It is well known that the lives of hundreds of millions of people globally are affected by the four noncommunicable diseases (NCDs) – cardiovascular and lung diseases, cancer and diabetes. A reminder may be timely, however, that as many people are affected by mental and neurological disorders (MNDs) – including depression, anxiety disorders, bipolar disorder, schizophrenia and dementia. MNDs can be a precursor to or a consequence of NCDs. They share many of the same determinants and consequences, and frequently occur in the same person. Both are risk factors for suicide.

This is why promoting mental health and well-being is a key part of WHO’s efforts to accelerate the work being done to prevent and control NCDs as it prepares for the Third United Nations General Assembly High-level Meeting on NCDs in 2018.

“These conditions cause great human suffering, cut lives short and threaten social and economic development,” says Dr Svetlana Axelrod, WHO’s Assistant Director-General for NCDs and Mental Health. “The world recognized the urgency to address these global challenges in target 3.4 of the Sustainable Development Goals: to reduce premature deaths from NCDs by one third by 2030 and promote mental health and well-being.”

The figures are striking. NCDs are the major killers of our time, causing 70% of deaths worldwide. Each year they kill 15 million people between the ages of 30 and 70 years. Over 300 million people suffer from depression and around 50 million people live with dementia. Close to 800 000 people die by suicide, which is the second leading cause of death among young people. NCDs are responsible for about a fifth of all years lived with disability, and major depression and anxiety disorders are among the leading causes of years lived with disability.

Mobilizing forces to accelerate progress

National and international responses to tackle NCDs and promote mental health and well-being have generally been slow, uneven, inadequate and fragmented, despite world leaders’ global commitments to address these challenges. At the High-level Meeting, world leaders will have the chance to make bold political commitments and take decisive action. Member States will come together to assess the progress made in addressing these global challenges, identify existing obstacles and decide on ways to accelerate future efforts.

In preparation, WHO is mobilizing stakeholders and has established the WHO Independent High-level Commission on NCDs. This comprises four heads of state, multiple ministers, and leaders in public health and development working to provide innovative, bold and practical solutions that countries can implement to address NCDs and promote mental health and well-being.

Strong links between NCDs and MNDs

Many MNDs and major NCDs share common features – they may strike at any age and can affect an individual’s entire life, requiring ongoing monitoring and management. They share many common underlying determinants, have similar consequences, and frequently co-occur.

Common determinants

Both NCDs and MNDs arise from a combination of common genetic and biological, psychosocial and behavioural, social and environmental factors. Risk factors for NCDs such as sedentary behaviour, unhealthy diets and harmful use of alcohol are also risk factors for MNDs.

One risk factor in particular – exposure to childhood adversity (such as physical and sexual abuse, neglect, family violence or the death of a parent) – is related to later-life MNDs and to a range of NCDs that have an onset in adulthood. Both groups of conditions disproportionally affect people from the most disadvantaged socioeconomic groups.

Similar consequences

These conditions also share overarching consequences, with a negative impact on people’s health and socioeconomic status. They can lead to significant levels of illness, disability and premature death. They carry a high level of stigma, which can lead to exclusion, discrimination and delay of care. The consequences of these conditions are felt not only by the individuals and families concerned but by society as a whole.

Comorbidity

NCDs and MNDs frequently co-occur: they can be precursors and consequences of one another, and have severe impacts. People who suffer from common mental disorders – depression and anxiety disorders – are at higher risk of developing heart diseases and diabetes. In parallel, people with heart diseases have a higher risk of developing depression. The prevalence of depression among people with heart diseases is up to three times higher than in the general population. People with heart diseases and depression have a much worse prognosis in terms of survival and quality of life.

Integrated response

“It is imperative that adequate attention is given to MNDs in national-level health planning,” says Dr Shekhar Saxena, Director of WHO’s Department of Mental Health and Substance Abuse. “If countries adopt integrated strategies for these conditions, recognizing their common consequences and comorbidity, health systems can move towards more integrated and more effective prevention, management and care.”

Integrating NCD and mental health services into primary care requires training and support for health workers in identifying and treating MNDs and NCDs, establishing links to secondary care specialists for supervision and referral when required, as well as integrating services and management of both MNDs and NCDs, especially for people with comorbid conditions. An integrated approach can improve accessibility and affordability, reduce fragmentation, improve efficiency, prevent duplication of infrastructure and services, and better meet people’s needs and expectations.

All this requires political will, but an integrated response is critical in the battle against NCDs and MNDs and for mental health and well-being.