Why Chronic Disease?

Current State:

Global health and health development efforts typically focus on “traditional” medical relief programs such as infectious disease, women and children’s health (child survival, nutrition, and now microfinance), and water purification / sanitation programs. And why not? There is a huge need and tese programs are especially desirable because the majority of cases they involve a known prevention or treatment that can have the largest “bang for the buck” with dramatic public health outcomes for the investment. This is why USAID, the Gates Foundation, and large health-focused donors have made significant investments over the years to TB, malaria, and HIV programs over the years. Of the roughly $12.9B¹ donated for international health relief efforts annually from the US, 99% of funding is aimed towards these conditions.

What’s Changing?

So why chronic disease? For anyone who has read The Bottom of the Pyramid or The World is Flat, you may be aware that times are changing (or have changed already) for a number of developing countries around the world. What impact does this have on health in these countries? With rapidly growing middle and middle-upper classes, especially in urban and suburban areas, these communities are starting to see a shift in “disease demographics” that will require a multi-tiered and multidisciplinary approach to slow the development of emerging diseases as a whole.

The World Health Organization (WHO) has been a strong leader in raising global awareness and a much needed sense of urgency around chronic disease. I promise, the numbers will blow you away. The developing world accounts for 80% of the global death burden for chronic diseases today. This is not just attributed to the populations in these countries; cardiovascular disease (CVD), diabetes, chronic obstructive pulmonary disease (COPD), and cancer are already the leading killers in the majority of developing countries in Africa and Asia, as they unquestionably are in the Western world.

WHO Statistics²:

• 80% of people with diabetes live in low and middle income countries
• Chronic disease currently accounts for 60% of global deaths but is expected to rise to 73% by 2020
• Diabetes estimates alone indicate a projected 200%+ increase from 180 million to 366 million by 2030 (90% of which is Type II diabetes and preventable)
• Most people with diabetes in low and middle income countries are middle-aged (45-64), not elderly (65+)

Please note, like many infectious diseases, chronic diseases among the poor are often PREVENTABLE and TREATABLE with known, proven prevention approaches and solutions. Without proper prevention and treatment, these productive members of society will often go blind, be placed on dialysis, or lose limbs (diabetes); require permanent oxygen dependency and/or physical handicap (COPD); or suffer from stroke, heart attack and death (CVD).

There is also a large economic case for a focus on chronic disease globally. The crippling rise in the cost of healthcare in the US is largely attributed to the burden of chronic disease prevalence, management, and treatment. At the same time, lost economic productivity due to chronic disease is already a reality for developing countries. The BRIC countries alone demonstrated a $1.15 trillion economic income loss in 2005³ (Brazil - $49.2B, Russia - $303.2B, India - $236.6B, China - $555.7B). The real ROI here is in prevention – both delaying and preventing the onset of disease all together.

A Call to Action:

It is clear that dynamic changes in patient needs and disease states create opportunities for both commercial and non-profit organizations to have a significant impact. A focus on prevention, early diagnosis, and sustainable treatment mechanisms are critical to addressing the needs of a population and vary dramatically based on specific environmental, physical, and cultural factors and trends.

Project HOPE and its partners have been strong leaders in this space. And while I’m not an expert in this field, I plan on using my emerging markets, healthcare, and consulting lenses to identify some new opportunities and solutions to address the community need in a number of countries around the world. Working with Project HOPE’s global and regional leads, local partners, subject matter advisors, and Deloitte we will aim to proactively anticipate these trends and aggregate organizations that invest as “first movers” in regions and countries where patient needs are urgent and growing.

Inaction is Your Choice:

Perhaps many in the Western world has “come to terms” with chronic disease or views it as a natural progression of society in a number of ways. I urge you to think differently. These issues require urgency in the US and Europe, in addition to emerging countries around the world where their resources and infrastructure aren’t targeted towards these conditions (largely focused on acute disease). These issues require massive education both for health professionals and communities, infrastructure and capacity building, and most importantly fundamental changes in lifestyle, behavior and mindset for patients and families everywhere.

Footnotes:

1. Conference Board; Non-Profit Quarterly, 2009; USAID Budget 2007; Foundation Center 2009

2. World Health Organization – Chronic Disease Report 2005

3. World Health Organization – Working Paper 2006, An estimation of the economic impact of chronic noncommunicable diseases in selected countries