A neglected crisis: The urgent need for increased funding for noncommunicable diseases
Noncommunicable diseases are responsible for 74% of all deaths globally, yet international global health funding has not reflected a correlative response. MPP student Adetomiwa Victor Owoseni explores the historical and political reasons for this in the context of US-funded health programmes.
Last year the United States, the largest donor source for global health, spent over $12 billion to fund health initiatives around the world. This funding, channeled through organisations such as the Global Fund, PEPFAR, USAID, and others, provides critical support to low-and-middle income countries (LMICs) and helps tackle some of the most pressing global health challenges. However, this funding downpour has left a critical group of illness, known as noncommunicable diseases (NCDs), out to dry.
NCDs are a group of illnesses such as cardiovascular disease, type II diabetes, and cancers that are not mainly caused by acute infection and can have long-term consequences, thus creating a need for long-term treatment and care. The term NCDs has historically been used to distinguish this group from “communicable,” or infectious, diseases, such as malaria and HIV. Older global health discourse often considered Global South countries as suffering primarily from communicable diseases while branding NCDs as an issue for higher-income countries as a result of high levels of urbanisation and longer life expectancies. This historical perspective, plus the large 1990s increase in global health funding to fight HIV, has meant that the vast majority of money allocated goes toward communicable diseases.
But the burden of NCDs has been rising rapidly. NCDs currently kill 41 million people per year, amounting to 74% of all deaths globally. Of these deaths, 17 million occur before the age of 70. NCDs disproportionally impact people in LMICs, accounting for three-quarters of total global NCD deaths and 80% of NCD-related premature deaths. The rise in these conditions has meant that LMICs have had to contend with a “double burden” of combatting infectious diseases and NCDs simultaneously.
Despite the clear rise in NCDs, international funding has not reflected a correlative response. While NCDs directly cause the majority of deaths worldwide, according to the World Health Organization’s (WHO) report Saving Lives, Spending Less they only account for 10% of the global health budget. In fact, only 1% of global health funding is allocated to interventions for NCDs in LMICs, where they account for 67% of deaths. Specifically from the U.S., less than 1% of development assistance for health is spent on NCDs.
Why has so little US funding gone to stemming the rise in NCDs?
Aside from historical reasons mentioned above, the answer is primarily political. Firstly, funding for global health is usually tied to robust evaluation mechanisms. This is for two reasons—to show that taxpayers’ money was allocated efficiently and to measure potential health benefits from funding initiatives. But wins from investing in NCDs can be difficult to quantify. Unlike in infectious disease response, where one can count the number of malaria nets delivered or vaccines injected into arms, investing in NCDs requires longer-term partnerships to see an impact.
Secondly, given the recent COVID-19 pandemic, HIV epidemic, and Ebola outbreaks, communicable diseases are oftentimes more politically salient to American voters. Infectious diseases carry the potential to spread from person to person, and an increasingly global world means that a rise in infections anywhere carries a direct risk to us all. Thus, voters can more easily conceptualise communicable diseases as a problem and support their funding.
Of course, the US is not chiefly responsible for providing this funding nor should a global response to NCDs be dependent on donor funding. However, given funding challenges in responding to these conditions, increased investment in NCDs from wealthy countries would provide significant dividends in advancing global health goals.
What are the benefits of increased spending on NCDs?
The WHO has shown that every $1 spent on effective NCD interventions produces an average $7 return on investment for economic output. Long-term investment in NCDs, for example improving access to primary care, strengthening broad health systems, and reinforcing society’s ability to support a healthy lifestyle, can have major benefits for development in LMICs. By taking a longitudinal approach to global health funding and financing NCD-related initiatives, wealthy countries have a real opportunity to make a meaningful impact.
And while NCDs and communicable diseases are often separated in global health discourse, if anything the COVID-19 pandemic has shown us how intertwined these two groups of conditions can be. Pre-existing chronic health conditions such as heart failure and chronic obstructive pulmonary disease can worsen COVID outcomes, while COVID infections may cause residual consequences that can potentially last for years, known as ‘Long COVID’. We know that viruses contribute to the development of many cancers, and immune suppressive treatments for some chronic diseases can predispose individuals to contracting infections. Therefore, responses to communicable diseases and NCDs are inextricably connected, and funding to strengthen health systems’ ability to respond to NCDs will potentially have positive spillover effects in the treatment of infectious conditions as well.
Given the rising burden of chronic, noninfectious conditions around the world, increasing funding for NCDs is critical for supporting global health goals in the twenty-first century. To stand in solidarity with these efforts, the U.S. and other wealthy countries must commit to playing the long game and invest in an adequate response to NCDs.
Adetomiwa Victor Owoseni is a Nigerian-American MPP student and Eisenhower Global Scholar.