Grappling with the Tensions around NCDs
By: Sir George Alleyne, Alafia Samuels and Karen Sealey
Recent global health conferences have highlighted many of the issues that health and other sectors must address to prevent and control NCDs. This growing awareness about non-communicable diseases (NCDs), coupled with the upcoming United Nations High Level Meeting on Non-communicable Diseases, marks a significant milestone in the effort to raise the political priority of NCDs. However, this has brought to the fore several tensions inherent in focusing on any particular health problem.
First, there will inevitably be challenges that arise from the nature of the diseases or health problems themselves, as different constituencies attempt to promote to one or other group of diseases, and clamoring to highlight “their” category of disease or heath issue – for example, communicable diseases vs. NCDs. Further strain emerges within disease groupings, with “factions” and advocates using one or other metric to claim priority for their disease, e.g. within NCDs, cancer vs. chronic respiratory diseases. It is also salutary to note that there are also tensions within the communicable disease community as arguments arise over the attention paid to malaria versus other infectious diseases such as HIV/AIDS. Although these tensions may be decried as being unhelpful, they do exist, must be recognized and, if possible, converted into sources of creative energy for improving health.
Here we explore the nature and geneses of some of the tensions around NCDs, but in particular that between NCDs and communicable diseases, and indicate possible means of reduction or resolution. We should be clear that the discordance between groups of advocates for one or other disease exists predominantly in the developing countries and within the international community. While it is true that NCDs have not had the priority that they merit on a global level, this is not the case in wealthy nations. In these countries, with their aging populations, enormous burden of NCDs and relatively low burden of communicable diseases, little or no tension exists, and expenditure is heavily slanted toward the care of patients with non-communicable diseases.
