The greatest health threat you’ve never heard of, but need to know about.

If you have a conversation with someone about the leading cause of global deaths, discussions will usually turn to Ebola, HIV or TB. Even more so, when we think of the biggest killers in the world’s poorer nations, we tend to think of infectious pandemics, under-nutrition or problems resulting from a lack of clean water and sanitation.

At the same time, when we think of challenges like diabetes, heart disease, obesity and cancers, we tend to think of lazy, aged populations living with too much, in rich communities.

But in reality, both of these statements are completely false – and both insidious yet widespread myths have dire consequences on the health of our populations.

This is where a new conversation around the facts becomes crucially important for Global Health. So what are the facts?

In 2014, three out of five people around the world die from one of a group of diseases called Non-Communicable Diseases (NCDs). Literally meaning a disease one cannot catch from another person, NCDs include diabetes, heart disease, cancers, chronic lung conditions and mental illness. Most people in today’s world don’t and won’t die of too little food, or a virus – but from preventable, chronic illnesses. Half of them will die before they’re 70.

Flickr /

Flickr /

NCDs are not diseases of the rich either, in fact the poorest at home in the USA – and globally – are among those worst affected. These are not diseases of laziness, or stupidity, or simply the outcomes of poor choices. NCDs are diseases with complex, shared risk factors and deeply linked to the built and social environment around us. The major drivers include poor diet often resulting from a food system geared towards overconsumption of poorer quality foods; the consumption of alcohol; tobacco use, particularly in low and middle-income nations which have become the new target for the global tobacco industry; and a lack of physical exercise, in part resulting from a rapidly urbanising and mechanising world.

In short, this group of diseases is largely a reflection of the technological and economic progresses we have achieved over the past few centuries and yet now kills approximately 36 million people per year – equating to 60% of global deaths. Affecting an individual over a long period, with high levels of suffering and sometimes pain, these diseases cause, result from and entrench poverty – with 80% of deaths occurring in developing nations. “NCDs hit the poor and vulnerable particularly hard, and drive them deeper into poverty” says Ban Ki-moon, Secretary-General of the United Nations, “More than a quarter of all people who die from NCDs succumb in the prime of their lives. The vast majority live in developing countries. Millions of families are pushed into poverty each year when one of their members have become too weak to work. Or when the costs of medicines and treatments overwhelm the family budget. Or when the main breadwinner has to stay home to care for someone else who is sick.”

So why does this matter to you and I, and why should we care? Well, these myths are not just frustrating for a medical doctor or Global Health academic like myself; they are also dangerous to us all. First, missing the link between NCDs and poverty means that the major killers in our poorest communities are largely left off the development and social security agendas. The Millennium Development Goals heralded a major success for global cooperation on poverty reduction and economic development, but largely failed to recognise and address NCDs. With 15 years passing since these goals were adopted and enacted, this was a major missed opportunity for our global community – with serious life costs. In the dawning of a replacement development agenda looking set to include targets on NCDs, the missing NCD-poverty link has never been more crucial.

Flickr/  Vox Efx

Flickr/ Vox Efx

The second outcome of these myths is that we continue to blame individuals for developing these diseases, rather than seeing the structural and social determinants that cause them. Rhetoric falls to persecution of the sick, rather than their human rights. As Richard Horton, Editor-in-Chief of The Lancet stated, “addressing chronic disease is an issue of human rights – that must be our call to arms.” Instead, we entertain dangerous rhetoric that previously termed ‘adult onset diabetes’ in children is simply an outcome of poor parenting, instead of seeing the pernicious and predatory marketing by soft-drink companies, an urban environment built for cars and not people, and a food system designed to maximise profit and consumption, rather than health and wellbeing. I could go on.

Put simply, Non-Communicable Diseases are the greatest health threat you have never heard of, but need to know about. It’s time we all set the record straight.

With this in mind and together with a group of young designers, communicators and public health thinkers from around the world, this week we launched a new campaign called The Face of NCDs. Focused on a crowd-sourced, online community, #TheFace aims to move the discussion past these myths and put a true narrative to these leading global killers. Led by our Melbourne based global, social movement NCDFREE and partnering with Remedy Healthcare and a host of organisations from around the world, we are crowd-sourcing faces and stories from people affected by an NCD in some way, or working to address them. We believe in the power of people and know that personal narrative is a strong catalyst for new discussion and innovative thinking. So in addition to disseminating information to the public, #TheFace is harnessing the possibilities of social media to encourage people to drive this new conversation themselves.

“If we come together to tackle NCDs, we can do more than heal individuals – we can safeguard our very future” says Ban Ki-moon.

This is a new conversation, long overdue. This is NCDs.

This article was co-published with Australian Health Blog, Croakey. For more on The Face of NCDs and to support those living with, or working in NCDs, head to today. This campaign is run by the not-for-profit social movement NCDFREE with no financial gain or conflicts of interest.

Dr Alessandro Demaio (MBBS MPH PhD) is Co-Founder of NCDFREE. He is also a Postdoctoral Fellow in Global Health at the Harvard Global Equity Initiative, Harvard Medical School and an Assistant Professor at the University of Copenhagen.



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Mental Health Reflection – You are not weak.

