Leading the Fight against Non Communicable Diseases
A global pandemic is taking the lives of millions of people worldwide, and keeping millions more in poverty, but has gone largely unnoticed until now, writes Jennifer Gersbeck.
On 19-20 September, the United Nations Summit on Non-Communicable Diseases will be held in New York. This is only the second time in the UN’s history that a health issue has received such a high level of global attention — in 2001 a UN meeting addressed the HIV/AIDS crisis.
This Summit marks a major turning point in global public health, and a tremendous opportunity to bridge the gap between knowledge and action. NCDs like cancer, diabetes and respiratory diseases ignore national boundaries – they are everywhere – and across the world they now have a bigger impact than infectious diseases. They kill more than 46 million people each year, and it has been estimated that by 2030 NCDs will kill six times as many people as infectious diseases. Clearly, a coherent international response is needed, and the NCDs Summit represents a good start.
Most Australians have been impacted in some way by NCDs – they’ve either had an NCD themself, or know someone who has. This is despite the fact that in Australia, over the past few decades, great strides have been made in tackling these diseases. We have reduced smoking-related diseases through controls on advertising, heavy tobacco taxes and changing attitudes towards passive smoking. Because of tobacco control, dietary improvements, and improved medical treatments, deaths due to heart disease and stroke have fallen by more than half since their peak in the mid 1960s. While our health system isn’t perfect, it’s still far stronger than in many other parts of the world, and if we need treatment we can usually get it.
Other countries aren’t so lucky. They don’t have the health infrastructure to deal with the increasing problem, and often lack the public education programs that have made such a big difference in Australia. In the Pacific, this problem is particularly pressing. The World Health Organisation (WHO) says that around 75 per cent of all deaths in 2007 in the Pacific were caused by NCDs, and in Fiji this figure was a high as 82 per cent.
It’s important that the Australian delegation speaks up about what we have learnt in our fight against NCDs, and about the steps we have already taken to reduce the impact of NCDs in developing countries. One such area is efforts to reduce the number of people in Asia and the Pacific who, on account of NCDs, lose their sight. In the upswell of activity around NCDs, the impact of blinding conditions like cataract and glaucoma has often been overlooked, despite these conditions having a greater burden than many other conditions, both communicable and non communicable.
The WHO’s most recent figures show that 285 million people worldwide are vision impaired, of whom nearly 40 million people are completely blind. Up to 60 per cent of children in poor countries who become blind die within one year, and the disabling impact of blinding conditions is higher than for unhealthy diet or physical inactivity. These are deeply shocking and unnecessary figures.
Over half of blind people are blind because they have cataract. In Australia, this condition is usually identified early and treated effectively. In developing countries, there is a lack of trained medical staff to identify blinding NCDs, and even when it is identified there is often a lack of hospitals and equipment to carry out surgery.
It is also important that diabetic retinopathy is addressed within broader efforts to tackle diabetes. Around three quarters of people who have diabetes for 10 years or more will have their sight stolen by diabetic retinopathy, and diabetes is the leading cause of blindness among the working aged population in developed countries. With early screening and treatment, virtually all diabetic retinopathy is preventable.
At a time when the global economy is particularly fragile, it makes sense to focus our attention on diseases which have the greatest economic impacts, and where our investment represents value for money. A study in 2003 showed that the elimination of avoidable blindness by 2020 would lead to savings of US$223 million to national health budgets. Blindness keeps people of working age out of employment, with a huge impact on individuals, families and national economies. For every blind adult in the developing world, a child usually stays home to provide care, missing out on education and life opportunities.
With today’s knowledge, 80 per cent of all blinding conditions are preventable or treatable, and it makes good common sense to support these programs. This is exactly what Australia is doing. Organisations like The Fred Hollows Foundation have a long history of global leadership in tackling blinding NCDs. In 2008 the Australian Government recognised the common sense in funding blindness prevention programs in developing countries, acknowledging that a small amount of money can have a dramatic impact. The Government committed to an Avoidable Blindness Initiative which is now being rolled out across Asia and the Pacific, transforming the lives of millions and strengthening health systems so that in the future these countries can address their own needs – not just blinding NCDs but other diseases as well. One of the best things about this initiative is that a Global Consortium of Australian eye care organisations have banded together and are working in partnership with the Australian Government and stakeholders across the region to share expertise and experiences and ensure that this money is spent as efficiently as possible.
World Sight Day, a global day of awareness raising and action about blindness and the importance of good eye health, falls on 13 October — only a few weeks after the UN Summit. The Summit and World Sight Day represent a terrific opportunity to proudly hold up what Australia has achieved in tackling blinding NCDs, and to enhance global commitment to addressing this key public health challenge.
Jennifer Gersbeck is CEO of Vision 2020 Australia.