Neil Schluger, MD


October 10, 2011

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Neil Schluger, MD: Hi. I'm Dr. Neil Schluger, Chief Scientific Officer with World Lung Foundation, and I'm here at the United Nations (UN) Summit on Non-communicable Diseases in New York City. I'm going to talk about the importance of noncommunicable diseases as a global public health matter of the highest urgency. On September 19 and 20, for the first time ever, a high-level meeting was held on noncommunicable diseases to bring important attention to a whole host of health problems around the world.

Noncommunicable diseases account for 36 million deaths per year in the world and include diseases like diabetes, cancer, heart disease, and lung disease. The sum of all these deaths from these diseases exceeds deaths from communicable diseases, which the UN has already paid great attention to and focused world attention on. This important step that the UN is taking this week will add information and, we hope, create a call to action on the part of governments around the world to devote resources and take necessary steps to reduce the enormous burden of disease from noncommunicable diseases.

The most important common factor of the most important noncommunicable diseases undoubtedly is tobacco. Tobacco kills 15,000 people a day in the world through cancer, heart disease, and lung disease. Tobacco unquestionably is the leading preventable cause of death in the world. We hope that the UN Summit on Non-communicable Diseases will focus great attention around the world on tobacco. There's great action that needs to be done.

One hundred seventy countries have signed the World Health Organization Framework Convention on Tobacco Control, which describes a number of steps that governments can take to reduce the spread of tobacco, the use of tobacco in their countries, thereby reducing the terrible toll that tobacco takes. The Framework Convention includes actions like raising the price of cigarettes through taxation, legal measures to limit the sale of tobacco to minors, prohibitions on advertising, and limitations on smoking behavior in public places. The Framework Convention sets out a number of steps that, if implemented, could reduce the toll of tobacco-related deaths around the world. The Framework Convention on Tobacco Control is an important focus of the UN Summit on Non-communicable Diseases, it's included in the discussion that the UN will have, and it's incredibly important for governments to take up these issues.

There are many other aspects of noncommunicable disease that affect lungs that are also going to be discussed at the UN summit, including asthma. We estimate 230 million or more people around the world are affected by asthma. Asthma is linked not only to exposure to things like tobacco smoke, but to air pollution, lower socioeconomic status, and shortage of medicines. These are all important issues that need to be addressed to reduce the burden of asthma.

Lung disease caused by biomass fuel burning around the world is also of growing importance on a worldwide perspective. Half of the world cooks or heats their homes with biomass fuel, which is solid fuel like wood, dung, corn cobs, or anything solid that can burned. In homes around the world where biomass is used for cooking and heating, levels of indoor air pollution reach astronomical levels, hundreds if not thousands of times the level of pollution that we observe even in industrialized countries and cities like New York. These extraordinarily high levels of indoor air pollution lead to premature lung disease in adults, particularly in women who are the most exposed populations to indoor air pollution from biomass fuel burning. Biomass fuels also have a tremendous effect on young children who are exposed to these high levels of pollution. As a result of biomass fuel burning, we see women with premature emphysema and other chronic lung diseases and young children with very high rates of acute respiratory infections. We estimate that between 1.5 million and 2 million people a year die as a result of exposure to biomass fuel burning.

Chronic obstructive pulmonary disease, another important noncommunicable lung disease, is mostly linked to tobacco exposure. Again, this really underscores the importance of the Framework Convention and the provision it includes for reducing the toll of death and disease due to tobacco.

The UN summit is a first step, but it's only a first step. It's a great success that the UN has committed itself to studying, organizing, and talking about noncommunicable disease, but, again, this is only a first step. The UN has not set any specific targets for reduction in death or disease from noncommunicable disease, and so the next steps really will be crucial. This is a global meeting. Following this, the attention will shift to national governments. Representatives to this meeting will go back to their governments and it's important for those governments to set targets that can be achieved, focused on. Representatives must then return in 2014 to the UN with a report on the progress they've made.

Physicians have an important role to play in advancing the agenda of the UN Summit on Non-communicable Diseases and there are really 2 important roles that physicians can play. First is advocacy; physicians have great credibility, knowledge, and expertise about these diseases and have very important roles to play as advocates with their governments and communities at large. It's really incumbent on physicians and crucial for physicians to take the message to their governments that these diseases, which cause more death than communicable diseases, have preventable causes and there are steps that we can take to reduce the amount of death and disease. The other important role that physicians have is with their individual patients. Physicians can always remind the patients about steps they can make to prevent the toll of noncommunicable diseases. Nothing is as important in this regard as physicians urging patients to abstain from tobacco use, to stop smoking cigarettes, and to encourage others to do the same.

It's very important that tobacco indicators be included in UN Millennium Development Goals. Statistics about usage of tobacco and sales of tobacco are very important to keep track of, and an important way in which governments can focus on their success in reducing tobacco-related disease. Tobacco accounts for 35% of all lung disease, about 25% of all heart disease, and about 11% of stroke. This is the key health measure that societies and governments can take to implement or to achieve progress in noncommunicable diseases in the world.

Fifteen thousand people a day die from tobacco use around the world. Nothing that we could do as a society, as a government, or as a global community will improve health as much as eliminating tobacco use around the world. In some advanced countries, wealthier countries like the United States, smoking rates have fallen dramatically. In New York City, only about 14% of the population smokes, and this contrasts with many developing countries where smoking rates exceed 40% or 50%. In China, for example, there are more smokers than there are people in the United States. There are 350 million people who smoke in China. This reflects the strategy that the tobacco companies and their allies have had to reach into developing country markets, where there's much less regulation and much less legal impediment to the sale and distribution of cigarettes, and achieve tremendous market penetration. The result that we'll see in the coming decades is a huge amount of death from heart and lung disease due to tobacco smoke.

The UN Summit on Non-communicable Diseases is an important step in bringing attention to cancer or lung disease, heart disease, diabetes, maternal health issues, but the global public health community has been somewhat disappointed that this meeting has not set specific targets and goals for progress in these diseases. We hope now as delegates to this meeting, when heads of state and ministers of health go home to their countries, that individual targets will be set, that specific concrete action will be taken to reduce the burden of noncommunicable diseases in the world, and that when this meeting is reconvened 3 years from now, there will be measurable progress and a commitment by the UN to reach tangible goals in the reduction of noncommunicable diseases around the world.

The most important step the UN and this summit could take would be to achieve concrete action on reducing tobacco consumption around the world. The most important way to do that would be to implement measures outlined in the Framework Convention for Tobacco Control. The treaty has been signed by at least 170 countries around the world, but its provisions have been implemented by relatively few of those countries. The UN summit is only the very beginning of what we hope will be sustained attention and progress on noncommunicable diseases.

Thank you. I'm Dr. Neil Schulger, Chief Scientific Officer at World Lung Foundation, and I'm here reporting from the UN Summit on Non-communicable Diseases in New York City.


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