COVID-19: A New Lens for Non-Communicable Diseases
In this editorial, the editors discuss non-communicable diseases (NCDs) in the COVID-19 lens.
On September 11, 2019, global leaders met at the UN in New York, USA, to set an international agenda on NCDs which cause three-quarters of global deaths. In 2015, Sustainable Development Goal 3.4 set the ambitious target for countries to reduce their risk of premature mortality from NCDs by a third relative to 2015 levels by 2030.
The Lancet NCD Countdown 2030, published on Sept 3, 2020, reveals that, among high-income countries, only Denmark, Luxembourg, New Zealand, Norway, Singapore, and South Korea are on track to meet this target for both men and women if they maintain or surpass their 2010–16 average rates of decline.
There is knowledge on how to reduce the risk of NCDs – for the most part through a combination of effective tobacco and alcohol control, and well understood health interventions for hypertension, diabetes, and cancer. But addressing the broader determinants of NCDs is difficult without more robust fiscal measures. Although NCDs have received plenty of political attention, action has clearly been inadequate.
A modelling study published in The Lancet Global Health suggests that, worldwide, one in five people are at an increased risk of severe COVID-19 should they become infected, mostly as a result of underlying NCDs. The enormous efforts to deal with COVID-19 have also disrupted the regular care often required by patients with NCDs. WHO completed a rapid assessment survey in May, 2020, and found that 75% of countries reported interruptions to NCD services. Excess deaths from the disruption caused by COVID-19 might make any gains against the virus a pyrrhic victory. COVID-19 and NCDs form a dangerous relationship, experienced as a syndemic that is exacerbating social and economic inequalities.
During the COVID-19 pandemic, many countries have seen the value of stronger tobacco and alcohol controls, an important step towards reducing NCDs. But others have struggled to balance public health measures against predatory commerce and economic recovery.
COVID-19 is a pandemic that must highlight the high burden that NCDs place on health resources. It should act as a catalyst for governments to implement stricter tobacco, alcohol, and sugar controls, as well as focused investment in improving physical activity and healthy diets.
COVID-19 has shown that many of the tools required for fighting a pandemic are also
those required to fight NCDs: disease surveillance, a strong civil society, robust public health, clear
communication, and equitable access to resilient universal health-care systems.
COVID-19 could provide new insights into interactions between the immune system and NCDs, and potentially change the way the world understands and treat these diseases. It might also generate new long-term disabilities that will add to the NCD burden.
2020 has shown the crucial relation between communicable diseases and NCDs. Both inflict an unacceptable toll on human life. COVID-19 must stimulate far greater political action to overcome inertia around NCDs.