With the world’s population rapidly aging, we are seeing how noncommunicable diseases are growing — particularly in developing countries. Governments, nonprofits and pharmaceutical companies are engaged, but more pressure is needed to raise public awareness about the issue.
People are living longer, with the proportion of those over the age of 60 projected to increase from 810 million today to more than 2 billion in 2050. This increase in aging is not evenly spread, as by 2050 up to 80 percent of all old people are projected to live in low- or middle-income countries.
Everyone wants to live longer, provided the extra years can be lived in good health. Unfortunately, aging can see the onset of chronic diseases or NCDs, and this disproportionately affects those living in LMICs.
This is because poverty — and all it entails — is a fertile breeding ground for NCDs, so poor countries are caught in a vicious circle. The more people who have NCDs, the more this reduces productivity and increases health care costs. This impacts on economic development and growth, which in turn reduces a government's ability to act to stem the onset of NCDs.
The rise of dementia
One NCD that has seen a sharp increase is dementia. It is estimated that 44.35 million people suffered from dementia in 2013, a figure projected to rise to 135.46 million by 2050, with 71 percent in the LMICs. In addition, it is projected that by 2050 the largest increase will be in East Asia and sub-Saharan Africa, the regions with the highest proportion of least developed countries.
So what needs to be done? The fight against NCDs takes place on many fronts: getting international attention, changing attitudes and awareness, and more research into drug treatment. And action is being taken at many levels by governments, nonprofits and pharmaceutical companies.
While a little tardy, the international community has started to take action to this demographic and economic challenge. The 2011 U.N. General Assembly had a special session on NCDs, with the U.N. Secretary-General Ban Ki-moon describing NCDs as “a new frontier in the fight to improve global health.”
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A U.N. follow-up meeting was held in May 2014, where governments pledged to “intensify efforts toward a world free of the avoidable burden of NCDs.” As Marc Wortmann, the executive director of Alzheimer’s Disease International, a leading nonprofit in the dementia field, puts it: “We have learned that high-level political commitment opens new doors for dementia policies and funding.”
An important recent international event in this regard was the G-8 Summit on Dementia hosted by the British government in December 2013, which resulted in the appointment of World Dementia Envoy Dr. Dennis Gittings, kick-starting global action on the issue.
Wortmann believes “there is some good progress from the summit,” with more funding committed, new funding models such as social bonds being explored, and national plans drawn up. However, he is impatient about the lack of progress: “Government development agencies like the U.K. Department for International Development have been extremely silent so far and don’t seem to recognize the huge impact this disease already has in lower- and middle-income countries.”
Following the G-8 summit, global NGOs have joined forces to create the Global Alzheimer’s and Dementia Action Alliance to raise awareness and change social attitudes.
Tackling NCDs and dementia ‘on the ground’
HelpAge International, a nonprofit working to support older people worldwide, found the fragmentation of the health system hindered moves to tackle NCDs and chronic conditions among older people in LMICs.
Believing better integrated health and care services would ensure continuity of care and enable people to manage chronic, long-term illnesses, they piloted projects in Cambodia, Mozambique, Peru and Tanzania that combined community-based interventions and policy, and influenced improved access to — and the quality of — health services to address NCDs.
As a member of a self-help club in Peru said: “Before our involvement we mainly provided therapeutic care to older people. Today, through senior clubs, we provide therapeutic care and are increasingly focused on delivering education and preventive activities.”
ADI’s approach in supporting those with dementia is through a "twinning" program, linking up national Alzheimer’s associations across the world. For example, the U.K. with India and the Netherlands with Indonesia. Pakistan and Western Australia have also worked together to establish a day care center for people with dementia in Lahore, the Australian association sending staff to help with training and provide information. The center opened in 2007, with a further one planned for Karachi.
Anastasia Psoma, who oversees ADI’s twinning program believes that “both associations gain new knowledge, skills and experiences to continue to build and strengthen their association.”
HelpAge International has also been working to support those with mental health problems — including dementia — in Latin America. It addressed the lack of awareness of dementia among people, the government authorities and health professionals. The project has disseminated information through education and training, and screened older people to identify a decline in cognitive function.
Working with the private sector
Big pharma is an essential element in the fight against NCDs and dementia, both in researching new drugs and in supporting nonprofits in their work. A concerted effort is needed to bring forward new drugs, as only three new drugs for dementia have reached the market in the past 15 years.
Gittings has challenged global pharmaceutical companies to develop new drug therapies, and the U.K. government is funding the Medical Research Council to lead the U.K. Dementia Research Platform, bringing together pharmaceutical and biotech companies, such as AstraZeneca, GlaxoSmithKline and others.
Pharmaceutical companies also partner with nonprofits. This June, for example, Eli Lilly & Co. announced it was partnering with the ADI to produce educational resources to improve communication about dementia and help accurate diagnosis.
Describing this collaboration, Trafford Clarke, managing director of Lilly's U.K. research center said: “We know there needs to be strong partnership between academia, biotechs, pharmaceuticals and research charities if we are to overcome today’s challenging medical conditions, such as Alzheimer’s disease. That’s why we’re proud to be part of the Dementia Consortium in the U.K. and to work with charities including Alzheimer’s Disease International.”
Progress in dealing with NCDs and dementia is a mixed picture.
“More countries are looking into the issue of dementia and bodies like the World Health Organization and the OECD are paying it more attention,” said Wortmann. “But it is not an easy shot and we need to keep pressure on our governments to act and provide more funding and improve care systems.”
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