This week, guest blogger Ashley Ng writes a reflective piece and poem on Mental Health, as Mental Health Day rolls by. Ashley is a PhD student at Deakin University and lives with diabetes.

safe_imageNCDFREE have recently launched their global campaign called #TheFace of NCDs. NCDs or Non-Communicable Diseases are health conditions that are non-infectious and cannot be passed from one person to another. They include chronic diseases such as diabetes, mental illness, heart disease. Sadly, there are a lot of negative connotations and stereotypes associated with these health conditions. #TheFace aims to dispel the myths, ignorance and misinformation about these NCDs but also urging people to share their story. Coinciding with mental health week, I would like to share the message that no matter what you are going through and what you are feeling right now, you are not alone. Your feelings and experiences may be unique, but rest assured that there are many others who are willing to give you a helping hand or even just a cuddle along the way.


For mental health week,
here’s a reminder that the world is never always bleak.

Many people suffer in silence,
while the health professionals call it non-compliance.

Do they ever ask or even remember,
to look beyond the number.

Sometimes it feels this way with my silent disease,
the highs and lows of diabetes I wish would cease.

Life with diabetes can be tough at times,
definitely tougher than coming up with rhymes.

Diabetes has made me a stronger person,
More resilient and determined to survive each season.

I reconnected with my passion of helping others,
and found my DOC friends, I now call my D sisters and brothers.

Every time I’m having a bad day,
the DOC cheers me up with what they have to say.

Please don’t struggle alone in the dark,
there will be others who see your spark.

Know that no one can survive in this world alone,
the online community never sleeps so there’s always someone on their phone.

Speak up, be brave and share your story,
It could be the end of someone’s worry.

Let them know they’re not alone,
together, the myths and ignorance around NCDs can be blown.

Let’s make life a better place,
tell your tale here and be #theface.


This article is reposted Diabetes Blog, Bitter Sweet Diagnosis.

TheFace Facebook TC

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Is There a Role for PPPs in Cancer Control?

This week, Harvard graduate and World Bank consultant Toni Kuguru writes on the role of Public-Private Partnerships in cancer control, focusing on resource-poor settings.

Pan Africa Life Cancer Challenge 2014

In July, nearly 500 people ascended onto the grounds of the Nakuru Athletic Club to receive free cancer screening.  Spread across six counties in Kenya, this was the third of six free screenings conducted as part of the Pan Africa Life Cancer Challenge 2014.  While cancer is the third leading cause of death in Kenya only after infectious and cardiovascular diseases[1], routine cancer screening – a cost-effective preventative measure – is alarmingly low throughout the country.  Therefore to raise awareness of cancer and the importance of routine screening and early detection, Pan Africa Life has partnered with the Africa Cancer Foundation, Philips Healthcare and public, private, semi-private health providers to offer one day of free cancer screening in six counties. In three cancer screenings, a total of 1,820 men and women were screened for prostate, cervical and breast cancer.

Patients waiting to be screened at the Nakuru Athletic Club

Patients waiting to be screened at the Nakuru Athletic Club

Cancer in Kenya – a few facts

The three most prevalent cancers are cervical, breast and prostate cancers and these three are responsible for almost a quarter of all cancer-related deaths[2].    This year alone, an estimated 2,461 women will die from cervical cancer, 1,969 women will die from breast cancer, and 2,048 men will die from prostate cancer[3].  Late presentation is one of the primary reasons for the high mortality rate amongst cancers that are largely treatable (if detected early).  According to the Ministry of Health (MOH), 80% of people with cancer present late-stage when palliative care is the only form of treatment that can be offered[4].

Importance of screening and early detection

For any cancer patient, early detection is critical to achieving a favorable outcome and could very well mean the difference between life and death. What’s more, early detection also leads to more affordable treatment options, which is particularly significant in a country like Kenya. Here, almost half of the population (46%) lives below the poverty line, access to health insurance is beyond the reach of most with only 10% of the population covered, and household out-of-pocket spending for healthcare remains high at 25% of total health expenditure [5],[6],[7],[8].

The MOH has identified cancer screening as the primary preventative measure against cancer.  This can be seen in the national cancer prevention and treatment policies including the national cancer management guidelines.   Yet, pap smear coverage amongst women aged 18 – 69 is unacceptably low at 3.2% or 4% in urban areas and 2.6% in rural areas[9],[10].  Mammography and breast screening coverage is even more dismal at 0.6% in urban areas and 0.7% in rural areas[11].

The escalating numbers of cancer mortality amongst preventable and treatable (if diagnosed early stage) cancers such as cervical, breast or prostate cancer suggest that 1) routine screening is not a priority of overburdened, under-staffed, and under-resourced public health facilities; 2) there is a general lack of public awareness of cancer screening, both the availability and benefits of routine screening; 3) late stage diagnosis is all too common; and 4) barriers to treatment are prohibitively high[12].  What this means is that we need solutions that address both the supply-side and demand-side issues of prevention and early detection.

