Although 80% of NCD deaths take place in low and middle-income countries, the fact is that for the 50 or so poorest countries in the world an unfinished litany of problems remains—infectious diseases, maternal and childhood illnesses, and unchecked population growth. NCDs come bottom of this list.Quite rightly so. Diseases that can't pass from one person to another, whose cause is usually multi-factorial and can't be isolated and analysed, come a long way down the pecking order of complaints that a world health authority should turn its hand to – especially when people are dying in ways that should be cheap and easy to prevent.
If we are to make any progress at all in getting NCDs noticed, we’ll have to show how their prevention and treatment can easily be integrated into existing health programmes that are already struggling in health systems starved of cash and capacity.How can you prevent something when you don't know what causes it? How, also, can you do it at no cost?
Another big vertical initiative is not what countries want or need. This points to an uncomfortable truth—we in the health community have not made an effective business case for NCDs. Deaths alone are not enough. We need to show why NCDs matter—and they do—for economic stability as well as poverty reduction. The macroeconomic case for action is lacking: an urgent gap to fill between now and September.So what is the 'business case' for emphasising NCDs, when Horton himself admits they are at the bottom of the heap as far as poor people's priorities go?
My cynicism knows no bounds perhaps, but the Framework Convention Alliance's interest in this conference indicates that tobacco control can be found lurking. I just hope that their keenness to promote the cause of NCDs doesn't lead to people being pressurised to sack employees who smoke, or otherwise make their lives difficult. I'm also intrigued about exactly what the conferences imagine they can do cheaply and easily to prevent non-communicable diseases ... but since they wish to discuss them at inter-government level this September, perhaps it won't be long before we find out.