Non-communicable Diseases (NCDs) are those that are not passed from person to person. Often, they are referred to as chronic diseases, in that they progress slowly and have a long duration – think diabetes, stroke, asthma, heart attack, obesity, high blood pressure, cancer.

These are not the classic ‘diseases of poverty’ – malnutrition, malaria, HIV/AIDS, and so on – the burden of which has been shouldered by the world’s poor, and for which poverty has always been a major driving force.

No, these are different. You may recognise them as diseases of affluence, diseases of excess. Lifestyles and social factors generally associated with wealthy western nations are important risk factors for these conditions, such as unhealthy diets, rich in fat, sugar, and refined carbohydrates; lack of physical activity; alcohol and tobacco consumption; and longer life-span.

Worldwide, these non-communicable, or chronic diseases are by far the leading cause of mortality, representing 63% of all deaths – some 36 million people.

Surely the affluent of the world are afflicted by the diseases of affluence; the impoverished, by the diseases of poverty… right? Diseases for us, diseases for them…? Well, given the historical association with wealth, it may come as a surprise that, of the 36 million deaths each year from NCDs, 29 million occur in low- and middle-income countries – that’s nearly 80%. (Source: WHO Noncommunicable Diseases Fact Sheet)

In other words, those low- and middle-income countries are disproportionately affected by the supposed ‘diseases of affluence’. Today, NCDs are the leading causes of death in all regions, save for Africa. But, as a 2013 WHO factsheet describes, even this is unlikely to be the case for long: ‘current projections indicate that by 2020 the largest increases in NCD deaths will occur in Africa…’ And by 2030, they are expected to overtake communicable and nutritional diseases combined as the leading cause of death in the region.

MDGs to SDGs
In 1987, the World Commission on Environment and Development defined the concept of sustainable development as meeting “the needs of the present without compromising the ability of future generations to meet their own needs”. Broadly speaking, there are three strands to this ultimate goal – the social, the economic and the environmental.

But there is an intriguing parallel between these three driving forces of development, and the causes of NCDs – as Dr. Richard Smith, director of the United Health Group’s chronic disease initiative, points out:

“we who think about NCD are used to the idea that social, economic, and environmental trends are major causes of the pandemic of NCD—as people move from working in fields to call centres, get richer, buy cars, smoke, drink alcohol, and eat more meat and fatty, calorie rich foods. But NCD also contributes to all three strands—creating young widows, plunging families into poverty, driving up health costs, driving inequity, and reducing social cohesion.”

The health of populations is integral to sustainable development, a fact that has been recognised by numerous UN declarations. The 2012 UN Political Declaration on the Prevention and Control of NCDs states: “[Non-communicable Disease] undermines social and economic development throughout the world.”

Unfortunately, the international response to the growing NCD problem has been sluggish. But the epidemic itself continues to grow, stifling development, and obstructing poverty reduction efforts in low-income countries by saddling the most vulnerable with the cost of healthcare, and forcing millions deeper into poverty.

Meanwhile, as western food markets have become saturated (people can only eat so much!), western food manufacturers are turning to emerging markets to ensure continued growth, bringing with them increasingly energy-dense, high-fat diets to meet the changing appetites and lifestyles of newly urbanised regions. Sadly, this also helps to drive the NCD epidemic. As one article in the Lancet notes:

“…diabetes is not rare in sub-Saharan Africa….Available data strongly link the present epidemiological transition in sub-Saharan Africa with so-called westernisation of lifestyle”.

Paradoxically, countries that have scarcely managed to deal with hunger and malnutrition are now exposed to the dangers of chronic diseases of affluence.

As we approach 2015, the Millennium Development Goals (MDGs) are to be replaced by the Sustainable Development Goals (SDGs). Exactly what should be included in these new goals is now on the agenda. The argument for explicitly ‘embedding’ non-communicable diseases is strong – they are a leading cause of death worldwide, and have far-reaching economic, societal and environmental effects, all of which hinders sustainable development. In the face of scarce resources, ill-equipped health budgets, and a slow global response, a new and frightening barrier to post-MDG development looms.

Further reading:

• Non communicable disease and sustainable development, British Medical Journal Blog – An excellent piece by Dr. Richard Smith, in which he examines the merits of explicitly integrating NCDs into the ‘post development agenda’.
• Tackling non-communicable diseases to enhance sustainable development (PDF), NCD Alliance – a great piece that examines the impact of NCDs in the context of the ‘three strands’ of sustainable development. Gives a a clear picture of how NCD hinders sustainable development initiatives.
• Global Status Report on NCDs 2010, WHO – a description of the global burden of NCDs, their risk factors and determinants.
• Noncommunicable Diseases fact sheet, WHO – Some current facts & figures relating to Noncommunicable diseases worldwide.
• Embedding non-communicable diseases in the post-2015 development agenda (summary), The Lancet (free registration required)
• From Millennium Development Goals to Sustainable Development Goals, The Lancet (free registration required)
• Rethinking Diseases of Affluence (PDF), WHO – this short fact sheet from the WHO examines the widespread misconception that chronic diseases only affect the affluent.
• Diabetes in sub-Saharan Africa, The Lancet (free registration required) – an eye-opening look at the reality of diabetes in sub-Saharan Africa.
• The Sustainable Development module here at DevelopmentEducation.ie