By Angelina Wilson and Emily Fisher
Prior to the United Nations (UN) Summit on Non-Communicable Diseases (NCD), we had learned that some countries were advocating for a special emphasis on mental health, and we had hoped that their efforts would mean we could share with you resolutions and global strategies relating to alleviating the burden of mental illness faced by many developing nations. This article is instead a story on the lack of a mental health story during the UN Summit held in New York, September 2011 and we are left wondering- Why? According to the World Health Organization Mental Health Atlas 2011 (1), there is a substantial gap between the burden caused by mental illness and the resources available to deal with it. In developing countries alone, 4 out of every 5 people are mentally ill but do not receive treatment (1). The UN summit on NCD resulted from the recognition of the alarming rate of morbidity and economic cost associated with NCDs because they have resulted in about 63 percent of death in the world today (2). This summit sought to focus on four major NCDs and how they can be combated, with a targeted focus on NCD effects in low and middle income countries. But, take a moment to consider the inextricable link between NCDs and poverty (4) and how this could be affected by the presence of mental illness: the impact of mental disorders on NCDs cannot be overstated because mental disorders can originate out of the environment in which people live (3) or if already present, worsen in unhealthy living conditions. For example, research has shown that diabetic patients have twice the risk for depression as compared to non-diabetic patients (4). In addition, research has illustrated that depression and lifestyle health risk behaviors such as lack of exercise, obesity and smoking are strong determinants of Alzheimer’s disease (4). Those with mental illness in some areas of the world are also often stigmatized and left without community or health resources, which drives the NCD burden up.
Since mental illness belongs to the umbrella of NCDs and can impact both the incidence of NCDs and the quality of life for someone with an NCD, it was expected that some attention would be given to its prevalence and effects during this remarkable summit. Unfortunately, little mention was made of the status of mental health in the NCD arena, or how mental illness severely impacts NCD prevalence, treatment and adherence. When looking at the major summit coverage, the lack of mental health focus is prominent. For example, on the WHO page on NCDs some of the key documents and addresses by members of WHO for the summit were presented (2). On this page four diseases were highlighted as the main focus of the UN summit and these were cancer, CVD, pulmonary heart disease and diabetes. These were paired with their associated risk factors. In the Political declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases, a number of strategies were mentioned for reducing the incidence of the four diseases mentioned above (5). Mental health was only mentioned as an end result when we effectively alleviate the burden of NCDs. It was also acknowledged that mental and neurological disorders do contribute to the burden on NCDs, but such a brief mention is not enough to make a difference. The NCD alliance, which is one of the biggest alliances formed to combat NCDs, also made no mention of mental health in their discussion for strategies to reduce the prevalence of NCDs (6). In addition, in highlighting strategies for leadership, treatment and prevention, no strategy was directed towards enhancing mental health.
The Movement for Global Mental Health provided an exception to the above cases. They were active in advocating for a focus on mental health leading up to the summit by urging for mental health to be made a priority during this summit and explaining the inextricable link between mental health and other NCDs (4). They also explained that mental health was associated with long term health costs and must be dealt with to reduce the burden of diseases. While one can expect an organization focused on mental health to share that priority with others, we have to wonder: what could they have done to get more people to listen and share this priority?
In conclusion, this lack of story raises a number of questions. What is the place of mental health on the NCD agenda? When will mental health become a priority among those targeting NCDs? We agree that the focus of this summit was on four specific diseases, but we also know how much mental health impacts even those four diseases. What do we need to do to have a global focus and strategy to address the known impact mental health has on the many facets of the NCD experience in developing nations?
1. World Health Organisation. Mental health Atlas 2011. Geneva: World Health Organisation; 2011.
2. WHO | United Nations high-level meeting on Non-communicable disease prevention and control [Internet]. [cited 2011 Oct 18]; Available from: http://www.who.int/nmh/events/un_ncd_summit2011/en/index.html
3. World Health Assembly. Prevention and control of Non-communicable diseases. World Health Organisation; 2000.
4. NGO forum for health. Joint Statement to the United Nations High-Level Meeting on Non-communicable disease Prevention and control. In: Mental health and the scope of Non-communicable diseases. Geneva/New York: 2011. p. 2.
5. United Nations General assembly. Political declaration of the High level meeting of the General Assembly on the Prevention and Control of Non-communicable diseases. New York: United nations; 2011. p. 13.
6. NCD Alliance. NCD Alliance Plan for the United Nations High Level summit on Non-communicable disease [Internet]. NCD Alliance; 2011. p. 20.Available from: http://www.ncdalliance.org/sites/default/files/rfiles/NCD%20Alliance%20Plan_web.pdf
Published: October 2011