Although much of the debate, money and politics around health in developing countries has for the last two decades focused on infectious diseases (particularly HIV/AIDS) the reality is that chronic conditions such as cancer, diabetes, chronic lung and heart disease are by some margin the biggest health problems facing such regions.
This major epidemiological shift has until recently been ignored by the global health policy community, but this looks set to change following a major UN Summit on Non-Communicable Diseases (NCDs) in New York in September 2011, which aims to create a new global agreement on how to tackle this problem.
Before governments agree to a whole new raft of cash and top-down schemes, it is worth taking a comparative look at the last time the UN and donor nations involved themselves in a major global effort to fight disease: HIV. This is the topic of a new CMPI study.
Some lessons are clear, like the need to focus properly on prevention. The UN’s big mistake with HIV was to prioritise treatment, even though the health infrastructure in the majority of developing countries was nowhere near up to the challenges of delivering complex HIV diagnostic services and treatments. This neglect of prevention led to new infections piling up more quickly than they could be treated, creating unnecessary suffering and costs. Fortunately for NCDs, there are plenty of off-patent and widely available preventative medicines (such as statins and aspirin) that can dramatically reduce the overall disease burden.
Policymakers also need to look at the experience of HIV and make sure their attempts to make NCD medicines more widely available do not undermine future innovation. Innovation in HIV/AIDS treatment has turned it from a terminal disease into a manageable chronic condition: it is not entirely unfeasible that future innovation will throw up a cure or prophylactic vaccine. Innovation will also be crucial if NCDs are to avoid swamping the health systems of both OECD and developing countries; but this depends on policymakers avoiding the temptations of compulsory licenses and other short-termist fixes.
Finally, HIV (and other areas of global public health) shows the shortcomings of foreign aid donors relying developing country public sectors to deliver healthcare, a strategy that has resulted in a huge amount of waste and corruption. If NCDs are to be tackled properly, there will need to be far greater collaboration with the private sector through contracting, partnerships or franchising.
It’s good news that international community is starting to pay attention to NCDs, after decades of neglect. But as with HIV, the scope for waste, error and costly misdirection is huge. This paper will hopefully help to prevent some of the biggest mistakes from being repeated.
