NCDs: what’s changed in 20 years?

This is the second in my series of three blogs to mark my 20 years of working in NCD prevention. In those two decades, about a third of a billion of people aged under 70 have died of an NCD (among them, friends of mine as young as in their 40s from cancer), and many more older people could also have lived longer, happier and healthier lives (among them, my dear dad). ‘Compression of morbidity’ is a deeply unattractive phrase, but delaying ill-health is every bit as important as delaying death.

This is about all of us and our loved ones, and we would do well to remember that.

The world has, of course, changed enormously and with increasingly dizzying speed. Back in 2005, Tony Blair was still British Prime Minister. The news held little on the need for action on climate change and we were ill-prepared for the shock of Covid-19. The UK was at the heart of Europe and multilateral organisations including the WHO were strong and supported by governments around the world. And much of my interest in NCDs comes from how that space has also constantly evolved, for good or ill, upending my understanding and expectation.

For a start, the science has proved to be anything but static. I knew, of course, that physical inactivity was harmful, but I didn’t know about the specific harms of sedentarism. There was no focus on ‘ultraprocessed food’ per se. I’d never heard of or seen a vape. Back then, the WHO had yet to designate alcohol as an NCD risk factor worthy of being separated out from ‘poor diet’. The idea of an effective drug for obesity was just a researchers' pipedream. It feels like barely a week goes by without the evidence piling up on the repercussions of air pollution for physical and mental health. Technology transforms and disrupts, at personal level (first through text messaging, then smartphone apps and social media) and now through the use of AI for diagnosis, treatment and research. 

One of the most important changes has been the gradual (albeit painfully slow) centring of people themselves: those living with NCDs. I’m sure most of us reading this have been to many well-intentioned conferences in which the voice of lived experience has been relegated to a 15-minute slot before lunch, squeezed to five minutes thanks to the overrunning of the previous ‘expert’ speakers. But of course it is exactly those living with NCDs who are the real experts. Stories are powerful, but this goes beyond advocacy: bringing lived-experience perspectives into the policymaking process will go a long way towards ensuring that those policies are fit for purpose. And it’s always worth remembering that today’s ’young advocates’ are the seasoned professionals of the future, as well as bringing their passions and perspectives to bear on policy today. 

Another vital shift has been the increasing awareness of the need to include NCDs in health planning for humanitarian emergencies. Traditionally, humanitarian aid has tended to focus on infectious disease, trauma and maternal and child health - but for someone with type 1 diabetes then a failure of their insulin supply is every bit as catastrophic. And in a world in which the average length of time spent as a refugee is now an astonishing 10 years, NCD prevention becomes increasingly important among these populations. There is still a long way to go before NCDs are fully embedded in emergency planning, but I would like to think that it is much harder today for those involved in NCDs to fail to know about this need - whereas in 2018 (to my shame) I simply hadn’t considered it before my work began with the Danish Red Cross.

And the last important change I want to highlight is how much more organised is the advocacy around NCDs, not least in the planning for the forthcoming UN High-level Meeting in September this year (the first such meeting in seven long, Covid-filled years). The photo of me at the top of this blog is from the Multistakeholder Hearing in the run-up to the very first HLM in 2011, which was only the second-ever UN meeting of its type on a health issue, the first having been held on HIV/AIDS in 2000. This year feels qualitatively and quantitatively different. The NCD Alliance (founded just ahead of the 2011 HLM) is doing a fantastic job of coordinating messaging and policy demands. The UK Working Group on NCDs (founded in 2018, ahead of the HLM that year - and which I now chair) is talking regularly to the UK government on our own priorities ahead of this year’s HLM. And, despite the enormous challenges faced by the WHO over recent months, colleagues there have been explicit in aiming many recent events - among them a high-level technical meeting on NCDs in humanitarian settings last year - at preparing for the HLM. 

So NCDs are no longer on the sidelines… but they are also not sufficiently centred. My next blog will have a look at what might - or might not - be coming next, both in the NCD space and professionally for me.