Global noncommunicable diseases--lessons from the HIV-AIDS experience.

T ubiquity and impact of non­ communicable diseases such as cardiovascular diseases, type 2 diabetes, cancers, chronic obstruc­ tive pulmonary disease, and psy­ chiatric disorders present major global health, development, and societal challenges.1 Acknowledg­ ing this fact, the United Nations (UN) General Assembly will hold a high­level meeting on global noncommunicable diseases on September 19 and 20, 2011, in New York. The movement to rec­ ognize and address the preven­ tion and control of global non­ communicable diseases in this way undoubtedly drew some inspira­ tion from a 2001 UN summit that produced a “Declaration of Com­ mitment” on the human immuno­ deficiency virus (HIV) and AIDS, generating awareness and resourc­ es, and propelling collective global action to confront the HIV–AIDS pandemic.2 And indeed, the expe­ rience with HIV–AIDS offers les­ sons that may apply to the initia­ tive for noncommunicable diseases. In the early days of HIV–AIDS, the U.S. Centers for Disease Con­ trol and Prevention and the World Health Organization emphasized disease surveillance to draw at­ tention to the problem and im­ prove our understanding of the growing magnitude, demograph­ ics, and cost of the epidemic. At the same time, the U.S. National Institutes of Health and others sought to understand the biology of the disease and to find effec­ tive therapies and preventive ap­ proaches, often necessarily sup­ porting research in geographic areas where the disease was high­ ly prevalent. There was also pres­ sure to deliver solutions expedi­ ently, to which the U.S. Food and Drug Administration responded by initiating a parallel­track ap­ proval process. Several powerful activist groups, motivated by the inevitable fatality of HIV–AIDS, launched influential advocacy campaigns, which drew active and vocal participation from physi­ cians, medical societies, high­ profile celebrities, and affected groups. These advocacy efforts garnered major resources in the form of the U.S. President’s Emer­ gency Plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis, and Malaria, which committed billions of dollars from many high­income countries to fight these diseases globally (see graphs). HIV is a transmissible infection with identifiable behavioral risk factors; it leads to a chronic debili­ tating disease that is fatal in the absence of early detection and ef­ fective treatment. Over the years, experts on HIV–AIDS have come to accept three realities: the search for cause and cure and the fight against the pandemic must be global rather than national; pre­ vention must inevitably be linked to early diagnosis and treatment, which means that approaches must be developed that effectively con­ nect community resources with or­ ganized health care systems; and although behavior plays a major role in risk for HIV, prevention ef­ forts need to integrate both behav­ ioral and biomedical approaches — for example, promoting con­ dom use and advances in bio­ medical interventions (e.g., micro­ bicides, pre­exposure prophylaxis, and treatment as prevention) are complementary in reducing inci­ dence. Taking lessons from the HIV– AIDS experience and applying them well could shorten the learning curve for noncommuni­ cable­disease prevention and con­ trol. Good surveillance systems for noncommunicable diseases and their risk factors are crucial for measuring the magnitude of the problem and its associated costs, identifying vulnerable sub­ groups, and evaluating the ef­ fects of policy and practice inter­ ventions, especially in low­ and middle­income countries where such data are woefully lacking. Serious global commitments to basic and applied research are essential; research is currently overwhelmingly concentrated in high­income countries, but the burden of noncommunicable dis­ eases is felt around the globe. Indeed, these diseases often dis­ proportionately affect low­ and middle­income countries and fre­ quently strike young and middle­ aged people who are at the peak of their economic productivity. Conducting research only in high­ income countries neglects the possibilities of elucidating vari­ ability in the causes of and risk for noncommunicable diseases among populations worldwide, of