The fact that noncommunicable diseases like diabetes and cancer are a problem in low-income countries still surprises some people, says Helen McGuire. After all, work in global health has understandably been most sharply focused on the communicable side of things—HIV, malaria, diarrheal diseases, and other deadly maladies that spread from person to person.
But, says Helen, who recently joined PATH as our first director of noncommunicable diseases, epidemiological evidence has been building for years that shows noncommunicable diseases are a serious and growing problem in poorer countries, just as they are in wealthier ones. In fact, she says, the global burden of disease attributed to noncommunicable diseases is greater than that attributed to communicable diseases and injuries combined. The question now is how to address what Helen calls the “double burden of disease”: the communicable diseases we must continue to fight and the burgeoning problem of chronic diseases.
On May 29, Helen will join a panel discussion on the subject at Women Deliver, an international conference focused on improving the health and well-being of girls and women. We asked her to give us a preview.
Which noncommunicable diseases are problems in low-resource settings?
The World Health Organization (WHO) has focused on cancer, diabetes, cardiovascular disease, and chronic lung diseases. In fact, WHO hopes to confirm the action plan to monitor progress against these diseases at the World Health Assembly next week. One of the reasons they’ve focused on these four is their impact on development and their common risk factors: physical inactivity, use of alcohol, unhealthy eating, and smoking. So when we look at prevention initiatives, we can have a greater impact by grouping these four diseases together.
Can you use the same kind of interventions to prevent or manage these diseases?
Prevention and management are two different things. Certainly for prevention, by addressing physical inactivity, alcohol use, unhealthy eating, and smoking, you potentially will have impact on those four noncommunicable diseases. But when we get to long-term disease management, because we have limited funding, we need to be especially creative. We need to think about how we can use the great work that’s been done in areas like HIV, tuberculosis, and maternal and child health, and ask ourselves: how can we leverage those care platforms to advance available and accessible care for people with noncommunicable diseases?
Is that what you’ll be talking about at Women Deliver?
Yes. We’ll be looking at how we can integrate noncommunicable diseases into the care platforms that have traditionally been oriented toward women. When do we interact with women, and how can we optimize that interaction to ensure that we’re not only addressing traditional global health issues, but being more comprehensive with the care and the messages that we provide?
Can you think of an example?
When a woman’s expecting a child, she might be screened for gestational diabetes. What are the messages we’re giving her about healthy eating and physical activity then? Women play such a wonderful role in shaping healthy lifestyles for the whole family that reaching them at this point might have an impact on their children and partners, too.
And we can also do better at providing services. At PATH, for example, we’re developing screening for gestational diabetes that doesn’t require fasting. Right now, let’s say a woman arrives at the health center, and she hasn’t fasted, and she learns that she needs to be screened for gestational diabetes. She has to go back home, she has to fast, and then she has to come back for the test. If she could be screened at the point of care—that is, when she arrives at the health center, without fasting—it reduces direct and indirect costs to the health system and to the woman herself.
What’s it going to take to put these kinds of changes in place?
Creativity and collaboration. We need to look at health issues in low-resource settings differently. Just because we have a double burden of disease doesn’t mean we’ve doubled the funding that’s available. And so, yes, we need to continue to be concerned about communicable disease. But we can’t ignore that with noncommunicable diseases, we now have a double burden. And we need creative ways to address this.