For most of human history up to this point, life and death have been shaped chiefly by infectious disease – smallpox, tuberculosis, plague, leprosy, syphilis, cholera, typhus, measles, malaria – along with the perils of childbirth and the traumas of violent injury. In the last century, though – as socioeconomic development, medical technology and disease control initiatives radically reduced the scale of pathogenic illness, improved perinatal survival and mitigated accidental risk – NCDs (primarily cancers, cardiovascular and chronic respiratory disease, diabetes and – shamefully late – mental illness) have emerged as a new frontline in global health. NCDs are responsible today for 73 per cent of mortality worldwide with the highest rates of death in low-and middle-income developing countries.

Mounting effective strategies to tackle NCDs will be critical, in coming decades, to our chances of maintaining socioeconomic progress in countries at all levels of development – which makes what can only be described as a singular listlessness in the international response all the more intriguing. Worldwide, 1.1 billion people have hypertension, 425 million adults have diabetes, about 40 per cent of adults are overweight or obese and almost 800,000 people die annually from suicide. Yet global leadership on NCDs has been slow to emerge – decentralised to selective national policy making, and reliant on voluntary engagement from increasingly powerful multinational corporate actors. ‘In 2014 NCDs constituted half of the entire global burden of disease but received less than 2 per cent of all international health aid (US$492 million out of US$36 billion). In contrast, HIV represented 4 per cent of the global burden of disease but received 29 per cent of global funds’ (Nelson Allen, 2017).

Aetiologically rooted in the ways we live, NCDs are commonly described as ‘diseases of lifestyle’ – associated most immediately with the food we eat, our levels of physical exercise, the recreational substances we consume, and the stressors we absorb. If infectious diseases are conceptualised as an external assault on human society by a pathogenic nature – a battle in which the protective intervention of the state is not only warranted but required – NCDs can be viewed by contrast as internal to the individual, emerging from within our bodily selves – the physical manifestation of the choices we make and the preferences we pursue, amplified by a combination of genetic and biological propensities.