Noncommunicable diseases are barriers to delivering on global health commitments related to poverty, equity, gender and more. An inclusive NCD agenda that recognises all NCDs - including thyroid disorders - is essential to deliver on these goals.

Since 2010, the noncommunicable disease agenda has been gaining political attention and will to act on NCDs as the leading cause of premature death and disability globally. This has allowed the NCD agenda to expand from its initial 4x4 approach – focused on four modifiable risk factors (tobacco use, physical inactivity, harmful use of alcohol, unhealthy diets) and four major NCDs (cardiovascular disease, cancer, diabetes, and chronic respiratory disease). Since 2018, we’ve had a broader “5x5” agenda, to include air pollution as a risk factor and mental health and neurological disorders as a major disease group. Now, it is time to expand the NCD agenda once again to ensure that no one is left behind.

The principle of ‘leaving no one behind’ is inherently underpinned by the 2030 Sustainable Development Agenda and the very concept of universal health coverage. However, even with the current ‘5x5’ NCD framework, the absence of various major NCDs has led to concerns that many people living with NCDs are falling between the cracks.

Thyroid disorders: What are they?

The thyroid gland is the “master controller” of metabolism and plays a key role in health and wellbeing. Thyroid disorders such hypothyroidism (too little thyroid hormone) or hyperthyroidism (too much thyroid hormone) can lead to health issues like diabetes, obesity, arthero-sclerosis, growth disorders, hypertension, osteoporosis, infertility, sexual dysfunction, endocrine cancers. 1.6 billion people are estimated to be at risk of thyroid disorders – yet these diseases are not officially included as noncommunicable diseases. This means that people living with thyroid disorders face barriers across a number of fronts: inclusion in policy agendas; healthcare professional awareness; prevention of diseases and complications; access to screening, timely diagnosis and care; data collection; research; and funding.

Addressing thyroid disorders within the NCD agenda

Many thyroid disorders are common and easily treatable, but these diseases often go undiagnosed. Recognition of thyroid disorders as NCDs could help ensure better diagnosis and care. Despite this, there is no WHO policy, other than that relating to iodine deficiency (a main cause of hypothyroidism that affects over 2 billion people globally), to deal with the rising prevalence of thyroid diseases. Addressing thyroid diseases is also addressing gender inequity in health. Gender is the key risk factor for thyroid disorders as they are 10 times more common among women than men and one in eight women will develop a thyroid disorder in her lifetime. Being over 60, having been recently pregnant and having type 1 diabetes also increase risk. While these risk factors are largely beyond our control, there are others that we can do something about, like smoking and an unhealthy diet – two key risk factors for the “big five” NCDs.

Actions to support thyroid health

Governments need to intensify their policies to raise awareness of thyroid disorders, as they can have an impact on the outcome of various other NCDs, increasing the disease burden for patients and the outcome of co-morbidities, as well as the economic burden for countries. Thyroid diseases should therefore be recognised as NCDs.

To implement inclusive NCD policies and support thyroid health, governments need to adopt a rights-based approach and build synergies with other policy areas, such as those addressing health inequalities. This includes gathering country-specific evidence and data to inform national plans and developing a clear and compelling narrative for advocates, governments and policy makers and ensuring that our health systems are responsive to a wide range of NCDs.

There are also evidence-based policies to address the causes of NCDs. The WHO Best Buys for NCDs are among the most effective, with a list of policy options for NCD risk factors. They include recommendations on price, advertising, labelling, availability, and public awareness that can be implemented by governments to create healthier environments for their populations.

There is an urgency to act if we want to achieve a more inclusive agenda. We are approaching the UN High-Level Meeting on NCDs in 2025, a critical time for governments to meet their global NCD targets, as well as the SDGs. There are imperative actions and steps that we can all work on to ensure progress. Thyroid health promotion, education and inclusion is one of them.

For the NCD agenda to be more inclusive and address gender inequality in health, people with thyroid disorders must not be left behind.

*This blog builds upon findings from the report “Leaving no one behind: Ensuring inclusive NCD responses” and the online event held in April 2022 supported by Merck KGaA (recording available here).

About the author:

Professor Leonidas H. Duntas, M.D. is Professor of Internal Medicine and Endocrinology at the University of Ulm, Germany, and at the Evgenideion Hospital, Unit of Endocrinology, Diabetes, and Metabolism, University of Athens, Greece. His main clinical and research interest is thyroidology, with a special focus on the impact of environmental and nutritional factors. Professor Duntas is currently the Secretary of the European Thyroid Association, and co-chairman of their Public Health Board. He is the author or co-author of 156 peer-reviewed original articles and reviews.