An alliance of institutions collectively managing an estimated 80 percent of all public health research funding worldwide today announced their first targets for concerted action in the fight against “chronic non-communicable diseases” (CNCDs).
Lowering hypertension (high blood pressure), and reducing tobacco use and the indoor pollution caused by crude cooking stoves in developing countries -- which together factor into roughly 1 in 5 deaths each year -- were chosen as initial priorities for the unprecedented coordinated research program under the new Global Alliance for Chronic Disease.
The priorities were set earlier this month in New Delhi, India, at the Alliance’s inaugural scientific summit.
Three new member institutions (the South African Medical Research Council, the Qatar Biomedical Research Institute, and the National Institute of Mental Health (NIMH) of the US National Institutes of Health) as well as a new category of partner institution (see appendix 1), were welcomed by the Alliance’s six charter institutions:
- Australia National Health and Medical Research Council
- Canadian Institutes of Health Research
- Chinese Academy of Medical Sciences
- Indian Council of Medical Research
- U.K. Medical Research Council, and
- U.S. National Institutes of Health, specifically its National Heart, Lung, and Blood Institute (NHLBI), the Fogarty International Center, now joined by NMIH (the three NIH members sharing one vote on the Alliance board).
The World Health Organization (WHO) is an observer on the board of the Alliance, created last June to support clear and coordinated research funding priorities in the battle against chronic, non-communicable diseases (CNCDs), namely:
- Cardiovascular diseases (mainly heart disease and stroke)
- Several cancers
- Chronic respiratory conditions, and
- Type 2 diabetes.
According to the WHO, of the 58 million deaths recorded in 2006, CNCDs caused about 60 percent.
Of the 35 million deaths caused by CNCDs, the Alliance’s first three research funding priorities are associated with 11.5 million of them (about one third; broken down below).
CNCDs cause twice as many deaths as the combined total of HIV/AIDS, tuberculosis, malaria, maternal and peri-natal conditions, and nutritional deficiencies.
The health impact and socio-economic cost of CNCDs is enormous and rising, upending efforts to combat poverty.
The Alliance’s multi-country, multi-disciplinary research in the first three priority topics, to be contracted next year, will focus in particular on the needs of low and middle income countries, and on those of low income populations of more developed countries.
They also agreed in New Delhi to commission several scoping initiatives to prepare future joint research related to obesity and diabetes, to be led by the Alliance’s acting Executive Director, Prof. David Matthews of Oxford University.
In total, Alliance members expect to invest tens of millions of dollars in their first coordinated research programmes over five years.
Members agreed that the research must, among other things:
- Involve local policymakers from the outset, with a commitment to scale up successfully tested programs
- Measure clinical outcomes – for example, a reduction in the incidence of stroke, not just a drop in the incidence of hypertension
- Not draw human and other resources away from any local health care system
- Create a tool-kit to be used later to scale up and replicate successfully tested programs
- Include a training / capacity building component.
Alliance members also agreed at their board meeting in New Delhi to fund a program to identify the world’s “Grand Challenges in Mental Health” under the leadership of the US National Institute for Mental Health, in association with Alliance Board Chair Abdallah Daar and Vikram Patel, of the London School of Hygiene & Tropical Medicine and the Sangath Centre in Goa, India.
The Alliance expanded its mandate to include mental illnesses because of their link to CNCDs and the rising toll they take globally, including 1 million suicides annually, eating disorders and alcoholism leading to death by injury. Some experts predict mental health problems will become the world’s second leading cause of disease burden by the early 2020s.
Says Dr. Pamela Collins, Associate Director for Special Populations and Director, Offices for Special Populations, Rural Mental Health Research and Global Mental Health at NIMH: “Working with in house and extramural program staff, NIMH develops global projects and provides technical consultation to the international mental health community. We are excited to be working with the Alliance and look forward to developing the Grand Challenges in Global Mental Health.”
It was agreed in New Delhi that Canada’s International Development Research Centre will host the Alliance secretariat. Ottawa-based IDRC was chosen from among six expressions of interest from around the world.
And, at the invitation of the Chinese Academy of Sciences, China will host the Alliance’s next scientific and Board meeting in 2010.
Hypertension
According to the World Health Organization, hypertension (high blood pressure) is the leading cause of cardiovascular deaths, causing 5 million premature deaths each year.
Experts estimate 1 billion people worldwide are affected by hypertension, with 1.5 billion victims predicted by 2025.
The World Hypertension League (WHL), an umbrella organization of 85 national hypertension societies and leagues, estimates that over half those with hypertension are unaware of it.
This major cause of illness, including strokes, is very poorly addressed in developing countries.
Tobacco
Tobacco (including India’s high-nicotine, flavored, filterless bidi products, dubbed “cigarettes with training wheels” by health authorities), is expected to kill 1 billion people prematurely this century.
The challenge is to reduce this toll, especially in the developing world, which is increasingly targeted by tobacco companies as western markets diminish.
Almost 5 million people died from smoking worldwide in 2000, rough half of them living in developing countries and half in rich nations.
At least half of these adults die between 30 and 69 years of age, losing decades of productive life. Cancer and smoking deaths have fallen sharply in men in high-income countries but are expected to rise globally unless smokers in low- and middle-income countries stop before or during middle age.
