The Tribune

By David Nabarro

Picture two scenarios. First, a hurricane whips into a Caribbean nation. Rooves are ripped clean off, people take shelter where they can. Hospitals are damaged and people with injury and infection find it hard to access health care.

Second, hospital wards quietly fill up with people fighting heart attacks and stroke, more and more people present themselves at clinics with Type 2 diabetes. The general health of a population is affected by diet and lifestyle, including factors like cigarette smoking, alcohol consumption and changes in diet.

In both scenarios people expect basic health services to be available, ready to provide help to women in labour or respond to medical emergencies. People who need caesarean sections for delay in labour, rapid response for children with infections, or treatment for accidents and injury still need urgent care. They depend on the services provided by well-functioning critical care units, and such services are often under threat due to shortages of trained staff.

The two scenarios painted are devastating. Both impact on the ability of health systems to respond to urgent needs. But because natural disasters can have such catastrophic impacts, the first scenario gets more attention than the second.

The truly troubling feature of the second scenario is that chronic and non-communicable diseases (NCDs) can be prevented through low cost actions.

According to the World Health Organisation (WHO), NCDs are by far the leading cause of death in the world, killing more than 38 million people a year. The four main types of NCDs are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and diabetes.

The number of people affected by NCDs is also increasing yearly and they are part of a worldwide epidemic of chronic sickness and death. The World Bank estimates that NCDs are linked to more than seven out of 10 deaths in the Caribbean region, which exceeds the global average of 63 per cent. This is a reflection of demographic and lifestyle changes.

What’s to be done?

First, prevention. There is good evidence on the risk factors, though many people do not know what they are. So, people first need to know why they are at risk and to be encouraged to remove the risks from their lives.

One risk is exposure to tobacco smoke (six million deaths per year). Another is low levels of physical activity (3.2 million deaths per year). Risk of NCDs are also related to consumption patterns - alcohol (1.6 million deaths per year), salt (1.7 million deaths per year) and calories. These increase the likelihood of people being overweight, having raised blood pressure, or having high levels of sugar or fat in their blood.

People most at risk need to be involved in planning and prevention initiatives. Joint action should be based on the best evidence of what works. A shared purpose, an agreed action plan and effective partnerships are vital for impact at this scale.

Second, early diagnosis. If people with NCDs are diagnosed early and get the best possible treatment the progress of illness can be slowed or event halted.

Responding to NCDs is a challenge when funds are limited. Health ministers are expected to respond to the full range of people’s health needs, giving particular priority to urgent life-threatening situations and the needs of the poorest. The health sector has to be ready for crises of all kinds, and Caribbean nations are increasingly at risk. Ministers have to engage other government departments to implement preventive programmes.

In tackling these problems, Health ministers look to the WHO for strategic guidance. The WHO must continue to support member states, setting standards for what needs to be done and how they can be achieved. It must continue to show leadership in bringing governments and specialists together to exchange experiences, learn from each other and work through difficult problems.

For me, the Caribbean is an important place: I have spent a lot of time here over the years through my work in global health. Many Caribbean nations are small islands and their health ministers must either be sure that they can offer in-country specialist care for urgent conditions or mobilise the resources needed for evacuating people with urgent medical needs to other countries. It is a region that is making great strides in health care, particularly in the use of data to improve access to care by targeting those who need it most.

But there is still a clear role for specialised international organisations, like the Pan American Health Organisation (PAHO) and the WHO, in setting standards and helping governments to achieve them. They provide the evidence, information and best practice that enable governments and societies to act.

Ministers of Health rely on this international support; it helps them to devise and implement the kinds of health systems that are best suited to people’s needs. It calls for high quality, transparent and accountable work underpinned by sound and consistent strategies. That is why the WHO needs strong leadership, now more than ever.

• David Nabarro is the UK Government-endorsed candidate for Director-General of the World Health Organisation.