The role of PPPs

Constrained by limited resources, many developing countries like Kenya are turning to public-private partnerships (PPP) to bolster government efforts at strengthening the health system and service delivery. PPPs can add value to quality health service delivery particularly in rural areas and amongst marginalized populations where infrastructure is underdeveloped and health worker density is low.  In fact, Kenya’s Vision 2030 proposed a reduced role of the government in health service delivery and the promotion of partnerships with the private sector to deliver quality health services.  Earlier this year, the MOH held a consultative cancer stakeholder meeting whereby PPPs were discussed as a welcome strategy for cancer care and control in Kenya.  Current examples in cancer prevention and control are the partnership between the MOH, Futures Group and IBM which aims to improve cervical cancer awareness and screening by strengthening cancer data collection and the integration into the national health information systems or Pink Ribbon Red Ribbon® which is a collaboration between NGOs, public and private partners including PEPFAR, UNAIDS, Merck and GlaxoSmithKline committed to reducing the number of deaths due to cervical and breast cancer by promoting early detection, vaccination, screening and awareness.

While the Pan Africa Life Cancer Challenge 2014 is a one-time event and part of the company’s CSR, the overwhelming response to the initiative highlights the need for cancer screening and demonstrates how private and public healthcare providers and corporate partners can work together to make cancer screening accessible and early detection possible.  Over the next few years, as the government attempts to reign in the ever-burgeoning public sector and NCDs radically change the landscape of the disease burden in Kenya, we can expect to see the government look to the private sector for expertise and financial resources resulting in [optimistically] more innovative and sustainable public-private partnerships strengthening health service delivery along the cancer care continuum.





[1] MOMS & MOPHS.  National Cancer Control Strategy 2011 – 2016.

[2] WHO.  Globocan 2012:  Estimated Cancer Incidence, Mortality and Prevalence Worldwide 2012.

[3] WHO.  Globocan 2012:  Estimated Cancer Incidence, Mortality and Prevalence Worldwide 2012.

[4] MOH data.

[5] World Bank:  World Development Indicators (2005)

[7] Chuma, Jane.  Viewing the Kenyan Health System Through an Equity Lens:  Implications for Universal Coverage.  2011.

[8] MOMS & MOPHS.  National Health Accounts 2009/10.

[9] MOMS & MOPHS.  National Cervical Cancer Prevention Program Strategic Plan 2012 – 2015.

[10] WHO.  World Health Survey Reports Kenya.  2013.

[11] WHO.  World Health Survey Reports Kenya.  2013.

[12] Rositch, Anne, et al.  Knowledge and Acceptibility of Pap Smears Self-Sampling and HPV Vaccination Among Adult Women in Kenya.  2012. – pone.0040766-National1.

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Climate Summit 2014 – live update from New York City

This week’s post comes from Dr Alessandro Demaio who is postdoctoral fellow in Global Health and NCDs at Harvard Medical School and an Assistant Professor at the Copenhagen School of Global Health.


Groundbreaking pledges of funding from the French, 120+ heads of state attending, famous faces calling for greater action and less talk. It’s all happening this week in New York City, where I join the UN Climate Summit. Hosted by Secretary-General Ban Ki-Moon today, it has been a ‘hit the ground running’ week leading up to this unprecedented event – with building expectation (some would say desperation) that this is where we might see major commitments from governments and an uprising of the public in favour of real climate action.


Tuesday morning in New York City and here is what we have seen so far:

  • More than 310,000 people took to the streets of the Big Apple calling for real action on this global threat on Sunday;
  • Barack Obama, David Cameron and Dilma Rousseff are among leaders in NY today – Australia is a conspicuously absent;
  • France pledged US$1B towards a Green Climate Fund;
  • Strong words from Austria, calling for a “universal, binding agreement” on climate to come from before the 2015 Conference of the Parties to the UNFCCC, Paris;
  • Chile has committed to a 20% reduction of CO2 by 2020 in addition to renewable sources already contributing 45% of national electricity and having a tax on CO2 emissions;
  • Japan’s prime minister says that his country has delivered the US$16bn in ‘climate aid’ that it promised over three years;
  • Leonardo DiCaprio sported a hipster beard to call governments on meaningless climate rhetoric and denial – “none of this is rhetoric, none of this hysteria, this is fact”.

Climate and Health.

But importantly, climate change is not just about polar bears, this is about you and me too. An important message emerging.

With the world watching, the rhetoric on climate is rapidly changing from one solely focused on the environment, to one firmly focused on global human health too. Hence my attendance.

Leading a charge in this space, the Global Climate and Health Alliance (GCHA) provides thought leadership regarding the overlap and interdependacies between climate with health – I have covered this before . But importantly, they also outline three actions for the health and public health communities for co-mitigation on climate and health.

1. Climate change must become a mainstream public health concern.

“Put simply, we will have no health on a dead planet” – says the Stockholm Resilience Centre’s Johan Rockstrom. A hotter, more polluted world in which food scarcities, weather extremes, polluted air/water/land and greater geopolitical instability poses a major risk to global and local public health.

We must continue to work to make these links known.

The World Health Organization head states “climate change, and all of its dire consequences for health, should be at centre-stage… whenever talk turns to the future of human civilizations. After all, that’s what’s at stake”.

2. Clean energy and active transport can save lives, carbon and money.

“Dramatic health benefits and associated cost savings would result from a global transition to clean energy, avoiding millions of early deaths each year through improved air quality” says GCHA. Urban areas are home to half the world’s population, but generate around 80% of global economic output, and around 70% of global energy use and energy-related greenhouse emissions. Air pollution is a growing burden to human health and already kills an estimated 7 million people each year.

