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Non-Communicable Diseases: The Next Great Global Health Challenge

Kids on the Cancer Ward at Butaro (2)

“We all have the same health problems, but we don’t all have the same access to health care.” 

That was the message Ernest Madu, MD, chairman and CEO of the Heart Institute of the Caribbean, shared with Perelman School of Medicine students and faculty during the Penn Center for Global Health’s inaugural Global Health Champion Award ceremony last month. Madu was honored with this award because of his pioneering efforts to improve access to health care in underserved communities in Africa and the Caribbean. 

Madu, a cardiologist by training, has worked for decades to develop novel methods to provide technologies that might be taken for granted in wealthier nations, such as the United States, to resource-limited settings. Seeing such huge disparities in access to what others might consider basic health care, such as EKG machines, inspired Madu to found the Heart Institute of Caribbean (HIC), in Kingston, Jamaica. 

Launched in 2004, HIC serves as a center of excellence for cardiovascular diseases, occupational health, diabetes care, and general internal medicine in the West Indies. Prior to HIC’s inception, the only option for patients in need of these services was to travel at huge expense to the United States or other countries with more developed health care infrastructure, meaning many serious conditions went undiagnosed or untreated. 

HIC is just one example of the many global health efforts being made worldwide to provide care and treatment for conditions such as heart disease, diabetes, and cancer in resource-limited settings.

Dr Fidel and pediatric cancer patient at Butaro_1“We are beginning to see a larger global health focus on diseases that have been more traditionally seen as ‘first world conditions’  known as non-communicable diseases, or NCDs,” said Glen Gaulton, PhD, vice dean and director of Global Health in the Perelman School of Medicine. 

And these advances in care can’t come soon enough. Heart disease is second only to HIV/AIDS as the leading cause of death in sub-Saharan Africa and is the number one cause of death for people age 30 and older. According to the World Health Organization (WHO), cardiovascular disease kills 17.5 million people each year, making it the leading cause of death among NCDs, followed by cancers (8.2 million), respiratory diseases (4 million), and diabetes (1.5 million). In total, NCDs kill 38 million people each year, with almost three-quarters of NCD deaths – 28 million – occurring in low- and middle-income countries.

The high burden of NCDs in the developing world is a fairly recent development that has been fueled by a variety of factors, including alcohol and tobacco use, air pollution, and diets containing higher levels of sodium, sugar, and saturated fats from processed foods. However, the high NCD burden is often masked by infectious disease epidemics, such as HIV, malaria, and tuberculosis, which continue to loom large in these regions. And because many of these countries are struggling with the dual challenge of combatting serious infectious disease epidemics and NCDs, this recent rise in NCDs is likely to lead to an even greater social and economic burden. 

“Similar to infectious diseases like HIV/AIDS, multiple interventions are required to treat and prevent NCDs, ranging from changing behaviors to improving treatment methods, meaning there must be a significant increase in prioritizing them as part of an overall effort to improve health care around the world,” Gaulton said.

However, the costs of treating conditions such as cancer or diabetes can quickly drain resources, driving families into poverty, no matter where they live, and the burden is even greater in low-resource countries. Lengthy and expensive treatments compounded with the symptoms of chronic illness that can keep people out of the workforce pushes millions of people into poverty annually, stifling development.

In addition to financial challenges, access to and the quality of care is that is available is inconsistent. In many areas of the world, equipment to screen for and treat diseases like cancer is out of date or even non-existent. 

“Access to quality care at an affordable price is one of the greatest challenges to combatting NCDs everywhere, but especially in resource-limited settings,” said Lawrence Shulman, MD, director of the Center for Global Cancer Medicine at the Abramson Cancer Center of the University of Pennsylvania. “When people develop a  disease like cancer in a resource-limited setting, they often get diagnosed at a later stage in their illness — if they get diagnosed at all — meaning they are already very sick when they seek treatment. Lack of access to affordable, quality cancer care results in millions of unnecessary deaths every year.”

Shulman is working to combat this challenge through various global health initiatives, including helping to lead a program in Rwanda to provide access to free, quality cancer treatments. In July 2012, Shulman helped establish the Butaro Cancer Center of Excellence in northern rural Rwanda in partnership with Paul Farmer, MD, co-founder of Partners in Health, and Agnes Binagwaho, MD, PhD, former Minister of Health for Rwanda. Former President Bill Clinton dedicated the center and today, thanks to support from Penn in collaboration with the Dana-Farber Cancer Institute and the Brigham and Women’s Hospital, Butaro is the primary cancer referral hospital in Rwanda and has provided free care to more than 5,000 patients.

“Where you are born and poverty should not be barriers to lifesaving cancer therapies that could be readily available,” Shulman said.

Butaro is just one example of many global health initiatives Penn is undertaking worldwide. From Rwanda to Botswana to Guatemala and many places in between, the Penn Center for Global Health is committed to improving health equity by raising awareness, improving access to care, and advancing research.

As Madu concluded while accepting the Global Health Champion award, “good health care is possible everywhere, we just need the resources to make it possible.” 

Watch Ernest Madu’s TED Talk on NCDs 

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