USAID Battles Insidious Non-Communicable Diseases

While the U.S. Agency for Development’s (USAID) first priority remains addressing infectious diseases such as malaria, HIV/AIDS, tuberculosis and common childhood killers such as pneumonia and diarrhea, the Agency is also battling cardiovascular and other non-communicable diseases in the developing world, where they have become major public health problems.

According to the World Health Organization, cardiovascular diseases (CVD), diabetes, obesity, cancers and respiratory diseases account for 59 percent of the 57 million deaths annually and four percent of the global burden of disease. Half of these (17 million annually) are CVD, the majority heart disease and stroke. Five of the top 10 selected global disease burden risk factors in the World Health Report 2002 are obesity, high blood pressure, high cholesterol, alcohol and tobacco. These non-communicable diseases cause the majority of the chronic disease burden.

“Chronic diseases are the major cause of death and disability worldwide," said Dr. E. Anne Peterson, USAID Assistant Administrator for Global Health. "Sadly, only a few largely preventable risk factors account for most of the world’s disease burden.”

A recent USAID report, “Foreign Aid in the National Interest,” observes that in all developing countries, except Africa, non-communicable diseases - including cardiovascular disease, circulatory disease, hypertension, stroke, diabetes, cancer and injuries - have overtaken infectious diseases as the leading cause of disability and death.

USAID supports programs to promote healthy lifestyles, nutrition and anti-smoking programs in Egypt, Russia, Bosnia, Croatia, Kosovo, Armenia, Kazakhstan, and Georgia. For example, since 1998 in Egypt, USAID has sponsored anti-smoking and public education campaigns on the dangers of tobacco use.

In Russia, USAID worked with the Quality Assurance Project to implement a quality management approach in Tula Oblast focusing on improving adult hypertension care at the primary care level. The project was able to reduce inpatient admissions by 17 percent and thus reduce the overall cost of care by 23 percent. As a result of the program, overall levels of hypertensive crises, strokes and myocardial infarctions decreased.

USAID also supports the American International Health Alliance (AIHA) in many partnerships that feature programs in cardiovascular health. AIHA's network of more than 100 partnerships has been highly successful in effecting sustainable change in the healthcare infrastructure of some 22 nations in Central and Eastern Europe and the Former Soviet Union.

In Georgia the proportion of total mortality due to CVDs was 70 percent in 1992. Recognizing that blood pressure control programs are considered the most cost-effective strategy for reducing the risk of CVDs, AIHA’s Mtskheta-Mtianeti/Milwaukee primary health care partnership developed a community-based program in 2000 aimed at increasing detection and control of high blood pressure. The program expanded to five districts and demonstrated impressive results with an overall average decrease of 12 percent and 10 percent respectively in the systolic and diastolic pressures levels compared to baselines.

In Bosnia, through a USAID-supported partnership involving clinicians from Tuzla, Bosnia and Buffalo, New York, the partnership is working to establish a "cardiac center for excellence" at Tuzla Clinical Center. The center provides the most advanced treatment in Bosnia for heart attack and stroke patients and has incorporated a teaching initiative on CVD risk factors and preventive care for health care workers and patients.