Rapid transition to active transport and cleaner energy alternatives will be a major focus of the Summit this week – hopefully with commitments and actions.

3. We need to make investment choices which benefit health.

Following an historic announcement by Hesta in Australia last week to pull any coal investments from their $26B retirement fund, this is a hot topic this week. Divestment is the concept of pulling invested funds away from companies or stocks which contribute to environmental damage – think big oil, gas and coal burners. Using investments as a political tool for change. The American billionaire family, the Rockerfellers joined more than 180 institutions — including philanthropies, religious organisations, funds and governments — pledging to sell assets tied to fossil fuel companies from their portfolios. This is seen as a momentous move and a powerful tool for forcing innovation and private-sector change.

Following live.

Combined with the United Nations General Assembly week here in New York City, this is set to be a very big day for climate change. We can only hope that it is.

To follow live from home or your smart phone, use #climate2014.

Above all – get involved, stay informed… this is our future.

Follow Alessandro on Twitter via @SandroDemaio

The Conversation


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Alcohol: breaking up is hard to do.

There are many absurdities in society that we overlook or come to accept. For me, there are few though more absurd than our relationship with alcohol. Addictive, harmful, carcinogenic and associated with a raft of social, economic and health consequences – we continue to accept its role as a social lubricant, a mark of celebration, a sign of manhood and a reflection of sophistication.

I have talked a lot about this before.

The public health community has long worked to address this issue. But facing an incredible force from the alcohol industry, limited progress has been made. We need to think outside the box.

With this in mind, in 2014 NCDFREE is hosting bootcamps for the brightest emerging minds from all sectors.

With just 2 hours on the clock and the challenge to ‘start a conversation around our relationship with alcohol’ through a short 1-minute film, this is what they came up with.

“It’s not me. It’s you.”

To learn more about NCDFREE, head to

Follow me on Twitter via @SandroDemaio

This film was sponsored by Remedy Healthcare.

The Conversation



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Part 2: Prevention and Control of Rheumatic Heart Disease in Kenya: Progress is on the horizon

This week on PLOS TGH – we hand over to Dr Duncan Matheka and his group, for their second post on Rheumatic Heart Disease in Kenya.


Rheumatic heart disease (RHD) has been long neglected in the developing countries – yet a ‘preventable’ disease that is easy to manage only if detected early. We hereby highlight a number of multi-sectoral initiatives mainly targeted at the Kenyan communities towards combating RHD.


1. RHD Family Support Clubs

RHD Family Support Clubs are a useful way of promoting holistic RHD care in Kenya. Kenya launched the Nairobi RHD Patient Support Club on Saturday 8th March 2014 at the School of Medicine, University of Nairobi. The club has adapted a person-centred model that has been effectively used by CLAN (Caring and Living as Neighbours – an Australian NGO) to improve quality of life for children and adolescents living with a range of chronic health conditions in low-income settings in the Asia Pacific region. CLAN utilizes a rights-based, community development framework for action, and focuses multisectoral, internationally collaborative action on five key pillars:

(1) Affordable access to medicine (monthly penicillin) and equipment (echocardiography) (2) Education (of children with RHD and their families, health care professionals, policy makers and the national and international community), research and advocacy
(3) Optimal Medical Management (through primary, secondary and tertiary prevention)
(4) Establishment and development of Kenyan RHD family support clubs
(5) Reducing financial burdens on and promoting financial independence of families living with RHD.

Support clubs offer material, moral, and psychological support within a cost-effective, strategic, sustainable, health system strengthening, multi-disciplinary approach. Successful engagement of a broad network of national and international multi-sectoral organizations around the Kenyan RHD support club launch of 8th March 2014 established the Kenyan RHD Community as a visual hub for ongoing person-centred health care in the country. The many and varied stakeholders engaged around the RHD Club meeting took up roles to support and work in partnership with the RHD community over the longer term, to ensure no affected child will: go without their monthly injection of penicillin; be lost to follow-up; miss out on education due to this disease; have their life cut short because they cannot access medical services; or suffer unnecessarily because of a lack of understanding of the best ways to manage RHD. Moreover, it offers an impetus for more sustained national action to reduce the prevalence of RHD in Kenya.

Early indications suggest support clubs as modelled in the Asia Pacific region have potential for empowering families and communities in Kenya to engage with a broad range of partners around a united vision of improved quality of life for children who are living with RHD in Kenya. Moreover, the club offers the members an opportunity to advocate for their needs collectively, while encouraging and supporting each other.


2. Education and Creating awareness

Health professionals have been travelling nationally to provide talks to primary school-going children in Kenya. In one program, student education utilized innovative technology (an interactive digital module) so as to optimally engage the children and promote learning about RHD (Kozicharow et al, 2013). The module developed by WiRED international (a US-based non-profit organization working in Kenya) had simplified animated presentations linking sore throat, rheumatic fever, and RHD, as well as prevention strategies. The module also introduced questions throughout the presentations to students and provided instant feedback to reinforce key concepts. WiRED promotes the vision that educating children at an early age has long-term benefits, because most children will retain key messages as they grow older, and pass the messages on to their families and peers during school holidays (Céspedes et al., 2013, Kozicharow et al, 2013). Teachers are also targeted during the training sessions so that they can act as reference points for the students who are in constant contact with them.

