SQU Med J, December 2010, Vol. 10, Iss. 3, pp. 306-309, Epub. 14th Nov 10
Invited Article
Submitted 15th Aug 10
Revision ReQ. 8th Sept 10, Revision recd. 21st Sept 10
Accepted 25th Sept 10

Obesity is an epidemic disease in Oman and something needs to be done about it,” according to Dr. Mostafa Waly 
of Sultan Qaboos University's Department of Food 
& Nutrition, He observes that  about half the men 
and women of Oman are obese or overweight, with 
the highest prevalence being 71% in Dhofar, Oman’s 
southernmost region.1 He also notes that there has 
been a significant concomitant increase in chronic 
non-communicable diseases (CNCDs) in Oman in 
the last few years.1 CNCDs include cardiovascular 
conditions (mainly heart disease and stroke), some 
cancers, chronic respiratory conditions and type 2 
diabetes.

  The situation with regards to CNCDs is serious 
in the whole Arabian Gulf region and some of the 
countries may actually be worse off than Oman. 
According to figures a few years ago about 64% 
of men and 70% of women in Saudi Arabia are 
obese, as are 79% of women in Bahrain. Diabetes 
affects around 18% of adults in Oman, but close 
to 24% in Saudi Arabia.2,3 The rest of the world is 
also suffering from an ever-worsening epidemic of 
CNCDs, which Dr. Margaret Chan, the Director-
General of the World Health Organization (WHO) 
calls “…one of the world’s fastest growing and most 
alarming health problems.”4 

Why are CNCDs such an alarming problem 
worldwide? Because they affect people of all ages 
(although the prevalence is higher with advancing 
age), nationalities and classes and cause the greatest 

global share of death and disability, accounting for 
around 60% of all deaths worldwide. Some 80% of 
chronic diseases deaths occur in low- and middle-
income countries (LMICs). They account for 44% of 
premature deaths worldwide.5 The number of deaths 
from these disease is double the number of deaths 
that result from all infectious diseases (including 
HIV/AIDS, tuberculosis and malaria), maternal and 
perinatal conditions, and nutritional deficiencies 
combined. Over the coming decades, the burden 
from CNCDs is projected to rise particularly fast in 
LMICs. Without concerted action some 388 million 
people worldwide will die of one or more CNCDs in 
the next 10 years.5 

CNCDs also have a huge negative economic 
impact. In 2006, it was estimated that over the 
following decade, China, India and the United 
Kingdom were projected to lose more than $558 
billion, $237 billion and $33 billion, respectively, in 
national income as a result of heart disease, stroke 
and diabetes, partly as a result of reduced economic 
productivity.6 It is likely that the negative economic 
impact for the Gulf region and other Arab countries 
will be considerable.

So what accounts for this dramatic increase? 
Some of the factors include longer average 
lifespans, tobacco use, decreasing physical activity, 
poor nutrition, and the harmful use of alcohol. 
Urbanisation makes the situation worse through 
various mechanisms, including air pollution, 
reduced opportunities for physical activity and 

Dalla Lana School of Public Health Sciences and Department of Surgery, University of Toronto, Canada; McLaughlin-Rotman Centre 
for Global Health, University Health Network and University of Toronto, Canada; Global Alliance for Chronic DIseases.
Email: a.daar@utoronto.ca

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EDITORIALEDITORIAL

Chronic Non-communicable Diseases as a 
Threat for All

Recent Global Initiatives 
Abdallah S Daar



Abdallah S Daar

editorial | 307

dietary changes. Fortunately, CNCDs are largely 
preventable.7 Up to 80% of premature deaths from 
heart disease, stroke and diabetes can be averted 
with known behavioural and pharmaceutical 
interventions.

Yet, until now, the prevention of CNCDs has not 
been a major priority in most countries in the world, 
and especially so in LMICs. In sub-Saharan Africa 
it is understandable that governments, donors and 
research-funding agencies have channelled most 
resources into infectious diseases such as HIV and 
malaria. The focus in much of the rest of the world 
has been on treatment rather than prevention. In 
Oman and the rest of the Gulf, most health care 
expenditure is now on treating and managing the 
consequences of CNCDs. 

