-income countries, and 9th in the world. Many countries are experiencing a rapid fiscal growth and with it expansion of their infrastructures. The increase in personal wealth means, for many, a graduation from foot or bicycle transport to motorcycles and automobiles. Sadly, this is also reflected in a commensurate increase in road-traffic injury rates. The WHO estimates that by 2030 trauma from traffic accidents alone will be the 3rd most common cause worldwide of both mortality and disability (as measured in disability-adjusted life years, or DALYs), and the majority of these accidents will happen in lower/middle-income countries, precisely those areas with the least developed emergency care and trauma systems.

Although a declaration adopted at the UN Summit laid out the economic and social importance of eradicating chronic disease, it fell short in two ways. It failed to address trauma systems and emergency care systems, and it did not provide concrete targets. Instead, the political declaration included suggestions, such as promoting healthier diets, tobacco-free workplaces, access to cancer screening programs, and breast-feeding for about six months from birth.

In addition, further attention needs to be paid to trauma morbidity and mortality, to the establishment of trauma and emergency care systems, and to the role of emergency medicine and acute care as the safety net for acute and chronic presentations of non-communicable diseases and communicable diseases from all categories. While major benefits will result from attention to primary prevention of the vertically integrated five major areas of NCDs, global health policy makers need to also focus on secondary prevention of NCDs by a horizontally integrated emergency medicine and acute care systems.

This article originally appeared in issue 6 of Emergency Physicians International

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