In Kenya, the Kenyan Heart National Foundation has also used its School-based ‘Talking Walls’ campaign to educate school-going children on prevention and control of RHD (Kenyan Heart website).


3. Screening and early diagnosis

Mater Hospital in Nairobi, Kenya runs a school-based rheumatic fever and RHD prevention outreach program which offers diagnostic, preventive, educational and curative services to primary and secondary school children in various parts of the country (Jowi, 2012).


 4. Advocacy and Streamlining Healthcare Infrastructure

As part of Non-Communicable Disease (NCD) prevention and care activities in Kenya, the Kenyan Ministry of Health (MOH) in collaboration with World Health Organization (WHO), World Heart Federation and NCD Alliance Kenya (NCDAK), is holding a stakeholders forum to work out best modalities of incorporating RHD within healthcare services in Kenya. The purpose of holding this forum is to increase awareness of the continuing burden of RHD and the need to specifically include RHD prevention and control as part of broader NCD initiatives. RHD prevention and control needs specific initiatives not addressed in the common risk factors approach by global and Kenyan NCD action plans, nor the current Kenyan National Health Sector Strategic plan.


5. Opportunity with healthcare decentralization

Kenya is currently undergoing decentralization of government functions, including healthcare, which means that there is a renewed opportunity to integrate RHD care into other regions of the country and build an overall healthier Kenya. As 47 counties of Kenya absorb the healthcare mandate, it is expected that greater community involvement will result in tailored healthcare for each region. Devolution will facilitate more straight-forward avenues for advocacy on NCDs at the county-level, as the decision-makers in government will be more localized and have so far demonstrated themselves as easier to communicate with. County health policymakers are usually also native to the communities that they serve and have a more vested interest in improved health outcomes in their designated regions, than the previous national level decision-makers – hence more community involvement, empowerment and development.


6. Role of multi-sectoral partnerships

For both healthcare devolution and expanded care for RHD, there is a push to build private-public partnerships. Both public and private healthcare providers must have a seat at the policy table and work together, as multi-sectoral action will have the biggest impact within communities. Yet, the need to safeguard public health (using a rights-based approach) must be emphasized and the terms of such partnerships critically evaluated and monitored. For instance, the World Heart Federation is partnering with Kenyan organizations (Kenyan Heart National Foundation, Kenya Cardiac Society, etc) to streamline healthcare provision for RHD patients.


In conclusion, besides the foregoing, there is need for more initiatives to combat RHD in Kenya by increasing community awareness and involvement and ensuring better healthcare infrastructure – thus promoting primary and secondary prevention of rheumatic fever and RHD.



  1. Kozicharow A, Ghuman S. Rheumatic heart disease project in Kenya tests WiRED training program. Available from: [cited 22 October 2013].
  2. Céspedes J, Briceño G, Farkouh ME, Vedanthan R, Baxter J, Leal M, et al. Targeting preschool children to promote cardiovascular health: cluster randomized trial. Am J Med 2013; 126: 27–35.
  3. Kenyan Heart Website:
  4. Jowi Christine Awuor. 2012. “African Experiences of Humanitarian Cardiovascular Medicine: A Kenyan Perspective.” Cardiovascular Diagnosis and Therapy 2 (3): 231–39. doi:10.3978/j.issn.2223-3652.2012.07.04.



Dr. Duncan M. Matheka is a Kenyan Medical Doctor and Public Health Researcher. He is the African Representative of Young Professionals Chronic Disease Network (YPCDN) and the Nairobi RHD Club Coordinator. Twitter @duncoh1

Dr. Laura Musambayi is a Kenyan Medical Doctor and the Nairobi RHD Club Assistant Coordinator.

Mohamed A. Omar is a fourth year medical student at the University of Nairobi, Kenya.

Dr Kate Armstrong is the Founder and President of CLAN (Caring & Living As Neighbours) and the Executive Secretary of NCD Child (a global coalition committed to integrating children and adolescents within the global NCD, health and development discourse). Twitter @ncdchild



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A people’s movement against chronic disease

This week, in time for the UN NCD Review meeting in New York City, Dr. Jeremy Schwartz makes the case for a strong civil society movement against global Non-Communicable Diseases.  

In some way or another, every one of us has been touched by a chronic disease. Words like hypertension, diabetes, and cancer are part of our everyday vocabulary. But most people I speak with believe that these diseases only affect people in rich countries- that these are not afflictions of the world’s poor. This is a myth. Six out of every ten deaths on earth are due to chronic, non-communicable diseases (NCDs). What’s more, eighty percent of these deaths occur in low- and middle-income countries. In these countries, for reasons we do not completely understand, NCDs affect people at a younger age, during their most economically productive years. Because of NCDs, $47 trillion will evaporate from the global economy over the next two decades.

 There are many reasons for this rising tide of NCDs. Western countries have exported many of their worst habits- like smoking and diets high in fat and salt- that cultivate these “lifestyle diseases”.  In poor countries, sedentary desk jobs are replacing more active manual labor. Digging deeper, though, the NCD epidemic becomes entangled with the wills of multinational food, agriculture, tobacco, and pharmaceutical companies. Trade agreements favor exportation of countries’ fresh fruit and vegetable crops and importation of canned foods high in salt. Lawmakers lack the political will to slap taxes on tobacco products. Medicines that are essential to treating these conditions remain unaffordable.

