Citation: The PLOS Medicine Editors (2012) Addressing Global Disparities in the Burden of Noncommunicable Diseases: Call for Papers. PLoS Med 9(12): e1001360. doi:10.1371/journal.pmed.1001360
Published: December 27, 2012
Copyright: © 2012 PLOS Medicine Editors. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: The authors are each paid a salary by the Public Library of Science, and they wrote this editorial during their salaried time.
Competing interests: The authors' individual competing interests are at http://www.plosmedicine.org/static/editorsInterests.action. PLOS is funded partly through manuscript publication charges, but the PLOS Medicine Editors are paid a fixed salary (their salary is not linked to the number of papers published in the journal).
Abbreviations: LMIC, low- and middle-income country; NCD, noncommunicable disease; WHO, World Health Organization
The PLOS Medicine Editors are Virginia Barbour, Jocalyn Clark, Laureen Connell, Amy Ross, Paul Simpson, Emma Veitch, and Margaret Winker.
Provenance: Written by editorial staff; not externally peer reviewed.
Noncommunicable diseases (NCDs), most often defined as chronic medical diseases including cardiovascular diseases (heart disease and stroke), cancer, chronic respiratory diseases (chronic obstructive pulmonary disease and asthma), and diabetes , are responsible for two-thirds of the world's deaths, one-fourth of which occur before the age of 60 years . Nearly 80% of NCD deaths occur in low- and middle-income countries (LMICs), where they are also increasing most rapidly . Trends in modifiable risk factors of tobacco use, unhealthy diet, physical inactivity, and harmful use of alcohol  suggest these statistics will only get worse: of the estimated 1.2 billion smokers in the world, most are from LMICs, where tobacco use is rising by 3% per year . People living in LMICs increased their consumption of meat, eggs, and milk by 50% on average from 1973 to 1996 , and more recent data show that populations in China have increased meat consumption through 2010 . Sales of refined foods—including soft drinks and processed foods that are high in salt, fat, and sugar—are increasing fastest in LMICs , and increased income tends to shift food importation to sugar and other sweeteners . While increased intake of protein and other nutrients are important for underweight individuals, saturated fats, sugars, and refined foods contribute to an unhealthy diet. The double burden of disease, in which significant numbers of overweight and underweight individuals exist within the same country , and often in the same household , is a particularly daunting challenge for LMICs.
In response to this growing burden, the United Nations held a High-Level Meeting on NCDs in September 2011  and the World Health Organization (WHO) just released a Draft Global Monitoring Framework for NCDs that included global targets for the prevention and control of NCDs . However, recognition has not yet translated to sufficient resources to address the burden: the WHO budget devoted to NCDs has been reduced by 20% since 2010 and comprises only 5%–8% of the total WHO budget . Less than 3% of global health aid is earmarked for NCDs, and the Bill & Melinda Gates Foundation offers less than 3% of its funding for research into NCDs . Consider this relatively meager allocation next to the prospect of rapid growth of international food and tobacco markets in LMICs . For example, the entire WHO budget is only half of the Coca-Cola Company's marketing budget . In fact, in addition to exploiting new markets, corporations are getting a place at the table: even as Mexico has developed the highest rate of obesity and overweight and the highest consumption of Coca-Cola in the world , the Pan American Health Organization, a regional office of WHO, accepts money from the Coca-Cola Company, PepsiCo, Kraft, Nestle, and Unilever , and some members of the WHO's Nutrition Guidance Expert Advisory Group have food industry ties, including receiving funding from Unilever and Nestle . Such relationships may undermine the credibility and potentially the independence public health organizations need to be effective .
Funding for NCDs is a different story in the high-income nations. Estimated 2012 National Institutes of Health funding for cancer and cardiovascular disease alone is more than $7 billion . However, results of research conducted in the United States may not always translate to US clinical settings , much less into improved health in LMICs. Even in infectious diseases, where more research specific to LMICs has been conducted, studies on implementing interventions may be lacking . Nevertheless, the relatively successful infectious diseases programs like HIV/AIDS treatment and prevention provide useful lessons for addressing NCDs, including improving advocacy and recognition of disease burden, national planning and resource allocation, long-term donor investment, and strengthening health systems .
With these global needs and disparities in mind, the editors of PLOS Medicine are issuing a call for papers into research and commentary on NCDs directed toward improving population health and reducing health disparities. For this theme, we include as part of the definition of NCD research the identification, treatment, and prevention of mental health and substance use disorders, because mental health disorders and substance abuse also cause considerable morbidity and mortality, contribute to NCDs, and similarly require the health systems necessary to care for chronic conditions . Topics PLOS Medicine will consider for the theme include the outcomes, exposures, and health system responses listed in the WHO's Draft Global Monitoring Framework for NCDs , as well as other research in prevention, identification, and treatment of this broader definition of NCDs. We will consider studies addressing the translation of research to implementation in practice in a variety of settings, but particularly for populations with poorer health. Translation of research need not be one way; innovative solutions for addressing NCDs in LMICs may have valuable lessons for high-income countries and vice versa. We encourage authors to explore the barriers and pitfalls to effective implementation and the unique challenges of implementing specific interventions in groups with disparities.
Decisions regarding publication of research articles will be based on importance, novelty, and rigor of methodology and analysis. Commentary articles submitted for the PLOS Medicine Magazine must be novel and well-argued. Authors are encouraged to refer to the Author Guidelines, available at http://www.plosmedicine.org/static/guidelines.action. As with all submissions to PLOS Medicine, authors are asked to submit a presubmission inquiry. There is no guarantee of acceptance; high-quality research that is in scope and methodologically appropriate for consideration will undergo our usual review process. Manuscripts that are considered potentially appropriate after evaluation of the full paper will undergo review by the editors, followed by review by an academic editor, and possibly external peer review including a statistical reviewer if the manuscript passes each previous phase of review. We will publish research and commentary on NCDs throughout 2013 and beyond, as well as on other important topics of global health relevance .
