Three letters!
Things could have been different! Totally different! If only we had the right three letters, at the right place, at the right time. We wouldn't face the "whys" along with countless and endless discussions on "why not!"
The alphabets that we are talking about are "N," "C" and "D," the short form of Non-Communicable Diseases -- the silent killers. The place we are talking about is target "6" of the Millennium Development Goals (MDG) and the right time was 2000, when the MDGs were being formulated!
Back in 2005, when our organisation first started talking about over-nutrition and obesity in Bangladesh, the experience was somewhat unpleasant! The reason was very clear! Health policies and programmes in countries like Bangladesh are driven by global agenda, and after 2000 the global agenda is MGD. This means whenever we or anyone tried to talk about NCDs -- be that about prevention, management or control perspectives -- the inevitable question was "why NCDs? NCDs are not in MDGs, they are not in global agenda and therefore they are not important!"
Let's concentrate on our country only to measure the devastating effect of NCDs, as it will be easier for us to compile! Silently, these diseases have become the largest health burden of the nation, accounting for 61% of lives lost. This burden is expected to increase as the proportion of people over the age of 65 increases to 6.5% of the population by 2025. Why this sudden shift towards NCDs in a country with under-nourished mothers and children? There population is aging, which means people are living longer but without healthier living conditions, better nutrition, and access to good healthcare. All these are making Bangladeshis more vulnerable to NCDs.
It may sound cruel, but we sometimes think it's better to die quickly! We think like this because it would save us the suffering and healthcare costs. But when we suffer from NCDs, the possibility of dying quickly disappears and burden of healthcare increases. We all understand this fact, but still we cannot do anything. We cannot make NCD a global agenda because we didn't think of it back in 2000. Now we cannot have an official target, which means we cannot measure where we are and where we should be. Which means we have to wait for 2015, to get over with MDGs and wait for few months (years) to get another target. And then we have to keep our fingers crossed for getting NCDs as a global agenda. All these could have been easy to solve, if we had those three alphabets, at the right place, at the right time.
Because we couldn't make right effort at the right time, dying of NCDs wouldn't get considered by the people with big pot of money! Many still thinks that rich are dying out of these diseases, and they have the money to take care. But how true is this? Evidences show just the opposite and prove that these diseases are just robbing poor nations and making them poorer!
Back in 2000, our organisation wasn't even born! We didn't know what NCD and MDG stood for. But now we want to know, why were NCDs overlooked back in 2000 when the MGDs were formulated? Did anyone even mention it? Why did less prevalent infectious diseases get a separate goal while the "elephant in the room" didn't? Was it because many NCDs (e.g. lung cancer) are caused by some profitable products that NCDs were not mentioned in MGDs? Was it avoided because no company makes human immune deficiency viruses (HIV) or malaria parasites or TB bacteria, but there are business empires built on fizzy drinks, tobacco and junk food?
We don't know what went on then, but we know that there are things that we can do now to stop and reverse this trend. The first thing is making a global agenda. Let's admit that, yes it is a problem. When you recognise the problem, half the battle is done. The other half includes known and proved interventions -- tackling tobacco, reducing salt intake, tackling malnutrition, ensuring lifestyle modifications and making basic drugs available for people affected with these diseases. But, we are still delaying in making NCDs a global agenda!
But there is a ray of hope. People are waking from sleep, and there is a growing call for drawing attention towards these silent epidemics. Such calls resulted in World Health Organization publication of "Chronic Diseases: A Vital Investment" in 2006, holding of a WHO global forum ministerial meeting this year at Moscow, making of NCD a theme at the annual conference of Global Health Council, holding of countless meetings and seminars around the world, student movements, youth movements (NCD Action Network) and, finally, the upcoming UN high-level meeting.
We sincerely hope that after September 2011, we will not have to hear "why NCDs" and there will be more voices saying "why Not NCD's"
Let's keep our fingers crossed!