theHealthTsunamiLong considered diseases of minor significance to global health, the main four NCDs—diabetes, cancer, cardiovascular disease and chronic respiratory disease now represent one of the major threats to human and economic development. NCDs kill and disable, impoverish families, impose a huge economic burden on governments and business, and overwhelm health systems. They are the world's number one killer, and no nation—rich or poor—is immune from their impact.

It is estimated that 36 million people die from NCDs each year, accounting for two out of three deaths. Contrary to popular opinion, NCDs have now taken hold in developing countries, with four-fifths of NCD deaths now occurring in low-and middle-income countries. Current data show women ages 15–49 years living in Africa have more than four times the risk of dying prematurely from an NCD than women of similar age living in high-income countries (World Health Organization, 2009).

The global diabetes epidemic alone, which currently affects 366 million worldwide, is projected to increase the greatest in Africa, the Middle East and South-Asia over the next twenty years.

Diabetes and related NCDs can cause and entrench poverty in developing countries. Where there is a lack of social and health insurance, out of pocket payments for treatment and care can trap poor households in cycles of catastrophic expenditure impoverishment and illness. In India, the treatment costs for an individual with diabetes are 15-25% of their household earnings. Risk of financial ruin is further compounded by the shift in age distribution of NCDs in lMCs, where it is increasingly striking household breadwinners. In India and China for example, diabetes hits a decade earlier than in Europe and USA. Debilitating complications and premature death of the main income earner means less money for basic necessities such as food and shelter and the key drivers of development such as education.

The economic effects at the household level add up to a substantial macroeconomic toll. Government budgets worldwide are bearing the immense cost of NCDs in lost economic growth, productivity and rising healthcare costs. It is estimated that for every 10% risk in NCD mortality, annual economic growth is reduced by 0.5%. For example, WHO estimate that China and India will lose USD 558 billion and USD 237 billion respectively in foregone national income as a result of largely preventable deaths from diabetes, heart disease and stroke. For these reasons, NCDs have been consistently identified by the World Economic Forum as one of the top global risks of our time.

NCDs are not only a cause of poverty and a major barrier to economic development, but these four diseases also undermine other key development objectives such as gender inequality, child and maternal mortality, and infectious diseases. This was recently recognized at the UN Summit on the Millennium Development Goals in 2010. The burden of NCDs was recognized as a critical determinant of achievement of the Goals, and this has been further justified in statistical studies showing that the NCD burden hinders progress towards the Goals after other factors are controlled.

Fortunately, cost-effective and affordable interventions are available and well established for preventing and treating NCDs. We have the skills, the expertise and the know how to turn this epidemic around.