How is it that an issue so grave is still news to so many? Let us not forget how HIV/AIDS leapt onto the global stage in the late 1980s. It was not simply because people were sick and dying. It was because scores of passionate activists banded together and forced the world’s decision-makers to pay attention. Money, political will, and progress in fighting back this pandemic followed.  NCDs need a voice. But the people must find it first.

HIV activists demonstrate outside the Food and Drug Administration Headquarters, October 1988. Source: The Atlantic

Here in the United States we have the luxury of a strong civil society- the collective of non-governmental organizations and institutions that advocate for us. We live amongst so many advocacy organizations that it is easy to lose sight of this. The American Heart Association, American Diabetes Association, and American Cancer Society are some of the largest. We wear ribbons and t-shirts displaying logos and disease-specific colors to show our support. We text-message donations from our cell phones. We take part in walk-a-thons, marathons, and telethons. According to The Giving Institute, Americans donated $33 billion to health-related organizations in 2013. These major organizations amass our donated wealth and are thereby able to act on our behalf- lobby government, fund biomedical research, and set up patient support networks.

Americans donated $335 billion to charity in 2013. Of this, 10% was directed to health-related organizations. Source: Giving USA 2014

Americans donated $335 billion to charity in 2013. Of this, 10% was directed to health-related organizations. Source: Giving USA 2014

Most of the world, however, lacks a strong civil society. Its people lack a voice and governments remain unaccountable. A critical check on the system is missing. But there has been some important progress. The NCD Alliance has provided a framework for evaluating a country’s commitment to, and progress in fighting, NCDs. An exciting effort in East Africa is bringing together the relatively new offshoot NCD Alliances in that region. Professor Gerald Yonga, a Kenyan physician and co-chair of this regional effort, spoke at the United Nations last month. He urged governments to prioritize NCDs in their development plans. He spoke of building this regional initiative and of its first product- a charter that was signed in early June by local advocacy groups from across the region. This is new and it is thrilling. It is giving a voice to the people. But ventures like this are not sustainable without financial resources. Our European counterparts have taken the lead on this. The Danish Civil Society Fund has underwritten the East African Alliances and provided much needed technical support.

East Africa NCD Alliance Initiative Planning Committee at Uganda NCD Alliance Headquarters, Kampala, Uganda.

East Africa NCD Alliance Initiative Planning Committee at Uganda NCD Alliance Headquarters, Kampala, Uganda.

Today and tomorrow, heads of state, diplomats, and ministers of health will convene at the United Nations in New York. They will assess progress made since a High Level Meeting on NCDs in 2011. My friend and role model, Dr. Sandeep Kishore, who founded the global, grassroots Young Professional Chronic Disease Network, will stand before this assembly. He will correctly insist that NCDs are the social justice issue of our time. Governmental and global priorities are misaligned. People are sick and dying from preventable diseases.

A Global Civil Society Fund for NCDs could change this. The United States and other countries of the “global North” must realign some of our aid toward supporting a vibrant civil society for NCDs. The East African example is a model that must be fortified and replicated. With far fewer dollars than is needed for prevention and treatment, a fund like this could catalyze a global people’s movement against NCDs. The people in this world who are most in need of a voice might finally be able to find one and true progress against NCDs will follow.

Dr. Jeremy Schwartz is a physician at Yale School of Medicine and Director of Chronic Disease Integration and Delivery Science at the Yale Equity Research and Innovation Center. Follow him @jeremy_schwartz

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What’s an NCD?

With the UN NCD Review this week in New York City, we recap on what Non-Communicable Diseases are… And why they matter.

This week in New York City, all eyes in the Global Health community will be on the UN NCD Review. As the last three years have flashed by since the 2011 High-Level Meeting, now is the moment to take stock and reflect on the progress – and challenges – of tackling this growing epidemic.

General Assembly resolution 66/2 of 19 September 2011, containing the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases called for the convening of a comprehensive review and assessment in 2014 of the progress achieved in the prevention and control of non-communicable diseases.


Forgotten what NCDs are? Watch this short voxpop from NCDFREE and jog your memory…


So what are the facts on NCDs?

– Non-Communicable Diseases are a group of varied and often chronic conditions including diabetes, heart disease (including stroke), cancers, chronic lung diseases and mental illness.

– Together, NCDs are the leading contributors of global morbirity and morbitity accounting for 60% of global deaths in 2010.

– 80% of global NCD mortality occurs in the world’s low and middle-income countries, representing a barrier to economic and social development.

– NCDs threaten to slow, halt and at worst, reverse progress on the MDGs and their replacement agenda.


To understand more, click on the e-lecture below to learn what NCDs are, who they affect and what you can do.


Dr Alessandro Demaio (@SandroDemaio) is Postdoctoral Fellow in Global Health at the Harvard Global Equity Initiative, Harvard Medical School and an Assistant Professor at the University of Copenhagen.

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A Peruvian Story of Cancer, and Health

This week, we bring you the latest in our Global Health short films, by Alessandro and the team at NCDFREE – partnering this time, with GlobalRT. Set in Lima, the films follows the stories for two young females affected by and affecting cancer. This film was commissioned and co-funded by GlobalRT, UICC and NCDFREE.



