IDC Covid-19 Inquiry _ Second Submission: Input from the UK Working Group on NCDs[1]


A global health crisis: responding to the International Development Committee’s inquiry on longer term issues, implications and lessons to be learned from Covid-19

Please note that we have responded to the points most relevant to our Working Group members’ experience and expertise.

1). The emergence, incidence and spread of coronavirus virus infections and the Covid-19 disease in developing countries:

The spread and impact of Covid-19 amongst older people and those with underlying chronic conditions in developing countries, especially in humanitarian contexts, are of particular concern. We know that people living with underlying chronic conditions/Non-Communicable Diseases – NCDs (such as cardiovascular disease -heart disease and stroke, diabetes, chronic lung disease and cancer), and older people are at higher risk of more severe illness or dying from Covid-19, and in some cases appear to be more susceptible to contracting Covid-19.  (NCD Alliance,27/4/2020, COVID-19 and Noncommunicable Diseases (NCDs): Questions and Answers )

NCDs already account for 70% of deaths worldwide, with mental-health conditions such as dementia adding significantly to this burden of ill health. NCDs are a global epidemic. The burden of NCDs diseases is rising disproportionately among developing countries and the risk of dying prematurely from an NCD is almost double that in high-income countries. (WHO -

This burden runs across the whole life course, with children and young people in developing countries having a higher NCD burden (measured through Disability Adjusted Life Years) than those in higher-income countries (The Lancet Commission on Adolescent Health and Wellbeing, graph p92 )

The risk of spread and impact of Covid-19 in humanitarian settings such as refugee camps (with the huge challenges of social distancing or regular handwashing), particularly where there is a high NCD burden (a challenge being increasingly recognised and responded to in humanitarian settings), will likely mean even higher incidence than other low and resource poor settings.

Overall there is a strong need for disaggregated data (by gender, age, ethnicity, existing underlying conditions etc.) to understand who is being infected (and impacted) -to ensure an effective, targeted response. There is good evidence from a large number of countries that do disaggregate data by sex that, although men and women are infected in roughly equal numbers, men are much more likely to die. The reasons for this must be better understood but it is likely to be linked to the higher incidence of many of the major NCDs in men and also their higher levels of tobacco and alcohol use.

2). The direct and indirect impacts of the outbreak on developing countries, and specific risks and threats:

The spread of the Covid-19 pandemic will exacerbate existing inequalities and have huge direct and indirect impacts on developing countries. We must respond to ensure now, more than ever, no one is left behind.

Recent data shows that 16% of the population of Africa is at increased risk from Covid-19 due to being older or having underlying conditions. This figure highlights how huge the impacts of Covid-19 will be in developing countries. (

The impacts can be broken down into different impacts (and some suggested actions) that relate particularly to NCDs:









3). The UK’s response, bilaterally and with the international community, to the spread of coronavirus to developing countries:

Funding must include a focus on those most at risk from the impacts of Covid-19 (ie older people and those with underlying chronic conditions) and MUST take a rights-based approach (non-discrimination).

There is a severe mismatch between the scale of the NCD challenge and the allocation of official development assistance: in 2018 only 2% of development assistance for health was spent on NCDs. (

The UK government must ensure that palliative care is mainstreamed into Covid-19 responses including the training of health care workers at all levels and access to palliative medications including morphine. Palliative care is not a luxury add-on, it is a necessity both for many people with covid-19 and for those with NCDs that require palliative care. In many low-resource settings, there are going to be terrible ethical decisions around who can benefit from treatment (even where available) and who is sent home when there is no hope or where systems are overwhelmed. The decision should not be 'all or nothing' but must include the option of palliative care - whether for Covid-19 itself or any other condition including NCDs. (

5). The implications for DFID’s policy on a global health strategy:

Long term focus on NCDs needed to mitigate impacts of future outbreaks of Covid-19 or other viruses. i.e increase resilience. A reduction in NCDs globally may help when future viruses emerge.

Focus on prevention of other conditions that can lead to a higher risk of serious outcomes of COVID-19 eg obesity - including physical activity, good nutrition and support to quit smoking, and secondary prevention through medication. Obesity is increasing in LMICs, because all too often it's seen as only relevant in high income countries - and it is increasing rapidly. (for example, Lao PDR has had one of the highest rates of increase of obesity in the world - an average annual increase of 9.5% for men and 6.6% for women from 1995 to 2015 - and that obesity prevalence is predicted to be 8.9% (men) and 12.3% (women) by 2025. World Obesity Federation. 'Obesity: missing the 2025 global targets'. 2nd edition. WOF, London, UK, 2020.

The links between underlying conditions and COVID-19 demonstrate the need for a cross-cutting, holistic approach for any future broader approach/strategy.

8). The impact of the outbreak on UK aid funding in the longer term:

UK aid funding needs to support the concept of ‘Build back better’, with a real focus on equitable Universal Health Coverage. This must include a trained and supported health workforce with a particular focus on: primary healthcare and community health workers; systems to manage multiple chronic diseases and acute infection in parallel; and investment in digital solutions where appropriate

Building Back Better must also include much broader issues that impact on global health eg air pollution (The Guardian, 5/5/20, Is air pollution making the coronavirus pandemic even more deadly? , focus on reduction in climate change, combating malnutrition in all its forms (including obesity), physical activity and the commercial determinants of health.

There is a huge potential for improved long-term health and prevention of NCDs, which are the leading cause of death in almost all regions of the world, much of that death being premature (This would also ensure we meet the target set out in SDG 3: to reduce premature mortality from non-communicable diseases, through prevention and treatment, by one-third by 2030).




[1] A network of over 20 UK-based national and international NGOs and research organisations, which work together to draw attention to the urgent need to address the burden of non-communicable diseases as an international development priority.