tag:theconversation.com,2011:/au/topics/ncd-4784/articlesNCD – The Conversation2023-10-24T04:11:28Ztag:theconversation.com,2011:article/2124492023-10-24T04:11:28Z2023-10-24T04:11:28ZIndonesia needs to triple its funding to control tuberculosis – here’s where to start<figure><img src="https://images.theconversation.com/files/552901/original/file-20231010-24-za7ydt.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Image of a tuberculosis patient.
</span> <span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Tuberculosis#/media/File:Depiction_of_a_tuberculosis_patient.png">Myupchar/Wikipedia</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Indonesia is still <a href="https://tbindonesia.or.id/wp-content/uploads/2023/02/Factsheet-Country-Profile-Indonesia-2022.pdf">struggling to fight tuberculosis (TB)</a>, with the second-highest number of cases worldwide.</p>
<p>In 2021, one study estimated Indonesia had a staggering incidence rate of TB <a href="https://rdi.or.id/wp-content/uploads/2023/08/Increasing-Financing-for-Tuberculosis-Programs-in-Indonesia.pdf">759 cases per 100,000 people</a> – more than double the World Health Organization’s 2021 estimate <a href="https://data.who.int/indicators/i/C288D13">354 cases per 100,000 Indonesians</a>. That compares with a global average of <a href="https://data.who.int/indicators/i/C288D13">134 per 100,000 people</a>.</p>
<p>Undeterred by the challenges posed by TB, Indonesia has set ambitious targets of reducing TB cases to <a href="https://tbindonesia.or.id/wp-content/uploads/2021/06/NSP-TB-2020-2024-Ind_Final_-BAHASA.pdf">190 per 100,000 individuals</a> by 2024 and to 65 per 100,000 by 2030. </p>
<p>With a staggering number of TB cases and those ambitious targets, the country urgently requires increased funding to combat this potentially deadly but preventable communicable disease. </p>
<p>Currently, insufficient funding is a significant obstacle in Indonesia to fight against TB. <a href="https://www.who.int/publications/digital/global-tuberculosis-report-2021/financing">Sustained adequate funding</a> would ensure the availability of essential resources, diagnostic tools, medications and healthcare services necessary to prevent, diagnose and treat TB effectively. </p>
<h2>Lack of funding risks more people getting sick</h2>
<p>Known as the <a href="https://www.who.int/publications/i/item/9789240013131">TB financing gap</a>, lack of funding can lead to inadequate diagnostic tools and equipment provision, resulting in delayed or inaccurate diagnoses. These delays have grave consequences.</p>
<p>Studies <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7558533/">have shown</a> delayed treatment of TB increases disease transmission, posing a greater risk to individuals and communities.</p>
<p>Worldwide, 1.6 million people died from TB in 2021, making it the <a href="https://www.who.int/news-room/fact-sheets/detail/tuberculosis#:%7E:text=A%20total%20of%201.6%20million,(above%20HIV%20and%20AIDS).">13th leading cause of death</a> – and the second leading infectious killer after COVID-19.</p>
<p>According to Indonesia’s national strategy, the country needs to spend <a href="https://tbindonesia.or.id/wp-content/uploads/2021/06/NSP-TB-2020-2024-Ind_Final_-BAHASA.pdf">Rp47.3 trillion (US$3 billion)</a> from 2020 to 2024 to control TB. However, the budget availability for that period is only around Rp15.7 trillion ($990 million). </p>
<p>Indonesia also lacks access to financing help pay for those extra control measures.</p>
<p>The <a href="https://www.who.int/publications/i/item/9789240013131">WHO Global Tuberculosis Report</a> said Indonesia needs US$429 million for TB prevention, diagnosis and treatment and US$87 million for tuberculosis care – a total of US$516 million. But it has only secured only US$111 million. </p>
<p>In fact, WHO data shows that since 2009, Indonesia has consistently <a href="https://rdi.or.id/wp-content/uploads/2023/08/Increasing-Financing-for-Tuberculosis-Programs-in-Indonesia.pdf">failed to meet the necessary TB financing requirements</a>, financing only 41% of the needed TB programs each year, on average.</p>
<p>This financing gap restricts the availability of essential medications for TB treatment. This issue is particularly concerning, as drug-resistant strains of TB are emerging, further complicating treatment efforts.</p>
<h2>The pandemic hit TB funding</h2>
<p>The COVID-19 pandemic has worsened the TB financing gap in Indonesia. </p>
<p>The government had to change its priorities during the pandemic, reallocating its health budget for COVID-19 treatment and mitigation efforts. </p>
<p>WHO said Indonesia’s TB funding decreased <a href="https://www.who.int/indonesia/news/campaign/tb-day-2022/fact-sheets">around 8.7% between 2019 and 2020</a>. </p>
<p>Upon closer examination,<a href="https://rdi.or.id/wp-content/uploads/2023/08/Increasing-Financing-for-Tuberculosis-Programs-in-Indonesia.pdf">Two significant reasons emerge</a> related to factors contributing to the funding gap. </p>
<p>First, the lack of adequate fund to cover the costs of TB services. This limits the reach and impact of programs. </p>
<p>There is also a tendency among patients to seek diagnosis and treatment at hospitals, rather than local primary healthcare centres and clinics. This leads to a heavier financial burden on the National Health Insurance system, because treatment costs in hospitals are more expensive.</p>
<p>Second, the lack of private sector involvement in diagnosis, reporting and treatment further compounds the problem, hindering progress. </p>
<h2>What should we do now?</h2>
<p>Increasing domestic financing for TB programs is crucial. </p>
<p>The Indonesian government should allocate a higher proportion of the national budget to prevent and control TB, as well as to conduct TB-related research. </p>
<p>Integrating externally-funded TB programs into the National Health Care system would ensure sustainability and align them with the national healthcare framework. </p>
<p>Strengthening the healthcare system is paramount, including bolstering the capacity and infrastructure of local health centres and clinics, training healthcare professionals, and improving diagnostic and treatment services. </p>