Earlier this year, I wrote a short piece on cancer care while shooting a global health film in the Peruvian capital, Lima. Highlighting the progress, myths and challenges in oncology and public health – and exploring some of the incredible work of innovative healthcare providers in resource-poor settings.

As an academic, I see an essential mandate of my role is to break down the barriers between science and the community. Not only to develop and further science – but also to communicate it to a broad audience in a way that is engaging, understandable and relevant.

To do this, I am always looking for new, effective ways to connect with a wide audience and with them, question the things we do as a society. Challenge the everyday rhetoric and flag processes, conditions or ideas that are unjust, unsustainable, inefficient or inequitable. Focusing on Global Public Health.

One very important way I see we as academics can continue to reach and engage everyone in science in 2014 – is through film. With this in mind and together with our sensational team at NCDFREE, we have now made a handful of short video-based narratives over the last 12 months – each focusing on an important health issue, hero or message.

For this latest film, we travelled to Peru to capture the story of a young cancer survivor and mother – and the doctor who made her survival possible. Entitled “Veronica: a Peruvian story of cancer, and health” – we highlight the journeys of two strong young woman affected by and affecting Non-Communicable Disease (NCDs). We aim to engage, inspire and challenge you – and your ideas about health.

Supported and commissioned by GlobalRT and the UICC – this film was shot working closely with an incredible local videographer, Lali Houghton.

For more information on radiotherapy and the important work of GlobalRT – or on NCDFREE and the making of this short film – head to the websites.

Dr Alessandro Demaio is Postdoctoral Fellow in Global Health and NCDs at the Harvard Global Equity Initiative, Harvard Medical School and an Assistant Professor at the Copenhagen School of Global Health. To follow the next journey in Global Health film, connect with Sandro on Twitter via @sandrodemaio and @NCDFREE.

The Conversation

The Conversation

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Translating the Untranslatable #imaginemed Part 3

This week on PLOS Translational Global Health, Alexandra Abel brings us the final part in the #imaginemed series.

Welcome back to Imagining the Future of Medicine at the Royal Albert Hall.

The final session began promptly as an eager audience clambered to re-take their seats. One man even hopped up on stage in an effort to more speedily access the stage-side stalls seating area! If you’ve been reading from Part 1, you’ll recognise this as our unanticipated stage invasion. Thankfully, hundreds didn’t follow after Dara quipped, “I like the way you climbed up on stage there”. After that tiny bit of excitement, on to session three… Translating the Untranslatable.

Alison talks about Music as a Healer. Photography: Alan Liu

Alison talks about Music as a Healer. Photography: Alan Liu

Someone very accustomed to being on stage at the Royal Albert Hall is Alison Balsom, who wanted to tell us about the healing power of music.

This is something very dear to me as I have always thought of music this way, and at uni, investigated benefits of learning a musical instrument for older people.

Alison started off with, of course, a beautiful trumpet performance, and then explained that a lot people say music can be medicine, but without much thought as to why this might be.

“As a musician, I feel that music is meditation. It’s self-expression. It’s physical. It’s thrill seeking. And it’s cerebral.” – Alison

Brass for Africa empowers young people through music and humanitarian programmes.

Brass for Africa empowers young people through music and humanitarian programmes.

Alison went on to show a video made especially for ImagineMed, filmed during her recent trip to Kampala with the fantastic Brass for Africa. This charity engages children from disadvantaged communities and works with them through music on wider issues they are experiencing. Brass for Africa’s most important projects are in two orphanages, The Good Shepherd Home and the Bethlehem Orphanage; and for the children there, the music project is the highlight of their week. The film showed how music had profoundly affected the lives of these children, and Alison’s message was that music can engage, empower, and repair, and has a vital place in science and medicine.

“Some people would argue that you don’t need music like you need food and water, but I would say it’s about flourishing as a human being, not just surviving.” – Alison

Tali talks about The Surprising Science of Future Thinking. Photography: Alan Liu

Tali talks about The Surprising Science of Future Thinking. Photography: Alan Liu

Next up was cognitive neuroscientist Tali Sharot, who began by asking the audience how they would talk themselves out of eating an imaginary ‘naughty treat’ placed in front of them. Would they think, ‘that will make me fat’, or would they think, ‘I’ll be healthier if I don’t eat that’. Most of the audience went voted for the fat option, but Tali went on to explain how this isn’t the best way to encourage positive behaviour. Along with our natural optimism bias, another focus of Tali’s research, she has found people are also resistant to warnings. We tend to tell ourselves not to worry about things that might happen, rather than implementing early mitigation measures, and we are naturally more receptive to information we want to hear. We appear to have an inability to learn from bad news, and children, teenagers, and the elderly are least likely to learn from warnings.

When a known camera was installed at a hospital to monitor staff’s practice of hand washing between seeing patients, only 1 in 10 people washed their hands. But when an electronic board was introduced, stating how well the ward were doing, i.e. “hand washing rates on this ward are at 60%, higher than average!” hand-washing rates rose dramatically to 90%. This is because of three principles that drive action to progress: immediate rewards, social incentive, and progress.

Katherine talks about How to Have a Good Death. Photography: Alan Liu

Katherine talks about How to Have a Good Death. Photography: Alan Liu

Penultimate speaker of the day was palliative care specialist Katherine Sleeman, who had the audience applauding in the first minute as she explained that despite the incredible advances in health and medicine over the last century, global death rates still remain unchanged at 100%!

