Hypertension, diabetes, stroke: they kill more people than infectious diseases and should benefit from a Global Fund

Non-communicable diseases such as diabetes, hypertension and cardiovascular diseases are responsible for 41 million deaths every year. That’s over 70% of all deaths worldwide. Most of these deaths (77%) occur in low- and middle-income countries, including those in Africa.

These conditions are currently more prevalent than infectious diseases. Sixty-seven percent occur before the age of 40. In addition to being the leading causes of death worldwide, non-communicable diseases impose enormous costs on individuals. They also undermine labor productivity and threaten economic prosperity.

The provision of health care in much of Africa still depends on external donors. Funding is insufficient to help low- and middle-income countries tackle non-communicable diseases. Most of the development assistance for health financing provided by international donors is allocated to infectious diseases and maternal and child health. In 2019, HIV funding was $9.5 billion. The amount allocated to non-communicable diseases was $0.7 billion.

Evidence suggests that tackling the non-communicable disease pandemic can also mitigate other challenges such as HIV, tuberculosis (TB), maternal and child health, and universal health coverage.

The Global Fund to Fight AIDS, Tuberculosis and Malaria is an international partnership. The fund invests $4 billion a year to fight these three diseases.

I believe now is the time to think about creating a Global Fund for non-communicable diseases, or expanding the mandate of the Global Fund beyond AIDS, tuberculosis and malaria. The epidemics of these conditions overlap. For example, research has shown that comorbidities such as diabetes and cancers are common among people living with HIV.

Expand health care provision

Disease-specific programs have limitations. As public health practitioners, we must learn from our mistakes. We need to build integrated health programs and systems that address interdependencies and comorbidities. An example would be to include diabetes screening in tuberculosis treatment programs.

In addition to integration, non-communicable diseases require increasing investments.

The Global Fund is seeking US$18 billion this year. Meanwhile, The Lancet NCD Countdown 2030 projects that non-communicable disease interventions require $18 billion a year. That’s what it would take to reach the UN’s goal of reducing non-communicable diseases by a third by 2030.

I would say that the case for investing in non-communicable diseases has never been stronger.

A roadmap

The World Health Assembly recently endorsed the World Health Organization’s roadmap for the prevention and control of non-communicable diseases covering the period 2023-2030.

The roadmap recommends actions to:

• promote “best-buys” interventions with a high return for every dollar spent, such as smoking cessation programs

• strengthen health systems

• reduce risk factors for non-communicable diseases such as smoking and unhealthy diets

• integrating non-communicable diseases into primary health care and universal health coverage.

This roadmap must be followed in line with commitments to reduce air pollution and promote mental health and well-being.

Lessons learned from the COVID-19 pandemic provide opportunities to strengthen emergency preparedness and responses beyond pandemics. Emergency risk management and the continuity of essential health services for all hazards – by closing fundamental gaps in the health system – can improve health security.

What should be done

How should Africa respond to the growing burden of non-communicable diseases? There must be strong political will and government buy-in, with strong multi-stakeholder participation.

The UN General Assembly Decision on HIV and Non-Communicable Diseases commits governments to identify and address HIV comorbidities and other links to pressing global health challenges. These include links to non-communicable diseases, learning from the perspective of people living with these conditions and emphasizing the importance of focusing on co-morbidities.

The WHO compact on non-communicable diseases proposes concrete actions. These actions should be data-driven and supported by indicators related to non-communicable diseases in health systems performance and access to health metrics.

Surveillance systems need to be more diverse. Systems should capture and track progress in sectors that affect health, such as housing and sanitation. This would strengthen monitoring of national systems and capacity to comprehensively address noncommunicable diseases.

Health system strengthening and quality of care will improve significantly with additional resources for non-communicable diseases through an entity like the Global Fund.

This article is part of a media partnership between The Conversation Africa and the 2022 Conference on Public Health in Africa.