<p>Additionally, exploring innovative financing pathways – such as engaging the private sector through public-private partnerships and leveraging international funding mechanisms – could provide the necessary resources to drive progress.</p>
<p>Closing the TB financing gap is essential, not only to improve patients’ health, but to also safeguard the well-being and socioeconomic stability of communities as a whole. </p>
<p>Indonesia must pursue <a href="https://rdi.or.id/wp-content/uploads/2023/08/Increasing-Financing-for-Tuberculosis-Programs-in-Indonesia.pdf">strategic actions to overcome these challenges</a>.</p><img src="https://counter.theconversation.com/content/212449/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Para penulis tidak bekerja, menjadi konsultan, memiliki saham atau menerima dana dari perusahaan atau organisasi mana pun yang akan mengambil untung dari artikel ini, dan telah mengungkapkan bahwa ia tidak memiliki afiliasi di luar afiliasi akademis yang telah disebut di atas.</span></em></p>Indonesia has the world’s second-highest rates of TB – but lack of funding means not enough people are being diagnosed and treated fast enough.Rahmah Aulia Zahra, Children, Social Welfare, and Health Research Officer, Resilience Development Initiative (RDI)Wewin Wira Cornelis Wahid, Program Officer, Resilience Development Initiative (RDI)Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1396822020-05-30T08:46:33Z2020-05-30T08:46:33ZYoung people are key to a nicotine-free future: five steps to stop them smoking<figure><img src="https://images.theconversation.com/files/338519/original/file-20200529-96709-1xawmf9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A girl holds a placard during a rally to create awareness about the effect of tobacco.</span> <span class="attribution"><span class="source"> Himanshu Bhatt/NurPhoto via Getty Images</span></span></figcaption></figure><p>Tobacco use kills more than <a href="https://www.who.int/news-room/fact-sheets/detail/tobacco">8 million</a> people each year. Most adult smokers start smoking before the <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61085-X/fulltext">age of 20</a>. This implies that if one can get through adolescence without <a href="https://www.mdpi.com/1660-4601/8/11/4118">smoking</a>, the likelihood of being a smoker in adulthood is greatly reduced. </p>
<p>Preventing young people from becoming addicted to tobacco and related products is therefore key to a smoke-free future. </p>
<p>With the advent of novel tobacco products and the tobacco industry falsely marketing them as less harmful than their combustible counterparts, the adage “prevention is better than cure” has never been more important for governments to heed if we are to achieve a smoke-free future.</p>
<p>Here are five things that governments need to do to ensure that a smoke-free future is realised.</p>
<h2>1. Raise taxes on tobacco products</h2>
<p>Tobacco <a href="https://cancercontrol.cancer.gov/brp/tcrb/monographs/21/docs/m21_complete.pdf">taxation</a> is one of the <a href="https://publications.iarc.fr/Book-And-Report-Series/Iarc-Handbooks-Of-Cancer-Prevention/Effectiveness-Of-Tax-And-Price-Policies-For-Tobacco-Control-2011">most effective</a> population-based strategies for decreasing tobacco consumption. On average, a <a href="https://pubmed.ncbi.nlm.nih.gov/22163198/">10%</a> increase in the price of cigarettes reduces demand for cigarettes by between 4% and 6% for the general adult population. </p>
<p>Because they lack disposable income and have a limited smoking history, young people are more responsive to price increases than their adult counterparts. Young people’s <a href="https://pubmed.ncbi.nlm.nih.gov/21737858/">price responsiveness</a> is also explained by the fact that they are also more likely to smoke if their peers smoke. This suggests that an increase in tobacco taxes also indirectly reduces youth smoking by decreasing smoking among their peers.</p>
<h2>2. Introduce 100% smoke-free environments</h2>
<p>Smoke-free policies reduce opportunities to smoke and erode societal acceptance of smoking. Most countries have some form of <a href="https://www.who.int/tobacco/global_report/en/">smoke-free policy</a> in place. But there are still many public spaces where smoking happens. Many of these places are frequented by young people – or example, smoking sections in nightclubs and bars – contributing to the idea that smoking is acceptable and “normal”.</p>
<p><a href="https://tobaccocontrol.bmj.com/content/14/5/300.abstract">Research</a> from the United States shows that creating smoke-free spaces reduces youth smoking uptake and the likelihood of youth progressing from experimental to established smokers. In the <a href="https://pubmed.ncbi.nlm.nih.gov/26911840/">United Kingdom</a>, smoke-free places have been linked to a reduction in regular smoking among teenagers, and research from Australia finds that smoke-free policies were directly related to a drop in youth smoking prevalence between <a href="https://pubmed.ncbi.nlm.nih.gov/21401766/">1990 and 2015</a>. By adopting 100% smoke-free policies governments can denormalise smoking and turn youth away from tobacco and related products.</p>
<h2>3. Adopt plain packaging and graphic health warnings</h2>
<p>The tobacco industry uses sleek and attractive designs to market its dangerous products to <a href="https://www.who.int/news-room/campaigns/world-no-tobacco-day/world-no-tobacco-day-2020">young people</a>. All tobacco products should therefore be subject to plain packaging and graphic health warnings so that their attractive packaging designs do not lead youth to underestimate the harm of using these products. Currently 125 countries require graphic images on the packaging of tobacco products. Countries like South Africa that rely on a text warning message are far behind the curve. Plain packaging on tobacco products has been adopted in <a href="https://www.tobaccofreekids.org/assets/global/pdfs/en/standardized_packaging_developments_en.pdf">13 countries</a> to date and, in January 2020, Israel became the first country to apply plain packaging to e-cigarettes.</p>
<h2>4. Outlaw tobacco advertising, promotion and sponsorship</h2>
