The Growing Global Burden of Noncommunicable Diseases

The United Nations (UN) estimates that 56.9 million people died in 2008. Of those, 63.5% died because of Group II causes (i.e., noncommunicable diseases (NCDs)), and almost 30% died because of just three types of NCDs: ischemic heart disease, cerebovascular disease, and chronic obstructive pulmonary disease. In advance of a high-level meeting of the General Assembly last September on that topic, the Office of the Secretary-General released a report that challenged the conventional wisdom on NCDs:

As the international community has intensified efforts to combat the global burden of communicable diseases…a growing burden of non-communicable diseases has emerged relatively unnoticed in the developing world. Today, the burden of non-communicable diseases in low- and middle-income countries exceeds that in high-income countries. While popular belief holds that such diseases afflict mostly high-income populations, nearly 80 per cent of non-communicable disease-related deaths occur in developing countries. Non-communicable diseases are the most frequent causes of death in all regions of the world except Africa…where such diseases are rising rapidly and are projected to…[be] the most common causes of death by 2030.

Group I causes of death include communicable diseases; conditions that mothers might develop during pregnancy, labor, or delivery; conditions that children might develop during their first few weeks of life; and deficiencies in iodine, vitamin A, iron, and protein energy. While there are often discrete, short-term interventions that can prevent Group I deaths—using contraception, for example, to avoid contracting sexually transmitted diseases—it’s hard to think of comparable ones that can prevent their Group II counterparts, which are almost inbuilt in modernization. As the World Economic Forum (WEF) and the Harvard School of Public Health (HSPH) noted in a joint study last September, “[t]he rise in the prevalence and significance of NCDs…is strongly associated with universal trends such as ageing of the global population, rapid unplanned urbanization and the globalization of unhealthy lifestyles.”

Here are some numbers to illustrate those three trends:

The UN estimates that global life expectancy will increase from 68 in 2005-10 (Bolivia’s life expectancy) to 81 in 2095-2100 (Iceland’s). The result: the global share of individuals who’re over 65 will increase from 9.1% (as of last year) to roughly 28% at the turn of the next century.

The McKinsey Global Institute estimates that the global urban population increases by over a million every week. The result: urban dwellers will account for a little over two-thirds of the global population by the middle of the century, up from a little over half today.

Although the last of these trends is harder to quantify, consider obesity as a proxy for “unhealthy lifestyles”: according to the World Health Organization, the rate of global obesity more than doubled between 1980 and 2008.

I’d add one more trend to the list: the explosion of the global middle class. According to a study by Homi Kharas and Geoffrey Gertz of the Brookings Institution, it included 1.845 billion people in 2009, less than a third of the global population that year; they project, however, that that figure will rise to 4.884 billion in 2030, close to two-thirds of the projected global population that year.

Unfortunately, the near-universal consensus that NCDs will exact a growing human and economic toll—the aforementioned WEF/HSPH study estimates that they’ll cause “a cumulative output loss of US$ 47 trillion over the next two decades”—isn’t reflected in donor priorities: in 2008, of an estimated $21.8 billion in global development assistance for health, only 2.3% was allocated to fighting NCDs. Of course, a lack of money isn’t the only obstacle; it may not even be the chief one. Thomas Bollyky, senior fellow for global health, economics, and development at the Council on Foreign Relations, notes that

[t]hese diseases are not all chronic, related to unhealthy habits, or even noncommunicable [emphasis mine]. As a class, NCDs have little in common other than being the diseases that become more prevalent as a population reduces the plagues and parasites that kill children and adolescents….Trying to address these diseases as a single class and on a global level…has made it difficult to mobilize states and sufferers of NCDs worldwide around a specific and meaningful policy agenda. And when NCDs are presented as imposing the same challenges in developed and developing countries alike, policymakers and potential donors are apt to conclude that they cannot be solved by international action and are simply the natural consequence of economic development.

Ironically, then, a key step to ensuring that NCDs receive more funding may to be ask if the very manner in which they’re now defined undermines collective efforts against them.

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