If you were to ask me three weeks ago about the leading cause of death in the world, I would have said that it would be HIV/AIDS. All the effort and funding that the local, national and international organizations are putting on HIV/AIDS really did make me believe that the disease is the number one killer in the world. When in actuality, cardiovascular disease (CVD) is the number one killer worldwide. But why do I not see international community doing anything about it?
Why do diseases like HIV/AIDS and Malaria “advertise” so well as the dark, grim reaper of the poor to the development agencies and the donors? Why can’t CVD “advertise” as well if it accounts for 30% of all deaths around the world[i]?
Several arguments that come across my mind:
– Some may argue that HIV/AIDS and Malaria are more easily prevented (through the practice of safe sex and sleeping under bed net, respectively) while preventing CVD is more difficult since it would entail an extensive lifestyle changes; and nobody wants to be told that they need to change every aspects of their life.
– Another point is that HIV/AIDS and Malaria are highly infectious, while CVD is not. The thought of infectious diseases like HIV/AIDS and malaria crossing the boundaries of our ever-globalized world and being late in controlling it can instill some fear in most of us.
– HIV/AIDS and Malaria affect many of the younger population while CVD affect the older population[ii],[iii]. From the cost-effectiveness perspective, it would be better to treat the younger population than the older since the younger ones can still be productive and (are assumed to) have longer life span ahead of them.
– Or perhaps, as proposed by Jeremy Shiffman, the policy communities for HIV/AIDS and Malaria are more successful than that of other global issues (like CVD) in portraying the burden and in establishing institutions that can continuously promote and sustain those portrayals[iv].
With the previous arguments in mind, what can be done to better advocate the cause of non-communicable diseases like CVD?
First of all, policy communities around the world for non-communicable diseases such as CVD need to unite and combine their efforts so their ideas and marketing efforts can be effectively portrayed to the international communities.
Second, policy communities for CVD need to actually state the magnitude and the importance of addressing this issue especially from the economic development and health expenditure perspectives in the developing countries. The CVD policy communities should also emphasize the potential long-term benefits for addressing and preventing this issue.
Third, local, national and international governments need to promote this effort by making it easier for people to access primary care and education services, as well as endorsing healthier lifestyles (i.e. exercise, balanced diet, moderate consumption of alcohol, etc).
Will there be times when non-communicable diseases like CVD make it to the global health development agenda? With the World Health Organization (WHO) announcing the start of the Global Non-Communicable Disease Network (NCDnet) to combat non-communicable diseases such as CVD as well as the existence of organizations such as World Heart Federation (WHF), I would say that there is a reason to be optimistic[v].
[i] Leading NGOs Call for International Action to Combat Epidemic of Non-Communicable Diseases. Public release 19 May 2009. http://www.eurekalert.org/pub_releases/2009-05/idf-lnc051809.php
[ii] American Heart Association. Heart Disease & Stroke Statistics: 2009 Update At-A-Glance. http://www.americanheart.org/downloadable/heart/1240250946756LS-1982%20Heart%20and%20Stroke%20Update.042009.pdf
[iii] The Center for Disease Control and Prevention. http://www.cdc.gov/hiv/topics/surveillance/basic.htm#aidsage
iv A Social Explanation for The Rise and Fall of Global Health Issues by Jeremy Shiffman.
[v] New Network to Combat Non-Communicable Diseases- 8 July 2009. http://www.who.int/mediacentre/news/releases/2009/noncommunicable_diseases_20090708/en/index.html
Note: In the United States alone, cardiovascular diseases account for 1,703,000 deaths of people above 45 years of age compared to the 26,000 deaths of people below 45 years of age. In contrast, the cumulative estimate number (prevalence) of HIV/AIDS cases in the United States through 2007 revealed 244,566 cases for those above 45 years of age compared to the 773,863 cases for those below 45 years of age.