<p>Traditional advertising and promotion of tobacco products has been banned in most parts of the world. But the tobacco industry has developed novel ways of keeping its products in the public eye.</p>
<p>Some common strategies used by the industry to target youth include hiring “influencers” to promote tobacco and nicotine products on social media, sponsoring events, and launching new flavours that are appealing to youth, such as bubble gum and cotton candy, which encourages young people to underestimate the potential harm of using them. Evidence also <a href="https://pubmed.ncbi.nlm.nih.gov/21401766/">shows</a> how the tobacco industry uses point-of-sale marketing to target children by encouraging vendors to position tobacco and related products near sweets, snacks and cooldrinks, especially in outlets close to schools.</p>
<p>Governments need to outlaw these tactics and impose hefty fines on tobacco companies that make any attempt to circumvent the law.</p>
<h2>5. Educate young people</h2>
<p>Given that tobacco <a href="https://www.who.int/tobacco/publications/economics/nci-monograph-series-21/en/">kills half</a> of its long-term users, the tobacco industry needs to get young people addicted to its products to ensure its survival. Young people need to be made aware of this. Governments should launch counter-advertising campaigns that educate young people on the tactics employed by the industry to target them so that they do not fall prey to them.</p><img src="https://counter.theconversation.com/content/139682/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sam Filby works for the Research Unit on the Economics of Excisable Products (REEP) at the University of Cape Town.</span></em></p><p class="fine-print"><em><span>Corné van Walbeek is the Director of the Research Unit on the Economics of Excisable Products (REEP) at the University of Cape Town. The unit receives funding from a variety of health foundations, including the Bill & Melinda Gates Foundation, the African Capacity Research Foundation, Cancer Research UK and the International Development Research Centre. The unit has never received funding from the tobacco industry, or any of its front groups.</span></em></p>With the advent of novel tobacco products and the tobacco industry falsely marketing them as less harmful, the adage “prevention is better than cure” has never been more important.Sam Filby, Research Officer, Research on the Economics of Excisable Products,, University of Cape TownCorne van Walbeek, Professor at the School of Economics and Principal Investigator of the Economics of Tobacco Control Project, University of Cape TownLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/271202014-05-26T20:08:03Z2014-05-26T20:08:03ZAdding GST to fresh food is a recipe for poor health<figure><img src="https://images.theconversation.com/files/49426/original/gs2z8yyg-1401077231.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Most Australians already fail to meet the recommended daily intake of fruit and vegetables.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/norwayneedles/3747187586">Strikkelise/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span></figcaption></figure><p>Recent calls by Australian <a href="http://www.smh.com.au/federal-politics/political-news/slap-gst-on-fresh-food-says-senior-coalition-mp-20140519-38k88.html">government ministers</a> and <a href="http://www.abc.net.au/radionational/programs/rnfirstbite/potential-health-impacts-3a-gst-on-fresh-food/5467836">senior officials</a> to broaden the goods and services tax (GST) base to include fresh fruit and vegetables would make the population’s diet go from bad to worse.</p>
<p>The latest <a href="http://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0.55.007">Australian Health Survey</a> results show less than 7% of the Australian population meet the recommended intake of vegetables (five serves per day for adults), and just over half (54%) meet the recommended serves of fruit (two serves per day for adults). </p>
<p>In contrast, a staggering 35% of the nation’s total energy consumed is from “discretionary foods” – foods considered to be of little nutritional value that tend to be high in saturated fat, sugar and salt, or alcohol. </p>
<p>Indeed, the poor diet of the population is now the <a href="http://www.healthdata.org/sites/default/files/files/country_profiles/GBD/ihme_gbd_country_report_australia.pdf">biggest contributor</a> to disease and illness in Australia - even more than smoking. And the <a href="http://www.thelancet.com/series/obesity">main driver</a> of the problem is the ever-increasing supply of cheap, tasty, high-calorie foods that are heavily marketed and widely available. </p>
<p>As other countries consider ways to combat the problem, the Australian government seems to be discussing options that will make it worse.</p>
<h2>Effects of adding GST to fresh food</h2>
<p>Price is one of the <a href="http://www.ncbi.nlm.nih.gov/pubmed/9787717">most important factors</a> that consumers take into account when deciding what to buy. Taste is the other main consideration. </p>
<p>Fresh fruit and vegetables are currently exempt from GST, which means there’s an incentive to buy them rather than <a href="http://onlinelibrary.wiley.com/doi/10.1111/obr.12107/abstract">less healthy</a> processed food.</p>
<p>Recent <a href="https://www.mja.com.au/journal/2013/199/8/removing-gst-exemption-fresh-fruits-and-vegetables-could-cost-lives">estimates</a> show that if the 10% GST were applied to fresh fruit and vegetables, their overall consumption would decrease by about 5%. </p>
