In recent years, non-communicable diseases (NCDs), such as cardiovascular diseases (CVD), diabetes, chronic obstructive pulmonary diseases (COPD) and cancers have become an emerging pandemic globally with disproportionately higher rates in developing countries . The World Health Organization (WHO) estimates that by 2020, NCDs will account for 80 percent of the global burden of disease, causing seven out of every 10 deaths in developing countries, about half of them premature deaths under the age of 70 -. According to WHO, it is estimated that the global NCD burden will increase by 17% in the next ten years, and in the African region by 27% . Almost half of all deaths in Asia are now attributable to NCDs, accounting for 47% of global burden of disease . Over 80% of cardiovascular and diabetes deaths, 90% of COPD deaths and two thirds of all cancer deaths occur in developing countries . The transition from infectious diseases to NCDs in LMICs has been driven by a number of factors, often indicative of economic development: a move from traditional foods to processed foods high in fat, salt and sugar, a decrease in physical activity with sedentary lifestyles, and changed cultural norms such as increasing numbers of women using tobacco . The impact of globalization and urbanization in low-and-middle-income countries (LMICs) has accelerated the growing burden of NCDs. However, governments in LMICs are not keeping pace with ever expanding needs for policies, legislation, services and infrastructure to prevent NCDs and poor people are the worst sufferers .
NCDs are a barrier to development . In LMICs, poverty exposes people to behavioral risk factors for NCDs and in turn, resulting NCDs become an important driver for poverty . The socioeconomic impacts of NCDs are also affecting progress towards the Millennium Development Goals (MDGs)  with serious implications for poverty reduction and economic development. Recognizing the importance and urgency, The United Nations High-level Meeting on the Prevention and Control of NCDs was organized in September 2011 . The WHO advocates policy makers to develop efficient strategies to halt ‘tomorrow’s pandemic’ of the chronic NCDs . In November 2012, WHO member states formally agreed on a comprehensive Global Monitoring Framework (GMF) for NCDs and the Global Action Plan for NCDs 2013–2020 (GAP) was formally agreed at the World Health Assembly in May 2013 ,,. A more concerted, strategic, and multi-sectorial policy approach is essential to help reverse the negative trends of NCDs in LMICs . In this backdrop, the CIHLMU Center for International Health at the Ludwig-Maximilians-Universität Munich (LMU) hosted a symposium on NCDs in developing countries as a part of a series that runs since 2010 contributing towards global health priorities by students of the PhD Program Medical Research – International Health as part of the programs regular curriculum. The objective of the symposium was to understand the current situation of various NCDs public health programs and the current trends in NCDs research and policy, promote exchange of ideas, encourage scientific debate and foster networking, partnerships and opportunities among experts from different clinical, research, and policy fields.
The international symposium on “Non‐Communicable Diseases in Developing Countries” was held on March 22, 2014 at the Ludwig-Maximilians-Universität Munich, Germany. More than seventy participants representing scientists, physicians, academics and students from several institutes in Germany and abroad attended the symposium. The symposium covered seven technical presentations on different aspects of NCDs in the developing countries with enriching discussions by speakers from Bangladesh, France, Germany, Vietnam and the UK. During the symposium PhD students from LMU and other academic institutes conducted poster presentations on NCDs and other global health priority topics.
Dr. Shariful Islam from CIHLMU and Senior Research Investigator, Center for Control of Chronic Diseases (CCCD), icddr,b opened the symposium on behalf of the organizing committee and stressed the recent global epidemic of NCDs affecting both the developed and developing nations. He stated that NCDs cause the largest mortality worldwide, accounting for 60% of global deaths. More than 80% of these deaths occur in LMICs, making NCDs a major cause of poverty and an urgent development issue. Dr. Islam stressed that NCDs strangle macro-economic development and keep the bottom billion locked up in chronic poverty. NCDs have a severe social and economic impact on individuals, communities and nations as a whole. The magnitude and rapid spread of NCDs means, we are all headed for a sick future unless we take action now. Thus, NCDs pose a double burden of disease in most LMICs where the health systems are least equipped to face the growing challenges. Prof. Dr. Thomas Löscher, Director, Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians-Universität, Munich, Germany welcomed all participants and speakers to the symposium and highlighted the fact that new funding initiatives such as the Global Fund had led to great success with communicable diseases, drawing a parallel to new demands in the current situation of declining communicable diseases and increasing NCDs.
Introduction to global epidemiology of NCDs and their control measures
Dr. Richard Smith, Former Editor, British Medical Journal, and President, United Health Group, UK.
The NCDs of global attention are CVD, diabetes, COPD and cancers. Tobacco use, poor diet, physical inactivity and alcohol are the four most common modifiable risk factors for NCDs. Mental health had only recently been included by the WHO as a NCD. The worsening burden of NCDs in the LMICs often comes accompanied by other factors straining health of the public. Results from Bangladesh data shows that during 1986–2006, deaths from NCDs increased from 8% to 68% in a rural area . The decreasing trend of CVD in USA since 1980 is a testament to the fact that even increasing trend of NCDs as insurmountable as they are can be reversed. The three levels of causes for NCDs include underlying drivers, behavioral risk factors and metabolic, physiological risk factors. The challenge is to define an appropriate level for intervention. In developed countries most resources are at the last level and a rethink of strategy is necessary especially for LMICs. A holistic approach which addresses all of the three levels is required and there is a need for cooperation from different sectors including a complete government wide action on risk factors, sustained primary health care (PHC) with priority packages, surveillance and monitoring and learning from the integration of other programs such as HIV/AIDS. Measuring the impact of intervention for NCDs is difficult due to non-availability of reliable data for the targets. A Global Monitoring Framework for NCDs approved in May 2013 would be presented to the UN in September 2014 and the development of Sustainable Development Goals (SDGs) in 2015. Dr. Smith emphasized the fact that community based public health interventions, low and medium complexity interventions and screening all show reductions in Disability Adjusted Life-Years (DALYs), therefore representing candidates for best buys in reducing NCDs. Access to drugs is poor for some essential drugs in LMICs. The interwoven nature of NCDs and sustainable human development has implications for social, economic and environmental development. The rapidly increasing levels of CO2 emissions around the globe need to be addressed. The big effects on health in the future would come from malnutrition, extreme weather events (flooding and droughts), water shortages, mass migration and wars over resources. Policies that address climate change (less pollution, motorized transport, and meat production) are good for NCDs and vice versa. Sustainable agriculture and food production (more fruit and vegetables, less meat) mean more food, healthier food, less hunger and NCDs, and better income for rural farmers.