Where’s the Money for NCDs?
By Michael Hodin
While there is a great deal of understandable and warranted angst over the lack of results from the UNGA high-level meeting on noncommunicable diseases (NCDs), it is the basic flawed assumptions underlying and feeding the program that are of greatest concern. To wit:
1. The UN’s focus on the so-called “big four” NCDs — cardiovascular disease (CVD), cancer, chronic respiratory disease, and diabetes — has and continues to exclude one of the largest of the NCDs: Alzheimer’s disease and related dementias.The growing and exploding issues of heart failure or type 2 diabetes, in particular, are, to be sure and simply blunt, huge. But how — and more importantly — why, would global public health experts exclude Alzheimer’s?
2. The bureaucrats and civil servants, however well-meaning, have, it would seem, in this matter of defining what counts for NCDs, arbitrarily decided to measure NCD impact for those ages 30–69. Huh? If you don’t count past age 69, it’s perhaps a reason you don’t include Alzheimer’s/dementia, which kicks in at its greatest prevalence after 85, when 25% to 50% will exhibit signs of the disease. This 80+ demographic is the fastest-growing age category on the planet, which helps to explain the projected huge increases in dementia prevalence: today, more than 47 million people live with dementia worldwide, and this number is projected to increase to more than 131 million by 2050, costing over $1 trillion — that’s a trillion — in the next three years alone.
3. So, here, two assumptions actually come together in the bizarre world of global public health and UN SDGs, that you don’t really count past 69. Wow!
4. And, that brings us to their third tragically out-of-date assumption, namely, the UN NCD Goal of “reducing by one-third premature mortality…ages 30–69…from NCDs…” We are now to accept that if you’re over 69, your death is not “premature,” and therefore not to be counted and implicitly not so important. In its own words, “People of all age groups, regions and countries are affected by NCDs. These conditions are often associated with older age groups, but evidence shows that 15 million of all…these premature…deaths attributed to NCDs occur between the ages of 30 and 69 years.” The arrogance of the language is itself stunning. The danger is it feeds under-recognition and under-treatment, even for areas it purports to address, like CVD. But a CVD like heart failure offers a telling example of how conditions common to older age — fatigue, weakness, loss of breath, themselves perhaps not fatal — are dismissed as accepted and acceptable parts of aging. Yet, if we were to more accurately measure these conditions for all ages, we would discover that heart failure in a 74-year-old can and should be addressed and treated.
5. And, finally, it is the core driver of the entire NCD project — measuring death, as above — which is the metric for action. And yet, we know that the increasing impact of NCDs is not death but quality of life. The associated declines in quality of life are an even greater contributor to the cost explosion of NCDs, rendering global society fiscally unsustainable in our era of population aging. For example, we have pretty good estimates that the rest of us are like Europeans over age 65 who can expect that more than half of their later years will be spent with conditions, often NCDs. These NCDs affect our ability to live independently to such a degree that we estimate long-term care needs among those 80+will triple over the next 50 years.
So, there you have it. The UN NCD Program doesn’t even take into account 21st-century longevity, the most massive and transformational megatrend of our time. But the worst of it is the implicit idea that if you’re over 69, you don’t count — even though there are already almost 460 million people over 70 globally, and this number is projected to increase to more than 1 billion by 2050. This, my friends, is “ageism”at its worst and with enormous implications. If you don’t get measured as a 73- or 85-year-old — which is apparently the approach of the UN NCD Program — you don’t get policy or funding attention either. No wonder, as reported widely, there has been criticism of the third United Nations high-level meeting on NCDs, including from otherwise friendly corners, such as from The NCD Alliance and 300 supporting organizations.
The good news is that however immune global bureaucrats seem to be to the real world, the private sector and the business community has a wholly different, more complete, and far more accurate measurement of need and, therefore, the march to solutions. Here are just a few:
1. From heart failure to Alzheimer’s, pharma companiesare tying market opportunity reflected in spend on innovation for new therapeutic solutions to the more accurate and fuller picture of NCDs. Namely, all of us. Whether you’re 35 with diabetes, 78 with heart failure, or 88 with Alzheimer’s, you can be certain that the private sector “has your back.” You do count and the effort, moreover, is not just in avoiding death — the WHO/UN metric — but in keeping you alive with an improved quality of life and an accompanying mitigation of spending.
2. The private sector innovative technology companies are also paying attention to you whether your 30 or 80, and, like their pharma counterparts, are investing in innovative solutions dedicated to better monitoring and earlier detection and diagnosis of all manner of NCDs. For example, technology-based home monitoring and remote care will increasingly be used to keep you healthier for longer and because there is market payback, is spending billions to enable a healthier and more active aging. As remote care becomes our 21st-century standard of care, replacing the exploding and often debilitating cycle of hospitalization and rehospitalization, we will see very substantial positive impact on NCDs.
3. The home care sector, an innovation in itself, recognize that people want to live in their own homes, whether they’re 35, 65, or 90. This desire to live independently, among our families, friends, and neighbors, doesn’t change, even as our abilities change and we begin to need help. Today, home care is such a major economic driver and job creator that in many countries the care providers can’t hire caregivers fast enough. As an example, there are actual waiting lists for care in Australia that private home care is working overtime to fill.
So, while there may be little of substance and no money out of the week’s confab on the East River in NYC, we can all take solace that there is plenty of innovation, attention, funding, and solutions from private business for healthier lives across all ages.
