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.
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.
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 www.thefaceofncds.org 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.