Global Health and the Future Role of the United States (2017) / Chapter Skim
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6 Promoting Cardiovascular Health and Preventing Cancer
6 Promoting Cardiovascular Health and Preventing Cancer
Pages 169-202
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. Globally, these chronic or noncommunicable diseases (NCDs)
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THE RISING ECONOMIC BURDEN OF NONCOMMUNICABLE DISEASES A study conducted by the World Economic Forum and the Harvard School of Public Health estimated that the projected increase in the global economic burden of five NCDs (CVD, chronic respiratory disease, cancer, diabetes, and mental health) would result in cumulative output losses of $47 trillion by 2030, which is roughly 75 percent of the 2010 global gross domestic product (GDP)
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FIGURE 6-2 Output losses over time by income status. SOURCES: Bloom et al., 2011; World Economic Forum.
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Finding: CVDs and cancers comprise more than 51 percent of the projected $47 trillion in cumulative lost output resulting from the increase in the global economic burden of five NCDs. THE RISING EPIDEMIOLOGICAL BURDEN OF NONCOMMUNICABLE DISEASES Of the 40 million deaths per year caused by NCDs, 17 million are considered to be "premature" (below the age of 70)
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In addition to mortality, cancer can also affect an individual's ability to work, which extends negative effects to the broader productivity of a country. For cervical cancer in particular, the percentage of attributable absolute DALYs varied across countries, for example from 1.6 percent in New Zealand to 13.4 percent in Brazil (Chaker et al, 2015)
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SOURCE: Global Burden of Disease Study 2015. Institute for Health Metrics and Evaluation 2016.
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PROMOTING CARDIOVASCULAR HEALTH AND PREVENTING CANCER 175 Tropical N Africa/ Latin East Southeast South Middle Southern West East Central America Asia Asia Asia East Africa Africa Africa Africa 1 1 1 1 1 4 8 5 3 3 2 2 9 6 12 13 13 14 6 5 5 4 9 11 16 17 13 7 13 6 12 8 8 29 24 26 17 22 14 18 20 27 39 57 56 22 52 25 26 91 1 4 1 5 76 54 9 10 55 6 17 11 12 219 245 63 40 70 54 1 6 1 11 20 7 6 7 5 3 3 2 126 118 143 156 131 144 160 152 141 149 129 112 58 129 169 86 101 118 18 23 11 20 19 40 19 31 32 4 7 8 13 5 9 24 18 16 59 80 67 101 141 43 81 67 66 69 10 33 107 65 62 44 70 63 39 45 36 63 47 48 98 79 79 30 8 27 54 38 36 105 129 104
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Institute for Health Metrics and Evaluation 2016. http://ghdx.healthdata.org/gbd-results-tool (accessed March 10, 2017)
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PROMOTING CARDIOVASCULAR HEALTH AND PREVENTING CANCER 177 Tropical N Africa/ Latin Southeast South Middle Southern West East Central America East Asia Asia Asia East Africa Africa Africa Africa 1 1 1 1 1 3 2 1 1 3 2 2 5 3 7 8 6 5 5 5 5 3 10 10 18 14 12 8 21 8 11 9 8 19 22 22 13 19 12 14 13 18 29 50 46 22 40 20 24 68 1 5 2 4 53 36 9 9 38 9 15 8 9 172 184 69 38 70 56 1 9 3 6 14 6 6 8 6 3 3 2 179 173 177 179 182 180 171 172 166 109 90 81 50 82 135 76 82 101 14 18 11 16 12 28 14 20 19 10 11 13 15 7 11 20 18 16 39 48 43 61 78 29 49 38 41 38 9 18 59 33 42 22 45 35 27 30 27 40 29 34 61 58 53 15 8 14 25 19 21 51 68 55
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Many countries experience difficulties effecting change in national policy and spending in part because NCDs like CVD are not prioritized in political agendas, despite their significant health and economic burden. In addition, the slow epidemic of NCDs does not create the type of panic or rapid response that infectious diseases like Ebola, multidrug-resistant tuberculosis (MDR-TB)
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. The 2014 Council on Foreign Relations Task Force report outlines steps the United States can take now to address the critical issues of NCDs, including promotion of cardiovascular health, and vaccination and screening programs to prevent cancer (Daniels et al., 2014)
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COST-EFFECTIVE AND HIGH-IMPACT GLOBAL INTERVENTIONS A 2011 World Economic Forum report identified a set of highly costeffective population- and individual-based "best buy" interventions for NCDs that can feasibly be implemented in resource-constrained LMIC health systems (WEF and WHO, 2011) (see Table 6-3)
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• Treatment of heart attacks with aspirin Cancer • Hepatitis B immunization to prevent liver cancer (already scaled up) • Screening and treatment of precancerous lesions to prevent cervical cancer NOTE: NCD = noncommunicable disease.
