Luna Florencia, Luyckx Valerie A
Programa de Bioética, Área Ética, Derechos y Bienes Públicos Globales, Facultad Latinoamericana de Ciencias Sociales (FLACSO), Buenos Aires, Argentina.
Institute for Biomedical Ethics and the History of Medicine, University of Zurich, Zurich, Switzerland.
Asian Bioeth Rev. 2020 Mar 20;12(1):5-25. doi: 10.1007/s41649-020-00112-8. eCollection 2020 Mar.
Non-communicable diseases are no longer largely limited to high-income countries and the elderly. The burden of non-communicable diseases is rising across all country income categories, in part because these diseases have been relatively overlooked on the global health agenda. Historically, communicable diseases have been prioritized in many countries as they were perceived to constitute the greatest disease burden, especially among vulnerable and poor populations, and strategies for prevention and treatment, which had been successful in high-income settings, were considered feasible and often affordable in low-income settings. This prioritization has reduced the communicable diseases burden globally but has left non-communicable diseases largely neglected. A new approach is urgently needed to tackle non-communicable diseases. Based on an analysis of potential features which may have underlain the different approaches to non-communicable diseases and communicable diseases until now, including acuity of disease, potential for control or cure, cost, infectiousness, blaming of individuals and logistical barriers, little ethical or rational justification can be found to support continued neglect of non-communicable diseases. Justice demands access to quality and affordable care for all. An equitable approach to non-communicable diseases is therefore strongly mandated on medical, ethical, economic, and public health grounds. Funding must not however be diverted away from communicable diseases, which continue to require attention-but concomitantly, funding for non-communicable diseases must be increased. International and multi-sectoral action is required to accelerate progress towards true universal health coverage and towards achievement of all of the sustainable development goals, such that prevention and access to care for non-communicable disease can become a global reality.
非传染性疾病不再主要局限于高收入国家和老年人。在所有国家收入类别中，非传染性疾病的负担都在上升，部分原因是这些疾病在全球卫生议程上相对被忽视。从历史上看，许多国家将传染病列为优先事项，因为它们被认为构成了最大的疾病负担，尤其是在弱势群体和贫困人口中，而且在高收入环境中取得成功的预防和治疗策略，在低收入环境中也被认为是可行的且通常是负担得起的。这种优先排序降低了全球传染病负担，但却使非传染性疾病在很大程度上被忽视。迫切需要一种新方法来应对非传染性疾病。基于对迄今可能构成非传染性疾病和传染病不同应对方法基础的潜在特征的分析，包括疾病的严重程度、控制或治愈的可能性、成本、传染性、对个人的指责以及后勤障碍，几乎找不到伦理或合理的理由来支持继续忽视非传染性疾病。公平要求所有人都能获得高质量且负担得起的医疗服务。因此，基于医学、伦理、经济和公共卫生理由，强烈要求采取公平的方法来应对非传染性疾病。然而，资金绝不能从传染病领域转移，传染病仍然需要关注——但与此同时，必须增加对非传染性疾病的资金投入。需要开展国际和多部门行动，以加速朝着真正的全民健康覆盖以及实现所有可持续发展目标取得进展，从而使非传染性疾病的预防和医疗服务能够成为全球现实。
