Neglected chronic disease: The WHO framework on non-communicable diseases and implications for the global poor

ABSTRACT

The current global framework on noncommunicable disease (NCD), as exemplified by the WHO Action Plan of 2012, neglects the needs of the global poor. The current framework is rooted in an outdated pseudo-evolutionary theory of epidemiologic transition, which weds NCDs to modernity, and relies on global aggregate data. It is oriented around a simplistic causal model of behaviour, risk and disease, which implicitly locates ‘risk’ within individuals, conveniently drawing attention away from important global drivers of the NCD epidemic. In fact, the epidemiologic realities of the bottom billion reveal a burden of neglected chronic diseases that are associated with ‘alternative’ environmental and infectious risks that are largely structurally determined. In addition, the vertical orientation of the framework fails to centralise health systems and delivery issues that are essential to chronic disease prevention and treatment. A new framework oriented around a global health equity perspective would be able to correct some of the failures of the current model by bringing the needs of the global poor to the forefront, and centralising health systems and delivery. In addition, core social science concepts such as Bordieu's habitus may be useful to re-conceptualising strategies that may address both behavioural and structural determinants of health.

KEYWORDS:

• Noncommunicable disease
• sub-Saharan Africa
• anthropology
• health systems

Acknowledgements

I would like to thank Prof. Arthur Kleinman, for his thoughts, comments and guidance in developing this paper. I would also like to thank the two anonymous reviewers whose insightful and detailed comments enabled further refinement and depth to the content in this paper.

Disclosure statement

No potential conflict of interest was reported by the author.