<p>When the long-term effects of this change <a href="https://theconversation.com/taxing-fresh-foods-could-have-a-big-bad-health-impact-19146">are modelled</a>, this would result in an additional 90,000 cases of heart disease, stroke and cancer each year, increasing health-care costs by around $1 billion.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/49432/original/9vth847w-1401079806.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/49432/original/9vth847w-1401079806.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/49432/original/9vth847w-1401079806.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/49432/original/9vth847w-1401079806.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/49432/original/9vth847w-1401079806.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/49432/original/9vth847w-1401079806.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/49432/original/9vth847w-1401079806.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Consumption of ‘discretionary foods’ may increase with the removal of the GST exemption on fruits and vegetables.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/muyyum/6950135761/sizes/l">Flickr: Muy Yum</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p>The effects are <a href="http://secure.secondbite.org/sites/default/files/A_review_of_the_literature_describing_the_link_between_poverty_food_insecurity_and_obesity_w.pdf">likely</a> to be felt strongest by people with low incomes. This group tends to spend a large proportion of its income on food and already has poorer health outcomes.</p>
<h2>Global actions in this area</h2>
<p>A move to increase taxes on fresh fruit and vegetables would fly in the face of global recommendations to improve poor health. The <a href="http://www.who.int/nmh/events/2013/revised_draft_ncd_action_plan.pdf">World Health Organisation (WHO) recommends</a> governments consider different economic tools (such as taxes and subsidies) to improve the affordability of healthier foods and discourage the consumption of less healthy options.</p>
<p>Several countries have recently adopted new taxes on unhealthy foods in line with these recommendations. From this year, <a href="http://www.theguardian.com/world/2014/jan/16/mexico-soda-tax-sugar-obesity-health">Mexico has introduced</a> a 10% tax on sugary drinks and a 5% tax on unhealthy snack foods. And <a href="http://www.spiegel.de/international/europe/battling-the-couch-potatoes-hungary-introduces-fat-tax-a-783862.html">Hungary has introduced</a> a tax on unhealthy foods.</p>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/21079620">Estimates show</a> that if Australia were to increase taxes on unhealthy food by 10%, this would greatly benefit health and result in substantial cost savings to the government. </p>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/19483200">Evidence indicates</a> the revenue generated from a tax on unhealthy foods should be used to subsidise fruit and vegetables in order to get even better health outcomes. </p>
<h2>Public health set to decline</h2>
<p>Australia has <a href="https://theconversation.com/who-reveals-how-tobacco-control-measures-are-improving-health-worldwide-15995">long been recognised</a> as a public health leader for its preventive health actions and, in particular, its efforts to reduce tobacco use. </p>
<p>But this reputation is set to decline with the massive cuts to <a href="http://www.budget.gov.au/2014-15/content/bp2/html/bp2_expense-14.htm">preventive health</a> in the latest budget.</p>
<p>If the country were to increase taxes on fruit and vegetables, it would undermine the reductions in chronic disease that have resulted from national success in tackling smoking. </p>
<p>It would also place the country at the bottom end of the list of countries taking globally recommended actions to improve population nutrition.</p>
<p>The question of how best to approach Australia’s rising health care, education and social welfare costs is clearly an important one. But we need to consider the ramifications of potential solutions on short- and long-term economic, social, environmental and health outcomes.</p><img src="https://counter.theconversation.com/content/27120/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gary Sacks receives funding from the Australian National Health and Medical Research Council (NHMRC)</span></em></p>Recent calls by Australian government ministers and senior officials to broaden the goods and services tax (GST) base to include fresh fruit and vegetables would make the population’s diet go from bad…Gary Sacks, Senior Research Fellow, WHO Collaborating Centre for Obesity Prevention, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/255892014-05-19T20:18:32Z2014-05-19T20:18:32ZWhy there’s lots to love – and learn – about English food<figure><img src="https://images.theconversation.com/files/48135/original/y37jfydv-1399611140.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The mad cow disease epidemic in the UK led to the creation of the Food Standards Agency, which put the public interest back into food policy.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/ennor/212478993">Barry/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span></figcaption></figure><p>When the English cricket team toured Australia last year they were ridiculed for their dietary requirements long before their humiliation on the pitch. But while English cricket may be wanting, England’s approach to nutrition leaves Australia in the dust.</p>
<p>The debacle around Australian food labelling policy highlights the problem. For two years now, the largest industry bloc in the country has systematically delayed, undermined and watered down efforts to have the nutritional content of foods displayed on the front of packaging. And with the current government, it’s working hard to get out of it completely. </p>
<p>By contrast, the United Kingdom has sector-wide agreement on traffic light labels.</p>
<h2>A new nicotine</h2>
<p>Why is Australian industry dictating the terms when poor dietary choices kill more people than tobacco? Very simply because salt, sugar and fat are the nicotine of food corporations. </p>
<p>They drive the profits of a $100 billion-sector that employs one in 20 Australians and walks tall in Canberra. The downsides of this success are unprecedented epidemics of obesity, diabetes and heart disease and billions of dollars in health-care expenditure. </p>
<p>But it seems it’s still easier to patch up the problem with the health system, than risk the wrath of the food industry by invoking prevention. Because there’s nothing to see if a stroke or a heart attack is prevented, but plenty to write about if the “nanny state” tries to prevent a grown adult eating a toxic waste burger.</p>
<p>Australia managed to overcome issues like these for smoking with some inspirational leadership. And our tobacco control measures are now the envy of the civilised world. </p>
