For the first time in human history, more people around the world are dying from noncommunicable diseases, like heart disease and cancer, than communicable ones, like malaria and polio. This change occurred in higher-income countries at some point in the middle of the last century. In lower-income countries, this shift is just a few years old. The way we think about mortality, however, has not kept up with this new reality. We tend to accept these deaths as unavoidable. They’re not. Changing this false perception is critically important to saving millions of lives across the globe.
Every year, noncommunicable diseases (NCDs) kill nearly 40 million people. Seventeen million of those deaths occur before the age of 70: too many lives taken too soon. In fact, seven in ten of all deaths each year are the result of noncommunicable diseases, which also include strokes, diabetes, and chronic respiratory diseases. Add in injuries and the total represents more than three-quarters of all deaths annually. Many of these deaths are preventable, but the world’s governments—including the U.S.—have not made stopping them a priority.
This problem is especially acute in low- and middle-income countries. As shown in the chart below, despite making up 67% of deaths in these countries, only 1% of global health funding is aimed at preventing noncommunicable diseases. As a global society, we lament NCDs, but we don’t do enough to stop them.
New vaccines and cures for communicable diseases are vitally important. I have invested $250 million to help eradicate both polio and malaria, following the lead of our friends at the Bill & Melinda Gates Foundation. There are, however, too many needless deaths each year from NCDs— often simply because of a lack of awareness. Governments often fail to recognize that people are dying from causes that are preventable and that they can do a great deal to save those lives through smart policies and targeted funding. It is not a choice between fighting communicable diseases and preventing NCDs. We can do both— and philanthropy has an indispensable role to play in each.
To draw more attention to this challenge, I accepted an invitation from the World Health Organization (WHO) to become its first Global Ambassador for Noncommunicable Diseases. Battling NCDs has been a major focus of our work at Bloomberg Philanthropies for many years given our mission to ensure better, longer lives for the greatest number of people. To do that, we must go where the data leads us—and it leads directly to NCDs and injuries. My goal as a WHO ambassador is to raise awareness about these overlooked killers and get more governments to take stronger action to combat them.
The one NCD that does garner major attention and funding is cancer. That’s critically important as curing cancer would be a monumental victory for humanity. The U.S. government spends about $5 billion annually on cancer research. Last year, I gave $50 million to help establish a new institute for immunotherapy research at Johns Hopkins University. Immunotherapy seeks to use the body’s natural defenses, rather than radiation or chemotherapy, to destroy tumors. Recent studies indicate that a cure could finally be within reach. Private and public money devoted to cancer research is money well spent.
Heart disease, however, kills twice as many people (17.7 million) as cancer (8.8 million), with injuries not far behind (5 million). And, while searching to find cures for diseases is important, the truth is we need to do a better job of preventing them in the first place.
One reason for the lack of attention given to NCDs and injuries is that people, citizens and government officials alike, tend to blame the victims’ personal negligence or genetics. It’s true that our behavioral choices often lead to disease and injury and that genetics can predispose us to certain conditions. But that doesn’t mean the outcomes are inevitable. Far from it. We know that with every category of disease and injury governments can take modest actions to reduce the likelihood that their citizens will fall victim to them.
Fear of communicable diseases has led society to mount major campaigns to defeat them—and that’s excellent. But our casual acceptance of NCDs has led society to tolerate them at tragically high levels. None of us can escape death, but it’s time to change our view of it. Most of us can live longer, healthier lives if we take simple steps and demand that our governments adopt basic, and often inexpensive, protections.
At Bloomberg Philanthropies, we work with all levels of government around the world, but we concentrate our resources on cities, because local officials are in the best position to tackle our greatest challenges quickly and innovatively. Preventing NCDs is no different.
As a part of my role with the WHO, we are launching a new global network of cities, called the Partnership for Healthy Cities, aimed at implementing policies and interventions to prevent deaths caused by NCDs and injuries. From passing sugary beverage taxes and smoke-free laws to making sure that city streets are safe and walkable, there are many, often simple, policies that can have a big impact. We know this firsthand. During my time as mayor of New York City, one of our proudest achievements was helping to increase residents’ average life expectancy by three years, thanks, in part, to policies that put people’s health first. Through this new network, we are confident that by combining strong local leadership, seed funding, and technical expertise, we can help city governments around the world save lives.
Follow the Data
Raising public awareness about causes of death that otherwise receive little attention is essential. But sometimes the lack of awareness stems from a real problem: a lack of data. Incredibly, nearly two-thirds of all deaths in the world go unreported, and millions that do get reported lack a documented cause of death. How are elected officials and health care leaders to target their resources on the leading causes of death when they don’t have good data on what those causes are—or whether their interventions are working?
The truth is if you can’t measure it, you can’t manage it. That is why we started our Data for Health program, co-funded by the Australian government. Data for Health is working with 19 countries—representing more than a billion people— to close the data gap on births and deaths. It’s our hope that the lessons we learn and the methods for collecting data that prove most effective will spread around the world and help governments better understand how to save more lives.
Tobacco is the classic example. The tobacco industry spent decades misleading the public about the dangers of smoking and fighting efforts to reduce it. When we proposed an indoor smoking ban in New York City, the industry went full tilt to defeat it. They lost, the ban proved highly effective and popular, and cities, states, and countries around the world have since adopted similar bans. Whether it’s smoking bans or tobacco taxes or regulations on packaging, the industry continues to fight any effort by governments to adopt policies that are proven to reduce use of their product—which is just about the only product sold legally that, if used as intended, will kill you about half the time.