In 2003, a study identified the grand challenges 
in CNCDs, building on previous experience with 
the Bill and Melinda Gates Foundation’s Grand 
Challenges in Global Health initiative.8,9 A grand 
challenge in this context was defined as, “a specific 
critical barrier that if removed would help to solve 
an important health problem.” Daar et al. used the 
Delphi structured consensus building methodology 
with a study panel of 155 geographically and 
culturally diverse stakeholders from 50 countries. 
They identified 20 grand challenges grouped under 
six goals, and proposed 39 potential research 
ideas. The six goals are: 1) raise public awareness; 
2) enhance economic, legal and environmental 
policies; 3) modify risk factors; 4) engage business 
and community; 5) mitigate health impacts of 
poverty and urbanisation, and 6) reorient health 
systems.10 

These goals may seem simple, but in fact they  
are very difficult to achieve at scale. For example, 
it seems simple to prevent and treat cardiovascular 
disease in an individual: eat healthy foods, increase 
physical activity, do not smoke at all, do not drink 
alcohol excessively, and seek health care regularly. 
However, a report from the Institute of Medicine 
notes, “the reality is much more complex. Behavior 
change is difficult, individual choices are influenced 
by broader social and environmental factors, and 
many people do not have the resources or access to 
seek appropriate health care.”11

Our Nature paper had among its co-authors 
a number of directors of major national research 
funding agencies, such as the US National 
Institutes of Health’s (NIH) National Heart, Lung 

and Blood Institute (NHLBI), the UK Medical 
Research Council, and the Canadian Institutes of 
Health Research.10 In the paper, we identified the 
need for coordinated efforts by governments, the 
WHO, the World Bank and regional development 
banks, philanthropic foundations, research donor 
agencies, and most relevant here, major national 
health research funding agencies.

Less than two years after the publication of 
the grand challenges paper, six major national 
research funding agencies got together in 
Seattle to launch the Global Alliance for Chronic  
Diseases (GACD).12,13 The initial six national funding 
agency members were the Canadian Institutes  
of Health Research; the NIH (represented by 
NHLBI and Fogarty International Centre, later 
joined by National Institute for Mental Health); the 
Medical Research Council (United Kingdom); the 
Australian Health and Medical Research Council; 
the Chinese Academy of Medical Sciences, and the 
Indian Medical Research Council (which is awaiting 
signature of the Memorandum of Understanding). 
The South African Medial Research Council joined 
later, and other agencies may join this year at our 
Board meeting in Beijing on 17 October 2010. I look 
forward to the day when Arab countries will join the 
Alliance. Qatar has shown some interest already. 

The GACD is the first such alliance with a 
specific focus on funding implementation research14 
in CNCDs in LMICs and under-served and low 
income populations of high income countries. It will 
support collaborative, coordinated research at global 
scale on low-cost interventions and on capacity 
building for research and health care delivery, in the 
process identifying common approaches to develop 
the evidence base to guide policy. 

In November 2009, the GACD identified its 
initial three specific priorities for research funding 
on a global scale: hypertension, which leads to 
stroke and in China, for example, is the largest cause 
of death in adults; reducing tobacco use, (smoking, 
if unchecked, will kill 1 billion people in the 21st 
century); and reducing indoor pollution caused by 
crude cooking stoves, which kills about 1.5 million 
people every year in LMICs.15 Other priorities for 
funding will be identified later. The first request 
for proposals, to fund implementation research in 
hypertension, is being developed now and will be 
announced at GACD’s Beijing meeting. The GACD 
will pursue synergies through such joint initiatives, 



Chronic Non-communicable Diseases as a Threat for All 
Recent Global Initiatives 

308 | SQU Medical Journal, December 2010, Volume 10, Issue 3

balancing concerns for prevention, treatment, 
and care; and between knowledge generation and 
knowledge translation into health policies and 
interventions that will save large numbers of lives. 