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. Of note, 7 of the top 10 risk factors contributing to global DALYs affect cardiovascular health (Forouzanfar et al., 2016)
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global health programs to hone in on prevention and screening efforts to reduce disease incidence, contain disease progression in early stages, and decrease the economic burden in countries with high rates of CVD and cancer. Solutions for prevention of these diseases may also have a parallel impact on many other health outcomes as well, as many NCDs share risk factors.
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. Regulatory Policies In addition to fiscal measures, policy makers have used regulatory means to influence behavioral and environmental factors contributing to NCD burden.
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Screening Programs for Early Detection and Treatment of Cardiovascular Disease Blood pressure screening is a relatively inexpensive and simple health service that could easily be integrated with the existing health services offered through established U.S. global health programs.
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cervical cancer and liver cancer -- have been linked to infections with human papillomavirus (HPV) and hepatitis B, respectively.
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By building on the valuable efforts of Gavi and working to fill the gaps in HPV vaccine coverage, the United States can capitalize on this momentum and significantly contribute to the progress being made to reduce the burden of cervical cancer. Although routine vaccines for cervical and liver cancers are effective low-cost preventive tools, early-stage detection is also critical for effective, less costly treatment for those not covered by preventive interventions or who have disease etiology that is not vaccine preventable.
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For these reasons, the committee feels that optimizing available resources and stakeholders through changes in health system design will be highly effective for improving cardiovascular health and preventing cancer, as explored in sections below. Integration of Services at the Community Level The dual burden of NCDs and infectious diseases in LMICs is exacerbated by well-documented interactions between communicable and noncommunicable diseases.
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While this will take time and sustained effort, there are short-term methods that can increase the capacity of countries to better address the burden of NCDs, including a broader use of the existing workforce. A 2015 assessment of community health workers in Bangladesh, Guatemala, Mexico, and South Africa found that health workers without formal professional training can be adequately trained to effectively screen for and identify people with a high risk of cardiovascular disease (Gaziano et al., 2015)
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Integrating HIV/AIDS Care and Cervical Cancer Prevention in Zambia Zambia has seen positive dividends from concerted efforts to train middle level health practitioners in screening methods for early signs of cervical cancer. The World Health Organization's endorsement in 2013 of the screening method known as VIA (visual inspection with acetic acid)
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However, according to an insights report from the World Economic Forum's Future of Health project, the willingness of the private and public sectors to coinvest depends on the right investment mechanisms being in place, on there being proof that those returns will materialize, and on the existence of a business model that makes it possible to share the benefits (WEF, 2015)
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in a district in Ghana as an important contribution to the development of evidence based innovative approaches to the management of noncommunicable diseases in low- and middle-income countries (LMICs)
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Shifting screening and monitoring of blood pressure from health facili ties to community health officers and private drug outlets.
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. NOTE: CVD = cardiovascular disease; NCD = noncommunicable disease.
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U.S. global health programs have established strong networks and knowledge bases in countries as a result of decades of effort by various agencies through infectious disease and maternal and child health platforms.
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for the major noncommunicable diseases, particu larly through the adoption of fiscal policies and regulations that facilitate tobacco control and healthy diets; • d etect and treat hypertension early; • d etect and treat early cervical cancer; and • i mmunize for vaccine-preventable cancers (specifically hu man papilloma virus and hepatitis B vaccines)
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Africa/ Middle East, Southern Africa, West Africa, East Africa, and Central Africa The nonbolded categories for "Cause" were included as the committee was interested in learning about their ranking as a whole when compared to the infectious diseases being targeted in the report. Furthermore, as the diseases of interest (cardiovascular diseases and cancers)
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2011. The global economic burden of noncommunicable diseases.
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2015. An assessment of community health workers' ability to screen for cardiovascular disease risk with a simple, non-invasive risk assessment instrument in Bangladesh, Guatemala, Mexico, and South Africa: An observational study.
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2015. Population-level scale-up of S c ervical cancer prevention services in a low-resource setting: Development, implementa tion, and evaluation of the cervical cancer prevention program in Zambia.
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2016. Innovative approaches to prevention: Tackling the global burden of cardiovascular disease.
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and cervical cancer. http://www.who.
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