September 22, 2010 | Read Time: 6 minutes
The billions of dollars nonprofit groups and governments have pumped into health programs in poor parts of the world have provided anti-AIDS drugs to millions of people and helped to cut the number of people dying from malaria, among other accomplishments. Now some global-health charities are turning their attention to diseases that can’t be spread through infections, such as cancer, diabetes, and heart disease. And they are urging donors to follow suit.
The health advocates point to statistics showing that these noncommunicable diseases, while sometimes thought of as “rich country” problems, have become the biggest killers in many low- and middle-income nations. Sixty percent of deaths in developing countries come from such illnesses, the World Health Organization says. Yet, according to a forthcoming report from the Center for Global Development, money to fight them amounts to less than 3 percent of the $22-billion that governments, businesses, and nonprofits spent in 2008 on health aid.
“We happily see declines in infectious diseases and unhappily see increases in non-infectious diseases, and donor funding has just not come close to responding to that changed health profile,” says Rachel Nugent, deputy director for global health with the Center for Global Development, a think tank in Washington. “There is a huge and glaring disparity.”
That message is slowly getting out. This week, Paul Farmer, the co-founder of Partners in Health, in Boston; the cyclist and anti-cancer advocate Lance Armstrong; and other nonprofit leaders will be discussing cancer in the developing world at the Clinton Global Initiative, the former president’s annual philanthropy gathering. The United Nations is holding its first high-level conference on noncommunicable diseases in 2011.
Spending Rises
With greater attention, money—at least a trickle of it—is beginning to follow. Just this week, the Medtronic Foundation, the philanthropy arm of the medical-device company, pledged $1-million for the U.N. event on noncommunicable diseases. The Center for Global Development estimates that support from private donors for noncommunicable diseases has risen steadily since 2004. Nonprofit groups that focus on diseases like cancer in the United States are spending money to experiment with overseas work, while global-health groups are developing new programs to fight noncommunicable diseases.
For example, groups like Susan G. Komen for the Cure, in Dallas, and Livestrong (called, more formally, the Lance Armstrong Foundation), in Austin, Tex., have held global anticancer events and conducted research on ways to fight cancer abroad. In 2008 the Armstrong foundation spent a year studying what it could do outside the United States; the charity is now testing two projects in Mexico and South Africa to fight the stigma that surrounds cancer diagnoses in those countries.
Population Services International, a Washington nonprofit organization that has large HIV and malaria programs, is focusing on preventive measures against non-infectious diseases, spending $500,000 to test an anti-obesity program in Mexico. It is also investigating potential projects to fight tobacco use in poor countries and protect women from gestational diabetes.
IMA World Health, a New Windsor, Md., nonprofit that provides medicines overseas, runs programs to treat Burkitt’s lymphoma, a form of cancer that mostly affects children in Africa, and to fight cervical cancer. Partners in Health, the Boston nonprofit, has trained local nurses to care for people with chronic diseases and now offers chemotherapy for some cancers and kidney dialysis at its sites in Rwanda and Haiti.
Economy’s Downturn
But seeking more aid for such efforts will be difficult, in part because some donors still don’t realize how widespread non-infectious diseases are in developing countries. What’s more, aid for global health may not be expanding enough to meet the needs to treat both types of diseases. In fact, existing health projects face cuts because of the global recession.
There are other reasons, too, why fighting cancer, diabetes, and other such illnesses in the developing world hasn’t attracted more money. Donors tend to stick with what they know, and in the health field that has often been infectious disease and efforts to reduce child and maternal deaths. Asked on a recent conference call about whether the Bill & Melinda Gates Foundation might tackle noncommunicable diseases, Ms. Gates agreed that diseases like diabetes have become a growing problem but said: “For now, the foundation is focused on what it’s focused on.”
In addition, noncommunicable illnesses aren’t discussed explicitly in the “Millennium Development Goals,” the antipoverty benchmarks developed by the United Nations.
Ann Keeling, chief executive of the International Diabetes Federation, says that has meant that health officials in poor countries don’t feel they can ask for money for such illnesses, and if they do they are sometimes criticized. “That policy is nonsensical and has to change,” she says.
Some health experts also say that these noncommunicable-disease advocates haven’t done a good enough job of making their case. They need to show, as infectious-disease advocates have done, how non-infectious illnesses hurt economies and national security, nonprofit officials say.
But there are also some very good reasons why donors have focused on infectious diseases. In many of the poorest countries, infectious diseases still do kill more people than noncommunicable ones. And many of these infectious diseases can be easily prevented, while in the case of some types of cancer, for example, palliative care may be the only option.
Low-Cost Efforts
Even so, experts who focus on non-infectious illnesses say there is a lot that donors, governments, and nonprofits can do to prevent and treat those conditions, often at little cost.
Anti-tobacco programs, for example, could cut down on lung cancer, while breast cancer can be treated through a combination of surgery and drugs. Vaccines can prevent some types of cervical cancer. And diabetes drugs are relatively cheap to produce.
“There is so much we can do,” says Felicia Knaul, a breast-cancer survivor from Mexico who serves as director of the Harvard Global Equity Initiative. She says that when nothing can be done but pain reduction, people in poor countries deserve that care as much as people in rich countries: “We believe it’s a human right to control human suffering.”
Ms. Knaul, Ms. Keeling, and others also emphasize that reducing deaths and improving care of people with chronic illnesses isn’t about big investments in specific diseases. Instead, it’s about strengthening overall health systems to help treat patients, rather than diseases, more effectively.
Ms. Knaul points to the comprehensive approach taken by Partners in Health and to Mexico’s national health-insurance program, which provides coverage for some types of cancers.
While the global economic climate could create tension among people who are seeking support to fight specific diseases, Ms. Knaul points out that all people working in global health have the same goals.
“Advocates are being drawn into this because of their own success,” says Ms. Knaul. She says it’s hard to imagine that the attitude will be: “I cured you from malaria, but if you get diabetes, I will let you suffer a terrible death.”
