Last week, the World Health Assembly, the governing body of the World Health Organization, voted in Geneva to adopt a new global target of a 25% reduction in premature mortality from noncommunicable diseases such as cardiovascular disease, cancer, diabetes and chronic respiratory diseases by 2025. All governments will now be obliged to collect data on diabetes and NCD deaths, and report regularly on progress to the United Nations. According to WHO officials, this mandatory target has the potential to drive significant action on heart disease, diabetes, cancer and chronic lung disease across all countries.
Timothy Armstrong, coordinator of Surveillance and Population-based Prevention in the Department of Chronic Diseases and Health Promotion at the WHO, said, “This is a landmark decision on the prevention and control of NCDs. For the first time, we are moving away from aspirational goals to an action-based approach that will be anchored in quantifiable targets.”
Representatives of non-governmental organizations (NGOs) also celebrated this new resolution. Ann Keeling, Chair of the NCD Alliance and CEO of the International Diabetes Federation declared: “The adoption of this bold and ambitious target is a landmark event in the fight against NCDs. For the first time all governments will be accountable for progress on NCDs. The NCD Alliance and its members and partners around the world have worked tirelessly for nearly a year for this. On behalf of the hundreds of millions of people with NCDs, we are delighted to see this result.”
While the vote is a step forward – at the UN High Level Meeting on NCDs in New York City last September, governments concerned about austerity and fiscal constraints and representatives of the food, tobacco, alcohol and pharmaceutical industries worried about threats to profits from a determined global campaign to prevent NCDs joined forces to delay any specific targets for reductions in NCD deaths.
Several daunting challenges face effective action to prevent premature deaths and avoidable illnesses from NCDs. Currently, the provisions of trade agreements negotiated through the World Trade Organization or bilateral or multilateral agreements among nations often preclude the effective regulation of the tobacco, alcohol and food industries that have played a prominent role in creating the current burden of NCDs. Ron Labonte and his colleagues explain these relationships in a recent report on international trade and chronic disease.
In addition, these agreements protect the intellectual property rights of pharmaceutical companies, making it more difficult for emerging and low income nations to produce and distribute at affordable prices the medications that can help prevent complications from heart disease, cancer or diabetes. As a public health commentator in Australia asked about last week’s agreement, “Will World Trade Organization (WTO), World Bank and International Monetary Fund (IMF) policies help or exacerbate the problem?” In the past, these organizations have often promoted corporate-managed trade at the expense of public health protection. Another obstacle to effective action is the determined efforts by multinational corporations to avoid public health oversight. In the United States and the United Kingdom, two countries with a long history of public regulation, the food and beverage industries have recently launched mostly successful campaigns to thwart stronger regulation of the products most associated with diet-related chronic conditions. If the governments of two of the wealthiest nations are unable to stand up to special interests, what are the chances for many poorer nations?
In addition, new worries about economic growth in India and China, two countries with the largest number of people predicted to come down with NCDs in coming decades, may limit resources for public health prevention and further tilt these governments to adopt pro-market policies that contribute to NCDs. As I noted in an earlier post, Coke, Pepsi and fast food companies have targeted China as their next growth area, ensuring a new generation of people with diet-related chronic diseases.
Some have also questioned whether the UN has the backbone or muscle to stand up to special interest. WHO is itself going through a complex re-organization, distracting top officials at least to some extent. Some critics have also warned about the growing dependence of WHO on corporate and philanthropic funding, trends which might compromise its ability to speak clearly for health.
The resolution on NCDs passed by the UN General Assembly in September 2012 requires countries to develop and report back to the UN their national NCD plans in 2014. What can public health professionals do to ensure progress by that date?
One concrete starting place is the Rio plus 20 United Nations Conference on Sustainable Development to be held in Rio de Janiero on June 20-22. At this meeting and in its aftermath, activists and governments can strengthen the ties between organizations and constituencies concerned about sustainable development and those concerned about NCDs. Solutions to each require charting a new path that ends the promotion of patterns of consumption that threaten the planet’s future and create new epidemics of NCDs. Charting policies that discourage the corporate promotion of unhealthy and unsustainable lifestyles and strengthening the capacity of governments and international organizations to act to protect public health and the environment are the broader goals of such an alliance. Such an agenda can begin to catalyze the movements that will have the passion and power to suggest that another road to human development is possible.
Different nations have the potential to play different roles in creating a new ethic of healthy and sustainable consumption. The wealthiest nations in North America and Europe can find new ways to re-create past successes in public health protection and apply them to the twenty first century challenges of growing inequality, persistent poverty and unsustainable consumption. Emerging nations like China, India, Brazil and South Africa can experiment with new approaches to bringing the benefits of prosperity to large sectors of their populations without imposing on them the burden of premature mortality, preventable illness and unaffordable health care costs now observed in many Western nations. Finally, the poorest nations have the most to gain by continuing progress in reducing infectious diseases without going down the road that will bring them to high levels of NCDs. All nations will encounter the determined resistance from the multinational corporations that continue to profit from current patterns of NCDs. Finding new ways to confront that force will determine whether counting NCDs, as now required by the World Health Assembly, can be a first step towards preventing them.
2. Dave Proffer via Flickr