Life expectancy has risen dramatically over the past century — particularly in developing countries — thanks to the introduction of innovations like antibiotics and vaccines, as well as improvements in the standard of living.
But at the same time, new public health challenges have emerged, including chronic diseases like cancer, diabetes and heart disease.
For us to live longer and better lives, a multifaceted, multidisciplinary approach is needed to target at-risk populations, address modifiable behaviors and empower communities to take health into their own hands.
The power of prevention
According to the World Health Organization, noncommunicable diseases kill more than 36 million people each year, with low- and middle-income countries accounting for 80 percent of those deaths. By 2030, NCDs — once dismissed as rich-people problems — will become the top killer in Africa, taking more lives than diseases like malaria and tuberculosis or the deaths of expectant mothers and their newborn children.
NCDs perpetuate poverty and stifle development. And yet, they’re also largely preventable through healthy lifestyle choices such as improved nutrition, increased physical activity and reduced consumption of alcohol and tobacco.
If these risk factors were eliminated, WHO says 75 percent of heart disease, stroke and Type 2 diabetes, and 40 percent of cancer cases, would be prevented.
In the United States, for instance, chronic conditions like obesity are responsible for seven out of 10 deaths per year, according to the Robert Wood Johnson Foundation. It’s why 75 percent of U.S. health spending goes toward these conditions, and why U.S. President Barack Obama’s landmark health reform law, the Affordable Care Act, focuses on prevention and encourages companies to promote healthy workplaces and exercise by offering free gym memberships to employees.
There are many other ways to incentivize healthy behavior and prevent chronic diseases.
The Chinese character for longevity is stretched across a canvas of red, the color of happiness, as children play doctor with a stethoscope. This poster is part of an effort by the National High Blood Pressure Education Program to educate Chinese Americans about the importance of measuring their blood pressure as part of a wider campaign to reduce disability and mortality.
In South Africa, a private health plan with a voluntary incentives program — offering instant rewards like movie tickets or mobile phones to patients who go to the dentist or have their cholesterol checked — saw a significant increase in the use of preventive health services. In Qatar, which has some of the highest obesity, hypertension and diabetes rates in the world, the “Step Into Health” program calls on citizens to take 10,000 steps a day, acknowledging the consumer culture and summer heat with a “walk the mall” initiative.
These initiatives put the individual in the driver’s seat by encouraging — and rewarding — a healthy lifestyle. Gone are the days when you were “dismissed” as healthy until you’re sick. Today, there’s growing awareness of the connection between living well and living longer.
The private sector: A game-changer
Over the past 15 years, the Millennium Development Goals have galvanized actions to reduce poverty and improve opportunity around the world. The mortality of expectant mothers and children under 5 has dropped thanks to the training of community health workers, expansion of routine immunizations and improved access to clean water and sanitation facilities, among other factors.
Yet despite significant progress, many countries won’t reach the MDG target of decreasing the mortality rate to 29 per 1,000 live births by the end of next year. The self-imposed deadline has been driving a array of results, including a new partnership between United Nations Population Fund, whose contributions include an e-learning model to teach birth attendants how to respond to red flags, and Amref Health Africa to train midwives.
Many pharmaceutical companies have also taken note, shifting their focus toward new markets in the developing world while adopting a shared-value business model that creates social change while generating economic returns.
A promotional video for The Lilly NCD Partnership, an Eli Lilly and Co. initiative that uses everything from awareness campaigns to screening drives to tackle diabetes in countries like Brazil and India, for instance, explains that the idea is to “find the right roles for the right medicines … even if they aren’t ours.”
That mindset was almost unheard of just a few years ago.
Dr. John Lechleiter, CEO of Eli Lilly and Co. and president of the International Federation of Pharmaceutical Manufacturers and Associations, is among the growing number of corporate executives who have emphasized the importance of public, private and civil partnerships to serve the underserved.
“... a society with more conscientious and goal-oriented citizens, well-integrated into their communities, that is likely to be important to health and long life.”— Howard S. Friedman, co-author of “The Longevity Project”
Mario Ottiglio, IFPMA’s director of public affairs and global health policy, says big pharma is helping to improve the availability of treatment and overcome distribution and supply chain problems through initiatives such as SMS for Life, which uses mobile technology to improve access to malaria medications in rural parts of Africa.
Technology, in these and many other initiatives, should be a tool, not a solution in and of itself. From telemedicine to wearable fitness devices, these innovations are what we make of them.
And while mHealth — which the WHO defines as “the use of mobile and wireless technologies to support the achievement of global health objectives” — can help us live better and longer lives, it’s important to remember that for people living in the developing world, there’s not always “an app for that” because tech gadgets remain unaffordable or because wireless connectivity is lacking.
