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.
“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.
“I am a strong believer in the power of business to improve our world,” the UN Secretary General said. But corporations, he said, need to hold each other accountable to do the right thing in promoting health.
According to some reports, like this one today from Bloomberg Businessweek, it sounds some corporations are lobbying to make the UN accountable and deferential to the needs of industry.
Ann Keeling, of the health advocacy umbrella group the NCD Alliance, said many of the provisions her group had asked for — such as imposing limits on salt content in food — have been taken off the table. Keeling says this appears to have been done at the behest of industry groups advising the UN on NCDs.
“It’s kind of like letting Dracula advise on blood bank security,” Jorge Alday, associate director of policy with World Lung Foundation, told Bloomberg. “There’s important expertise there, but you have to question the motive.”
Similarly, Jamie Love, director of D.C.-based Knowledge Ecology International and an expert on how patent law affects access to medicines, describes in a piece for Al Jazeera the desire by some in the drug and medical device industry to change patent law in a way that could undermine the stated goals of the UN meeting — to treat chronic diseases in poor countries.
As Love notes, one of the great successes in the fight against AIDS worldwide was the agreement by the pharmaceutical industry to relax patent protections on some critical anti-HIV drugs. This allowed the drugs to be made in India or Brazil at more affordable prices for poor countries.
The Bush Administration fought long and hard to get the drug companies to relax their control over the AIDS drugs. Now, Love says, many in the drug industry are pushing back hard (with some support, it appears, by the Obama Administration) against doing the same for chronic diseases. He writes:
The UN is being asked to backtrack from an important agreement to put “access to medicine for all” at the centre of trade policy. This comes at the same time that the United States and Europe are involved in all sorts of regional and bilateral trade negotiations that ratchet up intellectual property protections, making it harder to obtain affordable generic medicines. Inequalities of access to medicine and healthcare are already shocking, and these trade pressures just make things worse. Negotiators at the UN meetings, public health groups, politicians, and the public need to push back and demand changes in global trade negotiations.
The group Medicins Sans Frontieres (Doctors Without Borders) has said much the same thing.
The New York Times also reported Monday on efforts, by Western drug makers and the Obama Administration, to push against the generic drug market in China and India.
Also, Sarah Boseley at The Guardian reports today that Drug industry advocates ensure new drugs for cancer kept off the global health agenda.
Both UN Secretary General Ban and WHO Director General Margaret Chan emphasize that industry leadership and collaboration is especially critical to success in the push against chronic diseases, NCDs — because so many are, in fact, the result of industry practices today.
The question many are asking is if these industries will truly collaborate on this global health goal given the sacrifices and compromises being asked of them.
If not, they wonder if the UN and the global health community have the stomach take the lead, which, by necessity, means taking on some powerful industries.