<p>The UK has managed something similar with food - in particular its program of work to remove salt from the national diet is world leading.</p>
<h2>A silver lining</h2>
<p>Paradoxically, it was another food disaster that gave salt reduction efforts in the United Kingdom their leg up – bovine spongiform encephalopathy better known as mad cow disease. </p>
<p>Analysis of the mad cow disease epidemic showed that having the same UK ministry responsible for both farming practices and food safety produced unmanageable conflicts of interest. Policies designed to maximise profits allowed grossly unsafe approaches to animal husbandry to flourish. </p>
<p>Out of this was borne the UK Food Standards Agency, established to put the public interest back into food policy. Mad cow disease turned out not to be the health catastrophe first feared and the Agency was able to turn its attention to other areas. </p>
<p>Salt reduction was one of the first to benefit. The special provisions of the UK Food Standards Act allowed the Agency to publish all advice provided to ministers, and it has done this from its inception. </p>
<p>It also elected to take all decisions about food policy at open meetings of its Board, providing unprecedented transparency in decision making and recommendations. This is a far cry from the opaque processes operating in Australia.</p>
<p>The <a href="https://theconversation.com/should-the-food-industry-resign-from-the-health-department-too-23292">unedifying spectacle</a> of <a href="https://theconversation.com/big-food-lobbying-tip-of-the-iceberg-exposed-23232">recent Australian food labelling policy</a> needs no further description. But it’s symptomatic of a deeper problem - decisions about food policy are made at a glacial pace behind closed doors and are dominated by industry groups and commercial considerations. </p>
<p>In the first four years of its current action plan, the federal government’s Food and Health Dialogue set food reformulation targets in only 11 out of a possible 124 areas. And has formally reported on the success or failure of none.</p>
<h2>Hope yet</h2>
<p>What hope for us down under then? Well, it’s pretty much the Wild West out there at the moment, so the only way is up. If the previous government was slow on the uptake, perhaps the current administration can do better. </p>
<p>Government is right to see control of over-the-horizon health-care costs as key to balancing its books. Policies and incentives that steer Australians away from salt, sugar and fat will not only deliver for the national waistline, but also for the treasurer’s bottom line. </p>
<p>Immediate roll out of front-of-pack labelling would be a great opener. Not only would consumers get to see what’s in the foods they’re eating but industry will be forced to compete on health - five-star foods will attract more buyers than three-star products.</p>
<p>Better implementation of the Food and Health Dialogue objectives would make for a sweet follow through. Providing consumers with better choices is a first step. But changing the food environment so that healthier products become the norm will drive really large, really cost-effective improvements in health. </p>
<p>A government seeking a quick fix for its expenditures need look no further. England is already reaping the health and economic benefits of putting nutrition before politics; <a href="http://guidance.nice.org.uk/PH25">recent data</a> shows salt reduction is now preventing thousands of deaths, and saving the UK billions of dollars in health care costs. </p>
<p>It’s just not cricket for Australia to be left sitting on the sidelines.</p><img src="https://counter.theconversation.com/content/25589/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bruce Neal is Chair of the Australian Division of World Action on Salt and Health </span></em></p>When the English cricket team toured Australia last year they were ridiculed for their dietary requirements long before their humiliation on the pitch. But while English cricket may be wanting, England’s…Bruce Neal, Chair, AWASH and Senior Director, George Institute for Global HealthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/157702013-08-12T04:40:01Z2013-08-12T04:40:01ZStopping the silent epidemic of chronic kidney disease<figure><img src="https://images.theconversation.com/files/28245/original/r9fjb9r5-1375075951.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Despite a high global prevalence and inequities in treatment, kidney disease is not given priority in international health plans.</span> <span class="attribution"><span class="source">Daniel Oines</span></span></figcaption></figure><p><a href="http://www.kidney.org.au/LinkClick.aspx?fileticket=UZa5usbv2XE%3D&tabid=609&mid=850">One in nine Australians</a> over the age of 25 (that’s 1.7 million people) has chronic kidney disease. That’s more than the number living with <a href="http://www.lungfoundation.com.au/professional-resources/statistics/copd-the-statistics/">chronic lung disease</a>, <a href="http://strokefoundation.com.au/health-professionals/tools-and-resources/facts-and-figures-about-stroke/">stroke</a>, <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442453166">heart failure</a>, and all types of <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129542353">cancers combined</a>. </p>
<p>And the picture is just as bad in many other countries. But, for some reason, kidney disease hasn’t received the attention it ought in World Health Organization <a href="http://www.who.int/nmh/events/un_ncd_summit2011/political_declaration_en.pdf">priority documents</a> and <a href="http://www.nature.com/ki/journal/vaop/ncurrent/full/ki2012488a.html">national chronic disease programs</a>. </p>
<p>So what do kidneys do, and why is this disease worth prioritising?</p>
<h2>Chronic kidney disease</h2>
<p>Kidneys are essential organs involved in regulating blood pressure, bone quality, and red blood cell production (important for carrying oxygen in the bloodstream), control of essential electrolytes and removal of waste products from the blood. </p>
<p>Chronic kidney disease is a <a href="https://theconversation.com/a-quick-explanation-of-non-communicable-diseases-or-ncds-10923">non-communicable disease</a> involving a reduction in kidney function over time. It most commonly results from diabetes, high blood pressure or kidney inflammation. </p>
