My visit to
the United Nations’ headquarters during the UN review on non-communicable diseases (NCDs) on Friday, July 11, as speaker and moderator for two events, respectively, made me go down the memory lane for some reasons. As a young medical intern working in the then named North West Frontier Province of Pakistan (now Khyber Pakhtunkhwa), I was always overwhelmed by the number of patients coming in with NCDs-related complications, most of which could have been avoided through prevention and control. Middle aged women with complicated diabetes mellitus, with badly infected feet, admitted to the hospital for amputations. Men with untreated blood pressure, with repeated hospital admissions, with heart failure in critical condition, gasping for breath. Women with advanced cancer, presenting with breasts disfigured by large weeping ulcers.
As a new intern the memory of what I had learnt in medical school was still fresh; I and others working with me knew perfectly well that most of that suffering was unnecessary and preventable. With tight diabetes control and foot care, amputation could be avoided. If a preventive public health program involving opportunistic screening for high blood pressure had been in place in the country, patients with high blood pressure would have been treated in time averting heart failure. Through appropriate screening for breast cancer, early detection could be enabled, avoiding disease spread. Sadly, in my country none of the three preventive public health approaches were in place then, and their absence continued in the era of focus on the Millennium Development Goals (MDGs). Hence, the unnecessary suffering continues to this day.
My second memory is more recent and relates to the momentum generated by the MDG’s in 2000. The MDG’s galvanized unprecedented support for the development and health agenda. They become instruments around which governments, civil society and development partners rallied in support of time-bound, outcome-based targets. They were pegged in international, regional and national plans both as aspirations as well as hard outcomes. Their limitations notwithstanding, they signalled priorities for development spending and helped to mobilize domestic resources and political will. Relevant to health, maternal and child health, HIV and AIDs, malaria and tuberculosis were included in the framework. Sadly however, NCDs were missing from the agenda.
In policy and planning, internationally and domestically, that huge miss continued to be a sore point and lent impetus to global advocacy for NCDs, of which I became a small part.
So why am I telling this story now: because we have come a long way since then. The NCDs summit in 2011 and its outcome, the Political Declaration on NCDs set the momentum. Last Thursday, during the NCDs review at the UN headquarters in New York, a resolution was adopted, which explicitly recognized that NCDs should become part of the post-2015 agenda and development more broadly.
Speaking at the UN round table and moderating the civil society NCD Alliance event, the next day, I therefore knew that a new era of global shift towards NCDs had begun. But countries must tap this moment. The post 2015 era in which NCDs are being placed on the agenda is in stark contrast with the MDGs context with the post financial crises austerity of the former representing a different milieu from the fiscal space which characterized the setting in which the MDGs evolved. While the MDGs were for the aid system, the post 2015 goals are being developed for countries. Hence, domestic mobilization of support, integration of NCDs into intersectoral plans of governments and health system orientation from acute to chronic care within the framing of universal health coverage will be vital to the success of this new public health order.
You have already established your position as a pioneer in advocating for NCDs in Pakistan and abroad. Your contribution in bringing up the NCD on the global agenda, undoubtedly, has been successful as new MDGs will include specific goals on the containment of NCDs.
I am, once again, attempting to bring your attention to public health education that can make a difference in taking early action through effective awareness creation programmes. You have mentioned in your column three preventive public health approaches needed to fight disastrous effects of NCDs. If you allow me, I would like to add a fourth approach, public health education that is equally, if not more, critical, yet missing from our public health service. In fact, there are experts who argue that if adult population adopts good dietary and exercise practices in their middle age, they can prevent NCDs altogether. Public health education approach is comparatively low-cost alternative to more expensive health care of NCD patients. Moreover, educational interventions can make a difference in the entire spectrum of public health, for all ages and ailments. But I do understand Pakistan’s public health leaders’ reluctance to mention health education in any context, as medical community abhors the subject. I hope and pray that you will follow your conscience and not allegiance to the clan.