We encourage authors to submit their best work in NCDs to help address this critically important global health challenge. Publishing this essential research and commentary via open access in PLOS Medicine will ensure that it is widely distributed and accessed, reaching the individuals and countries who need it the most.
Wrote the first draft of the manuscript: MW. Contributed to the writing of the manuscript: VB JC LC AR PS EV. ICMJE criteria for authorship read and met: VB JC LC AR PS EV MW. Agree with manuscript results and conclusions: VB JC LC AR PS EV MW.
- 1. World Health Organization (2012) Noncommunicable diseases. Available: http://www.searo.who.int/LinkFiles_P/Meetings_Seminars_NCD_Paper.pdf. Accessed 4 November 2012.
- 2. Alwan A (2011) Global status report on noncommunicable diseases 2010. World Health Organization. Available: http://www.who.int/nmh/publications/ncd_report_full_en.pdf. Accessed 4 November 2012.
- 3. World Health Organization (31 October 2012) A draft comprehensive global monitoring framework, including indicators, and a set of voluntary global targets for the prevention and control of noncommunicable diseases. Available: http://apps.who.int/gb/ncds/pdf/A_NCD_INF1-en.pdf. Accessed 9 November 2012.
- 4. World Health Organization (2011) Prioritizing a preventable epidemic. A primer for the media on noncommunicable diseases. Available: http://www.wpro.who.int/noncommunicable_diseases/ncd_primer.pdf. Accessed 4 November 2012.
- 5. Chopra M, Galbraith S, Darnton-Hill I (2002) A Global Response to a Global Problem: The Epidemic of Overnutrition. Bull World Health Organ 80: 952–58 Available: http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862002001200009 Accessed 4 November 2012.
- 6. Li JP, Shangguan ZP (2012) Food consumption patterns and per-capita calorie intake of China in the past three decades. Journal of Food, Agriculture & Environment 10: 201–206 Available: http://www.isfae.org/scientficjournal/2012/issue2/pdf/food/37.pdf. Accessed: 29 November 2012.
- 7. Stuckler D, McKee M, Ebrahim S, Basu S (2012) Manufacturing Epidemics: The Role of Global Producers in Increased Consumption of Unhealthy Commodities Including Processed Foods, Alcohol, and Tobacco. PLoS Med 9 (6) e1001235.
- 8. Basu S, Stuckler D, McKee M, Galea G (2012) Nutritional determinants of worldwide diabetes: an econometric study of food markets and diabetes prevalence in 173 countries. Public Health Nutr 13: 1–8.
- 9. Food and Agriculture Organization of the United Nations (2006) The double burden of malnutrition: Case studies from six developing countries. Available: http://www.fao.org/docrep/009/a0442e/a0442e00.htm. Accessed 9 November 2012.
- 10. Doak CM, Adair LS, Monteiro C, Popkin BM (2000) Overweight and underweight coexist within households in Brazil, China and Russia. J Nutr 130: 2965–71.
- 11. United Nations (2011) Leaders gather at UN Headquarters for a High-Level Meeting on Non-communicable Diseases (NCDs). 2011 High-level Meeting on the Prevention and Control of Non-communicable Diseases. Available: http://www.un.org/en/ga/ncdmeeting2011/. Accessed 9 November 2012.
- 12. Wilson D, Kerlin A (19 October 2012) Special Report: Food, beverage industry pays for seat at health-policy table. http://www.reuters.com/article/2012/10/19/us-obesity-who-industry-idUSBRE89I0K620121019 Accessed 4 November 2012.
- 13. Stuckler D, Nestle M (2012) Big Food, Food Systems, and Global Health. PLoS Med 9: e1001242 doi:10.1371/journal.pmed.1001242.
- 14. The PLOS Medicine Editors (2012) PLOS Medicine Series on Big Food: The Food Industry Is Ripe for Scrutiny. PLoS Med 9: e1001246 doi:10.1371/journal.pmed.1001246.
- 15. National Institutes of Health (13 February 2012) Estimates of Funding for Various Research, Condition, and Disease Categories (RCDC). Available: http://report.nih.gov/categorical_spending.aspx. Accessed 8 November 2012.
- 16. Thomas K (2 November 2012) A Promising Drug With a Flaw. NY Times. Available: http://www.nytimes.com/2012/11/03/business/a-rising-anti-stroke-drug-is-tied-to-risk-of-bleeding-deaths.html?_r=0. Accessed 29 November 2012.
- 17. Cobelens F, van Kampen S, Ochodo E, Atun R, Lienhardt C (2012) Research on implementation of interventions in tuberculosis control in low and middle income countries: A systematic review. PLoS Med 9: e1001358 doi:10.1371/journal.pmed.1001358.
- 18. Lamptey P, Merson M, Piot P, Reddy KS, Dirks R (2011) Informing the 2011 UN Session on Noncommunicable Diseases: Applying Lessons from the AIDS Response. PLOS Med 8: e1001086 doi:10.1371/journal.pmed.1001086.
- 19. Bass JK, Bornemann TH, Burkey M, Chehil S, Chen L, et al. (2012) A United Nations General Assembly Special Session for Mental, Neurological, and Substance Use Disorders: The Time Has Come. PLOS Med 9: e1001159 doi:10.1371/journal.pmed.1001159.
- 20. The PLOS Medicine Editors (2009) A Medical Journal for the World's Health Priorities. PLOS Med 6: e1000072 doi:10.1371/journal.pmed.1000072.