Non-communicable diseases – Professor Stephen Leeder looks at what came out of the UN meeting on NCDs.
Despite the lack of definite goals and targets, the United Nations High-Level Meeting in New York that concluded on September 20, was a positive step in the right direction for dealing with the scourge of NCDs.
Late on the evening of September 19th, I watched a video stream from the massive United Nations Assembly Hall as the High-Level Meeting on Non-Communicable diseases (NCDs) opened at 9am New York time.
I was very excited – NCDs were at last being taken seriously by the nations of the world. The media release issued after the meeting provides a useful summary:
The two-day high-level General Assembly meeting, attended by more than 30 heads of State and Government and at least 100 other senior ministers and experts, is discussing a draft declaration calling for a multi-pronged campaign by governments, industry and civil society to set up by 2013 the plans needed to curb the risk factors behind the four groups of NCDs – cardiovascular diseases, cancers, chronic respiratory diseases and diabetes.
Steps proposed range from price and tax measures to reduce tobacco consumption to curbing the extensive marketing to children, particularly on television, of foods and beverages that are high in saturated fats, trans-fatty acids, sugars, or salt. Other measures would cut the harmful consumption of alcohol, promote overall healthy diets and increase physical activity. The overall toll of NCDs is estimated at 36 million out of a total of 57 million annually.
Out of this world
I was intrigued by how much this meeting looked like a meeting of the galactic federation in Star Trek: The Next Generation.
Even the architecture of the hall for 1300 people with its star-studded ceiling could have come from Gene Roddenberry’s imagination.
All those beings from far-flung nations brought along diverse problems, different interpretations and disparate solutions.
Yet here they were, seeking common solutions to a massive and growing threat to the health of the world.
This diversity is both the strength and weakness of the NCD cause. It permits the development of tailored, local solutions, such as a tough tobacco tax in one country that perhaps cannot be enacted in another.
Attending the meeting, beside high-ranking national officials, were representatives of citizen groups concerned about NCDs and related illnesses.
But also in attendance were those who fear a deluge of mental illness; those distressed by the millions of children dying from exposure to domestic cooking fires; those seeking to immunise women against cancer of the cervix; those frightened by the bleak and expanding horizon of dementia; and those who see clearly the human rights and equity concerns created by these diseases as they occur most frequently among the poor.
The complexity of NCDs
NCDs are too big and too distressing to hold in your mind for long, and too diffuse to provoke uniform solutions. We must segment them and tackle them bit by bit.
But therein lies a great danger because these diseases originate from complex, integrated distortions to the way we live.
They rank alongside climate change and the global economy as complex problems that we must face.
Say you have a dodgy computer. You could try to fix it by replacing the mouse but what if the problem is the result of dysfunctions in hard disk, keyboard and mouse. You may choose simply to buy a new computer.
But such an alternative sadly doesn’t exist for dealing with NCDs even though they are the result of a series of dysfunctions in the way we live.
The deliberations of the meeting were enshrined in a Political Declaration . It seeks to steer a course between segmentation of NCDs (reduce trans fats; promote more physical activity) and systems approaches; bring in UNESCO; adopt whole-of-government strategies).
The Declaration considers an array of interventions that are economically feasible in various nations.
The international treaty against tobacco is reinforced because smoking plays a role in many of the major NCDs.
The World Health Organisation receives strong support. It has previously proposed action on diet and physical activity and these recommendations are freshly endorsed, all the while allowing for the exercise of national sovereignty in implementation – or not.
Nutrition, including concerns about advertising to children, is covered thoughtfully with and nations urged to be take action to ensure healthier, labelled food is readily available.
For nations already experiencing food insecurity, either long-standing or as a consequence of the recent global financial upheaval, these recommendations will be difficult to enact.
The Declaration also clearly recognises that health services and systems alone cannot cope and calls for whole-of-government approaches.
It seeks the support of UN agencies concerned with agriculture and education, among others, to be involved.
This is one of several points in the Declaration where the necessity for an integrated, systems approach is specified.
Aspiration vs perspiration
Goals and targets, for which many argued before the UN meeting should be proposed, escaped lightly. Without them, accountability and measurement of progress are difficult to ensure.
They are to be developed by individual nations by 2012, with voluntary national adherence. The meeting asks the World Health Organisation to work with nations to develop monitoring and surveillance systems to judge progress.
Overall, the UN meeting has consolidated steadily growing global concern about NCDs and articulated what is known and the kinds of action that must be taken.
The huge increase in interest in these conditions by governments, health agencies, non-government organisations and academia in the past seven years is deeply encouraging, especially when competing worries such as climate change and economic instability could have easily displaced NCDs from both national and international agendas.
The implementation and action plan based on the meeting and the Declaration will be all-important.
It was good to see Australia’s federal health minister Nicola Roxon attend the meeting. Her commitment to preventative health is unusually strong.
Australia has much to contribute to the global fight against NCDs, having had considerable success in cutting tobacco use and reducing deaths from heart disease.
Now the opportunity to lead is once more there for our government - and us - to take. Let’s hope we can all rise to it.
This is the fourth part of our non-communicable diseases series. To read the other instalments, follow the links here:
Part One: Sir George Alleyne discusses why we need a new paradigm to tackle NCDs
Part Two: Regulating alcohol to control NCDs
Part Three: Stopping the obesity epidemic will require action on the population-level
Part Five: How plain packaging works to reduce smoking – one of the biggest causes of non-communicable diseases
Part Six: Blueprint for making medicines more affordable for everyone
Part Seven: Action on salt will mean longer, healthier lives
Part Eight: Death by suburban sprawl: better urban planning will combat sedentary lifestyles
Part Nine: Where we come from determines how we fare – the fetal origins of adult disease
Part Ten: Social inclusion brings respect and better health Sri Lankan elders