Breaking the cycle: Why anemia needs a place on the NCD agenda

Anemia remains a major and often overlooked global health issue, affecting nearly 1 in 3 women aged 15 to 49 in 2023. Often considered a symptom rather than a disease in its own right, anemia is increasingly recognized for its strong links to a range of noncommunicable diseases, or NCDs — including chronic kidney disease, diabetes, and mental health disorders such as depression and anxiety.

As global health leaders prepare for the upcoming fourth high-level meeting on NCDs and mental health in September, experts are calling for a more integrated, primary health care-driven approach. In Lena Wahlhed’s view, anemia would be an excellent starting place.

“If we keep treating these conditions in isolation, through vertical, siloed programs, we’re missing the bigger picture — and it might end up being more expensive than if we had a more horizontal view,” explained Wahlhed, director for alliance development at HemoCue. 

Wahlhed spoke to Devex about why it’s time to look at the social-level impacts of anemia and how point-of-care diagnostics, such as HemoCue’s portable hemoglobin analyzers, can help bring early screening for anemia directly into resource-limited settings.

This conversation has been edited for length and clarity.

You were on the ground in Geneva for the 78th World Health Assembly a few months ago. Where did you see anemia fitting into the conversations in a way that’s been missing before? And how does that reflect a broader shift in understanding it within the context of NCD prevention and care?

Women's health was high on the agenda during the FIND Diagnostics Day at the World Health Assembly, and anemia fits well into that dialogue as it is such an important issue across every stage of a woman’s life.

But with funding cuts and competing priorities, it's more important than ever to keep a laser-sharp focus on reducing maternal and child mortality and morbidity. If we can maintain that focus through anemia [care], we’ll at least support better chances for healthy pregnancies, safe deliveries, and a good start in life.

Anemia is also highly relevant in the context of mental health, which is part of the broader NCD agenda. It can both contribute to and result from depression and anxiety. And beyond that, it intersects with chronic diseases — from diabetes to early-stage chronic kidney disease, where hemoglobin levels serve as both an indicator and a treatment target.

Anemia is both a health and gender equity issue. How concerned should we be about the impact of shrinking global health funding on anemia-related programs? What ripple effects might this have for children, household income, and broader societal wellbeing?

It will indeed have an impact. I also think it’s worth saying that global health organizations, and all the people working within them, should be proud of what’s been achieved. Thanks to those collective efforts, many children are now thriving because they’ve had a healthy start in life. Many more women are surviving pregnancy.

Having said that, if funding for these programs doesn’t continue at the same levels, whether it’s for malaria, maternal and child health, HIV, or other [programs], we will start to see the effects. Not just now, but for years to come. Entire generations could be impacted.

We talk about ‘the intergenerational aspect’ of anemia. If we don’t break that cycle, it just keeps going. And we’re essentially denying children the chance to grow up healthy and to seize the opportunities they deserve — wherever they are. Maybe we haven’t reached all the goals we set out to, but we’ve come a long way. And if progress stalls now, we’ll start seeing more children who are stunted, more who are malnourished, and more girls who can’t finish school or women who can’t go to work. So the implications are huge, not only at the individual level, but for society as a whole.

How do point-of-care diagnostics, like those developed by HemoCue, help embed early screening for anemia into broader primary health care and NCD services, especially in low-resource settings?

Hemoglobin is the analyte used to detect anemia. It’s included on the World Health Organization’s  essential diagnostics list, making it a critical parameter at the first level of care.

Tools such as [the hemoglobin analyzer] from HemoCue are part of this essential diagnostics framework. I think one of the biggest advantages of our systems is how easy they are to use. Even non-professional staff can operate them after a short training, which makes a huge difference in low-resource settings. The analyzers are also incredibly robust. They can be transported long distances — we’ve even delivered them by drone to reach the ‘last mile’. The combination of durability, ease of use, and long lifespan makes them a cost-efficient investment.

You mentioned the portability of your diagnostics devices — that’s impressive. Drones, even?

Yes! It was actually quite a few years ago now, but we took part in a project with the Swedish company Globhe, UNICEF, and the Malawi Ministry of Health. They used a small drone to deliver one of our devices to a very remote area — a great example of innovation meeting real-world needs.

One persistent challenge is translating screening into sustained treatment and prevention. How can anemia programs be structured to drive both system-wide impact and personalized care, ensuring that screening leads to the right action for each individual?

Having your anemia program operate at both a broad and individual level is super important. On a large scale, screening programs can support wider, systemic improvements that can have real public health impact.

But when it comes down to the individual, when we actually need to do something, then it’s all about having the right test, at the right time, for the right person. And we need to remember that anemia is a symptom. So context matters enormously. Where in the world am I? Who is the person in front of me? Is it a young girl experiencing heavy menstruation? A person with renal disease maybe as a complication to diabetes? These distinctions are crucial.

How can global health leaders ensure anemia is addressed more holistically within the NCD agenda, especially as momentum builds ahead of the high-level meeting on NCDs?

I really think it comes down to seeing the patient as a whole person. The same individual with diabetes might also have tuberculosis, anemia, or HIV. If we keep treating these conditions in isolation, through vertical, siloed programs, we’re missing the bigger picture — and it might end up being more expensive than if we had a more horizontal view. That’s where the essential point-of-care diagnostics and holistic care really make sense. Hemoglobin testing, for example, is important [in its own right], in itself as well as across a range of NCDs, including cancer care, diabetes, renal disease, and even mental health. Essential diagnostics are important in every aspect of care, throughout our lives.

Visit Accelerating Action — a series highlighting pathways for funding NCD prevention and control, spotlighting innovative financing models and cross-sector collaborations.

This content is sponsored by HemoCue as part of our Accelerating Action series. To learn more about this series, click here.