Action on noncommunicable diseases: balancing priorities for prevention and care.

Editorials After long being neglected, the global problem of noncommunicable diseases (NCDs) has received increasing attention , culminating in a United Nations high-level meeting on NCDs in New York in September 2011. 1 The growing global NCD crisis is now killing 36 million people each year and needs urgent and comprehensive action. 2 Attention is mainly focused on cardiovascular disease, diabetes, cancers and chronic respiratory diseases, but debate remains about the relative importance of prevention and care. One of the lessons learnt from pioneering United Nations summits on HIV held in 2006 and in June this year is the importance of agreeing on priority actions for both prevention and care. 3 A focus on prevention alone disregards the needs of current and future patients, and may diminish the impact of prevention policies as people are reluctant to test for a disease for which there is no prospect of effective treatment. A balance must be found between the upstream, multi-sectoral policies for NCD prevention for the benefit of future generations, and the downstream, health-sector interventions for ensuring that people currently with NCDs obtain quality care. Where does the balance stand at present? The focus of discussions on priority actions within the health sector has so far mainly been on the multisectoral policies for prevention of NCDs – policies that lie beyond the health sector and mainly require government action, such as tobacco and alcohol control, ensuring environmental safety, and promotion of agricultural and food industry reforms. While necessary to reduce the future disease burden, prevention interventions will do little for the growing number of people who have already developed NCDs, and who are essentially being used to justify investments that will come too late to help them. As the global community gears up towards actions and investments aimed at limiting the number of future NCD patients, an important and unique responsibility for health advocates is to ensure that people with NCDs receive quality care today. The inverse care law applies to the global problem of NCDs: with 80% of NCD deaths occurring in low-and middle income countries, those most in need of care have least access. Health systems in developing countries have often been oriented towards tackling communicable disease and the approach to NCDs there is often unstructured, lacks systematic follow up and monitoring of chronic clinical care, and provides little information about morbidity or mortality, a crucial element for effective …