non-communicable diseases

RECENT POSTS

Visualizing Mexico’s fight against obesity (and junk food) | 

Guest post by Katie Leach-Kemon, a policy translation specialist from the University of Washington’s Institute for Health Metrics and Evaluation.

obesity
Flickr, Ed Yourdon

Mexico recently beat out the United States, though just barely, for having the world’s biggest waistlines. Not coincidentally, the Central American nation is also one of the world leaders in soft drink consumption.

In response to these two unfortunate trends, Mexican lawmakers appear likely to pass a 5% tax on junk food and 8 percent on soda. Through this tax, the government aims to generate billions of dollars in tax revenue and curb a growing obesity epidemic.

There’s a global push to increase efforts against so-called noncommunicable diseases (NCDs) like obesity, diabetes and heart disease – all of which are fueled by poor dietary or lifestyle behaviors.

The food and beverage industry has, since the beginning of this push against NCDs, pushed back against many efforts manufacturers see as singling out ‘fast food’ as bad food. So it is worth taking a closer look at how Mexico fares in its fight against fat. Continue reading

Food & beverage industries undermining global health | 

burger fries
Flickr, su-lin

The ‘junk food’ industry is a major threat to global health, according to  study published in The Lancet and as reported by The Guardian, Reuters, the Independent and other news organizations.

Makers of sugary drinks, high-caloric processed foods and other unhealthy food products are employing some of the same tactics of the tobacco industry to argue against causality (i.e., that high-sugar or high-fat foods can be blamed for the epidemic of obesity, diabetes and heart disease) and for self-regulation, contend the Australian scientists who wrote the report.

“”These industries are taking governments for a ride by saying: ‘We are part of the solution’ and installing codes they know will have no effect,” said Professor Rob Moodie at the University of Melbourne.

What’s at issue here is the widespread recognition within the public health and global health community that a lot of death and disability is caused by so-called non-communicable diseases (NCDs) such as heart disease, cancer, diabetes and the like. Poor diets and the rising global tide in obesity contributes to this problem.

In 2010, nearly 35 million people died from these diseases – or 65 percent of all deaths that year. The NCD death toll is expected to rise to 50 million deaths a year by 2030 if the trend continues. The World Health Organisation has set a target to reduce these deaths by 25 percent by 2025.

Given the increased attention to the toll taken by the NCDs, many health experts argue for imposing regulations and limits on especially unhealthy foods — much like health experts have done for tobacco. Not surprisingly, some within the food and beverage industry don’t like this idea. Some of the first signs of industry’s push-back on this global health initiative emerged at the UN more than a year ago.

Here are a few related, earlier stories:

World Health Organization partners with junk food makers to fight obesity

Pepsi exec tries to convince people that industry is serious about fighting bad food

The news reports cited at the top provide a good overview of the study and the issue, but this report from ABC Science (the ABC, in this case, referring to Australian Broadcasting Service) provides more depth and commentary from the researchers.

WHO says it has not been bought off by the food and beverage industry | 

Flickr, su-lin

A month ago, some investigative reporters at Reuters did a big expose article contending the World Health Organization had been compromised in its efforts to combat non-communicable diseases — aka NCDs like obesity, diabetes and heart disease — by allowing the food and beverage industry too much influence over its public health initiatives.

Here’s a rebuttal from WHO Director-General Margaret Chan ‘setting the record straight,’ which was issued on Monday. Continue reading

WHO report highlights chronic diseases & lack of global health strategy | 

Flickr, Erebos

Analysis

The World Health Organization has published its annual health report for 2012 and this year decided to “put the spotlight on the growing problem of non-communicable diseases.

Here are some of the news stories spawned by the WHO report:

Reuters/MSNBC Heart disease, diabetes spreading to poor regions

AP/Washington Post Diseases of affluence are spreading worldwide

Voice of America Non-communicable diseases cause most deaths worldwide

UN Dispatch The Good, Bad and Mixed News in World Health Statistics

This focus on the NCDs, (non-communicable diseases) is certainly legitimate since they are, as a general category, major contributors to the global burden of disease. But another way to look at this, of course, is that the WHO report has turned the spotlight away from other diseases.

Why the focus this year on diabetes, heart disease and other chronic illnesses? Why has the attention been shifted away from the still-expanding HIV-AIDS pandemic, the threat of drug-resistant tuberculosis or malaria?

