By the end of June, the Supreme Court is expected to rule on the constitutionality of the Patient Affordability Act. Much of the debate centers around the individual mandate that would require virtually all US citizens to obtain health insurance or face a penalty. But there is a much lesser known element of the law that may have as great an impact on our nation’s healthcare system as the adoption of the individual mandate. The Center for Medicare & Medicaid Innovation, which was created by and is funded by the Patient Affordability Care Act, is the first nation-wide initiative to focus purely on improving the cost-efficiency of government healthcare programs.

The enormous costs of our government healthcare programs is frequently acknowledged by politicians and policy analysts. The latest CBO report expects between 6% and 10% of our total GDP to be spent on Medicare and Medicaid over the next ten years—where the actual figure will fall depends primarily on the GDP growth rate and whether the Bush tax cuts are allowed to expire. It remains that under almost any plausible fiscal scenario, healthcare outlays are the federal government’s largest source of spending growth over the next decade. Read more

This post was originally published on the Center for Strategic and International Studies’(CSIS) “Smart Global Health Blog.”

It was written in response to a question posed by CSIS: Do you think it’s possible to create a unified social movement for NCDs, akin to the movements that already exist for individual chronic diseases? If so, why? If not, what initiatives can we implement in the place of an effective social movement to move an NCD agenda forward?

A unified social movement for NCDs isn’t in the cards.

Building a movement around a diverse set of diseases with broad and varying constituencies just won’t work.

What we need is evolution and revolution in the way we think about combating chronic disease.

In 2009, Michel Sidibé, the Executive Director of UNAIDS, announced that it was time for a “prevention revolution” in the fight against HIV/AIDS. He articulated what we learned in epidemiology 101—treating those who are sick is absolutely essential, but the only way we can actually beat an epidemic is to prevent it from growing.

Those hoping to build a movement for NCDs have focused on the lessons that can be garnered from the early days of the fight against HIV/AIDS. But we can’t forget that we are in very different situation from the AIDS activists of the 1980s and early 1990s, who were fighting a mysterious illness with unknown origins and no treatment options.

Instead, we are at an incredibly unique moment and vantage point in time, with knowledge and tools that those early HIV/AIDS activists could not have dreamed of. We know our epidemic. We know how it is caused, we know what the risk factors are, and we have even estimated how and when it will hit us and how much it will cost.

What we need is “prevention revolution” for NCDs that will use the information we have to change the way we think about combating illness. This revolution would shift the focus from what currently divides the NCD community—specific diseases and conditions—to what unites it—the need to address shared risk factors.

Many will lament, correctly, that changing lifestyles—eating, drinking, and smoking habits—is incredibly difficult.

But we have examples of real success, from the change in attitudes in the United States around tobacco use, to growing awareness in India and China about the dangers of diabetes and unbalanced diets.

Currently, initiatives like President Clinton’s Alliance for the Healthier Generation and First Lady Michelle Obama’s “Let’s Move” campaign are demonstrating how top-down approaches can bring diverse constituencies together to focus on healthy lifestyles (here’s to hoping that they will be equally successful in encouraging their spouses to attend the UN NCDs Summit!).

This kind of broad based coalition building, with government educating and regulating, civil society advocating, and industry becoming a responsible stakeholder, is what will lead to a prevention revolution and real success in the fight against NCDs.

The movement will be more diffuse, less focused, and perhaps more chaotic than past initiatives. But it will also be more flexible and adaptable. It will bring advocates together, rather than separate them over a competition for resources. It will allow cash strapped governments to take the most cost-effective and sustainable path toward preventing economic catastrophe. Even industry will be able to realize benefit in a healthier population ready and able to consume more nutritious products.

Rather than searching for the next viral video or social media campaign to launch the NCDs movement, we must get down to the much harder work of revolutionizing the way we think about how to combat chronic disease.

Do you remember those Lipitor commercials from a few years ago? A cocky man struts his stuff around the pool, flexing his overly tanned muscles and prepares to dive in. Instead of impressing the ladies with his double pike, he lands flat on his stomach, suffering from a premature heart attack caused by a cholesterol problem he was completely unaware of.

How is this at all relevant to global health or larger world politics? I’m sure you can think of a few countries now strutting their stuff on the world stage. Empowered by high economic growth and a debilitated West, Brazil, Russia, India, China, and the newest member of their club, South Africa, are increasingly optimistic (and perhaps even cocky) about their position in the world and their potential for economic dominance in the future.

But these BRICS are walking around carrying their own heart stopping baggage. They all face enormous challenges in what many predict will be growth crushing epidemics of noncommunicable chronic diseases (NCDs) like heart disease, diabetes and cancer.

In China, 80% of deaths are caused by NCDs, and the country’s rapidly aging population in addition to its declining population growth ensure that the burden of these diseases will only grow, in both absolute numbers and economic cost.

Nearly three out of every four deaths in Brazil is caused by NCDs.

Indians have their first heart attack six years earlier than the rest of the world—killing or disabling a startling number of people during their most productive years of life.

And the economic costs of NCDs are staggering. A recent study estimated that $35 trillion dollars in global economic output will be lost from 2005-2030 because of NCDs. With 80% of chronic disease related deaths occurring in the developing world, we can be sure that the BRICS and other emerging markets will suffer economically if this issue is not dealt with soon.

Despite such scary statistics, the BRICS have a unique opportunity to lead the international community in preventing a public health and economic catastrophe.

In September, the United Nations General Assembly will host a special two-day High Level Meeting on Non-communicable Diseases. Many hope that it will be a turning point in the fight against NCDs. Thus far, it looks like the event will be a bust.

The UN has not been able to get a single head of state/government from a major power to commit to attend the Summit. The Americans and Europeans are tied up with their own economic issues and are largely fatigued by their already extensive commitments in global health. The Caribbean countries, which courageously led the effort to put NCDs on the agenda, don’t have the clout or the resources to influence nations outside of their region.

It is exactly this lack of leadership that opens a door for the BRICS. They have the chance to set the agenda for an issue with incredible global implications without the interference or resistance of the United States or European Union (they could only dream of such circumstances on other global governance issues like the Doha trade talks or climate change negotiations).

The BRICS need to grab this opportunity by the horns. A great start could include the simultaneous launching of national strategies to combat NCDs. This would be followed by a joint proposal for the UN Summit on how the international community can move forward together to combat noncommunicable diseases. While specifics would obviously need to be worked out, a joint proposal from the BRICS, presented ideally by their heads of state/government, would bring much needed attention to the battle against NCDs.

The BRICS, as an unofficial alliance, would gain prestige for finally demonstrating real leadership, rather than acting only as a talking shop.  They would also produce momentum for moving their domestic NCDs agendas forward.

Developing countries would benefit by finally having a global health strategy developed by countries facing similar resource limitations (in comparison to being dictated to from on high by Western donors).

Likewise, rich countries will feel less anxiety that the summit’s only real agenda is to get them to pony up more funds for yet another global health initiative.

There is clearly still a great deal of work to be done before a comprehensive solution to the challenge of NCDs can be developed. However, with no one at the helm, it is unilkely that the international community will be up to the task. The BRICS have domestic and foreign policy incentives for taking up this issue and presenting a united front. Their leadership is not only desirable, but increasingly, necessary.

Without urgent action, we’re headed for a (figurative) belly flop caused by a very real cardiac arrest (or more precisely, several million of them).