By: Alanna Shaikh

One of the big narratives of global health over the last decade has been the changing role played by non-communicable disease. Diseases like cancer, heart disease, and diabetes, were once seen as the exclusive burden of healthy countries. Poor countries, on the other hand, faced infectious diseases like tuberculosis and polio. Now, though, that picture is changing, and in some unexpected ways. A new article in eHospitalist News provides a good overview.

First of all, the old school diseases of the wealthy world are increasingly prevalent in poor countries. Asthma, obesity, and diabetes are all shaping up to be serious problems in city dwellers throughout the developing world. And they are often caused by the same lifestyle factors that drive these conditions in the wealthier world – tobacco use, physical inactivity, unhealthy diets, and the harmful use of alcohol.

However, lifestyle isn’t the only factor in con-communicable diseases. Obesity and malnutrition actually often go together. Concurrent infections, lack of access to health-care and environmental toxins also make chronic diseases worse. Subsequently, poor countries are ending up with not just the diseases of the wealthy but a bonus helping of chronic conditions caused by the problems specific to poverty. One prime example: lung disease in the wealthy world is primarily the result of cigarette smoking.  In poor countries, it’s more likely to be caused by chronic pollution, especially indoor air pollution from biomass fuels, and then made worse by smoking. Those kinds of problems are ugly, and hard to solve.

Finally, the line between infectious diseases and chronic diseases is fading fast. It’s becoming obvious that many diseases land somewhere in between. Neglected tropical diseases (NTDs), it seems, are a prime example. Dr. Peter Hotez (pretty much the most respected NTD expert in all of human existence, as far as I can tell) points out that most NTDs don’t spread from person to person, and they cause chronic, lifelong harm to the people infected. At the same time, they do spread as a result of environmental factors, and their spread can be stopped with the right kind of public health efforts. So they’re not strictly non-communicable either.

Another example can be found in Africa, which is seeing a rise in cardiovascular disease due to infectious causes, primarily bacterial infections like tuberculosis and streptococcus. According to Dr. Ana Mocumbi, a cardiologist and researcher at the Maputo Heart Institute in Mozambique, these conditions “can be considered neglected diseases because, despite considerable numbers of people, they have not been the subject of systematic research or structured control programs and did not benefit from translation of knowledge obtained in other areas of human knowledge…”

The situation, I think, is best summed up by Paul Farmer, “”It can’t be diabetes versus mental health or rheumatic heart disease versus cancer. It has to be a very collaborative effort that draws on partnerships and synergies. … In building platforms for the delivering of care for chronic disease, we need to do many things at once.”

Alanna Shaikh is an expert in health consulting, writing about global health for UN Dispatch and about international relief and development at Blood & Milk. She also serves as a frequently contributing blogger to ‘End the Neglect.’ The views and opinions expressed by guest bloggers are not necessarily the views and opinions of the Global Network. All opinions expressed here are Alanna’s own and not those of any employer or the US government.