by Shenglan Tang
Over the past two decades, international health policies have been predominately focused on achieving the Millennium Development Goals (MDGs) which emphasize the fight against infectious diseases like HIV/AIDS, TB and malaria, and the tackling of maternal and child health problems, among others. To a large extend, this has skewed disease control priorities in China toward infectious disease control, influenza, etc. However, non-communicable diseases (NCDs) which account for more than 85 percent of the total burden of disease in China, have never been high on the list of national disease control priorities. This is unfortunate as China has fallen behind decades in its development and implementation of effective policies to tackle these diseases. China now has more than 200 million hypertensive patients and more than 90 million diabetes patients. Only a small proportion of these patients are under effective treatment and control, and funds provided from central and local governments for NCD control have been very limited.
According to the World Economic Forum’s 2010 Global Risks report, NCDs pose a greater threat to global economic development than fiscal crisis, natural disasters, corruption or infectious diseases. In contrast, HIV/AIDS in China has attracted much political attention and significant financial resources, although China had just over 750,000 HIV-positive patients in 2011. Why has this happened? One reason is that since the late 1990s, there has been millions of dollars invested by international donors/ organizations in support of China’s fight against infectious disease control, particularly HIV/AIDS. These donors include The World Bank, Britian’s Department for International Development, the Australian government, other bilateral aid programs and The Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria. Many of these organizations required matching funds from either central or local governments as a precondition for their support. More recently, the Bill and Melinda Gates Foundation has joined other organizations to invest USD$50 million for HIV/AIDS control. Unfortunately, the same level of support from international donors/organizations has not been present for any other public health issue except tobacco control with support from the Gates and Bloomberg foundations. Nor has the government of China allocated adequate financial resources to tackle the increasing challenge of NCDs.
As a WHO official over the past six years, I had many chances to meet senior representatives from Western governments responsible for international health development. I asked them why the international donors/organizations have allocated billions to support HIV/AIDS and other infectious diseases in China, India and Asian countries where the burdens of NCDs have, by far, been much heavier than that of HIV/AIDS. Their answer was that it was "easier for their governments to justify the use of the aid money for infectious diseases, as these diseases could more easily spread to the Western countries.” They argued it would be difficult to support NCD control in low- and middle-income countries, although they clearly understood the heavier burden and the need for NCDs to be prioritized. As WHO reported recently, 80 percent of deaths from NCDs now occur in low- and middle-income countries, up from 40 percent in the 1990s.
The mortality rate in China from stroke, for example, is 4-6 times as high as in France, Japan or the U.S. International organizations and national governments agree that the rise of NCDs has devastating social and economic consequences for developing countries. Last September, the UN Assembly held a summit on NCD control in New York. This is the second time in UN Assembly history that a health-related issue was discussed. (The first was, not surprisingly, on HIV/AIDS control). Unfortunately, this summit has not resulted in meaningful policies and actions, nor has it been backed by billions of dollars. The commitments that emerged from the summit were largely rhetorical, as pointed out by Thomas Bollyky in his recent article published by Foreign Affairs. The political declaration only recognized the “epidemic proportions” of NCDs, but it did not mandate specific methods nor even argue for their adoption. Prior to the UN summit, the World Bank published a report titled “Toward a healthy and harmonious life in China: Stemming the rising tide of NCDs.”
The report paints an alarming situation facing China and proposes a comprehensive strategy for fighting NCDs. In China, it is often the poor who are mostly likely to suffer from NCDs rather than the rich. Now is the time for urgent action by the Chinese government to develop domestically-driven and evidence-based disease control policies with adequate funding, without the influences of international politics, and while continuing the fight against infectious diseases. There must be enough room in the political agenda for this multi-pronged approach.