Indoor air pollution from cooking stoves
About 3 billion people cook their meals with wood, dung, coal and other solid fuels over open fires or on primitive stoves inside their homes.
As a result, the WHO estimates that 1.5 million people die prematurely each year.
The Alliance program will, among other goals, develop and evaluate new designs capable of large scale manufacturing, along with local and regional commercialization strategies.
Mental Health
According to the WHO, “mental, neurological, and substance use disorders are common in all regions of the world, affecting every community and age group across all income countries. While 14% of the global burden of disease is attributed to these disorders, most of the people affected - 75% in many low-income countries - receive no treatment or care.
Estimates in 2001 suggested that about 450 million people worldwide suffer from mental or neurological disorders or from psychosocial problems such as those related to alcohol and drug abuse. Many of them suffer silently and alone without care on the frontiers of stigma, shame, exclusion and death.
Major depression is now the leading cause of disability globally and ranks as the 4th leading cause of disease burden global, rising to the 2nd leading cause by the early 2020s, according to WHO prediction.
Globally in 2001, 70 million people suffered alcohol dependence, about 50 million had epilepsy and 24 million had schizophrenia. For every successful suicide (1 million in 2001), the WHO estimates between 10 and 20 people attempt it.
* * * * *
Quotable quotes:
Abdallah S Daar, Chair of the Alliance, Professor of Public Health Sciences at the University of Toronto and University Health Network’s McLaughlin-Rotman Centre for Global Health: “Our 2007 study in Nature identified the Grand Challenges in chronic non-communicable diseases. This month in Delhi, some of the world’s leading CNCD experts discussed potential early research funding priorities, such as the link between undernutrition in early life and the risk of diabetes and heart disease later, the connection between tuberculosis, diabetes and chronic obstructive lung disease, the strength of evidence for nutritional advice given to the public, and the growing epidemic of diabetes and obesity in developing countries. At future scientific and board meetings we will return to these and other topics, but for now we wanted to pilot the concerted research approach that, once successfully demonstrated for one condition, can be used for others.”
Dr. Elizabeth Nabel, Director, NHLBI: “Alliance members intend to jointly develop the request for proposals and combine on the peer review of those received, coordinate funding by Alliance members and partners, create standardized data gathering tools and databases, and harmonize evaluation methods. The Alliance represents an important new vehicle for making optimal use of limited global resources available to reduce the enormous toll of these largely-preventable diseases.”
Dr. David Matthews, Professor, Oxford University and acting Executive Director of the Alliance: “The epidemic of chronic disease in the world has accelerated. We urgently need to understand how to reverse the trend, not just in small trials, but in all the world communities. This new initiative will provide urgently needed resources to find and implement solutions”
Dr. Alain Baudet, President, Canadian Institutes of Heath Research: “We know quite a lot about how to manage chronic diseases on a small scale. The challenge is how to scale up interventions, especially in low resource settings. For Canadians, this includes our own aboriginal populations, whose health outcomes need to be improved dramatically. For example, they have some of the highest incidence of diabetes type 2 in the world.”
Prof. Warwick Anderson, CEO of the Australia National Health and Medical Research Council: “Australia has some of the most advanced medical care in the world, yet our aboriginal population continues to suffer from high levels of both infectious and chronic diseases, including mental illness. They have high rates of diabetes, and many wind up with end-stage kidney failure, requiring prolonged dialysis or transplantation. We must address chronic diseases seriously and urgently.”
Sir Leszek Borysiewicz, Director, Medical Research Council of the UK: “We wanted to take an engineering approach: what is the problem, how can we bring different people together to design a solution, develop a plan to implement the solution, and then scale it up. We wanted policymakers to be involved from the beginning. This is implementation science. And that is what we need now.”
Dr. V.M. Katoch, Director-General, Indian Council of Medical Research: “India has become the diabetes capital of the world; its people suffer from cardiovascular diseases at an early age and millions suffer chronic lung diseases as a result of smoking tobacco and our own type of cigarettes, the bidi, which the government is unable to regulate or tax. And indoor pollution from old fashioned cooking stoves is a major cause of chronic lung diseases, especially among children and women. These problems cannot afford to wait to tackle these problems.”
Prof. Depei Lu, President, Chinese Academy of Medical Sciences: “China has a huge population, and CNCDs and mental health problems constitute a huge burden of disease and disability. The Alliance provides a mechanism for us to work with our colleagues around the world to identify how best to address these conditions. We welcome the Alliance to China next year.”
* * * * *
Appendix 1
Partner organizations:
- The National Institute of Medical Research, Tanzania
- The World Heart Federation,
- The Pan American Health Organization
Media contacts at member institutions:
National Heart, Lung, and Blood Institute (NHLBI) of the U.S. National Institutes of Health:
+1-301-496-4236
nhlbi_news@nhlbi.nih.gov
Canadian Institutes of Health Research
+1-613-941-4563; +1-613-808-7526 (m)
mediarelations@cihr-irsc.gc.ca
U.K. Medical Research Council
Ms. Hazel Lambert, +44-(0)-207-670 5301; +44 (0) 20 7637 6011
press.office@headoffice.mrc.ac.uk
Australia National Health and Medical Research Council
Ms. Carolyn Norrie, +61 (02) 6217 9342; +61-0422 008 512 (m)
carolyn.norrie@nhmrc.gov.au
