UN Summit on Non-Communicable Diseases
The big disease charities get together
Click here for February report on Big Snack and the UN Summit
Click here for March report on WHO and the UN Summit
Click here for April report on DOHaD and the UN Summit
Facing chronic diseases: Ann Keeling, NCD Alliance chair (left); Luiz Santini
and Brazilian President Dilma Rousseff (centre), Jean Claude Mbanya (right).
Our news team reports: How to reduce the risk of heart disease, common cancers, and other chronic diseases? The Moscow pre-Summit just ended, leading up to September's UN Summit in New York, had the title 'First Global Ministerial Conference on Healthy Lifestyles and Communicable Disease Control'. Commenting, Association Council member Fabio Gomes says: 'This already was a depressing start. The term "control" usually implies a medical approach, and does not even necessarily imply reduction of incidence. Worse, the term "lifestyle" implies that responsibility for prevention is that of the customer and consumer. Tell that to children bombarded with advertisements for energy-dense fast and other junk food'.
The Moscow meeting, convened by the World Health Organization, is probably best seen as a consciousness-raising exercise aimed at governments in particular of lower-income countries, who still are not yet fully alerted to the fact that almost everywhere in the world now, incidence of and deaths from non-communicable diseases (NCDs) far outnumber those from infectious diseases and malnutrition. The draft 'Moscow Declaration' prepared by WHO rightly states that 'A paradigm shift is an imperative in dealing with NCDs' challenges… NCDs are caused not only by biomedical factors but also by social, economic and environmental factors' and further, that: 'Effective NCD prevention, control and management requires concerted whole-of-government action across a number of sectors such as health, education, energy, agriculture, sports, transport and urban planning, industry and trade, finance and economic development'.
All true, but to what effect? The final Moscow statement contained nothing in the way of quantified time-based targets, of the type that appear in the UN Millennium Development Goals. The general mood is to develop and deepen 'public-private partnerships', and to entrust the transnational and other very large food and drink manufacturers whose products are in large part the cause of the problem, to volunteer and enact solutions. 'There is no evidence that this voluntary approach works' says Council member Geoffrey Cannon. 'How could it? The manufacturers of energy-dense fatty, sugary or salty products, including snacks and drinks, are responsible to uphold their bottom lines and their share prices. The only approach that will work, and that is known to work with tobacco control, is statutory regulation – the use of law in the public interest'.
The global professional organisations unite
This is not an isolated view. The NCD Alliance has been formed, with the specific purpose to influence the outcome of the New York Summit. Its members include the global cancer control organisation (UICC), the World Heart Federation (WHF), and the International Diabetes Federation (IDF). Alliance Chair is Ann Keeling, a UK citizen who took on this role as from being CEO of the IDF, whose President Jean Claude Mbanya from Cameroon is pictured right, above. Control of chronic diseases is now a national priority in many middle- and low-income countries, as indicated in the picture centre, above, marking the announcement in March by Brazilian President Dilma Rousseff and Brazilian national cancer institute chief Luiz Santini, of a new national initiative to control women's cancers in Brazil.
What is striking about the NCD Alliance requests of member states who will attend the UN Summit, is that its proposals on prevention give governments a central responsibility, do set targets, and do address what remains perhaps the most outrageous practice of the transnational food and drink product industries – the advertising of ultra-processed fatty, sugary or salty energy-dense products to children, as shown in Box 1 below. The Alliance also makes some crisp time-based proposals on alcoholic drinks, and on saturated fats as well as trans fats, on sugar as well as salt, and on the enabling of everyday physical activity. Commenting, Association Council member Carlos Monteiro says; 'Let's hope the NCD Alliance stays with its statements and puts them across effectively in New York this September'.
Box 1
Proposals for prevention: NCD Alliance
The 'Asks' of the NCD Alliance addressed to UN member states, specifically addressing prevention of chronic diseases, including a request concerning human rights and the 'social determinants' of disease, are:
- Accelerate the effective implementation of the Framework Convention on Tobacco Control.
- Establish effective population-wide prevention, early detection, screening and awareness-raising programmes for NCDs targeting high-risk populations
by 2020, including, but not limited to:
By 2018, reduce the mortality and morbidity of gastric, colorectal,breast, cervical cancer; diabetes; and cardiovascular diseases (including heart disease and stroke) by increasing early detection programmes.
By 2018, implement national immunisation strategies for HPV and HBV for populations at high risk and strategies to prevent rheumatic fever to avert rheumatic heart disease.
Reduce or eliminate environmental (including indoor air pollution), occupational and other contextual risk factors associated with NCDs. - Implement global and national trade and fiscal measures to provide incentives for production, distribution and marketing of vegetables, fruit and unprocessed food.
- By 2013, develop and implement comprehensive strategies to decrease childhood obesity, and eliminate all forms of marketing, particularly those aimed at children, for foods high in saturated fats, trans-fats, salt and refined sugars by 2016.
- By 2013, develop and implement regulatory measures to achieve substantial reductions in levels of saturated fats, trans-fats, salt and refined sugars in processed foods. Aim to reduce worldwide salt intake to less than 5g/day per capita (2,000 mg sodium/day) by 2025.
- Develop and implement policies for urban design to include safe open spaces and encourage walking, cycling and other physical activities.
- Develop and implement comprehensive strategies to decrease the harmful use of alcohol, in particular, among youth.
- Accelerate approaches to address the social determinants of NCDs, including malnutrition, and reduce the vulnerability of women, children, indigenous peoples and populations at particularly high risk.
