Dear Mr. Bloomberg:
Congratulations you on your recent appointment as Global Ambassador for Noncommunicable Diseases for the World Health Organization. You have proven yourself a global citizen extraordinaire through you industry leadership, public service, and philanthropy. As you sign on to work with political leaders around the globe to find solutions to the burden of non-communicable diseases – things like heart disease, stroke, cancer, diabetes and chronic respiratory diseases – I have one request.
Please don’t forget mental health. Here’s why:
1. Mental and behavioral disorders cause more health burden than any other non-communicable disease. That’s right. The economic burden of mental and behavioral disorders is greater than any and all of the four other major categories of non-communicable disease: cancer, chronic respiratory diseases, diabetes and cardiovascular illnesses. Around the world, 22.2% of disability is attributable to mental and behavioral disorders.
2. People die from Mental and Behavioral Disorders. It is well-documented that individuals with mental and behavioral disorders – particularly depression, schizophrenia, and bipolar disorder – die approximately 25 years younger than their peers without mental illness. This is partially because people with serious mental illness seek and receive less health care and partially because the vast majority of people who die by suicide suffer from untreated mental illness.
3. People with serious health conditions – like diabetes, cancer, and coronary artery disease – are less likely to seek treatment, receive treatment and adhere to treatment if they also have mental health problems. Case in point: the American Heart Association recently recognized that depression is associated with worse prognosis following a cardiac event, and noncompliance rates are three times greater for depressed individuals compared with non-depressed individuals with cardiac illness. Same is true in Africa where approximately two-thirds of HIV-infected individuals have co-morbid depression and/or anxiety at some point over the course of their lifetimes. No treatment or poor adherence is not only potentially fatal for the individual but also guarantees the continuing spread of the HIV.
4. We have treatments that work. Ignoring mental and behavioral disorders would be tragic but understandable if we had no treatment options, but we have evidence that standardized treatments like Interpersonal Psychotherapy and Cognitive Behavioral Therapy are effective treatments in high, middle and low-income countries alike. We also have evidence that integration of mental health services into primary care using a team-based approach to manage chronic and complex medical conditions results in more holistic and less fragmented patient care, which translates into better health outcomes for everyone.
5. We can’t afford not to. Ignoring mental and behavioral disorders as we expand our global health focus on non-communicable diseases would be a costly and self-defeating strategy. Instead, building health systems that integrate care, leverage technology, and invest in training more health professionals in mental health services will accrue benefits across the population. Right now, depression alone is on course to be the single leading cause of disability by 2030. Political will, global collaboration, and strategic solutions can alter this projection for the better.
Mr. Bloomberg, fellow Hopkins alum, you have hit the ball out of the park time and again in your career. As WHO Ambassador, good luck, and as you tackle the important non-communicable diseases of our day, please remember it would be crazy to leave out mental and behavioral disorders.