<p>Disease onset is frequently insidious (and often asymptomatic until late stages) so awareness and early identification can be difficult. </p>
<p>The term “end-stage kidney disease” refers to the stage of kidney failure (about less than 10% of normal function) wherein kidney replacement therapy, namely dialysis or transplantation, is required to sustain life.</p>
<p>Major risk factors for chronic kidney disease include hypertension, obesity, diabetes and ageing – all of which are <a href="http://www.who.int/topics/global_burden_of_disease/en/">on the rise</a> globally.</p>
<p>Importantly, kidneys are not the only organs damaged. Chronic kidney disease is a cause, consequence and risk multiplier for many other diseases, including heart disease. </p>
<p>And even after adjusting for traditional cardiovascular risk factors, such as high cholesterol and blood pressure, chronic kidney disease independently increases your risk of heart disease by between <a href="http://www.ncbi.nlm.nih.gov/pubmed/23727170">two and four times</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/27013/original/zyzyrp9b-1373207201.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/27013/original/zyzyrp9b-1373207201.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/27013/original/zyzyrp9b-1373207201.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/27013/original/zyzyrp9b-1373207201.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/27013/original/zyzyrp9b-1373207201.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/27013/original/zyzyrp9b-1373207201.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/27013/original/zyzyrp9b-1373207201.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">One in six people worldwide are affected by chronic kidney disease.</span>
<span class="attribution"><span class="source">Bhakua/Flickr</span></span>
</figcaption>
</figure>
<h2>The global picture</h2>
<p>The global prevalence of chronic kidney disease is estimated at between 8% and 16% of the population, meaning up to <a href="http://www.ncbi.nlm.nih.gov/pubmed/23727169">one in six people worldwide</a> are affected.</p>
<p>Health-care expenditure on chronic kidney disease totalled a staggering US$60 billion in the United States in 2007, representing <a href="http://www.ncbi.nlm.nih.gov/pubmed/23727169">27% of the total Medicare budget</a>. In the United Kingdom in 2009-10, more than <a href="http://www.ncbi.nlm.nih.gov/pubmed/23727169">AUS$2.4 billion</a> was spent on the illness - equalling $1,320 for each person diagnosed. </p>
<p>More than 50% of this money was spent on managing end-stage kidney disease, despite it accounting for only 2% of the affected population. In Australia, the cost of treating end-stage kidney disease between 2009 and 2020 is estimated at <a href="http://www.kidney.org.au/LinkClick.aspx?fileticket=vave4WFH73U%3d&tabid=635&mid=1837">A$12 billion</a>.</p>
<p>In low- and middle-income countries, often with more fragile health-care systems, these costs can be crippling for both governments and individuals.</p>
<h2>Kidney disease, equity and development</h2>
<p>A bi-directional relationship between poverty and chronic kidney disease means poverty makes you more likely to develop the illness, and poverty worsens the outcome once you have it.</p>
<p>Even in Australia, end-stage kidney disease is more common in <a href="http://ndt.oxfordjournals.org/content/27/11/4173.long">socioeconomically disadvantaged areas</a>. <a href="http://www.aihw.gov.au/ckd/end-stage-kidney-disease/">Regional and remote areas</a> have more cases of kidney disease and <a href="http://ndt.oxfordjournals.org/content/27/5/2069.long">poorer survival</a>.</p>
<p>In particular, Indigenous Australians carry a disproportionate burden of chronic kidney disease; they are <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737420068">four times more likely</a> to die from it than non-Indigenous Australians. </p>
<p>A similar picture is seen in Indigenous populations worldwide such as Native Americans, First Nation Canadians, South American Aborigines and New Zealand Maori.</p>
<p>Around <a href="http://www.ncbi.nlm.nih.gov/pubmed/23022428">1.4 million people globally</a> receive dialysis for end-stage kidney disease, a number which is increasing by 5% to 10% every year. </p>
<p>But number is limited by the financial costs of providing care; it’s likely that many more are dying of this preventable and treatable condition because they can’t afford treatment. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/27014/original/547s8rj5-1373207919.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/27014/original/547s8rj5-1373207919.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/27014/original/547s8rj5-1373207919.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/27014/original/547s8rj5-1373207919.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/27014/original/547s8rj5-1373207919.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/27014/original/547s8rj5-1373207919.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/27014/original/547s8rj5-1373207919.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Kidney disease is a notable absentee from the WHO’s grouping of priority non-communicable diseases.</span>
<span class="attribution"><span class="source">US Mission Geneva/Flickr</span></span>
</figcaption>
</figure>
<p>Globally, over 80% of patients receiving treatment for end-stage disease live in high-income countries, which account for less than 20% of the world’s population. </p>
<p>Countries such as India are seeing increasing numbers of people suffering from chronic kidney disease but <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2647401/">less than 10%</a> of the people who need dialysis receive it. </p>
<h2>Prioritising health</h2>
<p>Despite a high global prevalence, inequities in treatment, and being noted by the 2011 World Health Organization high-level meeting on non-communicable diseases as posing “<a href="http://www.who.int/nmh/events/un_ncd_summit2011/political_declaration_en.pdf">a major health burden for many countries</a>”, kidney disease is still a notable absentee from the grouping of priority non-communicable diseases.</p>