One easy answer is that the WHO annual statistics report always picks a theme and this year’s flavor is chronic disease.

Before, it was AIDS. Another year, it was TB or malaria. To WHO’s credit, one year the organization focused the attention on the much-neglected problem of mental illness worldwide. Another time, the spotlight was on deaths from accidents (which is a much bigger contributor to global mortality than you might think).

All of these are legitimate health concerns. But the nagging suspicion — or perhaps just inkling — you get from all this is that the shifting spotlight indicates no real strategy for global health.

I’ve long been disturbed by the lack of a clear, comprehensive strategy in global health — as well as the lack of a clear definition of what the hell we even mean by global health. Many tell me to lighten up, that the diversity of opinion and a de-centralized approach to the fight against disease is actually a good thing.

I’m not so sure, and I’m not alone in my uncertainty. See this post from the Center for Global Development’s Amanda Glassman and Kate McQueston Making Priority Setting a Priority for Global Health, which offers links to other related posts.

Update: Here is Amanda’s more recent perspective published in the British Medical Journal.

Kate Kelland of Reuters earlier this week also did a great report on the ‘squishiness’ of the WHO health statistics and the debate over how best to measure the burden of disease globally. It’s worth a read and mentions a group of Seattle number-crunchers, at the UW’s Institute for Health Metrics and Evaluation (e.g. a recent report on malaria) who are trying to bring more reliability and perhaps order to all this.

But, clearly, it’s not just a matter of improving the numbers. The international community has no consensus on what we mean by global health, let alone consensus on which problems deserve the most attention and resources.

 

Final wrap on UN Week and the ‘historic’ global health confab | 

Tom Paulson

Someone important going to the UN

A news analysis:

As I head home from the Big Apple, the big news here today is that Palestine formally requested membership at the United Nations as a step toward becoming an independent nation. The actual vote comes later but the UN isn’t really a democracy. The U.S. has vowed to kill it with a veto in the UN Security Council.

Iranian President Ahmadinejad’s antics at the UN are already old news. Other top stories today include a satellite coming down and some Swiss nerds claiming they sent subatomic particles faster than Einstein said they can go.

An earlier meeting by the UN General Assembly was repeatedly hailed by those who care about poverty, health and social justice as “historic.” But it seemed to come and go with little notice.

I reported earlier this week on this much lower-profile UN High-Level Meeting on Non-Communicable Diseases (NCDs), admitting the entire time that I wasn’t quite sure what happened at this global health confab, or if it will matter much.

I couldn’t tell in part because of the byzantine manner which the UN does things, beginning with the apparently common UN practice of deciding on the outcome of a meeting before you have the meeting. I also couldn’t tell because the media is highly constrained and can only talk to participants at about the same level of engagement as someone jailed in solitary confinement.

That said, the UN meeting on NCDs does have the potential for something great … to emerge from this fog of sound-bites, press briefings and celebrity appearances. This could actually turn out to be historic, an expansion and re-ordering of the global health agenda.

It isn’t yet, however. As several of us who follow global health closely (obsessively, sometimes angrily) have noted, the UN didn’t really accomplish much of substance this week. As Laurie Garrett, perhaps the top global health journalist (or former journalist?) now with the Council on Foreign Relations, wrote on her blog:

After months of haggling, millions of dollars’ worth of meetings and travel costs and a prodigious mountain of studies and documents prepared in anticipation, the final Declaration of the UN High Level Meeting  is little more than a wishy-washy rendition of problems and vague solutions that are obvious to even casual observers….

Laurie, who is a friend, goes on to cite my earlier reports saying much the same thing and then calls me “super-insightful.” Wow, and I only paid her $20. Others just call me cranky. But I think we all want this thing to move forward, to expand the reach of the fight against the diseases of poverty. Continue reading

Did something that matters happen at the UN global health summit? | 

Tom Paulson

The media covering the media covering President Obama speaking at the UN

The big global health meeting at the United Nations has come and gone I still can’t quite tell if anything actually happened.

Maybe that’s normal, when it comes to how things get done at the UN.

After all, the Obama Administration has said if the UN were to recognize Palestine as a state, it would be “merely symbolic.” And yet they’re still fighting like hell to keep it from happening.

