NCDs, UHC, and MDGs

Universal health coverage has received a great deal of attention in the past few decades, arguably due to the rise of non-communicable diseases. As Maher and Sridhar point out, NCDs are no longer limited to wealthy populations; they have infiltrated previously unaffected portions of society and are rooted in social determinants of health. The insidious nature of NCDs complicates the fight against them; the effects of NCDs are not immediately observable, and are thus easily left untreated. Furthermore, the fact that ailments such as diabetes, heart disease, and obesity are wreaking havoc on impoverished populations poses another issue: many of the plagued individuals do not have access, or cannot afford to buy access, to the health care necessary for treatment.

                Not surprisingly, there has been a call for universal health coverage to combat this issue. Unfortunately, there has been limited success in mobilizing policy-makers and donors to allocate time and resources to NCDs. Millennium Development Goals, in this vein, have been unsuccessful, and indicative of the first world powers from which they originate. As long as wealthy nations have control within global organizations such as the WHO and IMF, NCDs will continue to fall to the wayside. Wealthy countries have dealt with such afflictions for years- the only difference being that for the most part, citizens of such nations can more easily afford individual treatment.

                Additionally obfuscating the plight against health disparity, rising NCDs, and health inequality and inequity is the simple fact that policy-makers have failed to construct clear guidelines for action. UHC is especially emblematic of this; the term universal technically means that there is a legal obligation of the state to provide health care to all its citizens. However, this definition does little to clarify what standard of health care this entails, or under which conditions. It also ignores individuals not belonging to a state, such as refugees. The MDGs are responsible for this confusion- according to O’Connell et al, the MDGs focused too much on national aggregates of health disparities, and this emphasis masked inequality. All in all, the MDGs are an extension of the United Nation’s failures; smaller states are ignored, and larger entities are put on a pedestal. As long as countries such as the US and other western powers are symbolically in control of the UN and other trans-lateral bodies, NCDs will continue to spread at an infectious rate, and health disparities will follow in suit with the rising wealth discrepancies that are observable globally.

Non-Communicable Diseases and the MDG agenda

Non-communicable diseases, such as cancer, diabetes, cardiovascular disease and mental illness, are on the rise. Three out of five deaths worldwide are cause by non-communicable diseases, and yet only three percent of the global public health budget is being spent on assistance for low and middle-income countries. 

As a rule as the rates of infectious disease decrease, the rates of non-communicable diseases rise. This phenomenon is being observed all over the world, but particularly in nations with historically high burdens of infectious diseases. As we get better at treating diseases like lower respiratory infections and cholera rates for diseases such as cardiovascular disease and cancer have risen.

People are living longer and comparatively healthier lives, but with increased life expectancy come a higher risk for developing non-communicable diseases. There is an adage, at least in the biological sciences, which states that if you live long enough you will get cancer. It is the inevitable result of the years and years of the genetic replication that occurs in the body. But in reality most people develop cancers because of factors outside of age, most of which are self-imposed. This can be said of most non-communicable diseases, which are generally associated with lifestyle choices: factors like high-blood pressure and smoking are the leading risk factors for lost DALYs worldwide. These risk factors have become increasingly prevalent in poverty stricken nations: indeed there is a general consensus that Africa is facing a ‘smoking epidemic’ in the next 12 years.

And yet most people do not think of sub-Saharan Africa when they think of lung-cancer and heart disease. These are diseases of the rich and fat nations, and the notion that these diseases are on the rise in poverty stricken countries does not fit will with the images of theses regions that have been fed to us for so long. Unfortunately the prevalence of these diseases is rising at a staggering rate, not helped by the poverty, lack of strong health systems and legal or political will power to make a difference in the countries that are facing the rising tide of non-communicable diseases.

We most re-evaluate the way the non-communicable diseases are being perceived, and attempt to combat the rising risk these diseases pose to global health. With the upcoming evaluation and re-assessment of the millennium development goals, there should be a push towards preventing these diseases, as we will only see a continued rise in their rates over the next decade.

Acronyms to Save the World

As the reality of 2015, and the deadline for Millennium Development Goals (MDGs) gets closer and closer, it’s time for those proponents of global development to evaluate the changes seen under the MDG era and start thinking towards the future towards new goals and strategies.

The general consensus as far as the effectiveness of the MDGs is- and get ready for it to be vague- that we still have a lot of work to be done. Criticisms, of course, vary, and some critics looking towards 2015 are focused on the strategies used to meet goals for the purposes of improvement, while others scrutinize the goals themselves and how they could more accurately represent both universal and country-specific needs post-2015. Still another group chooses to discuss the relevance of having a program liked the MDGs, we’ll return to that later.

The MDGs are a broad set of goals cover an impressive range of social, economic, and biological initiatives that are necessary for lessening inequality and improving lives on a global scale. They require an incredible amount of work to be done on every organizational level imaginable, and incorporate a diverse cross-section of fields. Arguably though, the public health sector both affects and is affected by each of the goals, and it’s no coincidence that the public health community

As discourse progresses on the post-2015 agenda, what role will the global public health community play in setting the agenda?

This is the essential question, and a movement is growing to make Universal Healthcare (UHC) the common standby.

Within that discussion, it has become clear that there is no dearth of precedents for UHC as a global policy. In descriptions of basic human rights employed in a legal sense in many state documents as well as international definitions (see: The U.N. Charter and the Declaration of Universal Human Rights or their citations in many U.N. resolutions and satellite organizations) adequate health and sanitation and access to healthcare services and sanitary resources fall well within the tent of accepted tenants.

However, one issue follows, and that is not whether or not UHC falls within the boundaries of human rights, but rather the question of what falls within the boundaries of UHC.

Global criticism of UHC points out that if the goals of UHC are to improve all around equity of access to healthcare services, there are plenty of precedents for governance and regulatory actions parading under the banner of UHC that fall short of those goals. A common occurrence is UHC models that raise universal quality but fail to address gaps in access among different groups, or models that preserve inequality by relying heavily on the private sector to provide resources and services.

In many circles there is a call for leadership in developing more specific expectations for UHC programs and a tighter framework that aligns goals with methods. Returning to the question of whether or not the MDGs were appropriate, efficient, and successful when it came to making positive strides towards global development, I’m not sure. However, I feel confident that as an internationally recognized program with the strong backing of the U.N., the MDGs have an incredible potential for setting the development, and therefore the global public health, agenda for the post-2015 era. Efforts to set a positive agenda would be best served trying to find a more efficient structure for realizing the MDGs.