Historically, infectious diseases such as HIV/AIDS, Tuberculosis and Malaria have been at the center of global health initiatives, as they easily spread across national borders and threatened the lives of millions of people in low- and middle-income countries with under-developed health care systems. Yet as the world celebrates its progress on the reduction of infectious diseases, the globalisation of unhealthy lifestyles, rapid and unplanned urbanisation, and liberal market forces have propelled a possibly greater threat to the health and development of the Global South, organisations like the World Health Organisation (WHO) fear. This threat is often referred to as “the invisible epidemic” of non-communicable diseases (NCDs), yet strategies on how to overcome them still remain unclear.

WHO 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases

Causes and effects of non-communicable diseases

Source: World Health Organization

This blog entry is the first in a series of contributions exploring the rise of NCDs as a major health and development issue in low- and middle-income countries. The aim is to present and discuss evidence of the leading actors who are increasingly seeing NCDs not only as a challenge for developing countries, but also as an issue of transnational health governance that cannot be resolved at the national level alone.

A 2010 report from the WHO suggests that NCDs are overtaking infectious diseases in terms of global mortality rates. As indicated below, NCDs now represent the most frequent cause of death in all world regions, country income category, and by sex, except for the African continent. A 2011 article in the Economist, which also identified NCDs as having surpassed infectious diseases in global mortality rates, forecast NCDs to exceed mortality from infectious, maternal, and child diseases even in Sub-Saharan Africa by 2030.

Figure 1. Total deaths by broad cause group, by WHO Region, World Bank income group and by sex, 200

Total deaths by broad cause group, 2008

Source: World Health Organization, p.10.

The WHO estimates that NCDs caused 63% of the deaths worldwide, or 36.1 million of the 57 million deaths in 2008.  NCD-related global deaths in 2008 were comprised of cardiovascular diseases (17.3M), followed by cancers (7.6M), chronic respiratory diseases (4.2M), diabetes (1.3M) and other NCDs (5.7M).  The WHO also forecasts the death rate from NCDs deaths to increase by 17% in the next 10 years.

NCDs are no longer just a problem for wealthy countries

NCDs have commonly been understood as lifestyle issues in affluent countries. Yet they are affecting people in developing countries much more than generally believed. Of the 36 million deaths that occurred globally from NCDs in 2008, 29 million deaths – or 80% – were in low- and middle-income countries. And in terms of deaths occurring under the age of 60, this group constituted 29% of NCD deaths in these countries compared to 13% in high-income countries (p. 10). In conclusion, the WHO states:

“the combined burden of these diseases is rising fastest among lower-income countries”.

While many developing countries are still affected by the risks associated with poverty such as unsafe water, unsafe sex, poor sanitation and hygiene – “traditional risks” to health – the emerging concern with NCDs suggests added challenges for a growing and aging population which is becoming less active, overweight, and smoking and drinking alcohol more than before.

Poorer countries thus face a rising burden from the modern risks to health whilst concurrently combating traditional health risks with very limited resources and are likely to need international support to develop and improve their healthcare infrastructures. Yet according to these reports, global donor spending on NCDs has so far been inconsistent with the significant human, social and economic burden that NCDs represent.

High burden but little help

A 2010 working paper from the Centre for Global Development showed that less than 3 per cent of all development assistance for health, or $503 million out of $22 billion, was spent on NCDs in developing countries. Likewise, whilst NCDs are estimated to cause over half of disability worldwide and are estimated to become the leading cause for disability by 2030, donor spending in this area has been miniscule. In terms of the disability-adjusted life year (DALY), a measure of the burden of disease represented as the number of years lost due to ill-health, disability or early death, donors provided only about $0.78/DALY for NCDs in developing countries in 2007, compared to $23.9/DALY for tuberculosis, HIV, and malaria.

Thus it is perhaps remarkable that NCDs were not included in the Millennium Development Goals, which has had enduring consequences for the perception and reception of the risks and costs of these diseases. Moreover, it was only in 2011 that the United Nations held for the first time a High-Level panel on Non-Communicable Diseases and acknowledged NCDs as a serious threat to global health. Once a “rich man’s burden”, the load is evidently shifting.

The next blog entry will explore the principal actors who have been involved in the elevation of NCDs to a major issue for transnational governance and development.

Eloise Johnston is an MA student in International Relations at Macquarie University, Australia, and currently a research intern at the Max Planck Institute for the Study of Societies.


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