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Saving Lives, Taking Risks... and NCDs

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We're hearing more and more in the media about the UN General Assembly meeting on non-communicable diseases (NCDs), which will take place in New York on 19-20th September. Scientists and researchers are grappling with the technical issues, politicians and diplomats are engaging with economic and policy matters. But a lot of people still seem puzzled about why, now, have NCDs suddenly come to the top of the global health agenda? Let me try and explain.

What are NCDs? They fall under four main groups: heart and circulatory diseases, cancers, long-term lung diseases and diabetes. The individual risks for all of these increase considerably as we get older, so they are mainly problems for the middle-aged and elderly. Most people with NCDs encounter reduced quality of life, and increased demand for health services, over quite long periods of time. Worldwide, 36 million people are estimated to die from NCDs every year (which accounts for more than half of all deaths), and 9 million of these deaths happen to people less than 60 years old. Several bloggers including Riva Greenberg and Nalini Saligram have explored specific issues in more detail. But let's get back to why NCDs are suddenly the big issue.
Probably just about everyone would agree that saving lives is a good thing. But when we talk about a life that has been saved, what we're actually focussing on is someone who has emerged successfully from a life-threatening situation. Many circumstances threaten lives, but the most common saved-life scenario follows a medical intervention against a particular illness. What isn't normally mentioned at that time is the inevitability that the person whose life has been saved will eventually go on to die, probably of another cause. So actually a "saved life" might more precisely be called a "postponed death".

Measles vaccine is a great example here. Around 20 years ago, I can remember having to follow up devastating measles epidemics in African villages, which were killing thousands of children. Although measles has not been totally eradicated, big epidemics are now rare - because many millions of children have been vaccinated, and consequently millions of lives have been saved. The Gates Foundation is one example of many agencies working globally to control measles and other infectious diseases using vaccines. But this fantastic progress actually also means that millions of deaths have been postponed, and many of the children who otherwise would have died of infectious diseases will go on to live well into adulthood - and hence become susceptible to NCDs later in life. This process, across whole populations, is technically known as "epidemiological transition" - in other words, changing patterns of various disease epidemics across different age groups over time.
Then there is the question of taking risks. A number of lifestyle issues are connected with the development of NCDs, of which the four major ones are tobacco, unhealthy diets, physical inactivity and inappropriate use of alcohol. As national economies develop, individual purchasing power grows, and more aggressive marketing develops around cigarettes, alcohol, fast food and devices that reduce physical activity (cars, for example). Thus, almost without noticing, increased risks creep into peoples' lives.

Put all of this together: health services postponing millions of deaths; more people surviving to ages when NCDs are more common; socioeconomic development increasing exposure to specific NCD risk factors. This is the NCD "perfect storm" that we all now face. What needs to be done? It is meaningless to talk about eradicating NCDs, because they are inevitably associated with many deaths in old age. But we do need to consider, very urgently and seriously, how to delay the age at which people experience NCDs and how to care effectively for people living with NCDs. Both of these strategies will reduce the number of premature deaths due to NCDs.
If I may turn my title around, from the UN summit we need NCDs to be managed by politicians prepared to take risks, and thus save lives.