I came to New York to cover a meeting called the UN High-Level Meeting on Non-Communicable Diseases, which concluded yesterday. This was billed as a historic moment in global health, only the second time the UN has held such a meeting. The last one, in 2001, launched the Global Fund to Fight AIDS, TB and Malaria — a massive, if imperfect, effort that has saved millions of lives.

The aim of this week’s special session on global health at the UN General Assembly meeting is potentially even more significant than it may sound.

On the surface, it was a call to expand the already strained global health agenda to include non-infectious killers like cancer, diabetes and heart disease — the NCDs (or non-communicable diseases). That’s a big deal because it adds a lot to the agenda, given that chronic diseases kill more people (about 36 million per year) than AIDS, TB and malaria combined.

But it may be even bigger than that.

If you dig a little deeper here, this is the big — mostly unspoken — question: Is this move to get chronic disease on the agenda actually a move away from the standard disease-oriented approach to global health — and toward a more “systems” approach? Continue reading

UN health summit makes food, beverage and drug industries nervous | 

Flickr, Roadsidepictures

Members of the United Nations General Assembly met this week to come up with a plan to combat chronic disease in poor countries that appears to have some in the food, beverage and drug industries worried.

Ten years ago, a similar meeting here produced a massive global response to the AIDS pandemic, most notably with the creation of the Global Fund for Fighting AIDS, TB and Malaria (which yesterday, despite clearly saving many millions of lives, got slammed for not working as well as advertised).

The expectation at the UN meeting is that delegates will decide that somebody should do something … and would like to be more specific, but then say they are late for another meeting, grab their hats and coats and make for the door.

Part of the problem is that many chronic diseases are “lifestyle” diseases — lifestyles that a lot of corporations want us to buy into.

The need for action is clear: Chronic or non-communicable diseases (aka NCDs) are the world’s big killers, representing about 60 percent of all causes of death. Cancer, heart disease, stroke, lung disease (mostly from tobacco), diabetes and the like kill many more people — most of them in the developing world — than do infectious diseases like AIDS, TB or malaria.

But governments, donors, the drug industry and health agencies don’t set their global health priorities simply on the basis of the burden of disease, as reasonable as that might sound. Some diseases are too complex, their treatment too expensive, to feasibly act against in poor countries.

Many of the NCDs are, however, easily and cheaply treated or prevented. High blood pressure can be treated with drugs costing pennies per day. Tackling some of the biggest killers, the World Health Organization says, can be done at a cost of about $1.20 per day.

Simply educating people about a healthy diet and the risks of tobacco or excessive alcohol use could do a lot.

It all sounds do-able, this aim to shift the global health agenda to include these non-contagious killers. So why the pessimism about getting a meaningful game plan out of this UN meeting?

Part of the problem is the concerns of industry. These health goals sometimes run up against powerful commercial interests in the food, beverage and pharmaceutical industries.

UN

UN Secretary General Ban ki-Moon

“There is a well-documented and shameful history of certain players in industry who ignored the science, sometimes even their own research, and put public health at risk to protect their own profits,” UN Secretary General Ban Ki-moon said Monday in a speech on the NCDs.

Ban cited the tobacco and alcohol industries, but also makers of processed foods high in salt, sugar and fat — and the media companies that advertise unhealthy products. Continue reading

Guest post: Global health needs to focus on health, not disease | 

This is a guest post from Wendy Johnson, a physician at the University of Washington with extensive experience working health issues in low-resource communities in Africa.

———————————————————————————————————————————

Wendy Johnson

The UN High-level Meeting on Non-communicable Diseases (NCDs) couldn’t come at a worse time.

While the delegates, disease experts and functionaries gather in New York to discuss how to create a more comprehensive global health agenda, political leaders in a smaller city to the south with much more power to set that agenda will likely be dismantling the infrastructure and funding needed to support the fundamental change needed – health systems improvement.

As this story from Reuter’s notes, all foreign aid, and especially the USAID budget, is under serious threat, both from the so-called “super-committee” on debt and the deliberations over current spending bills taking place in Washington D.C.  According to the article, House Foreign Affairs Committee Chairwoman Kay Granger is a proponent of deep cuts in aid who believes in limited programs that demonstrate quick impact and further U.S. national security.

This does not bode well for those at the UN meeting who will be arguing that the U.S. and other rich countries should make the long-term commitments necessary to address the disparities in NCDs such as diabetes, heart disease and cancer treatment in poor and middle-income countries.  Continue reading