By Sara Martin
Vice Chair, Access Accelerated
Senior Director, Global Policy Partnerships, Bristol Myers Squibb
A Member Company of Access Accelerated since 2017
The NCD burden: Unequal access, unequal impact
Noncommunicable diseases (NCDs) like cancer, diabetes, and cardiovascular and respiratory diseases cast a long shadow over global health and our collective economic prosperity. While these conditions affect us all, their impact is not evenly felt. Low- and middle-income countries (LMICs) shoulder a disproportionate burden, with over 75% of NCD-related deaths occurring in these regions.
The latest analysis of the Global Burden of Disease Study 2021, published in The Lancet last week, reveals a declining trend in NCD mortality rates across high-income countries and regions, while low-income counterparts continue to grapple with this burden. What’s fueling these inequities? The answer is complex. Economically and socially disadvantaged groups tend to be more exposed to harmful products, lack health education and awareness, and are more vulnerable to the serious financial consequences of illness, including unemployment and poverty. Moreover, they may face limited access to quality healthcare: the high cost of care (including burdensome out of pocket payments), geographic remoteness of health centers, and under-resourced health systems all create major barriers to quality prevention, diagnosis, and treatment, further impacting health outcomes.
As a result, people in LMICs are 1.5 times more likely to die prematurely from NCDs compared to those in high-income countries. This disparity is a stark reminder that health and its consequences are not just about individual choices but are influenced by factors far beyond any one person’s control. It particularly underscores the need to bridge the gap between healthcare advancements and their equitable access, as emphasized by the Global Burden of Disease Study 2021 analysis.
Health equity: the key to achieving the SDGs
Now we stand at a critical crossroads: the 2030 Agenda for Sustainable Development, with its focus on ‘Health for All’ and leaving no one behind, clearly demands a strong commitment to health equity. This means ensuring that everyone, regardless of geography, race, gender, income, or education levels, has the opportunity to reach their full health potential.
Indeed, equity is central to achieving the Sustainable Development Goals (SDGs), particularly SDG 3: ensure healthy lives and promote well-being for all. Without addressing NCD inequities, progress toward the SDGs, including universal health coverage (UHC), will be impossible.
Health equity is a powerful accelerator
Fortunately, there is increasing awareness among leaders of this divide and a growing appetite to address it. To bolster this groundswell, the NCD Alliance (NCDA), through the support of Access Accelerated, recently published two resources on addressing health inequities in the context of NCDs: (1) a conceptual framework and (2) a practical guide for community advocates. Building on the foundation that began with Access Accelerated’s support, I am pleased that the company I work for, Bristol Myers Squibb, is now supporting NCDA to roll out the framework and build the health equity case for people living with NCDs.
The conceptual framework serves as a highly useful in-depth introduction to health equity in the context of NCDs, and outlines eight key areas for action, including ensuring involvement of people living with NCDs in policy decisions, access to people-centered and integrated care, creating health enabling environments, mobilizing financing and resources, addressing stigma and discrimination, prioritizing health literacy, and generating evidence to inform policies and programs. The practical guide, meanwhile, walks community advocates step by step through the process of creating an NCD Equity Report that can then be leveraged to develop effective, evidence-based advocacy strategies.
A whole-of-society approach to NCD equity
One major challenge in achieving NCD equity is that many of its influencing factors lie outside of the healthcare sector entirely. Social determinants, like income, education, and the environment, play major roles in shaping health outcomes. From health education to the affordability and ease of access to care, to the financial burden of illness, these all influence health equity.
That means that it’s not enough to attempt to address NCD inequities in a single-sector silo: solutions will rely on sectors like education, urban planning, environment, and finance working together.
While multisectoral action among government sectors is critical, governments will also need to look beyond the public sector and forge meaningful collaborations with partners in civil society and the private sector.
Putting equity into action
Access Accelerated has long had equity at the forefront of our work, by supporting projects that are sensitive to the needs of underserved and hard-to-reach communities. This has included, for example, a project by the World Heart Federation that worked to address the considerable burden of cardiovascular disease faced by women of African descent in Colombia. In Kenya, another project focused on improving access to care for people living in rural areas.
Access Accelerated has also collaborated with partners, including the World Bank, in their efforts to generate evidence and investment cases to inform policies aimed at improving equitable access to NCD care. A recent World Bank study, supported by Access Accelerated, shed light on the impact of NCDs in Kosovo. Among the landmark findings, it revealed a concerning disparity in NCD care access, with the Roma, Ashkali, and Egyptian communities, as well as rural populations, struggling to reach essential care.
The road to health equity takes many forms. In another example, the World Bank provided Ministries of Health and Finance with the technical expertise and evidence needed to introduce taxes on unhealthy sugar-sweetened beverage (SSBs). This is not only an opportunity to respond to the rising NCD burden and generate much needed revenue, but it is also a way to address health inequity as lower-income households tend to consume more of these beverages and therefore bear more of their negative health effects.
Pulling the right levers: NCD financing strategies for health equity
The moral case for investing in health equity is plain to see: it’s the right thing to do. But it’s also good for the economy. After all, healthy people are more productive and contribute more to a nation’s economic prosperity. Likewise, by preventing and managing NCDs—the world’s leading cause of death and disability—we can reduce the significant financial burden these diseases place on individuals, communities, and healthcare systems.
But achieving these economic and financial gains calls for dedicated financing to ensure continued access to NCD services for vulnerable and marginalized communities.
While the future of development assistance for health remains uncertain, there is an opportunity to support countries to raise domestic financing by leveraging innovative financing mechanisms and public-private partnerships to bridge financing gaps.
Other measures, such as health financing reforms focused on current budget spending, would enable governments to enhance overall health spending efficiency and allow for more equitable resource allocation.
Critical milestones on the horizon
The Second Global Dialogue on Sustainable Financing for NCDs and Mental Health in June 2024 and the UN High-Level Meeting on NCDs in 2025 will provide valuable opportunities to create fresh inroads and advance efforts. For the new phase of Access Accelerated, this crucial time will mean even more emphasis on creating innovative, locally driven solutions to support countries’ capacities to strengthen sustainable domestic NCD financing, meaning countries are more able to deliver affordable, quality health services and overcome the barriers that stand between disadvantaged groups and NCD care. By prioritizing equity in NCD responses, we can ensure that no one gets left behind.