One in ten of all deaths around the world is caused by smoking. Most take place in developing and middle-income countries where tobacco companies have shifted their marketing, lobbying, and legal efforts. With smoking on the decline in the U.S. and much of Europe, the industry is targeting the poor and using its deep pockets to bully governments from implementing life-saving public health measures.
We’re helping these governments stand up for their people through the Anti-Tobacco Trade Litigation Fund, which we created with the Gates Foundation. The fund supports governments like Uruguay, which last year successfully fended off a tobacco industry lawsuit arguing that its graphic package warnings ran afoul of international trade laws. The case was dismissed in 2016 by a World Bank tribunal, handing Uruguay a major victory and establishing a critical precedent.
Elsewhere, Romania passed a comprehensive tobacco control law; Shanghai and Shenzhen passed and implemented comprehensive smoke-free laws; the Philippines and Bangladesh began displaying new graphic tobacco packaging warnings; and Colombia and Ukraine both significantly raised tobacco taxes. It was not a good year for the tobacco industry.
Since 2007, we have committed almost $1 billion to our tobacco control program and helped save 30 million lives. Back then, 11 countries had gone smoke-free. Today, the number stands at more than 50, covering nearly 1.5 billion people. This success demonstrates the important role philanthropy can play in spreading ideas that work.
In addition to tobacco, one of the leading causes of noncommunicable disease is obesity. A common reaction to public health interventions aimed at combatting obesity is that government shouldn’t be involved, people should be allowed to make their own choices—and if they become obese and develop a disease as a result, that’s their fault. Leaving aside the fact that taxpayers bear a large burden for these diseases, a critically important role of government, I’ve always believed, is to help protect people from harm. That’s why we have laws requiring seat belt use. Those laws were controversial when they were first introduced. They’re not anymore.
People also have misperceptions around what causes obesity. They tend to think it’s primarily an issue of laziness—a lack of exercise. But that’s not true. The main culprit is diet. And the single biggest contributor to the problem is soda and other sugar-sweetened beverages, because they contain a lot of calories but consuming them doesn’t reduce your appetite. With no nutritional value, they are the definition of empty calories.
As awareness of the dangers posed by sugary drink consumption spreads, countries and cities have begun taking action. Two years ago, no municipalities had sugary beverage taxes. Now, seven cities and counties, representing more than eight million residents, have them. Last year, four large U.S. cities—Chicago (Cook County), Philadelphia, San Francisco, and Oakland—passed taxes on sugar-sweetened beverages. In each case, I backed efforts in support of these new laws. And, through grassroots organizing, these cities passed new taxes despite campaigns by the soda industry that outspent proponents at every turn.
More cities are likely to follow as the evidence in favor of the tax becomes increasingly irrefutable. In 2014, I supported an effort in Berkeley to become the first U.S. city to have a tax on sugarsweetened beverages. The law passed. And last month, a study showed that sugary beverage sales have declined by almost 10%—with more than a 15% increase in the sales of bottled water. A recent study of Mexico’s sugar-sweetened beverage tax found that purchases of taxed beverages have also declined by nearly 10%. In 2015, soft-drink companies mounted a concerted campaign to overturn the law, but thanks to the power of grassroots opposition, which we supported, they failed.
One area where we have made major gains against NCDs and injuries has been in vehicle crashes. But those gains have been limited to the U.S. and Europe—and they are now in danger: over the past two years, U.S. crash deaths have risen. Yet, as bad as the problem is here, it’s far worse in the rest of the world. Vehicle crashes kill 1.3 million people each year and injure up to 50 million more.
Vehicle crashes kill 1.3 million people each year and injure up to 50 million more. Crashes are the tenth leading cause of death in the world, and the number one cause of death for people aged 15 to 29. Once again, low- and middle-income countries suffer the most. Even though these countries have only half the world’s cars, they account for 90% of all road deaths.
One reason is that roads, walkways, and other infrastructure are not designed for safety. We are, however, working with governments and transportation experts to change that. Unsafe vehicles are also an important cause of crash deaths. In the U.S. and Europe, basic safety protections, like air bags and electronic stability control, are required by law. But in much of the rest of the world they are not, allowing automakers to sell cars that are virtual death traps. More than a century after Henry Ford began mass-producing cars, 80% of countries do not regulate vehicle safety standards.
In low- and middle-income countries, automakers—including U.S. and European manufacturers—routinely sell cars and other vehicles without many of the basic safety protections that are standard here at home. The result: an awful lot of people are being killed in crashes that they would have likely survived in the U.S. or Europe. This is especially disturbing because it costs so little to make cars safer, usually just a few hundred dollars. Yet hardly anyone is talking about this.
Our road safety program is beginning to change that through our work with consumer groups and governments. We have funded vehicle testing in Latin America, India, and Southeast Asia, and the results have been publicly released so that consumers can make more informed decisions. We have also begun conversations with manufacturers in the hopes of convincing them to make commitments to meet UN safety standards in every country, but we know that voluntary compliance is not enough. More governments must establish safety standards, and we have begun working with partners in countries to encourage them to take action.
The Work Ahead
Tobacco, sugary beverages, road crashes, and other NCDs and injuries are in desperate need of more attention and funding from both philanthropists and governments. The return on investment will be enormous, because many of the best solutions require relatively small sums—often to support grassroots organizing and advocacy campaigns.
There are philanthropists, elected officials, and leaders of non-governmental organizations who have made this life-saving work a top priority. But not enough. By encouraging everyone to do more, we can save millions of lives, spare millions more from pain and suffering, and create a safer, healthier, and happier world. It would be hard to find more inspiring and important work.
Michael R. Bloomberg
To learn more about Bloomberg Philanthropies work over the last year, read the Annual Report, available on Bloomberg.org.