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Learning from AIDS: Responding to Non-Communicable Diseases

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As executive director of UNAIDS from 1994 to 2008, I was privileged to have a front row seat at one of the great global health struggles of modern times. Although our work against AIDS is far from finished, we have stabilized the pandemic and started to imagine a world without AIDS.

Unfortunately, the same is not true of non-communicable diseases (NCDs) like cancer, cardiovascular disease, chronic respiratory disease and diabetes, which cause nearly two out of three deaths in the world (80 percent of those in developing countries).

Infectious diseases like AIDS continue to have a devastating impact on the health and development of many low- and middle-income countries, particularly in Africa. However, NCDs have slowly emerged, in the words of The Economist, as "the poor world's greatest health problem" and the major causes of premature deaths there.

NCDs are a time bomb. If left unaddressed, they will lead to more death, disability and the implosion of already overburdened health systems in developing countries at huge cost to individuals, families, businesses and society. Like AIDS, NCDs are a problem for rich and poor countries alike, but the poor suffer the most.

The 2011 U.N. High-Level Meeting on NCDs -- only the second time the UN had convened a major meeting on a health issue, following the U.N. AIDS Summit in June 2001 -- was a landmark event in the short history of the fight against NCDs but was not a tipping point. Much more remains to be done.

I believe we have learned much from AIDS that can help leaders design effective and sustainable responses to NCDs:

  • Leadership: Strong national leadership at the highest level was critical in achieving a coordinated and broad-based response to AIDS. Just as national AIDS programs have served as the basis for international support of AIDS funding, national governments and international donors should invest in country-based NCD programs.
  • Key Role of People Affected: People living with HIV have been playing a key role in raising the profile of AIDS, holding governments and international organizations accountable andmobilizing affected communities. With the exception of survivors of breast cancer, this is rarely the case with NCDs. People affected with NCDs must step forward and play a more prominent role.
  • Multidisciplinary Response: AIDS was not simply a health problem. It took many years for the AIDS response to evolve from a purely infectious disease approach to a broader societalapproach. The NCD problem won't be fixed by medical professionals alone. We need a response that is multidisciplinary and society-wide.
  • Rallying the World: We must rally the whole world around NCDs the way we did with AIDS. Communication messages came from the ground up. Souls were touched. There was a clear ask. Civil society and NGOs from around the world were engaged. It takes time, but we're making a good beginning in building the NCD movement.
  • Time-Bound Targets and Accountability: The AIDS response benefitted from global and country-level commitments with concrete indicators and agreed targets. It is vital that NCDs have these as well. In May, the World Health Assembly approved a target of reducing mortality from NCDs by 25 percent by 2025. That's a promising start, but more is needed. The NCDAlliance has put a great deal of thought behind a comprehensive set of asks. Let us add our voice and advocate for those.
  • Prevention and Treatment: Despite successes in both AIDS prevention and treatment, nearly twice as many people are newly infected with HIV as are put on treatment every year. We cannot treat ourselves out of the AIDS pandemic. In the case of NCDs, treatment is important but prevention is key. We must invest resources in both prevention and treatment.
  • Science and Technology: Of course, technology and science played a role in the AIDS response, particularly the discovery of antiretroviral treatment, but we also learned there were limits to our reliance on technology. Indeed, there are technical solutions for NCDs, but NCDs are fundamentally not a technical problem: this is a bigger challenge than giving everyone a pill and monitoring blood pressure. I'm convinced we need radical changes in lifestyle, in how society is organized and in the business practices of the food and beverage industry.
  • Efficient Resource Utilization: The urgency of the AIDS response sometimes caused ineffective use of resources. We cannot afford those mistakes with NCDs. In this era of scarce resources, we need to ensure access to the most feasible, cost-effective and sustainable NCD interventions to the populations most at risk, while continuously learning from programs and services on the ground.

The AIDS response taught us that efforts to address a pandemic are incremental and take time. We must have patience. And we need to be both opportunistic and strategic to design an NCD response that is commensurate with the scale of the problem.

I am not suggesting that we should transpose mechanically the AIDS experience to the very complex realities of NCDs, but I believe that leaders of the NCD response can be inspired by, and learn from, the AIDS experience. With more people living for longer periods with AIDS, it is the chronic nature of AIDS that is giving governments and health experts a new opportunity -- to use health systems set up for HIV/AIDS care and treatment and strengthen them to address NCDs.

It would be tragic to save a person from a disease like AIDS if that person then dies from one like cancer.

CORRECTION: An earlier version of this post incorrectly stated that the World Health Assembly approved a target of reducing mortality from NCDs by 25 percent by 2015, not 2025.

This article is one of several being published to mark the first anniversary of the 2011 United Nations High-Level Meeting on Non-Communicable Diseases on Sept. 19. The series is coordinated by Arogya World in partnership with the Young Professionals Chronic Disease Network and will be housed at www.arogyaworld.org.