Disability, noncommunicable disease and health information

Perspectives Noncommunicable diseases (NCDs) are a major cause of preventable disability worldwide. 1 While actions to monitor NCDs have gained significant momentum in the global health agenda, similar developments to monitor and manage the growing burden of NCD-related disability have been relatively slow. The global NCD action plan was developed to support country efforts in addressing the devastating social, economic and public health impacts of NCDs. 2 The NCD action plan includes nine voluntary targets and a monitoring framework. However, the monitoring framework has been criticized for its focus on mortality while neglecting adequate measures of morbidity and disability. 3 This has resulted from focusing on existing data within health information systems, rather than on identifying appropriate data for measuring disease burden. Indeed, the issue of the chro-nicity of NCDs seems absent in most monitoring and evaluation frameworks, with an implicit assumption that the only outcome of interest for countries is premature mortality. Responding to this limited scope, several alternative frameworks have been proposed to provide more comprehensive approaches to the prevention and control of NCDs. While these frameworks offer a broader approach to NCD prevention, they offer little for the millions of people already living with an NCD. Disability related to NCDs needs to be addressed in line with principles of the Convention on the Rights of Persons with Disabilities, including the provision of long-term rehabilitative services. As defined in the Convention, persons with disabilities are those who have long-term physical, mental, intellectual or sensory impairments, which hinder their full and effective participation in society on an equal basis with others. Here we argue for the need to improve health data by incorporating measures of NCD-related disability into discussions on NCD prevention and control; strengthen information systems to better capture data on disability; and to align NCD and disability measurement and monitoring strategies. Low-and middle-income countries have a large and growing NCD burden (Fig. 1). NCDs already account for two out of every three years lived with a disability 5 and in 2008, 80% (29 million) of all NCD-related deaths were in low-and middle-income countries. 5 NCDs also affect people at younger ages in low-and middle-income countries, with around one-third of NCD-related deaths occurring among people younger than 60 years of age. 1 Seventy per cent of people living with diabetes live in low-and middle-income countries, 6 where access to health care and social support are limited. It is …