Diseases neither know nor respect national boundaries. Consequently, our efforts to use the power of research to develop new ways of fighting disease must have a vision that extends beyond borders. This week in New Delhi, we have an exceptional opportunity to do just that by focusing attention on what may be the world’s quietest epidemic: the global surge in heart disease, cancer, diabetes and other non-communicable diseases.
The US National Institutes of Health (NIH) and the Indian Departments of Science and Technology and Biotechnology are convening a joint summit on cost-effective technologies to treat and prevent non-communicable diseases. These diseases are globally on the rise. In fact, this year, non-communicable diseases will account for two of every three deaths worldwide.
In India, non-communicable diseases have eclipsed infectious diseases as the leading cause of death and now contribute to 53% of the nation’s mortality. Of compounding concern is the high prevalence of metabolic risk factors, such as high blood pressure and elevated levels of blood glucose and cholesterol. An estimated one-third of Indians have high blood pressure and more than one-quarter have elevated cholesterol. These troubling trends have prompted health minister Ghulam Nabi Azad to issue a call to action to strengthen efforts to combat non-communicable diseases.
The economic toll also is alarming. According to the World Health Organisation, India stands to lose $237 billion between 2004 and 2015 due to lost productivity from premature deaths caused by non-communicable diseases. India is not alone — the United States and many other nations are experiencing similar economic effects.
Addressing this will require the involvement of many sectors of society, including healthcare organisations, food producers, educational institutions, governments and non-profit organisations. To ensure the wisest use of limited resources, such efforts must be supported by data generated by well-designed scientific studies.
One research frontier is identifying disease risk factors and developing strategies to reduce or eliminate these risks. Tobacco and many other risk factors for non-communicable diseases are well-recognised. However, others, such as salt consumption and exposure to smoke from unvented indoor cooking stoves, are less appreciated.
Risk-reduction efforts will demand a nuanced understanding of local communities. Public health authorities in Tamil Nadu, for example, have adapted a version of NIH’s Diabetes Prevention Programme for use in their rural areas.
In contrast to the US programme, their effort does not emphasise weight loss, because most participants are not overweight. Instead, the programme strives to reduce metabolic risk factors for diabetes by encouraging exercise and consumption of lentils, millet and other high-fibre, high-protein foods.
Research is vital to realising the tremendous potential of mobile communications technologies to improve health. For instance, US researchers have developed a quarter-sized, lens-less microscope that, when connected to a mobile phone, can beam high-quality images of cells and microbes to computers halfway around the globe. The computers can automatically interpret the images, providing a convenient way to manage diseases in patients who live far from medical centres.
Another shift is occurring in how health technologies are developed. Recently, some of the most cost-effective strategies have arisen from research that reflects the needs of developing communities. From India, these include the ‘Jaipur knee’, a prosthetic knee joint for amputees that costs only $20, low-cost intraocular lenses for cataract surgery, and a hand-held electrocardiogram (ECG) device that has reduced the cost of ECG testing to $1 per patient.
Clearly, medical innovation is a two-way street, with ideas flowing back and forth between laboratories around the world. The United States and India share a 50-year legacy of global health discovery through cooperation in such areas as vaccine development and agricultural innovation. Our challenge now is to join our innovative capacities to address the growing burden of non-communicable diseases.
This is one epidemic in which there truly is no ‘us’ and ‘them’, only ‘we’. Because all nations are feeling the devastating impact of non-communicable diseases, all must come together to forge the solutions.
Francis S Collins is director, US National Institutes of Health
The views expressed by the author are personal