Grand Challenges

As countries develop and progress, health priorities must expand beyond eradication of communicable diseases to include control of non-communicable chronic diseases (NCD). Four primary NCD - cardiovascular disease (mainly heart disease and stroke), type 2 diabetes, some cancers, and chronic respiratory diseases — henceforth referred to as "physical" NCD — are responsible for 35 million deaths annually. They are the leading cause of mortality in the world, much of which is premature and avoidable. Nearly 80% of NCD deaths occur in low- and middle-income countries. Over the last 20 years, the burden of disease, i.e., the impact of NCD worldwide as measured by morbidity and mortality, rose from 47% to 54%. An aging population, longer life expectancies, population growth, urbanization, and globalization of risk factors have made NCD a threat to worldwide development and economic growth and an urgent global health priority. This article, the third in a series of five, argues that mental health care should be integrated into the NCD agenda, reviews the evidence for models of integration in high- and low-income countries, identifies the challenges and opportunities for addressing the rising burden of mental health and NCD, and recommends strategies to advance a more integrated agenda.