The WHO's division of chronic diseases and 
mental health is headed by Dr. Ala Alwan, Assistant 
Director-General of WHO, estimates that it is 
possible to achieve a 2% annual reduction in CNCD 
death rates worldwide over the next 10 years. If we 
achieve this with concerted action, we can avert 
at least 36 million premature deaths in the next 
decade. Some 17 million of these prevented deaths 
would be among people under the age of 70.5

The WHO itself is, of course, taking CNCDs 
very seriously. It is a member of the Board of the 
GACD. Its Plan of Action on CNCDs, which was 
endorsed in 2008 at the 61st World Health Assembly, 
has 6 major objectives: 1) raise the priority accorded 
to CNCD; 2) establish and strengthen national 
policies and plans for prevention and control; 3) 
promote interventions to reduce the main shared 
modifiable risk factors; 4) promote research for 
prevention and control; 5) promote partnerships, 
and 6) monitor CNCDs and their determinants and 
evaluate progress.16

It has developed a Global Strategy on Diet, 
Physical Activity and Health; passed a new 
resolution on ‘Marketing of foods and non-
alcoholic beverages to children’; is working on a 
global strategy to reduce the harmful use of alcohol, 
and has created NCDNet, the Non-communicable 
Diseases Network.17

As the Institute of Medicine report notes 
there remains a “profound mismatch” between 
the compelling evidence documenting the health 
and economic burden of cardiovascular diseases 
(and by extension, other CNCDs) and the lack 
of concrete steps to increase investment and 
implement…prevention and disease management 
efforts in developing countries.” The GACD, whose 
members account for more than 80% of health and 
biomedical research funds in the world, hopes to 
help fill this gap. 

The Nature paper on grand challenges in 
chronic non-communicable diseases identified the 
first goal as raising public awareness.10 The first 
grand challenge in that goal is to “raise the political 
priority of non-communicable diseases.” This is 
where we should start. The investment needed is 
in prevention. The lives of millions of people are 

at risk, and although the populations of the Gulf 
countries are not huge, they do have very high levels 
of obesity and of chronic diseases such as diabetes, 
and the impact on Gulf societies in the long run 
is likely to be severe. The questions to ponder are 
therefore as follows: Is prevention of chronic non-
communicable diseases a high enough priority 
for Gulf politicians? What can the health/medical 
community do to make it the highest priority?

References 
1. Joseph A. Non-communicable diseases become 

more prevalent. Muscat Daily 29 March, 2010.

2.  Skyler JS, Ed. Diabetes Atlas. 2nd ed. Brussels: 
International Diabetes Federation, 2003.

3.  Nishtar S. Lessons in tackling chronic diseases. BMJ 
2006; 333:820.

4.  Chan M. Agreements at World Health Assembly: A 
gift to public health. Closing remarks at 63rd World 
Health Assembly. Geneva, Switzerland, 21 May 
2010. From: http://www.who.int/dg/speeches/2010/
W H A _ c l o s i n g _ 2 0 1 0 1 8 0 5 2 1 / e n / i n d e x . h t m l 
Accessed: Aug 2010.

5.  World Health Organization. Preventing chronic 
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6.  Suhrcke M, Nugent RA, Stuckler D, Rocco L. Chronic 
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8.  Varmus H, Klausner R, Zerhouni E, Acharya T, Daar 
AS, Singer PA.  Public Health. Grand challenges in 
global health.  Science 2003; 302:398–9.

9.  Grand Challenges in Global Health. From www.
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10. Daar AS, Singer PA, Persad DL, Pramming 
SK, Matthews DR, Beaglehole R, et al. Grand 
challenges in chronic non-communicable diseases.  
Nature 2007; 450:494–6.

11.  Institute of Medicine, US National Academies of 
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He a l th - in - th e- D e v elo p in g-Wo rld - A- Cr i ti c a l -
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Accessed: Aug 2010.

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Abdallah S Daar

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diseases. Science 2009; 324:1642.

13.  Global Alliance for Chronic Diseases. From: www.
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15.  Six of the world’s foremost health research agencies 
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From: http://www.nhlbi.nih.gov/about/globalhealth/
pdf/alliance.pdf  Accessed: Aug 2010.

16. WHO. Plan of Action on Non-communicable Diseases.  
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