<p>Kidney disease is noted in the <a href="http://www.who.int/nmh/publications/ncd_action_plan2013.pdf">draft global action plan for controlling non-communicable diseases 2013-2020</a> as being “closely associated” with priority diseases. And therapy to prevent kidney disease progression is an aim within diabetes actions. </p>
<p>But the action plan still only focuses on the <a href="http://whqlibdoc.who.int/publications/2009/9789241597418_eng.pdf">four prioritised non-communicable diseases</a> – heart disease, diabetes, chronic respiratory disease and cancers.</p>
<p>Governments and health systems must develop strategies to both prevent kidney disease and provide treatment to everyone who needs it. </p>
<p>This involves implementing proven preventative measures globally, while developing low-cost dialysis methods that reduce financial barriers to care, and new effective treatments for chronic kidney disease.</p>
<p>We must be clear about the links and common origins of chronic diseases if we are to combat them. The burden of kidney disease should be recognised and it should be prioritised alongside other highlighted non-communicable diseases. This would galvanise action against their shared risk factors. </p>
<p>Whatever our future global health and development agenda looks like, kidney disease must be a priority within it.</p><img src="https://counter.theconversation.com/content/15770/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Georgina E Taylor is employed by Monash University in kidney research.</span></em></p><p class="fine-print"><em><span>Peter Kerr receives funding from National Health &Medical Research Council, Australia.</span></em></p><p class="fine-print"><em><span>Vlado Perkovic undertakes research on kidney disease, and is a practising nephrologist. He receives funding from the National Health and Medical Research Council, the Heart Foundation, and a range of commercial sources to fund his research. </span></em></p><p class="fine-print"><em><span>Brendon L Neuen and Sandro Demaio do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>One in nine Australians over the age of 25 (that’s 1.7 million people) has chronic kidney disease. That’s more than the number living with chronic lung disease, stroke, heart failure, and all types of…Sandro Demaio, Australian Medical Doctor; Postdoctoral Fellow in Global Health & NCDs, Harvard UniversityBrendon L Neuen, Medical student, James Cook UniversityGeorgina E Taylor, Medical student, University of TasmaniaPeter Kerr, Professor and Director of Nephrology, Monash UniversityVlado Perkovic, Executive Director, Professor of Medicine, George Institute for Global HealthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/121502013-02-12T00:47:09Z2013-02-12T00:47:09ZNo place for industry in the fight against lifestyle diseases<figure><img src="https://images.theconversation.com/files/20157/original/bbfbx7h6-1360629892.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Health problems due to poor eating habits are becoming the leading cause of death and disability in the world.</span> <span class="attribution"><span class="source">stu_spivack/Flickr</span></span></figcaption></figure><p>The biggest causes of ill health in all but the very least developed countries are now non-communicable or chronic diseases. Lung cancer from smoking, obesity from an unhealthy diet and liver problems from alcohol are killing millions of people each year. If we’re to reach the <a href="http://www.who.int/en/">World Health Organization’s</a> 25-by-25 target (reducing the incidence of non-communicable diseases by 25% by 2025), we need concerted action to reduce consumption of unhealthy commodities.</p>
<p>Western nations have had some (albeit small) success in curbing these problems, with regulation and policy proving to be particularly effective for tobacco control. But lifestyle-related diseases are now increasing at an alarming rate in low- and middle-income countries and require urgent action.</p>
<p><a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)62089-3/fulltext">A new international analysis</a> of food, drink, and alcohol industry involvement in policies aimed at tackling non-communicable diseases (published as part of a <a href="http://www.thelancet.com/series/non-communicable-diseases">series today in The Lancet</a>), shows that despite government reliance on industry self-regulation and public-private partnerships to improve public health, there’s no evidence to support either their effectiveness or safety.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/20154/original/k55pbvy3-1360628275.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/20154/original/k55pbvy3-1360628275.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=902&fit=crop&dpr=1 600w, https://images.theconversation.com/files/20154/original/k55pbvy3-1360628275.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=902&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/20154/original/k55pbvy3-1360628275.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=902&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/20154/original/k55pbvy3-1360628275.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1134&fit=crop&dpr=1 754w, https://images.theconversation.com/files/20154/original/k55pbvy3-1360628275.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1134&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/20154/original/k55pbvy3-1360628275.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1134&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Tobacco, alcohol and processed food and drink have made multinational corporations major drivers of the world’s chronic disease epidemics.</span>
<span class="attribution"><span class="source">rubybgold/Flickr</span></span>
</figcaption>
</figure>
<p>So the role of the processed food, tobacco and alcohol industries in tackling lifestyle diseases must be re-assessed if we want to see change in public behaviour around food.</p>
<p>The key task now is to make recommendations for governments, public health professionals, and society on the involvement of these industries. We would like to start with the proposal that industry should have no role in forming national or international policy on chronic disease prevention and mitigation. This is because “unhealthy commodity” industries are using similar strategies to the tobacco industry to undermine public health policies and programmes.</p>
