Chronic, noncommunicable diseases (NCDs): A silent scourge threatening to overwhelm global health

September / October 2011 | Volume 10, Issue 5

Woman smokes cigarette, smoke covers her face, field in background
Photo by Mukunda Bogati/Photoshare

Fogarty has developed a number of programs
designed to build capacity in noncommunicable
disease research in developing countries, where
nearly 80 percent of NCD deaths occur.

By Steve Goldstein

Noncommunicable diseases (NCDs) are the quiet killers, attracting less attention than infectious diseases and, due to their steady, relentless nature, accepted by many as matters of fate. This is ironic, since behavior can influence the risk factors for these diseases. In 2008, according to WHO, 63 percent of global deaths were attributable to NCDs, mainly due to cardiovascular disease, diabetes, cancer and chronic respiratory disease.

Once thought to be the afflictions of developed nations, NCDs are projected to increase everywhere, but more so in low- and middle-income regions. Nearly 80 percent of NCD deaths occur in low-and middle-income countries and NCDs are the most frequent causes of death in most countries, except in Africa, where infectious diseases end lives before NCDs take hold.

Morbidity and mortality data from WHO reveal that the disproportionate impact on lower resource settings is growing. Over 80 percent of cardiovascular and diabetes deaths, and almost 90 percent of deaths from chronic obstructive pulmonary disease, occur in low- and middle-income countries. More than two-thirds of all cancer deaths occur in low- and middle-income countries. By 2030, NCDs are expected to account for three-quarters of the disease burden in middle-income countries, up from two-thirds today.

So where does grant making for capacity building and training fit in? A large percentage of NCDs are preventable through the reduction of four main behavioral risk factors: tobacco use, physical inactivity, alcohol abuse and unhealthy diet. Others are treatable with drugs to reduce blood pressure and cholesterol. But changing behavior, improving diet, eliminating substance abuse and enhancing access to expensive drugs are challenging in settings where choices are limited by economics.

In 2008, Fogarty chose to address NCDs as one of its five strategic goals and funds a number of programs designed to build NCD research capacity in developing countries. Fogarty recently launched an initiative called Chronic, Noncommunicable Diseases and Disorders Across the Lifespan (NCD-Lifespan), combining and building on previous programs devoted to increasing expertise in NCDs, operations research, genetics and population studies in low-resource settings. In addition, for more than a decade Fogarty has supported research regarding tobacco consumption and ailments triggered by occupational and environmental issues that include asthma, lung disease and some cancers.

Another program - Fogarty International Research Collaboration Awards - supports studies on a wide variety of topics, among them breast cancer in Egypt and Chile, kidney disease in Nicaragua and cardiovascular risk factors in the Philippines. Finally, a component of the Medical Education Partnership Initiative is strengthening training in cardiovascular research in Uganda and Zimbabwe, and HIV-related cancers in Malawi.

Although the UN meeting on NCDs will not include mental health, Fogarty has a long-established program that supports studies of brain disorders in the developing world.

The rapidly growing burden of NCDs in low- and middle-income countries is accelerated by the negative effects of globalization, rapid unplanned urbanization and increasingly sedentary lives.

People in developing countries are increasingly eating foods with higher levels of carbohydrates and sugars and are targeted by marketing for tobacco, alcohol and junk food.

The costs to health-care systems from NCDs are high and projected to increase. Significant costs to individuals, families, businesses, governments and health systems add up to major economic impacts. Heart disease, stroke and diabetes cause billions of dollars in losses of national income each year in the world’s most populous nations. Economic analysis suggests that each 10 percent rise in NCDs is associated with 0.5 percent lower rates of annual economic growth.

NCDs are quiet killers with an explosive impact. But as the articles focusing on Chronic Diseases demonstrate, both awareness of the epidemic and efforts to curtail it are growing.

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