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Political commitment, integrated strategies and affordable medicines are necessary for addressing NCDs

02 November 2011


Non-communicable diseases (NCDs) are threatening millions of lives unless major policy changes take effect, according to experts speaking at a press conference held in Lille, France as part of the 42nd Union World Conference on Lung Health.

NCDs, such as diabetes, cardiovascular diseases, cancer and chronic respiratory diseases including chronic obstructive pulmonary disease (COPD) and asthma, are increasing in low- and middle-income countries where access to affordable medicines poses a challenge. Prof Asma El Sony, Director of the Epidemiological Laboratory in Sudan, gave an example from a recent Union international survey: a single asthma inhaler can cost up to 14 days’ wages for a patient -- a heavy financial burden to bear, especially since a patient with severe asthma needs an average of 16 corticosteroid inhalers a year.

Cécile Macé, Coordinator of the Asthma Drug Facility (ADF) at The Union and Chair of the NCD Alliance Working Group on Essential Medicines and Technologies, pointed out that although affordable generic medicines are available internationally, many NCD sufferers in low- and middle-income countries do not have access to them. One problem is that some countries do not have national evidence-based treatment guidelines for NCDs, or have guidelines but do not implement them. Cécile Macé explained that most essential medicines for NCDs are currently off-patent or not patented, which means that they can be procured as generic products at low cost. However, since many countries appear to be unaware of this, Ms Macé emphasised the importance of collecting and disseminating independent international data on the availability and prices of treatments. An NCD Alliance briefing paper on Access to Essential Medicines and Technologies for NCDs is available for further information.

Asthma is the most common chronic disease among children, which can continue to impact them into adulthood, according to Dr Karen Bissell, Deputy Director at The Union’s Centre for Operational Research as well as deputy coordinator for ADF. The recently published Global Asthma Report 2011 provides an overview of what is known about the causes and triggers of asthma, the global prevalence, progress and challenges for asthma management. It reports that asthma that is undiagnosed, untreated or poorly treated is more costly for health systems than properly managed asthma. Patients without medicines and proper care suffer unnecessarily from their asthma, and many repeatedly end up in hospital. Dr Bissell therefore urged the international community to address issues of affordability and availability of essential medicines, especially in low- and middle- income countries.

Prof Anthony Harries, Senior Advisor at The Union and honorary professor at the London School of Hygiene and Tropical Medicine, discussed the long-known link between diabetes and tuberculosis. Diabetics have been shown to have a three times greater chance of developing active TB than a non-diabetic. TB patients who have diabetes also take longer to recover and may have a recurrence of TB. The dramatic increase in diabetes worldwide therefore has implications for the future of TB control. The Union’s recent collaboration with the World Health Organization resulted in a Collaborative Framework for Care and Control of Tuberculosis and Diabetes, which aims to tackle this issue.

Tobacco use is a major risk factor for cardiovascular diseases, cancer and chronic respiratory diseases including COPD. However, tobacco use and exposure to smoke are also leading to an increase in tuberculosis and asthma. This needs to be addressed on a policy level alongside conventional strategies for controlling NCDs. Speakers agreed that NCDs are adversely impacted by tobacco use and therefore it is an issue that needs to be taken seriously by policymakers, according to Dr Nils Billo, Executive Director at The Union. It is important to highlight to governments the effectiveness of raising taxes, especially in deterring youth from starting to smoke and encouraging smokers to quit, according to Sylviane Ratte, Tobacco Control Technical Advisor to The Union. Taxation will help reduce the tobacco epidemic, which causes one in six NCD deaths worldwide, Ratte emphasised.