Cancer and heart disease have long been considered problems of the rich world, taking a back seat in poorer countries struggling under the burden of infectious diseases like HIV and malaria.
But the great majority of preventable deaths from non-communicable disease occur in the developing world, and rising middle income powers like India, Brazil and China are beginning to recognize the threat to their populations and economies.
“These are the central health issues now in these very large countries,” Gene Bukhman, director of the Program in Global Non-communicable Disease and Social Change at Harvard Medical School, told the NewsHour at the International Conference on Global Health. The impact on those countries has “opened a window” to address the problem around the globe, he said, and has led to growing momentum around the issue.
"Chronic non-communicable diseases deliver a two-punch blow to development,” World Health Organization director Margaret Chan said earlier this year. “They cause billions of dollars in losses of national income, and they push millions of people below the poverty line, each and every year."
The U.N. called a special high-level summit on the issue for September, and it is being addressed by experts meeting at the International Conference on Global Health this week in Washington.
“There is a huge gap in the chance of survival [of cancer] if you are born in a poor country and get this disease versus if you are born in a rich country,” said Felicia Knaul, head of the Harvard Global Equity Initiative. “The opportunity to survive...should not be determined by income, yet all over the world it is.”
About 83 percent of preventable cancer deaths occur in low and middle income countries, and 95 percent of preventable pediatric cancer deaths.
She pointed to several myths that make it difficult to combat the disease in these countries, including that complex chronic diseases can't be treated effectively in poor countries and that doing so would take away vital resources from other services for infectious disease.
There is a new push to mend the split between those advocating for more infectious disease investment and those trying to shine a light on the chronic disease burden, but on the ground level it still creates problems.
Walter Gwenigale, Liberia's minister of health, said malaria and diarrheal disease are still considered the “big killers” in Liberia, but that he has watched the country's health issues begin to shift as the population of urban areas has exploded. One half of the country now lives in cities, and doctors are starting to see more chronic illness, including conditions like obesity, for the first time.
Warnings that Americans have heard so many times they seem routine -- that diet, exercise, and use of tobacco and alcohol all play a big role in your health -- are now being extended to parts of the world where campaigns and messaging around this are relatively new, said Srinath Reddy, president of the Public Health Foundation of India.
Building health system capacity will be crucial to responding to the changes, but while countries like India and China may have the health worker capacity to begin to adjust, other countries have a very long way to go.
Sara Sutlac, who works with Partners in Health in Rwanda, said she has seen cancer patients who were sent from doctor to doctor without being given a diagnosis, even when presenting with large tumors.
“Care is really not available. There are few to no trained oncologists in countries like Rwanda,” Sutlac said. She urged those in the health community to learn lessons from the provision of infectious disease care in low-resource settings and to collaborate with peers in the health field working on infectious diseases.
Funding for all health initiatives is a big concern this year as donor governments have signaled they can't contribute as much as in the past during the economic downturn. That will make approaching health goals in an integrated way even more crucial when trying to broaden health goals.
“We can't separate all these illnesses,” she said. “They shouldn't be in such competition, we need to think about it in terms of the health system as a whole.”