Noncommunicable diseases (NCDs) - mainly cardiovascular disease, diabetes, cancer and chronic respiratory disease - are not just one of the world’s most pressing health concerns but also a significant development challenge. They impede social and economic development and are driven by underlying social, economic, political, environmental and cultural factors, broadly known as ‘social determinants’. Working alongside specialist health partners, actors outside the health sector are uniquely well positioned to address the social determinants of NCDs.

1. Addressing the social determinants
of noncommunicable diseases
Brian Lutz
Policy Specialist: AIDS and MDGs
HIV, Health and Development Practice
Bureau for Development Policy, UNDP

2. Jessy’s and other women’s stories at http://www.nytimes.com/2013/10/16/health/uganda-fights-stigmaand-poverty-to-take-on-breast-cancer.html
Video: http://www.nytimes.com/2013/10/16/health/uganda-fights-stigma-and-poverty-to-take-on-breastcancer.html#videoModal

3. Culture and identity
Poverty
Stigma
Health care
Transport
Education

4. http://www.undp.org/cont
ent/undp/en/home/library
page/hiv-aids/discussionpaper--addressing-thesocial-determinants-ofnoncommu/

5. NCDs are a development issue
NCDs have social determinants
Action on social determinants of
NCDs is possible and necessary

6. What are NCDs and their risk factors?
Source: Global status report on noncommunicable diseases 2010. Geneva: WHO, 2010

7. NCDs are a large and growing health challenge
100%
80%
Deaths
globally
60%
40%
65%
68%
74%
1990
20%
57%
2010
2015
2030
0%
Deaths in lowincome
countries
100%
80%
60%
40%
20%
0%
54%
2015
Deaths in lower
middle-income
countries
42%
2030
Other
100%
80%
60%
40%
NCDs
60%
69%
2015
20%
2030
0%
Source: Lozano et al. 2012; WHO projections of mortality and causes of death
(http://www.who.int/healthinfo/global_burden_disease/projections/en/)

9. NCDs also negatively impact human development
•
•
•
Macroeconomic
Premature morbidity
Premature mortality
Lost income, employment
NCDs and risk
factors
MDGs
•
•
•
•
•
•
Household
Higher healthcare expenses
Diversion of labour
Stigma and discrimination
Health system costs
Strain on health budgets
Diversion scarce resources
Worsening risk pools
Source: see, e.g., Bloom et al. 2011; Global status report on noncommunicable diseases 2010. Geneva: WHO,
2010; Swartz 2010; Mahal et al. 2009

10. NCDs are a development issue
NCDs have social determinants
Action on social determinants of
NCDs is possible and necessary

11. Social choices drive NCD epidemics
NCD examples
Social (structural)
determinants
Trade
Food/ ag policy
Employment
Urbanization
Social protection
Housing
Norms
Exclusion
Governance
More non-health sector
Risk factors
Biological and
behavioral risk
factors
• Obesity
• Tobacco use
Health-seeking
behavior
Health – level
and distribution
NCD morbidity and
mortality
• Cardiovascular
diseases
Examples follow
More health sector

12. CVD shows inequities by socio-economic status
Cardiovascular mortality (aged 45-64) by district socio-economic level in Porto Alegre,
Brazil, 2008
Source: Bassanesi et al. 2008

13. Social gradients in obesity differ across countries
Obesity prevalence in women by education status in countries at different levels of
economic development
Source: Monteiro et al. 2004

14. The poor in poorer countries smoke more
Smoking prevalence by income quintiles
Source: Global atlas on cardiovascular disease prevention and control. WHO, World Heart Federation and World Stroke Organization, 2011

15. Source: Hawkes 2006

16. NCDs are a development issue
NCDs have social determinants
Action on social determinants of
NCDs is possible and necessary

17. Overarching frameworks exist
2003
WHO Framework Convention on Tobacco Control
2004
Global Strategy on Diet, Physical Activity and Health
2008
Action Plan for the Global Strategy for the Prevention
and Control of NCDs 2008-2013
2010
Set of Recommendations on the Marketing of Foods
and non-Alcoholic Beverages to Children
2010
Global Strategy to Reduce Harmful Use of Alcohol
2011
WHO ‘Best Buys’
2013
NCD Global Monitoring Framework (GMF)
2013
The Revised Global Action Plan for the Prevention and
Control of NCDs 2013-2020

18. Typology of multisectoral action

19. NCD-specific: ban of tujilijili in Zambia
Source: http://www.add-resources.org/liquor-sachets-banned-in-zambia.5043749-76586.html; http://allafrica.com/stories/201204160957.html

20. NCD-sensitive: housing experiment in the USA
Less obesity
Less diabetes
Source: Orr et al. 2003; Moving to Opportunity for Fair Housing Demonstration
Program: Final Impacts Evaluation. US Department of Housing and Urban
Development (HUD), 2011

21. Framework for action on SDH outside the health sector

22. Thank you !