Neil Canavan

September 21, 2011

September 21, 2011 (New York, New York) — After 2 days of testimony at the United Nations (UN) High-Level Meeting on Prevention and Control of Non-Communicable Diseases (NCDs), the consensus of a host of international representatives was clear: NCDs pose a direct and escalating threat to the continued economic development of low and middle income countries.

The United Nations member states signed a declaration that addresses tobacco, industrially produced trans fats in foods, and several other key issues related to the world's leading NCDs: cardiovascular disease, cancer, diabetes, and chronic respiratory diseases.

"More than 25% of those who succumb to NCDs are in the prime of their working lives," warned UN Secretary-General, Ban Ki-moon, "and the vast majority of these individuals are in developing countries."

What one delegate described as "the globalization of unhealthy lifestyles" and a growing global population is driving the increased prevalence of NCDs. According to the World Health Organization (WHO), deaths from NCDs will increase by 17% overall in the next decade, with a 24% projected jump in the poorest nations of Africa. Over the next 20 years, the World Economic Forum estimates that losses related to disease treatment and lost productivity will exceed $47 trillion.

Further consensus at the meeting was reached as to the specific root causes driving the increase of NCDs: the use of tobacco products, excess alcohol consumption, poor-quality food, lack of exercise, and lack of access to healthcare services and medicines.

The American Heart Association (AHA), one of several groups invited as part of the official US delegation, states in a release that it was "pleased by the commitment to accelerated implementation of the World Health Organization's Framework Convention of Tobacco Control and that countries recognize the fundamental conflict of interest between the tobacco industry and public health." The UN concurred that tobacco taxation is an effective strategy to reducing tobacco consumption. AHA also backs the UN commitment to eliminate industrially produced trans fats in foods and to implement interventions to reduce the consumption of salt, sugars and saturated fats.

"Although the declaration lacked a global salt reduction target, the association remains hopeful that it will be another step in helping consumers understand that salt reduction as important for cardiovascular health," the organization says. AHA recommends a maximum sodium intake of 1500 milligrams a day, which is significantly lower than the average American's current intake.

Dr. Margaret Chan, Director-General of the WHO, was emphatic in linking some of the problem to the profit motive. Striking first at the obvious target of tobacco companies, she then shifted her comments to the increasing availability of processed foods. "Obesity for children is growing faster than obesity in adults," she said. "Why? Advertising and marketing readily cross borders. Kids the world over love the same cartoon characters, [marketing tools] that tell them what to eat and what to drink." She urged governments to combat bad dietary habits with education, and appealed to the food industry to provide their customers with healthier choices.

The pharmaceutical industry was also singled out. "The skyrocketing increase in NCDs throughout the developing world means the [drug] market is huge, but industry must also understand the importance of price," she said. "True, many first-line treatments are off-patent, but they are still not affordable for the masses. Nobody objects to industry making profit, but what we’re talking about here is the difference is between reasonable profit and greed."

Drug pricing and access to intellectual property were mentioned by a number of speakers. The delegate from India encouraged what she termed "open-source drug development," whereas others were more direct and strident in their views, making it clear that as this global healthcare initiative moves from problems to solutions, access to affordable medicines — and the contentious issue of generic biologics — will be a major battleground.

A World of Suggestions, No Shortage of Ideas

Many delegates shared their proactive efforts on the local level: low-cost cervical cancer screening programs; diabetes education; providing clean-burning cook stoves; and even the promotion of sports to enhance the appeal of physical activity.

Speaking during the closing session of the meeting, New York City Mayor Michael Bloomberg highlighted his local, low-cost efforts to combat NCDs, such as an antismoking campaign that includes the highest excise tax in the nation on tobacco products, and broad restrictions on where smoking is allowed. These programs have resulted in a drop of current smokers in New York from 22% to 14%. Regulations regarding trans fats and posting calorie contents on restaurant menus have also produced results, for "little or no cost to the local government."

The cost of any initiative to stem the tide of NCDs was a major theme of the meeting, as a UN report on "best buy" solutions to address NCDs was issued just prior to the meeting's start.

As the meeting closed, the immediate path to action remained unclear, however. As stated by Nancy Brinker, CEO of the Susan G. Komen for the Cure, and WHO Goodwill Ambassador for Cancer Control, the mission is simple: "Where you live should not determine whether you live."

United Nations 2011 High-Level Meeting on Prevention and Control of Non-Communicable Diseases (UN NCD Summit). September 19-20, 2011.

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