<p>Regulation, or the threat of regulation, is the only way to change the behaviour of these transnational corporations. It has changed the way the tobacco industry operates and it could have the same beneficial effects on the food industry. Through the sale and aggressive marketing of tobacco, alcohol, and ultra-processed food and drink, multinational corporations are now major drivers of the world’s growing epidemics of chronic diseases.</p>
<p>Most health problems in Australia are now attributable to a poor diet, insufficient physical activity, tobacco or alcohol. This means we have to move on processed and fast foods in the same way that we have on tobacco. Foods high in salt, fat, sugar and calories are unfortunately a great way for the industry to make profit, so voluntary solutions are unlikely to work.</p>
<p>It’s for very good commercial reasons that the food industry systematically waters down public health reform proposals and plays a central role in influencing public behaviour through sophisticated marketing practices, without concern for the long-term health outcomes.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/20152/original/b7zpm72z-1360627354.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/20152/original/b7zpm72z-1360627354.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/20152/original/b7zpm72z-1360627354.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/20152/original/b7zpm72z-1360627354.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/20152/original/b7zpm72z-1360627354.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/20152/original/b7zpm72z-1360627354.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/20152/original/b7zpm72z-1360627354.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Cutting salt from food in the United Kingdom has not harmed industry.</span>
<span class="attribution"><span class="source">L. Marie/Flickr</span></span>
</figcaption>
</figure>
<p>And self-regulation is often just another way to block public health efforts. We have been working with industry and government for five years now to reduce the amount of salt in food, for instance. After all these years, the best evidence we have suggests that average salt levels in the Australian food supply have gone up, not down.</p>
<p>Clearly, we need to find a way to put health ahead of profit. The <a href="http://www.food.gov.uk/">UK Food Standards Agency</a>, which was launched in the aftermath of the <a href="http://eden.lsu.edu/topics/agdisasters/bse/pages/default.aspx">mad cow or bovine spongiform encephalopathy (BSE) outbreak</a> in the United Kingdom, is one example of a good solution. The agency board was appointed to act in the public interest; it was given a unique statutory right to publish all advice it provided to ministers; and it committed to make decisions about food policy only at open board meetings. And it delivered - foods in the United Kingdom are systematically less salty than in Australia.</p>
<p>Despite business sector concern, action toward healthier food needn’t harm industry. When business was forced to cut salt from foods in the United Kingdom, the sector didn’t miss a beat. There were no mass redundancies, corporate failures or lost markets, just thousands fewer strokes and heart attacks each year.</p>
<p>Our Lancet study also shows that saturation of markets in high-income countries means that the food and alcohol industries are now focusing on emerging global markets, just as the tobacco industry did. Almost all foreseeable growth in the profits of these industries selling unhealthy commodities will be in low-income and middle-income countries where consumption is currently low. We clearly need to protect our poorer neighbours, who do not have as many resources to spend on health, from their profit motive as much we need to protect ourselves.</p><img src="https://counter.theconversation.com/content/12150/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bruce Neal - Conflict of Interest Statement
Current support and support in the last five calendar years from commercial entities (year of most recent support)
• Consultant/Advisor/Consultant Fee, Advisory boards or fees for attending a meeting – Roche (2010), Takeda (2010).
• Lecture fees (honoraria) travel fees or reimbursements when speaking at the invitation of a commercial entity – Abbott (2012), Amgen (2007), AstraZeneca (2010), GlaxoSmithKline (2007), Novartis (2012), Pepsico (2011), Pfizer (2011), Pharmacy Guild of Australia (2012), Roche (2012), Sanofi Aventis (2006), Servier (2008), Tanabe (2007).
• Research support from a commercial entity – Australian Food and Grocery Council (2012), Bupa Australia (2012), Johnson and Johnson (2012), Merck Schering Plough (2011), Roche (2012), Servier (2012), United Healthcare Group (2012), Bupa (2012).
• Employment by a commercial entity - none
• Equity ownership/stock options - none.
• Patents and/or royalties that might be viewed as creating a potential conflict of interest - none
• Any other financial support that might be viewed as creating a potential conflict of interest - none
• Any other non-financial roles that might be viewed as creating a potential conflict of interest – Professor Neal interacts regularly on a non-financial basis with multiple large corporations in the Pharmaceutical Industry, the Food Processing Industry and the Quick Service Restaurant industry in Australia and overseas.
</span></em></p><p class="fine-print"><em><span>Rob Moodie received funding from the Department of Health and Ageing for work on the National Preventative Health Taskforce. He is deputy chair of the ANPHA Advisory Council.</span></em></p>The biggest causes of ill health in all but the very least developed countries are now non-communicable or chronic diseases. Lung cancer from smoking, obesity from an unhealthy diet and liver problems…Bruce Neal, Chair, AWASH and Senior Director, George Institute for Global HealthRob Moodie, Professor of Global Health, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.