In a chaotic Libya or a post-war Iraq, achieving individual safety and the most basic of health care might seem to be the best any government or aid organization could hope for. But areas in transition and those still tending to the societal wounds of war are actually well poised to combat chronic conditions, such as heart disease and other non-communicable diseases, argued the authors of a new essay published online Saturday in the World Health Organization's Bulletin.
"The post-conflict period can provide a window of opportunity to undertake fundamental reforms to better address the population's health needs," noted the essay's authors, led by Bayard Roberts, of the London School of Hygiene and Tropical Medicine.
At a September United Nations (U.N.) meeting in New York, representatives flagged as a global priority reducing the toll of non-communicable diseases, which include cancer, diabetes and respiratory illnesses, and account for nearly two thirds (63 percent) of all deaths worldwide.
Rather than burdening a tenuous government with such a large task, Roberts and his co-authors noted that humanitarian organizations, such as NGOs, should insist on policies and programs that curb many of these often-neglected diseases.
Of all the non-communicable diseases, mental health issues have commanded the most attention in post-conflict areas. Even so, social services and mental health treatment are sorely lacking in many of these countries, where "exposure to violent and traumatic events, forced displacement, impoverishment, uncertainty and isolation" contribute to overall psychological burden, the authors noted. And in all of self-declared Somaliland, for example, there are "no psychiatric professionals or related medications available in primary or secondary health services." Without treatment, Roberts and his team noted, "high levels of psychological distress contribute to harmful health behaviors, such as hazardous drinking and increased smoking, which in turn increase the future burden of non-communicable diseases."
Although strained regions often scramble for resources just to build or rebuild infrastructure, stemming non-communicable diseases—for which global costs are projected to reach $47 trillion in the next 20 years—could also be a wise economic move. Such efforts end up lowering health care costs in the long run. And international aid organizations could focus on making care for non-communicable diseases, such as hypertension—currently a prevalent condition in Iraq—affordable for all, rather than only to those who can pay for expensive treatment at a private institution. This inequity, hardly specific to post-conflict countries, "creates a vicious cycle whereby poverty and disease continually reinforce one another," Roberts and his colleagues argued, echoing U.N. Secretary-General Ban Kai-moon's remarks in September that heart disease, diabetes and other non-communicable diseases "hit the poor and vulnerable particularly hard and drive them deeper into poverty."
An end to unrest can be good news for countries in the form of new development and international investment. Much of that expansion is likely to lead to more urban lifestyles, which are associated with unhealthful behaviors, such as smoking and drinking, as well as with increases in obesity. Finally, a newly peaceful or still-unstable region often has lax or poorly enforced trade regulations, leaving "an open door for multinational companies to influence policies in ways that undermine efforts to control tobacco and alcohol use or improve unhealthy diets in transitional countries," the authors noted.
The end of a major conflict—whether short lived or decades long—can be a key time to channel resources from international interest and aid. And investing some of that in mitigating the quieter killers, such as diabetes and heart disease, is a crucial step toward building a stronger society for the long term, the Roberts and his co-authors argued.
Building off of the U.N.'s September conclusion that "these diseases are one of the major challenges to international development," the authors noted, fighting non-communicable diseases in post-conflict areas "is an important gap that must be filled."