EDITOR’S NOTE: Collective efforts against noncommunicable diseases have failed because of the disparate nature of these diseases and the decision to try to address them on a global level, Council on Foreign Relations senior fellow Thomas Bollyky argues in this article for the Foreign Affairs magazine. A few excerpts:

When most people in developed countries think of the biggest health challenges confronting the developing world, they envision a small boy in a rural, dusty village beset by an exotic parasite or bacterial blight. But increasingly, that image is wrong. Instead, it is the working-age woman living in an urban slum, suffering from diabetes, cervical cancer, or stroke – noncommunicable diseases (NCDs) that once confronted wealthy nations alone.

NCDs in developing countries are occurring more rapidly, arising in younger people, and leading to far worse health outcomes than ever seen in developed countries. This epidemic results from persistent poverty, unprecedented urbanization, and freer trade in emerging-market nations, which have not yet established the health and regulatory systems needed to treat and prevent NCDs. According to the World Economic Forum’s 2010 Global Risksreport, these diseases pose a greater threat to global economic development than fiscal crises, natural disasters, corruption, or infectious disease.

The international community has done little to help. Most donors remain focused on the battle against infectious diseases, reluctant to divert their funds. A recent UN General Assembly meeting devoted to NCDs produced few concrete measures. With the global economy still in decline and funding scarce, the chances of new effective cooperation seem smaller than ever.

Collective action on NCDs need not wait for UN endorsement, economic recovery, or a reallocation of money away from campaigns against infectious diseases. The international community can make progress now by addressing those NCDs that are especially prevalent among poor people in developing countries and by helping their governments combat those diseases. For this effort to succeed, the United States must lead the way. In doing so, it can help curtail avoidable sickness and death and set the precedent for action on other emerging global health challenges that share the same origins and devastating consequences for the world’s poor as the NCD crisis.

The disease divide

The NCD problem in developing countries is far worse than it has ever been in the developed world. NCDs in emerging-market nations are arising in young working-age populations at higher rates and with more detrimental outcomes than in wealthy states. According to theWorld Health Organization(WHO), 80 percent of deaths from NCDs now occur in low- and middle-income countries, up from 40 percent in 1990. People with NCDs in middle-income countries are more than twice as likely to die before age 60 as those in high-income nations, and people in low-income countries are four times as likely to do so.

NCDs that are preventable or treatable in developed countries are often death sentences in the developing world. Whereas cervical cancer can largely be prevented in developed countries thanks to the human papillomavirus vaccine, in sub-Saharan Africa and South Asia, it is the leading cause of death from cancer among women. The mortality rate in China from stroke is four to six times as high as in France, Japan, or the United States. Ninety percent of children with leukemia in high-income countries can be cured, but 90 percent of those with that disease in the world’s 25 poorest countries die from it. By 2030, NCDs will be the leading cause of death and disability in every region of the world.

The rise of NCDs has devastating social and economic consequences for developing countries. The frequent onset of these diseases among younger populations consumes scarcehealth-careresources, saps labor from thework forceand hinders economic development, and makes it harder for governments to address other threats, such as infectious diseases. On the household level, NCDs consume budgets and rob families of their primary wage earners. A recent report by Harvard University and the World Economic Forum projects that over the next two decades, NCDs will inflict $14 trillion in economic losses on the developing world.

Republished with permission from the Foreign Affairs magazine. View the full article.

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