WMA Statement on the Global Burden of Chronic Non-Communicable Disease

Adopted by the 62^nd WMA General Assembly, Montevideo, Uruguay, October 2011
and revised by the 73^rd WMA General Assembly, Berlin, Germany, October 2022

PREAMBLE

Chronic non-communicable diseases (NCDs), are the leading cause of mortality and disability in both the developed and developing world. The four main NCDs are cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes (referred to as NCD4 hereafter) and they account for seven of every ten deaths worldwide. Eighty per cent of deaths due to NCDs occur in low- and middle-income countries (WHO).

NCD4 are not replacing existing causes of disease and disability, such as infectious disease and trauma, but are adding to the disease burden. While all countries face the triple burden of infectious diseases, traumas and chronic diseases, it is a much more difficult challenge for developing countries. This increased burden is straining the capacity of many countries to provide adequate healthcare services as well as increase life expectancy.

Chronic diseases are not equally distributed, which has a significant effect on health inequalities. For example, NCDs occur more frequently among socioeconomically underprivileged individuals with inferior chronic disease outcomes. Conversely, life expectancy and other health outcomes are markedly higher in more developed countries than in less developed countries, and in the higher socio-economic segments of society.

In addition, this burden is also undermining nations’ efforts to spur economic growth. NCDs are a barrier to development. In low- and middle-income countries (LMICs), poverty exposes people to lifestyle-mediated risk factors for NCDs and in turn, resulting NCDs become an important driver for poverty. Chronic diseases and poverty are linked in a vicious circle, hindering economic development and worsening poverty.

Ongoing and anticipated global trends that will lead to more chronic disease problems in the future include an aging population, urbanization and inadequate community planning, increasingly sedentary lifestyles, increasing psychosocial stress, climate change and the rapidly increasing cost of medical technology to treat NCDs. Chronic disease prevalence is closely linked to global social and economic development, globalization and mass marketing of unhealthy foods and other products.

The prevalence and cost of addressing the chronic disease burden is expected to rise in coming years. In addition to the individual and public expenses, chronic diseases lead to a marked economic burden because of the mutual effects of healthcare costs and lost productivity from disability and death. The WHO considers the global burden of chronic diseases as one of the most important challenges facing the field of health for this century.

 The rapid increase in chronic diseases represents a major health challenge for global development, for which immediate global action is needed.

Eighty percent of the global burden of chronic diseases affects LMICs, where most of the world’s population lives. The impact of this devastating burden is constantly growing. Chronic diseases and poverty are linked in a vicious circle, hindering economic development and worsening poverty.

Solutions

The NCD4 merit global attention. The primary solution for these diseases is prevention. Tobacco use, poor diet, physical inactivity and alcohol abuse are the four most common modifiable risk factors for NCDs. Poor mental health has recently been included as an additional risk factor for NCD. National policies that help people achieve healthy lifestyles and behaviours are the foundation for all possible solutions.

Increased access to primary care combined with well-designed and affordable disease-control, disease prevention and health promotion programs can greatly improve healthcare. Partnerships of national ministries of health with institutions in developed countries may overcome many barriers in the poorest settings. In addition, having health insurance improves health outcomes. Conversely, in some countries the lack of health insurance hinders the practice of preventive and primary care and is linked with adverse health outcomes. Uninsured individuals may postpone pursuing assistance when ill or injured, and they are more likely to be hospitalized for chronic illnesses such as diabetes or hypertension. Furthermore, children without health insurance are less likely to receive immunizations, and regular primary care.

Medical education systems should become more socially accountable. The World Health Organization (WHO) defines social accountability of medical schools as the obligation to direct their education, research and service activities towards addressing the priority health concerns of the community, region, or nation they have a mandate to serve. The priority health concerns are to be identified jointly by governments, health care organizations, health professionals and the public. There is an urgent need to adopt accreditation standards and norms that support social accountability and community engagement. Educating physicians and other health care professionals to deliver health care that is concordant with the needs of the population and the resources of the country must be a primary consideration. Led by primary care physicians, teams of physicians, nurses and community health workers will provide care that is driven by the principles of quality, equity, relevance and effectiveness.

