NCDs, Women and the UN Agenda - Public-Private Ingenuity Required

Chronic diseases are the leading cause of death among women, accounting for 65 percent of global mortality. However, there is limited information on the broader social implications of NCDs on women.
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Most people are all too familiar with the burden of chronic disease -- either because they live with such an illness or because a loved one does. Noncommunicable diseases (NCDs) such as cancers, heart disease, asthma or diabetes are collectively the leading cause of sickness and death in rich and poor countries alike. Many low-and middle-income nations are facing epidemic rates of NCDs. Women are disproportionately affected when they or a family member has an NCD because they are the primary caregivers and often breadwinners in many households. Given the many demands on limited government resources, how do we facilitate more equitable access to health care to more people?

Chronic diseases are the leading cause of death among women, accounting for 65 percent of global mortality. However, there is limited information on the broader social implications of NCDs on women.

A recent study led by Arogya World with partners in the private and public sectors surveyed 10,000 women in 10 countries (Afghanistan, Brazil, India, Indonesia, Kenya, Mexico, Russia, South Africa, the United Kingdom and the United States) to shed light on the impact of NCDs on their lives. Early results reveal that most women surveyed live in households where they or another member of the home has been diagnosed with a chronic illness. The rates were significantly higher in countries like Brazil and India than in the U.S. or the UK. Nearly half of the survey respondents indicated that these costs pose some level of a financial burden. Moreover, many of the women surveyed had to either stop working or reduce they amount of time they spend at work in order to care for a loved one with a chronic disease -- putting further strain on household finances.

While the pervasiveness of NCDs is well-established in wealthy nations, it is less known that 80 percent of NCD-related deaths occur in low- and middle- income countries, most of which continue to struggle with issues such as maternal mortality, child survival, infectious diseases and HIV/AIDs. Indeed, countries like India and China face tremendous challenges when it comes to NCDs. An estimated 60 percent of the world's diabetic population resides in Asia with a prevalence of 11 percent among adults in China and nearly 20 percent in urban areas of India. Cancers are the second leading cause of mortality globally and more than 60 percent of these deaths occur in low- and middle- income countries. Likewise, an estimated 60 percent of the burden of heart disease rests on developing countries.

In 2011, the World Health Organization put forth an ambitious goal of reducing the global burden of the four leading NCDs (cancer, heart disease, asthma and diabetes) by 25 percent by 2025. This week, Health Ministers gather at the UN Headquarters in New York to report on the progress they have made toward achieving this target. This is a critical moment in the history of health, but what follows will be even more crucial. That is, representatives need to go home and do the hard work of developing and implementing plans to reduce the prevalence of chronic disease in their respective countries.

But countries cannot solve the NCD crisis alone. The complexity of chronic diseases requires a multisectoral response. Civil society, led by the NCD Alliance, has taken a lead in mobilizing non-state actors in pushing countries to accelerate investments in NCDs. It will take the herculean efforts of governments, multilateral institutions, local and international NGOs, academe and the private sector to develop comprehensive solutions to enhance primary care, strengthen health systems and build the health workforce to improve the quality and accessibility of prevention, early diagnosis, management and treatment of NCDs. We need to encourage public-private solutions around reducing the burden of chronic disease, leveraging the strengths of each sector to stem the tide.

An important consideration in improving access to services -- not just for NCDs, but also other conditions -- is that of affordability. For many families, particularly those in the developing world, taking care of a loved one with a chronic illness can pose a significant economic challenge. It can be a catalyst for financial ruin, perpetuating the cycle of poverty. One major trend that emerged from the Arogya survey is that cost is a major factor to accessing health services, not only countries such as Indonesia and Kenya, but also in emerging economies such as India, Mexico and Russia, and to a lesser extent in the U.S. and UK.

The reality of global health is that the available resources are not sufficient to meet the needs. For many countries, universal health coverage (UHC) has emerged as an enabler of providing better health care to more people. At its core, UHC facilitates greater accessibility to life-saving treatment without the danger of catastrophic out-of-pocket expenses. The adoption of UHC is by no means an easy task, particularly when countries are faced with the increasing prevalence of NCDs. Therefore, governments must engage civil society and the private sector to think creatively about how to make it a reality.

Ministers of Health have the challenging task of developing pragmatic plans to accelerate the prevention, treatment and management of chronic diseases in their respective countries. Furthermore, there must be greater recognition that prevention and changing risk behaviors are also important elements of the response. Beyond financial resources, donor countries, civil society and industry can provide support in the form of technical skills, advocacy, research, innovation and capacity building. But political commitment must be linked with public-private sector collaboration. Key actors from different sectors must continue to find ways to partner in novel ways. Together, we can build a sustainable response to the NCD epidemic for women, men and their families -- wherever they may live.

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