Like most Indians at present, 26-year-old performance artist Jazz Sethi sits terrified at home, afraid of catching COVID-19. Sethi was diagnosed with Type 1 diabetes in 2009, and in 2018 she established The Diabesties Foundation, a not-for-profit organization dedicated to Type 1 diabetes education and awareness, as well as advocating for access to affordable health care.
During the first wave of COVID-19 last year, she had trouble obtaining a lifesaving nasal spray for treating severe hypoglycemia in people with diabetes. Sethi ultimately had to source it from London and ask friends to ship it to her home in Ahmedabad, which was also a struggle due to travel restrictions.
The hustle and struggle in trying to find it — and then waiting for it to arrive — made her anxious. Today, many among Sethi’s circle, friends of friends and family members, are all testing positive for COVID-19. She said there is a general panic in the air as people search for lifesaving care, oxygen, and hospital beds for their loved ones — and all too often run out of time.
Data shows that people living with noncommunicable diseases are at a higher risk of severe complications from COVID-19, more likely to be hospitalized, and at a higher risk of death. Over a year into the crisis, it is clear we are dealing with two pandemics in one: an acute pandemic — COVID-19 — on top of the chronic pandemic of NCDs. When the two are mixed, the result is a deadly “syndemic.”
The impact of COVID-19 on people living with NCDs
People living with NCDs have been at the epicenter of COVID-19. Many of the 3.4 million lives already lost were people living with underlying health conditions — such as high blood pressure, obesity, heart failure, and diabetes.
Health services and routine care have been delayed and disrupted as health workers and systems have pivoted to respond to COVID-19 in almost every country. Over two-thirds of 105 nations surveyed by the World Health Organization reported disruptions to NCD diagnosis and treatment, with over half of the countries reporting delays in cancer diagnosis and treatment specifically. We have seen supply chain failures for lifesaving insulin and postponed treatments for stroke and cardiovascular disease.
Disruptions will result in a longer-term upsurge in demand for later-stage NCD care, which overstretched health systems will struggle to manage.
Things were bad enough before the pandemic. NCDs — including cancer, cardiovascular disease, chronic respiratory disease, diabetes, and neurological and mental health conditions — cause more than 70% of global deaths and now constitute 7 of the 10 leading causes of deaths worldwide. Deaths from dementia, diabetes, and kidney disease have overtaken other global health priorities, including HIV/AIDS.
NCDs are the largest, and yet most underfunded, public health issue globally. For too long, they have been overlooked by leaders and policymakers as major obstacles to development and causes of premature death, disability, and economic hardship in low- and middle-income nations. Despite global targets, decades of underinvestment mean that only one-third of countries were providing drug therapy and counseling services to their populations to prevent heart attacks and strokes — the world’s two biggest killers.
Our failure to invest in NCDs has come back to haunt us. In the first instance, though, we need to get some of the basics right. The COVID-19 pandemic has exposed how vital it is that we invest in healthy populations and strengthen health systems.
One thing is certain: There will be another pandemic, and all countries have to be better prepared. That means recognizing NCD prevention and care as essential aspects of health security.
Up until 2020, NCDs were rarely mentioned within this context. Rankings and indexes for health security — for example, the Global Health Security Index — have historically taken a narrow approach, focusing on intensive care and other indicators to determine how prepared countries are to respond to a pandemic. But we have repeatedly seen that high scores have not matched the reality of the COVID-19 response; in fact, they have been completely reversed at times.
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Prevention saves lives and makes economic sense
In response to COVID-19, legislation and other sweeping changes were enacted in a matter of weeks to protect the public. We need the same urgency now for the NCD prevention agenda.
The vast majority of NCDs can be prevented or significantly delayed. All major NCDs share common risk factors — unhealthy diets, smoking, alcohol, physical inactivity, and air pollution — and there are tried, tested, and cost-effective public health policies to tackle them and promote healthy environments.
The levers for NCD prevention and promoting healthy societies lie in the hands of governments and the instruments they control: legislation, regulation, and fiscal measures. A new vision and commitment are required to create and sustain healthy populations, with a focus on ensuring that everyone has the right to healthy places to live, grow, move, work, and play. This also requires political leadership that works across sectors well beyond health.
Over a year into the [COVID-19] crisis, it is clear we are dealing with two pandemics in one.
—Integration and pandemic preparedness
Integration of NCDs into universal health coverage, primary health care, and communicable disease programs needs to be scaled up, but this doesn’t mean reinventing the wheel.
Global COVID-19 vaccination efforts, for instance, will reach entire populations in an unprecedented time scale and so provide an unmissable opportunity to better document and track their health needs: to screen for NCDs, leverage supply and cold chains for insulin and other essential medicines, and support other inoculations, such as flu vaccinations for older people and HPV vaccinations to prevent cancer.
For the global health community, it is important that the COVID-19 response doesn’t become another separate silo. The pandemic teaches us the opposite lesson: that we must do better by tapping synergies in services centered around people rather than single diseases.
It cannot be that a person living with HIV and diabetes or high blood pressure can access treatment for one of their conditions but not the other. We must center health systems and programs on what matters for people and their quality of life, recognizing that many who are living with a chronic condition are facing more than one.
Building back better and fairer to guarantee people like Jazz Sethi their right to health and protect them against future pandemics won’t be possible if their voices are not meaningfully heard or their wishes better reflected in policy decisions. Now is the time. In the words of WHO Director-General Tedros Adhanom Ghebreyesus: “If not now, when?”
Visit the Building Back Health series for more coverage on how we can build back health systems that are more effective, more effective, equitable, and preventive. You can join the conversation using the hashtag #BuildBackHealth.
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