WHO´s role in addressing noncommunicable diseases

Raising the Priority Accorded to Noncommunicable Diseases in Development Work

Von Janet Voûte / Weltgesundheitsorganisation WHO

Noncommunicable diseases (NCDs), now account for a large enough share of premature deaths and poverty to merit a concerted and coordinated policy response. WHO responds with an Action Plan and builds up a global network to fight noncommunicable diseases.

Four types of NCDs – cardiovascular diseases, diabetes, chronic respiratory diseases and cancers – caused more than 35 million deaths worldwide in 2004, including more than 28 million in low- and middle-income countries. Up to 14 million of these 28 million deaths from NCDs in low- and middle-income countries are premature.

The situation of Switzerland’s partner countries

In all of Switzerland's 54 partner countries, and by any metric, noncommunicable diseases demand attention. 27 per cent of total annual deaths in these partner counties are premature deaths from noncommunicable diseases.

Eight of the top-10 leading causes of deaths in females in middle-income countries are related to NCDs (i.e. stroke, ischaemic heart disease, COPD, hypertensive heart disease, diabetes, breast cancer, stomach cancer and lung cancer). In low-income countries, three of the top-10 leading causes of deaths in females are related to NCDs (i.e. ischaemic heart disease, stroke and COPD).

Similarly, eight of the top-10 leading risk factors contribute directly to premature deaths from NCDs in middle-income countries (i.e. high blood pressure, tobacco use, overweight and obesity, physical inactivity, the harmful use of alcohol, high blood glucose, high cholesterol and low fruit and vegetable intake). In low-income countries, 7 out of 10 leading risk factor causes of death contribute directly to premature deaths from NCDs (i.e. childhood underweight, high blood pressure, high blood glucose, tobacco use, physical inactivity, suboptimal breastfeeding and high cholesterol).

If nothing is done, NCDs will increase by a further 17 per cent before 2015, most markedly by a further 24 per cent in Africa, 23 per cent in the Middle-East and South-East Asia, 21 per cent in the Western Pacific, 16 per cent in the Americas and 6 per cent in Europe.

If nothing is done, deaths from noncommunicable diseases will increase dramatically in developing countries.

Developing countries and the poorest people disproportionally affected

At a macro-economic level, non-communicable diseases place a heavy burden on the economies of low- and middle-income countries. The World Economic Forum's Global Risks Assessment Report in 2009 ranked the global NCD epidemic as the fourth highest global risk in terms of potential severity in economic and loss of life (only potential global oil and gas price spikes, retrenchment from globalization and global asset price collapses were predicted as more having more severe socio-economic implications and more likely to emerge). WHO estimates that heart disease, stroke and diabetes reduce GDP between 1 and 5 percent in low- and middle-income countries experiencing rapid economic growth, as many people die prematurely.

At household level, sufficient evidence is emerging to prove that non-communicable diseases in low- and middle-income countries contribute to poverty. The poorest households in low- and middle-income countries spend often more than 10 per cent of their income on tobacco. The cost of caring for a family member with diabetes can be more than 20 per cent of low-income household incomes in low- and middle-income countries, until households are impoverished by the cost of care and can no longer afford these health care services. Standard treatment regimens are often unaffordable.

Increasingly, public policy makers in low- and middle-income countries are challenged to formulate, with the involvement of sectors outside health, effective national policies and plans to prevent premature deaths from NCDs, thereby addressing one of the key public health and development challenges of the 21st century.

Accordingly, WHO's Director-General, Dr Margaret Chan, declared on 6 July 2009 during the ECOSOC High-level Segment: "We must make the prevention and control of non-communicable diseases and improvement of maternal health top priorities of the development agenda. Both are part of the agenda for strengthening health systems and revitalizing health care. Both are fully ready and mature areas for efficient interventions with a huge return. Both are begging for more attention."

Despite this call for support, only a very small percentage of the more than 22 billion in Overseas Development Assistance is today directed at the prevention and control of noncommunicable diseases.

Technical support is required in the following areas; primary prevention to reduce the level of exposure to risk factors, health care for people with noncommunicable diseases, and surveillance to quantify and track noncommunicable diseases and their risk factors.

WHO building intersectoral support of the NCD Action Plan and mobilizing a global response

Up to 14 million premature deaths from NCDs could be prevented annually in low- and middle-income countries by
a) mapping and tracking NCDs through surveillance;
b) reducing the level of exposure of individuals and populations to the main shared modifiable risk factors (i.e. tobacco use, unhealthy diets, physical inactivity and the harmful use of alcohol); and
c) strengthening primary health care to enable services to respond more effectively and equitably to the health-care needs of people at high risk of NCDs.

To scale up the global response to combating premature death from NCDs, Member States of the World Health Assembly endorsed the Action Plan for the Global Strategy for the Prevention and Control of noncommunicable Diseases in May 2008, which provides a roadmap for Member States, international partners and the WHO Secretariat in scaling up national, regional and global efforts to prevent and control NCDs between 2008 and 2013, particularly in low- and middle-income countries.

The Action Plan contains six objectives, with specific sets of action under each objective, which should be implemented by countries, international partners and WHO. The objectives are:

1. To raise the priority accorded to NCDs in development work at global and national levels and to integrate prevention and control of such diseases into policies across all government departments.
2. To establish and strengthen national policies and plans for the prevention and control of NCDs.
3. To promote interventions to reduce the main shared modifiable risk factors for NCDs (i.e. tobacco use, unhealthy diets, physical inactivity and harmful use of alcohol).
4. To promote research for the prevention and control of NCDs by developing a prioritized research agenda focusing on prevention and strengthening national capacity for such research in low- and middle-income countries.
5. To promote partnerships for the prevention and control of NCDs.
6. To monitor NCDs and their determinants and evaluate progress at the national, regional and global levels.

*Janet Voûte is the Partnerships Adviser to the Assistant Director General of Noncommunicable Diseases and Mental Health at WHO. She is responsible for enhancing partnership activities across the cluster as well as for designing a new partnership strategy in support of the Global NCD Action Plan. From 2000 to 2008, she served as the Chief Executive Officer of the World Heart Federation, a non-governmental organization network of 195 cardiology societies and heart foundations. Ms. Voûte is a featured speaker on partnerships, cardiovascular disease, obesity and overweight, as well as workplace wellness, at meetings of the World Economic Forum, OECD and the European Commission, among others. Contact: voutej@who.int


WHO launched a new network to combat noncommunicable diseases on July 8 2009 during the ECOSOC High-level Segment. For more information please consult http://www.who.int/ncdnet/en/