A grey area: do the elderly hold the key to tackling non-communicable disease?

Written by Amelia Tait of the UCL Institute for Global Health.

On Tuesday 4 December, the Attlee Suite in the Houses of Parliament was filled to the brim with more than 140 audience members, policy makers, and global health experts from around the world meeting to discuss the growing global burden of non-communicable diseases.

Professor Anthony Costello, Director of UCL’s Institute for Global health, chaired the debate and opened by remarking that the “wicked problem” of NCDs accounts for 63% of deaths worldwide.

Non-communicable or lifestyle diseases, such as heart disease, stroke, cancer and diabetes are medical conditions of a non-infectious nature, and – in Costello’s words – are “the biggest killer of people in the world”.

Learning from HIV?

The panel’s experts led a debate on the ways in which the NCD movement can learn from the precedents set by the HIV/AIDS movement in the 1980s.

Susan Shurin, panel speaker and Chair of the Global Alliance for Chronic Diseases, expressed her belief that the AIDS model provided an example of a multi-pronged approach to prevention, treatment and increasing global awareness.

Isabel Nunes, an HIV positive member of the HIV/AIDS Alliance, revealed another connection between HIV and NCDs.

Nunes, an audience member, spoke up about how Antiretroviral therapy (ART) increases the life expectancy of infected individuals and, thus, transforms HIV into a chronic disease. Such therapies have saved her life, but , she emphasises “non-communicable diseases are a side effect from the treatment”.

An old answer for a new problem

However, the limitations of comparisons to HIV became apparent when the demographics of sufferers were considered by Shah Ebrahim from the London School of Hygiene and Tropical Medicine.

Ebrahim reminded the audience that it is elderly people who constitute the majority of sufferers of NCDs. Expanding on this, he claimed that the NCD movement had failed to rally a common cause because “we are obsessed with the idea of avoidable mortality occurring in people under the age of sixty”.

He argued that such notions need to be overcome, and the key to implementing political policy lay in allying with elderly people. “Globally, elderly people vote, elderly people have political power, and elderly people are the natural constituency we should be working with,” he remarked.

Lord Crisp, Chair of the All Party Parliamentary Group for Global Health, agreed with Ebrahim, suggesting that perhaps an example could be taken from the American Association of Retired Persons (AARP), which provides elderly people with a forum in which to voice their opinions on American policies.

Meg Hillier, Labour MP, commented on the reality of elderly voters in the UK. “The great wisdom in British politics is that above a certain age people don’t change the way they vote” she began, arguing that this meant that politicians no longer attempted to appeal to those over the age of 55, who are believed to be “set in their ways”.

The silver lining

Hillier went on to remark: “these old orthodoxies are being torn up around the world and in the UK”. Though warning of the dangers of over-legislation, she claimed not recognising the issue would be “very foolish” of politicians.

Putting the reality back into mortality statistics, she declared: “The age to which you live a healthy life is the same, but the age of death is much further beyond”, demonstrating that it is not length, but quality, of life that is essential. “We are living for longer with chronic ill-health and disabilities,” she concluded.

What’s in a name?

Another portion of the evening’s debate was dedicated to discussing how to make a name for NCDs: by changing it. “A clunky, clumsy name” remarked Lord Crisp, needs to be altered to “a simple message about lifestyle”.

Susan Shurin also objected to the current terminology, noting the communicable aspects of many so-called non-communicable diseases. Costello, rounding off the discussion, suggested the term to be changed to “chronic wellbeing”.

It is clear that is hard to find a household name for these household diseases. The term “lifestyle disease” could be considered too pejorative, while “chronic wellbeing” arguably does not convey the urgency of the diseases being addressed. The discussion thus left one question in everyone’s minds: how can we communicate about non-communicable diseases?

Will, ideas and execution

Lord Crisp, taking the model from the Institute for Healthcare Improvement (IHA), claimed change is a three-step process of will, ideas and execution. “We’ve got to build the will to make the change,” he emphasised.

It seems clear from the passion displayed during the debate that there is plenty of strong will to save and improve lives. And the discussion – running a half hour longer than intended – was certainly not void of ideas.

We are now faced with the responsibility to execute these ideas to, as Susan Shurin articulated, “improve the prosperity and the quality of life of people around the world”.

This post reports the parliamentary debate ‘The Non-Communicable Diseases (NCD) Time Bomb’ that took place on December 4 2012.

The Speakers were: Professor Anthony Costello (Director UCL Institute for Global Health, Chair), Lord Nigel Crisp (All Party Parliamentary Group on Hepatology), Susan Shurin (Global Alliance for Chronic Diseases), Harry Rutter (Director of National Obesity Observatory), Shah Ebrahim (London School of Hygiene and Tropical Medicine).

Audio from the event is available  on Sound Cloud: http://bit.ly/RHeYtO