Katherine explained that the success of modern medicine has resulted in death being viewed as failure, and just 0.1% of the NHS budget is put towards palliative care. The majority of us will live with, and die from, chronic medical conditions, resulting in a slow deterioration of function. She noted that a ‘good death’ may mean different things to different people, but sophisticated hospital care may paradoxically be worsening, not improving, our quality of life… and quality of death. Palliative care can be very individual, finding out a patient’s worst problems and trying to improve them, but it may not be a case of quality versus quantity as studies have shown palliative care helps cancer patients to live longer.

Palliative care doesn't have to be quality of life versus quantity. Photography: Alan Liu

Palliative care doesn’t have to be a case of quality of life versus quantity. Photography: Viviana Motta

Society needs death as much as it needs new life, and yet it is often so poorly planned for. Katherine’s message was that people find it hard to talk about death, but it is an important conversation to have so we can start ‘saving deaths’ as well as saving lives. I can safely say that Katherine’s talk was one of the most warmly received, and it was fantastic to see such a wonderful reaction to an incredibly important topic generally regarded as morbid or taboo.

“Stop whispering and start talking.” – Katherine

Ben talks about Bad Science. Photography: Alan Liu

Ben talks about Bad Science. Photography: Alan Liu

Our final speaker of the day was Bad Science writer Ben Goldacre. I mean someone who writes about bad science, not a bad science writer as one lovely tweeter noted (thanks, George Ward, for pointing out my grammatical ineptitude early on). Ben is actually a rather good science writer and an excellent science speaker, and it was fantastic to have him close the show at ImagineMed.

Ben outlined the need for, and success of, his popular All Trials campaign, which calls for greater clinical transparency and the results of all trials to be published. He explained that 85% of drugs prescribed today came on the market over 10 years ago, and the trial data for these medications needs to be available now so we can be certain we are using evidence-based interventions. Ben showed us 47 slides in 15 minutes, but his message was simple: access to full methods and results matter.

Ali says we must believe in the power of imagination. Photography: Alan Liu

Ali says we must believe in the power of imagination. Photography: Alan Liu

Just before the end of the show, our wonderful director Ali Rezaei Haddad took to the stage to say a few closing words and thank the many people who helped make this event possible. A few years ago, when Ali founded the Avicenna Project, he never thought it would lead to a full day event at the Royal Albert Hall. A children’s cancer lecture series for 50 people at our university led to a general forum on health and medicine for 500 people at the Royal Geographic Society in 2013; and the day after our 2013 event, he picked up the phone and called the Hall (without fear of sounding stupid). Ali’s message was that we must all believe in the power of imagination, or exciting ideas will never take form.

~ That’s all, folks! ~

A very happy team at the end of the show!

A very happy team at the end of the show!

The event was live streamed by the fabulous Be Inspired Films, and we are extremely happy to say that people from 44 different countries tuned in to watch the live stream.

We also hosted a multilingual live blog on our homepage throughout the day. At one point during the show, our server actually crashed because thousands of people were trying to access the website at once!

Thank you to our multilingual live blogging team, Nadia Ceratto, Christina Wong, and Mahiben Maruthappu, and social media coordinator Reena Wadia. Also to our photographers Alan Liu, Vivana Motta, and Ellie Pinney, and programme artist Conor Farr.

Post-show festivities in the gallery. Photography: Zinah Sorefan

Post-show festivities in the gallery. Photography: Zinah Sorefan

Videos of all of the talks and performances are now available to view on the ImagineMed website.

A massive thank you to all of our speakers and performers. And to our host, Dara, who hopefully collected some interesting anecdotes for his doctor-dominated dinner parties.

Thanks to the team at the Royal Albert Hall, including: Chris Cotton and Jasper Hope; Ed Cobbold and Caroline McNamara for their tireless efforts in the planning of this event; Rick Burin for delightful emails and concurrent expert press exec-ing; Mo Crowe for knowing absolutely everything and keeping us all calm backstage; Jess Silvester for never losing patience with marketing requests; Lord Matt Griffin for first-rate digital content management in the face of tricky web CMS; and Ellen Morgan, who managed to get one of our top online game scores, even higher than the girls who set the questions.


The ImagineMed circle.

The Royal Albert Hall really is an incredible place. Not only is it a world-renowned performance venue, it is also a charity dedicated to increasing access to the arts and sciences, supporting the cultural life of the country, and inspiring future generations. Officially named the Royal Albert Hall of Arts and Sciences, it has played host to a number of science events featuring leading experts such as Stephen Hawking, Richard Dawkins, even Albert Einstein. And Einstein knew a thing or two about imagination…

“Imagination is more important than knowledge. For knowledge is limited to all we now know and understand, while imagination embraces the entire world, and all there ever will be to know and understand.” – Albert Einstein


I hope you enjoyed the #imaginemed series. Thanks for reading, and please do watch the videos when you have the time! Again, you can find them here.


Alexandra Abel is a graduate from Imperial College London and the Royal College of Music. She has a keen interest in both Global Health and Performing Arts. From September, she will be a medical student at Hull York Medical School.

Join her on twitter @alexandraabel

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