Tackling the dual burden

Health ministers and delegates from around the Commonwealth convened in Switzerland to discuss the health care challenges of managing both communicable and non-communicable diseases at their annual meeting on the wings of the World Health Assembly.

Due to levels of poverty, lack of education and other social factors, many Common­wealth member states classified as low- and middle-income countries are particularly affected by the dual burden of dealing with communicable diseases – such as HIV/ AIDS and tuberculosis – and the steep rise of non-communicable diseases (NCDs) – cardiovascular conditions, cancers and diabetes, among others. The theme of this year’s Commonwealth Health Ministers Meeting, on the eve of the 65th World Health Assembly in Geneva, looked at how lessons learned from tackling communica­ble diseases in these countries can be ap­plied to the growing threat of NCDs across the Commonwealth.

Opening the annual meeting on 20 May, Commonwealth Deputy Secretary-General Ransford Smith said, “Many health sys­tems in the Commonwealth operate under enormous constraints. In many instances, they are structured only to deal with com­municable diseases generally, and thus are not optimally equipped to deal with non-communicable diseases.”

These low- and middle-income countries account for approximately 80 percent of reported deaths by NCDs globally – kill­ing 35 million people worldwide each year. Smith continued, “To better respond to both communicable and non-communicable dis­eases will require improved understand­ing of these diseases as well as improved reporting and surveillance so as to direct health care resources to where they are most needed.” Ministers were optimistic that many countries can build on lessons learned from dealing with communicable diseases when integrating NCD treatment into existing health services.

Health ministers heard from Professor Sir Michael Marmot, Director of the Inter­national Institute for Society and Health, UK, as well as delegates from Australia, Nigeria, Pakistan and Tanzania who shared their countries’ experiences of manag­ing both types of diseases. The speakers discussed the role of culture in affecting people’s behaviour and attitudes towards their health, and the common causes behind these illnesses which are rooted in social factors such as income, education, social status and living conditions. For example, bad housing can lead to poor ventilation and the development of tuberculosis – a communicable disease. At the same time, the same living conditions can mean fewer open spaces for exercise, resulting in obe-sity and, potentially, diabetes – an NCD.

Ministers called for the integration of health systems to address both communi­cable and non-communicable diseases, and to respond to the growing prevalence of the latter. Stressing the need for better national leadership of state-owned and managed strategies and programmes, high-level ad­vocacy, partnerships between organisations and community and resource mobilisation, delegates also examined how various pro­grammes currently used to treat communi­cable diseases could also be used to tackle NCDs. For example, using mobile counsel­ling and treatment facilities to deliver mes­sages and monitor for risk factors during treatment for communicable diseases.

Underlining the urgency of the problem, Dr Mwele Ntuli Malecela, Director Gen­eral of the National Institute for Medical Research, Tanzania, warned that the Mil­lennium Development Goals (MDGs) for 2015 could not be reached without also addressing the increasing threat of NCDs. With the MDG deadline fast approaching, the Health Ministers Meeting stressed the importance of recognising the link between communicable and non-communicable dis­eases, and to use this knowledge to combat the dual burden of disease spreading across the Commonwealth.


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