Global fight against non-communicable diseases should take lessons from HIV-AIDS, say experts

In a perspective article in this week's New England Journal of Medicine, the Emory experts cite the need for a collective global effort to stem the impact of cardiovascular diseases, type 2 diabetes, cancers, chronic obstructive pulmonary disease and psychiatric disorders. These present major global health, development and societal challenges, say the authors.

A United Nations General Assembly high-level meeting on Sept. 19-20 on global non-communicable diseases will likely draw on experiences against the HIV/AIDS pandemic that began with a "Declaration of Commitment" at a 2001 UN summit, generating awareness and resources, and propelling collective global action.

The perspective's authors are K.M. Venkat Narayan, MD, Ruth and O.C. Hubert Professor of Global Health, Rollins School of Public Health, Emory; James Curran, MD, dean, Rollins School of Public Health, Emory; Jeffrey P. Koplan, MD, MPH, vice president and director, Emory Global Health Institute and president, International Association of National Public Health Institutes (IANPHI); Carlos del Rio, MD, chair, Hubert Department of Global Health, Rollins School of Public Health; and Mohammed K. Ali, MBChB, assistant professor of global health, Rollins School of Public Health.

According to the article, public health experts have learned three primary realities from HIV/AIDS that could be directly translated to non-communicable diseases: research, prevention and treatment efforts must be global rather than national; prevention must be linked to early diagnosis and treatment, connecting community resources with organized health care systems; and prevention efforts must integrate both behavioral and biomedical approaches.

"The lessons learned from global efforts against HIV and AIDS should help us shorten the learning curve for preventing and controlling non-communicable diseases," says first author K.M. Venkat Narayan. "These include the need for good surveillance systems for diseases and risk factors, identifying vulnerable groups, especially in lower resource countries, and a serious global commitment to basic and applied research."

Although non-communicable diseases often disproportionately affect low- and middle-income countries, the impact is felt in all countries, and these diseases often strike young and middle-aged people at the peak of their economic productivity.

Combating these diseases will require collective action to promote public health programs including tobacco and trans-fat elimination and health-friendly policies in trade, agriculture, transportation and urban planning, the authors note. They also emphasize the need to combine behavioral and biomedical interventions. Although interventions promoting healthier lifestyles are effective, for some they are insufficient on their own and mainly benefit the most motivated adapters. This leaves large groups of at-risk people who could benefit from proven biomedical interventions such as statins, hypertension and diabetes drugs, or aspirin.

"We've learned from HIV/AIDS that a broad approach including prevention, detection, and treatment -- both behavioral and medical," is essential, says Curran. "Financial, research, healthcare, and policy commitments all are necessary to combat such a widespread disease challenge."

Without accessibility to early prevention and treatment efforts, countries will end up paying far more for advanced disease. Low-resource countries may offer opportunities for testing innovative models that would be more difficult to implement in countries with more developed health systems.

"The HIV/AIDS pandemic has taught us the value of involving all elements of society, including affected communities and populations of all income levels," says Koplan, "Most importantly, we must realize the value of international public health partnerships."