Tackling the Global Epidemic of Non-Communicable Diseases

Guest student blog by Fiona Rae, third year medical student at the University of Edinburgh [fionaelizabethrae@gmail.com].

In September 2011 the issue of non-communicable diseases (NCDs) will be brought to the attention of a UN General Assembly at a High Level Meeting in New York. In April 2011, key stake-holders are gathering for a preparatory WHO led-forum on NCDs in Moscow. However, in March 2011 on a particularly blustery day in Edinburgh, students, activists, academics and policy-makers gathered to offer their own contribution towards ‘tackling the global epidemic of non-communicable disease’ by participating in a conference organised by Edinburgh University’s Global Health Academy. Representing the student-led campaign Universities Allied for Essential Medicines (UAEM), I entered the discussion, hoping to inspire and expecting to be enlightened.
I was not disappointed. However, I imagine that some of the audience was when it was revealed that keynote speaker Dr Ala Alwan of the WHO was unavoidably held up in Geneva and so would be presenting electronically rather than in person. Nevertheless, Dr Alwan’s presentation was still vibrant. NCDs cause 35 million deaths every year, accounting for about 60% of the global disease burden. 80% of this burden is borne by Low and Middle-Income Countries (LAMICs). In fact 9/10 deaths before age 60 from NCDs occur in LAMICs. But, in the next 10 years NCD deaths in Africa are projected to increase by 27%. Such an emphatic overview further opened my eyes to the reality that in terms of fighting the Global Burden of Disease, we are already losing the battle. Even more worrying is the dangerous lack of awareness of this threat of NCDs to global health. Just one week before this conference I sat with a hundred other third year medics in a lecture on cardiovascular disease and was ‘taught’ by a specialist pathologist that atherosclerosis is a disease of affluence and ‘not something that you find in the developing world.’ However, I now know that an estimated 80% of deaths due to cardiovascular disease currently occur in LAMICs!

It is easy to feel disempowered by such widespread misconceptions, but the rest of the morning’s talks were uplifting. Playwright Mr Murray Watts, took a philosophical perspective on tackling NCDS and iterated that ‘despair is not the opposite of hope. . .cynicism is’. Students are frequently harangued for being too idealistic. However, Watts emphasised that being unchangingly pessimistic is not a mark of wisdom. Mary Cuthbert, head of the Scottish Government Tobacco Control Policy, certainly brought this message home when discussing the process of achieving Scotland’s Public Smoking Ban. Cuthbert described how 20 years ago, the idea of a smoking ban was deemed highly unrealistic, 10 years ago was thought to be ‘political suicide’ and now 5 years on since successful implementation of the ban there has been a 15% drop in hospital admissions for asthma in children and a 17% fall in heart attacks.

However, my optimism did not survive the conference’s panel discussion. A specialist psychiatric registrar in the audience asked the panel where mental health disorders fitted into the upcoming NCD conferences. The answer? They don’t. The panel responded that the current UN outlook is that not everything can be included, and the focus is going to be on the four diseases causing the greatest mortality: cardiovascular disease, cancer, diabetes, and respiratory disorders. It pained me to see lessons from the communicable diseases being ignored. For years we have been focused on the ‘Big Three Killers’, HIV, malaria and TB, whilst the Neglected Tropical Diseases remain critically underfunded, because these have the misfortunate of destroying lives, but not always ending them. It seems that the international community is incredibly narrow-minded in its approach to tackling the global burden of disease, despite the WHO’s famously broad definition of health.

The afternoon of the conference was a ‘speed-dating’ series of 5 minute presentations from grass-roots organisations. Representing UAEM, an international student-led campaign, I outlined our solutions to improving access to NCD therapies. First up was our mission to ensure that future NCD medicines developed in universities will be affordable and available in the developing world. This we hope to achieve through equitable licensing strategies between universities and the pharmaceutical industry. Second, our intention to raise awareness of the importance of rational procurement of NCD medication by empowering students to take action on this issue, for example through our past work in expanding the WHO’s Essential medicines List (EML) to incorporate NCD therapies (1). I also emphasised our intention in 2012 to campaign for the addition of mental-health drugs to the EML. Perhaps this generation of ‘idealistic students’ can hope for a future where we recognise the importance of holistic healthcare.

For more information on UAEM please visit www.facebook.com/uaemuk or www.uaem.org or email Fiona Rae at fionaelizabethrae@gmail.com.

Fiona Rae is a third year medical student at the University of Edinburgh who graduated from Bristol University last year with a BSc in International Health. She has been a member of UAEM for 3 years and has a special interest in intellectual property rights, the pharmaceutical industry and new models of incentivising health technology research.
(1) Kishore, S, P. Herbstman B, J. (2009) ‘Adding a Medicine to the WHO Model List of Essential Medicines’, Clinical Pharmacology and Therapeutics, 85(3): 237-239