It’s been almost 10 years since the World Economic Forum identified non-communicable diseases as a global risk to economic development, and since the first UN high-level meeting on NCDs took place in which a political health declaration was made. Additionally, it’s been almost five years since the 2030 Agenda for Sustainable Development and its Sustainable Development Goals were set, where government officials made a bold commitment to reduce, by 2030, premature deaths from NCDs by one third.
In retrospect, have we made real progress? I believe we have, but the progress is too slow, as seven in 10 people worldwide die from cardiovascular diseases, cancer, diabetes and chronic lung diseases. According to the World Health Organization, this includes 15 million people dying from an NCD between the ages of 30 and 69 years, which is considered “premature,” having a considerable impact on productivity and economic growth across the world. Nevertheless, only two percent of international health funding to low- and middle-income countries has been dedicated to preventing NCDs, according to a report by Bloomberg Philanthropies.
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How can we accelerate progress?
According to the World Health Organization, three of the challenges impeding progress include insufficient technical and operational capacity, insufficient financing to scale up responses and lack of accountability. Various multilateral organizations have advised that to approach the NCDs burden effectively, governments, civil society and the private sector at global, regional and national levels must collaborate for the prevention and control of NCDs, though governments must lead the way by establishing national policies and plans with specific targets and indicators. I personally agree with this recommended approach, as we won’t be able to tackle such a big health issue by working in silos. Most importantly, things need to move from declarations, policies and multisectoral panel discussions to actual joint actions.
Cancer, for example, is the second leading cause of death globally, with WHO estimating that it accounted for 9.6 million deaths in 2018. By 2025, there will be an estimated 19.3 million new cancer cases and 11.4 million cancer deaths, according to the Cancer Atlas project. When analyzing the fight against cancer, there are some cases of how the collective us has contributed to progress. It seems we have learned something good from our enemy after all: the power is in the numbers.
According to the World Cancer Research Fund International, being overweight or obese increases the risk of 12 common cancers, five more than the evidence showed 10 years ago. The organization’s recommendations to reduce the risk of cancer include being physically active and maintaining a healthy diet by eating daily wholegrains, fiber, vegetables and fruits. I came across a public-private partnership that’s proven to be effective and, although its main objective was not aimed at preventing cancer per se, is definitely contributing to cancer control efforts by addressing childhood obesity. For the past 10 years, the Mondelēz International Foundation has been partnering with private and public organizations across the world supporting the delivery and evaluation of school-based healthy lifestyle programs, focusing mainly on fostering healthy dietary and physical activity behaviors. Program reports commissioned by partner organizations between 2014 and 2016, as well as a subsequent study published in Food and Nutrition Bulletin in 2018, concluded the programs are having a positive impact on nutrition and physical activity knowledge and behavior change. Specifically, there was a 12 percent increase in understanding what good nutrition is, including knowing the number of fruits and vegetables to eat daily; a six percent increase in physical activity to at least 30 minutes daily; and an 11 percent increase in eating more fruits, vegetables and other fresh foods, as part of the gardening programs. This PPP also shows that impact takes time and joint commitment. These types of initiatives should be able to withstand leadership changes of all sorts, from government, companies and NGOs, as it’s not about idealisms or individual recognition but rather, about solving a problem for the benefit of society as a whole.
Another effective PPP for cancer control is focused on cervical cancer prevention and early diagnosis. Cervical cancer is the fourth most diagnosed cancer in women, with an estimated 570,000 new cases in 2018, according to the WHO. It’s one of the few types of cancer that can be prevented by having regular screenings, receiving the human papillomavirus vaccine and the early treatment of pre-cancerous lesions. The Partnership to End AIDS and Cervical Cancer was announced in 2018 as a PPP to prevent cervical cancer progression and mortality among HIV-positive women in eight sub-Saharan African countries. The founding members of the PPP included the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the George W. Bush Institute and the Joint United Nations Program on HIV/AIDS (UNAIDS). Earlier this year, Merck joined the partnership and its contribution will include provision of HPV vaccines. Since the its inception, more than 500,000 women have been screened for cervical cancer, nearly 32,000 women have been treated for pre-cervical cancer lesions and over 147,000 girls have been vaccinated against HPV.
While City Cancer Challenge is not a PPP, it’s a foundation that leverages the power of locally-driven PPPs to deliver quality and equitable cancer care in cities across the world. In 2015, 400 million people lacked access to essential health services, according to the WHO. City Cancer Challenge engages city stakeholders in the design, planning and implementation of cancer care solutions to close major gaps—from diagnosis to treatment to palliative care. While cities take the lead in developing cancer treatment solutions, they work closely with City Cancer Challenge’s multisectoral community of local and global partners, which include various private sector companies such as Roche, who provide technical assistance through each phase of the initiative. By taking a health systems approach, cities reduce inequities in access to quality cancer care and improve the health and wellbeing of their citizens. In 2018, City Cancer Challenge engaged more than 50 partners, 817 healthcare professionals and 147 health facilities, directly impacting more than 600 patients and reaching nearly 32.7 million people in seven countries around the world.
What can we learn from these examples?
My takeaway is that it’s not impossible to effectively manage conflicts of interests between the public and private sectors and focus on the common goal of addressing the burden of NCDs to make a difference in cancer control. By joining forces, we can hold each other accountable; and by combining resources, both financial and technical, the impact can be greater and we can accelerate change. After all, just like the disease, our strength is in the numbers. If we can all unite and act with certainty to reduce the global cancer burden, our efforts would be much more effective, and we would be able to change the disease projections. Let’s set our differences aside and focus on the common goal: to live long and productive lives. Start by listening to a stakeholder with a different point of view. Debate ideas. Begin implementing pilot programs and then scale them up. Give them continuity. Don’t give up.
Melissa Gomez is Vice President and Health Sector Lead at Edelman Miami.