A Public Health Emergency In Slow Motion

Governments and global health agencies turned a blind eye to the threat of noncommunicable diseases as they thought that these were problems of the rich countries

- Dr K Srinath Reddy

About 15 years ago, speaking at a global health conference, I described the rising threat of non-communicable diseases (NCDs) as a public health emergency in slow motion. Relaxation of patent protection rules was permitted for responding to a public health emergency (PHE) under the Doha Declaration of the World Trade Organisation. I argued for its extension to medicines and technologies needed to provide essential healthcare for NCDs.

The Secretary-General of the United Nations later described a PHE when a high-level global leadership meeting was convened in 2011 to adopt a political declaration on the prevention and control of NCDs. The declaration acknowledged NCDs as the leading cause of death and disability the world over. While low and middle-income countries (LMICs) contributed to 70% of the global deaths due to NCDs, 90% of those deaths occurred below 70 years of age.

NCDs were not listed in the Millennium Development Goals of 2000, despite being the leading causes of death. International aid agencies declined to consider them while providing development assistance to LMICs, as did the World Bank. Governments of LMICs, too, did not accord priority to NCDs, guided as they were by the funding priorities of donor countries.

NCDs encompass many ‘non-infectious’ conditions affecting the heart, blood vessels, nervous system, lungs, kidneys, liver and gastrointestinal system, bones and joints, eyes, ears and oral health. They include cancers and diabetes. Despite the name, some of the conditions classed as NCDs have an infectious aetiology, like cancers of the cervix, stomach and liver, and rheumatic heart disease. The term ‘chronic diseases’ is preferred by some, but acute heart attacks and brain strokes challenge that description.