Distributions of funds for health should be based on all individual nation needs. No nation can accomplish positive NCD4 outcomes by tackling a single cause of death.

Strengthening the healthcare infrastructure, including training the primary healthcare team, chronic disease surveillance, public health promotion campaigns, quality assurance and establishment of national and local standards of care, is important in caring for the increasing numbers of patients with NCD4. Most premature deaths due to NCDs are preventable; however, in most developing countries health systems are inadequate, or unprepared to appropriately act on NCDs.

One of the most important components of healthcare infrastructure is human resources; well-trained and motivated health care professionals led by primary care physicians are crucial to success. International aid and development programs need to move from “vertical focus” on single diseases or objectives to a more sustainable and effective primary care health infrastructure development.

RECOMMENDATIONS

Recalling its Statement on Hypertension and Cardiovascular Disease and its Declaration of Oslo on Social Determinants of Health, the WMA calls on:

National Governments to:

1. Recognize the importance of socio-economic development for health and reduce socioeconomic status disparities in income, education, and occupation;
2. Support global immunization strategies;
3. Support global tobacco and alcohol control strategies, as well as control strategies addressing other forms of addiction, particularly drug use;
4. Promote healthy living and implement comprehensive, collaborative policies and strategies at all relevant levels and divisions of government that support prevention and healthy lifestyle behaviours;
5. Set aside a fixed percentage of the national budget for healthcare infrastructure development and promotion of healthy lifestyles and invest in better management of NCDs4 including detection, care and treatment;
6. Advocate for trade / commercial agreements that protect rather than undermine public health;
7. Develop and execute global and national action strategies for mitigating the health effects of climate change;
8. Promote research for prevention and treatment of NCDs, including research on occupational health hazards leading to chronic diseases;
9. Promote access to good quality effective medicines to treat NCDs;
10. Develop monitoring and surveillance systems for NCDs and,
11. Reinforce primary health care, human resources and infrastructure.

Its Constituent Members to:

12. Increase physician, public and NGO awareness of optimal disease prevention behaviours;
13. Enhance skills and capacity to promote a team-based multidisciplinary approach to chronic disease management;
14. Advocate for integration of NCD prevention and control strategies in government-wide policies;
15. Promote high quality training and professional associations for more primary care physicians and advocate for their equitable distribution;
16. Advocate for high quality readily accessible resources for continuing medical education that is responsive to societal needs;
17. Support establishing evidence-based standards of care for NCDs;
18. Promote an environment of support for continuity of care for NCDs, including collaborative efforts to encourage patient education and self-management;
19. Support strong public health infrastructure and,
20. Recognize and support the concept that addressing and acting on social determinants are part of prevention and health care.

Medical Schools to:

21. Develop curriculum objectives that meet current societal needs;
22. Create primary care departments;
23. Provide community-oriented and community-based primary care training opportunities in primary care specialties that allow students to become acquainted with the basic elements of chronic care infrastructure and continuity of care;
24. Promote the use of interdisciplinary, interprofessional, intersectoral and other collaborative training methodologies within primary and continuing education programs and,
25. Include instruction in chronic disease prevention, including nutrition and lifestyle promotion counselling, in the general curriculum.

Individual Physicians to:

26. Work to create communities that promote healthy lifestyles and prevention behaviours;
27. Offer patients smoking cessation, weight control strategies, substance abuse counselling, early screening, self-management education and support, nutritional counselling, and ongoing coaching;
28. Inform patients about the dangers of illusory or insufficiently proven remedies or procedures, and charlatanism practices;
29. Promote a team-based multidisciplinary and value-based approach to chronic disease management;
30. Ensure continuity of care for patients with chronic disease;
31. Model healthy lifestyles by maintaining personal health;
32. Become community advocates for improved social determinants of health, equity in health care and for best prevention methods and,
33. Work with parents and the community at large to ensure that parents have the best advice on maintaining the health of their children.