Non-Communicable Diseases: Equity, Action, and Targets

Non-communicable diseases (NCDs), including cardiovascular diseases, diabetes, chronic lung diseases, cancers, mental health, and injuries are now the leading drivers of morbidity and mortality globally. They disproportionately affect poor and marginalized groups in low- and middle-income countries. The ‘causes of the causes’ of much of the global burden of these diseases make them difficult to address with curative services alone. Proximal causes include raised cholesterol, blood pressure and glucose; intermediate causes include tobacco, alcohol, poor diet, physical inactivity, air pollution, and many other often man-made risks that are related to our lifestyles. Distal causes include urbanization, population ageing and trade. Premature death and disability due to NCDs can therefore be viewed as failures of both health systems and the broader socioeconomic system. NCDs are increasingly recognized as critical goals for health agendas, including explicit NCD-related Sustainable Development Goals, and clear global consensus that addressing NCDs will require strong primary health care to achieve high-quality universal health coverage. Effectively responding to the growing burden of NCDs will require multisectoral alignment and heterogeneous interventions at both the healthcare service delivery level and policy levels. Strong evidence exists for many interventions, including the strengthening of health workforces by utilizing mid-level practitioners and community health workers; improving access to medicines by expanding essential medicine lists; and implementing cost-effective taxation policies for alcohol, tobacco, and sugar-sweetened products. To date, the financial resources allocated to these interventions is vastly insufficient. Increasing both the domestic fiscal resources managed by local governments, and overseas development assistance from donors and development partners, are urgent priorities in order to effectively respond to the growing burden of NCDs and prevent further avoidable morbidity and mortality in the future.