Non-communicable diseases in low and middle-income countries: a priority or a distraction?

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Abstract
Non-communicable diseases (NCDs) as a proportion of total mortality inevitably rise as an epidemiological consequence of population ageing and hazardous exposures, particularly smoking, increase. A decade ago we were told that the ‘ageing crisis’ would swamp public resources,1 and the same message continues to be reiterated.2 Now we are being told that NCDs in the developing world represent a ‘race against time’,3 although over the last two decades the ‘threat’ of coronary heart disease has been continually highlighted, without much sign of prioritization.4–7 In the majority of countries, all-cause mortality at ages 15–59 has shown a persistent, downward trend over the last two decades, although these favourable trends have been attenuated markedly in sub-Saharan Africa and some eastern European countries as a result of deaths due to HIV and to injuries, respectively.8 As the crisis has not materialized and the race has not yet been lost, it is pertinent to ask who are the likely beneficiaries of these alarmist strategies. In the former case, the private pensions sector stood to gain considerable investment had World Bank policies to develop mandatory ‘multi-pillar’ systems of publicly and privately managed pensions and a voluntary pillar of personal savings been taken up. In the latter case it is the pharmaceutical and the global health care industries that may benefit. Of course, in both cases, there is an altruistic element of preventing suffering and helping the sick.