Empowering the community
When it comes to effective strategies to promote living longer, Ayham Alomari, senior health officer at the International Federation of Red Cross and Red Crescent Societies, emphasizes the importance of a community health approach versus an approach that focuses on one disease or a select few of them.
IFRC engages community volunteers to raise awareness of NCDs and promote healthy lifestyles. Take, for instance, its Mother and Child Health Care Program in the indigenous communities of Guatemala, where maternal and infant mortality rates are high. Through initiatives like mother support groups, which involve house visits and follow-up meetings on everything from breast feeding to family planning, IFRC creates a culture of knowledge sharing.
A major success story for Concern Worldwide comes from using the Lantana plant, which some people in Tanzania see as a natural deterrent to mosquitos, in the fight against malaria, the No. 1 killer in the country’s Ngara area.
“The results have been dramatic with the incidence of mosquitoes down as much as 80 percent,” said Joseph M. Calahan, CEO of Concern Worldwide, explaining how what appears to be an effective, inexpensive, sustainable solution came from the people themselves.
He suggested that communities in need are much more likely to accept and adopt local solutions.
To live longer, better lives, people must become active partners in their own health care. They must understand the risks that face them and overcome the traditional structures that may prevent them from asking questions, voicing concerns or proposing solutions.
Leslie R. Martin and Howard S. Friedman, professors of psychology and co-authors of “The Longevity Project,” found that social connection is a powerful predictor of longevity. Connecting with others, they say, may in fact do more for our health than eating our vegetables.
“Our studies suggest that it is a society with more conscientious and goal-oriented citizens, well-integrated into their communities, that is likely to be important to health and long life,” Friedman said. “The international development community overlooks these issues at its peril.”
People who have more frequent interactions with others live longer lives on average, especially when those interactions involve helping one another. Networks of support help individuals put into practice the habits they already know are most likely to lead to better, longer lives.
So many aspects of the wellness movement have to do with helping ourselves as individuals — with apps that help us track our steps or our meals, for instance. Imagine how public health would benefit were there a greater emphasis on helping others.
Policy as part of the picture
The success of community approaches to improving health depends on a commitment from policymakers, whether it involves urban planning or workplace rules that encourage a more active lifestyle, increase productivity and enable us to live well and longer.
The World Bank’s proposed policy interventions to address NCDs include raising taxes on tobacco, regulating salt in processed foods, banning advertising of alcohol products, providing subsidies for healthy food and reducing harmful emissions.
There’s no shortage of ideas. The Global Alliance for Clean Cookstoves, for instance, launched in 2010 by the United Nations Foundation with support by then-U.S. Secretary of State Hillary Clinton, wants 100 million homes to adopt “new clean stoves and fuels by 2020” — an effort meant to reduce the health and climate change hazards that come with toxic smoke from open fires and dirty stoves.
In India, a range of partnerships and initiatives have led to a transition from biomass cook stoves to more energy-efficient cook stoves, which is reducing the pollutants from cooking with solid fuels.
Global leaders have been focusing more attention on chronic diseases and wellness, as well. In 2011, the United Nations convened a meeting on NCDs culminating in the issuance of a political declaration to help prevent and control them through policies and other interventions targeting common risk factors like tobacco and use, poor diet and lack of physical activity. Earlier this year, U.N. member states met to review progress, welcoming the creation of the Interagency Task Force on the Prevention and Control of Noncommunicable Diseases and the Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013-2020.
Many countries have imposed smoking bans, and study after study suggest their positive health impact. To sustain the momentum, it’s important to continue monitoring tobacco use, identify priority areas and launch political interventions to reduce consumption, according to the authors of a study on smoking prevalence and cigarette consumption across 187 countries published earlier this year in the Journal of the American Medical Association.
Given all of the breakthroughs in health care, diagnostics, prevention and nutrition, life expectancies under 50 may well be a thing of the past.
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● An unparalleled opportunity to improve the health of the most vulnerable. Will we take it?
“We have the knowledge. We can marshal the resources. We just need to think big, act creatively, think smarter and collaborate,” Calahan of Concern Worldwide said. “And, yes, it’s imperative that we surface the ideas of those closest to the problems we are trying to address. Invariably, they have the best insights.”
As the fight against NCDs intensifies, so too will the fight for a world in which the opportunity for a long and healthy life is determined not by where you are born, but by the choices you make.
Healthy Means is an online conversation hosted by Devex in partnership with Concern Worldwide, Gavi, GlaxoSmithKline, International Federation of Pharmaceutical Manufacturers & Associations, International Federation of Red Cross and Red Crescent Societies, Johnson & Johnson and the United Nations Population Fund to showcase new ideas and ways we can work together to expand health care and live better lives.