NCDs: The Silent Killer in Low-Income Countries

Don’t smoke.  Drink in moderation.  Eat right.  Exercise….  Many of us have, at one time or another, written such messages on a post-it note and stuck them to the bathroom mirror…but what just happened at the UN Summit on NCDs is bigger.  This was only the second time a UN summit addressed a health topic, the first topic was HIV/AIDS, and now this second summit addressed non-communicable disease.  The meeting achieved broad consensus that we must address these “big 4” causes of NCDs,  and laid out priorities and strategies.  It also described what  global NCD partnerships might look like –shared learning rather than large-scale donor funding from rich countries to poorer ones.  Some participants were disappointed that the meeting fell short of defining targets, indicators or criteria for progress.

This CSIS video summarizes the meeting well, featuring Nils Daulaire,  Director of the Office of Global Health Affairs at HHS,  Ambassador Ebrahim Rasool  (South Africa), and Medtronics Senior Executive, Trevor Gunn.

The resolution, which was passed at the summit,  is actually a great read!  It gives an overview of the global epidemiology of non-communicable diseases, discusses causes, advocates a whole of government approach (South Africa, in particular is walking this talk) and gives a concrete sense of what good policy might look like.  It recognizes the need for health system strengthening, and the global importance of anti-tobacco efforts (like smoke free workplaces and cessation initiatives that use text messaging), and it includes guidance about food systems, advertising, healthy environments.  It’s all there, and I have a feeling that it will be as challenging to implement this agenda in the US as in some of the lower-income settings.  The global effort will target  cardiovascular disease, cancer, respiratory illness and diabetes, focusing on four drivers — tobacco, alcohol abuse, poor diet, and physical inactivity.  There was and will continue to be tension and debate around balancing prevention  and treatment.  The CDC will serve as the point organization in defining this along with WHO the FDA,  NIH and others.

In attendance at this high level meeting was Dr. Jim Cleary, an international expert on pain policy, and the UW-Madison Global Health Institute’s Special Advisor for NCDs.  See his blog at  In conversations at UW-Madison, Jim has challenged us all to think comprehensively about care for NCDs,  and remember that the lifetime death rate for human populations is 100% and holding steady!  Everyone dies, therefore, in addition to thinking about prevention, we must also think about what it means to have a healthy death, and that means compassionate care and pain management for all.   This one is for you Jim———>