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Prof Asma El Sony speaks on behalf of The Union at UN Summit on NCDs

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Prof Asma El Sony of Sudan, Past President of The Union, represented The Union at the UN High-Level Meeting on Non-Communicable Diseases (NCDs) last month in New York. She spoke about the increasing impact of chronic respiratory diseases and other NCDs on low-income countries as part of the Roundtable on the Rising Incidence, Developmental and Other Challenges, and Social and Economic Impact of NCDs and Their Risk Factors. Following is a summary of her main points:

INTRODUCTION

 

Good afternoon, I am Prof Asma El Sony of Sudan, representing the International Union Against Tuberculosis and Lung Disease, an international scientific institute and federation of members from 150 countries. The Union has been working on behalf of global lung health for 91 years. Each year it works in some 80 low- and middle-income countries, offering technical assistance, conducting research and providing training dedicated to finding health solutions for the poor.

 

My topic is respiratory diseases – diseases that affect your ability to breathe, and breath is life. When you can't breathe easily, it is difficult to work, go to school, sleep, eat or carry out any daily responsibilities. Consequently the impact of lung diseases on individuals, families, communities and economies is enormous.

 

Hundreds of millions of people suffer from lung disease, struggling each day for breath. Chronic respiratory diseases cause approximately 7% of all deaths worldwide and represent 4% of the global burden of disease. Lung diseases afflict people in every country and every socioeconomic group, but take the heaviest toll on the poor, the old, the young and the weak. Some of these diseases are communicable, such as influenza, but three of the major lung diseases – asthma, chronic obstructive pulmonary disease and lung cancer – are non-communicable diseases, our topic at the UN here this week.

 

ASTHMA: Key Points

 

  • The rising incidence of asthma over the past 30 years has produced worldwide public health concern. WHO reports that 235 million people now suffer from asthma.
  • For more than 20 years, the International Study of Asthma and Allergies in Childhood (ISAAC) has been tracking changes in the prevalence of asthma in children in 105 countries. Their data show that asthma is on the increase in many low- and middle-income countries, and it is more severe in these countries.
  • The World Health Survey found an 8.2% prevalence of diagnosed asthma among adults in low-income countries and 9.4% in the richest countries. Middle-income countries had the lowest prevalence at 5.2%.
  • Smoking and secondhand smoke are two of the strongest risk factors — and triggers — for asthma.
  • Although asthma is frequently thought of as an allergic disease, this does not apply to all cases, and the non-allergic mechanisms need to be the focus of more research.
  • Surveys around the world found asthma treatment falling short, with few patients consistently using the inhaled corticosteroids that effectively manage the disease. For example, the Asthma in America survey found only 26.2% of patients with persistent asthma used these medicines.
  • While many countries now have asthma management guidelines, many health workers do not know how to diagnose or treat asthma, and health systems are not organised to handle this type of long-term, chronic disease.
  • A 2011 Union survey of the pricing, affordability and availability of essential asthma medicines in 50 countries found dramatic variations. For example, one generic Beclometasone 100µg inhaler in a private pharmacy cost the equivalent of nearly 14 days' wages — and a patient with severe asthma requires about 16 of these inhalers per year.
  • The Asthma Drug Facility established by The Union has been able to bring down the cost of treating a patient with severe asthma to approximately US$ 40 per year. This is a model that could be applied to other diseases.
  • When people with asthma do not have access to ongoing care, they often end up in emergency rooms and hospitals — a costly and unnecessarily disruptive process for all involved.
  • Although economic data are unavailable for almost all low-income countries, a 2009 systematic review found annual national costs (in 2008 US dollars) ranging from $8,256 million in the United States to $4,430 million in Germany.
  • In Finland, where an asthma management programme has been in place since 1994, the mortality, number of hospital days and disability due to asthma fell 70–90% between 1994 and 2010 and a conservative estimate of the savings was $300 million in 2007 alone.

Chronic Obstructive Pulmonary Disease (COPD): Key Points

 

  • COPD is an umbrella term used today to describe emphysema and chronic bronchitis. It is a progressive and debilitating condition that can not be cured.
  • According to WHO, more than 3 million people died of COPD in 2005, 90% of them in low- and middle-income countries.
  • By 2030, COPD will be the third leading cause of death worldwide.
  • The leading risk factor for COPD is smoking, so it is no coincidence that COPD rates are rising in the countries where use of tobacco is also on the increase.
  • To reverse the epidemic of COPD, it is essential to reduce the number of people who smoke.
  • Other contributing risk factors include air pollution, secondhand smoke, biomass smoke and occupational exposures.
  • Indoor air pollution from burning solid fuels for cooking, light and heating is another major risk factor, especially in the low- and middle-income countries. Solid fuel use was responsible for 1.5 to 2 million deaths in 2004, with 28% in Africa, 32% in South-East Asia, and 30% in the Western Pacific. In 2007, more than 70% of the population in rural India and Africa continued to use these fuels.
  • While inhaled bronchodilators and corticosteroids can be used to treat COPD, they can not cure it.
  • Smoking cessation is the only convincing intervention that has reduced the rate of decline in patients with COPD.

 

Tobacco Control: Key Points

 

  • Tobacco is the leading risk factor for all three of the major non-communicable lung diseases – lung cancer, COPD and asthma. Consequently you can not talk about addressing lung disease without talking about tobacco control.
  • And you can't talk about tobacco control without acknowledging that, as tobacco use has gone down in industrialised countries, the tobacco industry has targeted low- and middle-income countries as its new and lucrative market.
  • Today there are 1.2 billion smokers in the world, and 90% of them live in low- and middle-income countries.
  • Imagine the impact on global health, as well as on other factors from air pollution and garbage collection, if those 1.2 billion people stopped smoking.
  • The world's first public health treaty – the WHO Framework Convention on Tobacco Control – is moving us in that direction.
  • 174 countries representing 87.4 % of the world's population are parties to the FCTC, but implementing the treaty continues to be a slow process because of lack of resources and pro-tobacco interests.

 

CHALLENGES/CONCLUSIONS

 

  • The cost of lung disease runs to billions of dollars each year in lost productivity and increased health care expenses – to say nothing of diminished and ruined lives;
  • To move forward we will need to build a strong partnership between non-governmental organisations, such as The Union, governments, civil society, the private sector and community groups.
  • Our goals must be:
  • to offer widespread support to the 174 nations that have ratified the FCTC and call upon the remaining countries to address the need for tobacco control;
  • To demand increased research funding to develop tools and treatments for lung disease;
  • To strengthen health systems and work towards the fair and equitable distribution of health care resources to all who need them;
  • To lobby for improved legislation protecting the quality of the air we all breathe;
  • To ensure that every health worker, parent, child, teacher, employer, religious leader, community leader, media representative and government official understands the risks and symptoms of lung diseases and how to keep lungs healthy, because lung health is essential to breath and life.

OTHER UNION ACTIVITIES AT THE UN "SUMMIT":

 

  • As one of the four principal partners in the NCD Alliance, The Union served on the Steering Committee, working groups and other committees that pushed for the Summit to take place, lobbied for the strongest possible outcomes document and participated in advocacy and communications efforts over the course of the summer.
  • To help build the case for the Summit, The Union participated contributed to NCDA publications on NCDs and Women, NCDs and Children and a briefing paper on Essential Medicines.
  • At a side event organised by the NCDA on Saturday, 17 September, The Union launched the Global Asthma Report 2011, which was produced with the International Study of Asthma and Allergies in Childhood (ISAAC), and the Collaborative Framework for Care and Control of Tuberculosis and Diabetes, developed by the World Health Organization and The Union.