Will industry influence derail UN summit?
BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d5328 (Published 23 August 2011) Cite this as: BMJ 2011;343:d5328
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The current standstill in the negotiations of the United Nations High
-Level Meeting (HLM) on Non-Communicable Diseases (NCDs) [1] member states
has shocked the international community. Judging from articles written in
The New York Times, the Financial Times, the Huffington Post and even Le
Monde, morale is at its lowest for a conference which promised to be a
historical landmark in global health [2].
NCDs, such as obesity, type 2 diabetes and certain cancers, have been
at the center of global health discussion for quite some time now. This
group of diseases, once traditionally considered restricted to developed
nations, is now becoming a real issue for the developing world where
nearly 80% of NCD deaths occur [2, 3]. If no plans are made to combat NCDs
it is feared they will kill more people in Africa than Communicable
Diseases such as HIV and malaria which have been traditionally associated
with the continent [2].
The Moscow Conference which took place in April marked a first step
in the international community's recognition of the threat of NCDs. One of
the reasons behind the enthusiasm is the fact that these diseases are
generally avoidable by removal of risk factors. 80% of type 2 diabetes and
heart problems as well as 40% of cancers would thus be avoided with
increased physical activity, an improved diet and no exposure to tobacco
[4].
Following the Conference, a United-Nations High Level meeting was
scheduled with the idea of establishing a global action plan to put a halt
to the NCD pandemic. Unfortunately, discussions have been recently put on
halt as a conflict has emerged between the G77 and a group formed by the
USA, Canada and the European Union. The main areas of discourse concern
the financial aspect of the plan as well as the difficulty of quantifying
the objectives and feedback on set targets. And these countries do have a
point.
With the financial crisis affecting all nations, the idea of having
to provide more financial aid to foot a global effort to reduce NDCs is
one that may seem hard to imagine for many governments that already have
to cut costs elsewhere. But as Andrew Jack from the Financial Times
suggests the extra resources could be generated by taxing the risk factors
themselves [5]. Creating a global equal tax for tobacco products could for
example contribute to the budget for the global fight against NCDs all the
while (financially) deterring individuals from using one of the main risk
factors for certain cancers. Nalini Saligram and Sandeep Kishore explain
the financial issue from a different perspective [6]. In their view the
current budget is not enough to support a global initiative and although
more financial contribution will be needed at first they will eventually
result in savings in the long term as the cost of preventing becomes less
than the cost of treating [7].
The objectives set out by the UN HLM to combat the pandemic of NCDs
need to be achievable. As Margaret Chan, director general of the WHO,
stated in her review of the Zero Draft [8], these need to be quantifiable
and therefore clear measurable targets should be set. Just as the member
states agreed only recently to treat 15 million people with HIV by 2015,
so they should agree on a practical target for NCDs such as reducing
preventable deaths from NCDs by 25% by 2025, suggests Ann Keeling, chair
of the NCD Alliance [9]. Measurable targets will enable realization of the
scale of the task and help generate more interest in methods of combating
the problem; furthermore these can always be readjusted when a review of
the progress is done.
One final point to add to Deborah Cohen's Feature Article in the BMJ
[10] is the regulation of salt and sugars (as well as saturated fats etc.)
in ready-made foods. They represent a risk factor group which contributes
to the risk of contracting NCDs [11] and as thus their use should be
governed by international regulations, suggests Jorge Alday, director of
the World Lung Foundation.
We now have to wait for the discussions to continue and await with
eagerness the results of the UN HLM. In the meantime it is up to us health
professionals and medical students to continue to challenge the
international community with debates and discussions. As future policy
makers and implementers, recent medical graduates and medical students in
particular should aim to take part in this debate through initiatives such
as the Young Professional Chronic Disease Working Group, an online
discussion group. In any situation, the discussions need to press on and
differences be put aside so as to put a halt to a pandemic responsible for
nearly 100,000 deaths a day.
References
1. http://www.who.int/nmh/events/un_ncd_summit2011/fr/index.html
2. Global Status Report on Noncommunicable Diseases 2010. WHO 2011.
Available at: http://
www.who.int/chp/ncd_global_status_report/en/index.html (accessed 30 May
2011)
3. Global Status Report on Noncommunicable Diseases 2010. WHO 2011.
Available at:
http://www.who.int/chp/ncd_global_status_report/en/index.html (accessed 30
May 2011)
4. Chronic Disease Report. World Health Organisation. 2005. Available
at: www.who.int/chp/chronic_disease_report/media/CANADA.pdf. Accessed on
26 August 2011
5. Jack A. Efforts to tackle diseases under threat. Financial Times.
18 August 2011. London
6. Saligram N, Kishore SP. We Need Measurable Outcomes From The UN
High-Level Meeting on NCDs. Huffington Post. 17 August 2011.
7. Rijken PM, Bekkem N. Chronic Disease Management Matrix 2010.
Results of a survey in ten European countries. On behalf of the European
Forum for Primary Care. NIVEL, Dutch Institute for Health Services
Research, 2011.
8. Draft outcome document of the High-level Meeting on the prevention
and control of non-communicable diseases". United Nations; published 23
June 2011. Available at:
http://www.un.org/en/ga/president/65/issues/ncdiseases.shtml (accessed on
28 June 2011).
9. Kelland K. Europe and US accused of stalling UN disease talks.
Reuters. 17 August 2011.
10. Cohen D. Will industry influence derail UN summit? BMJ 2011;
343:d5328
11. Grant W. The Political Economy of Food Governance. International
Studies Review. Volume 13, Issue 2, pages 304-309, June 2011
Competing interests: Member of the Young Professional Chronic Disease Working Group
This report by Deborah Cohen on the politics and influences behind
the story is to the point in worrying if anything valuable will be agreed.
For the governments and donors on the consumer sides, agreements may be
real problem unless the investigations and drugs having no impact or
negative impact on the CURE RATE of the relevant disease(S) are not
prohibited or at least restricted. Industry including private medical
practice being commercially oriented may press for continued
experimentation and evidence irrespective of impact on cure rate.
Hopefully something will surely come out on chronic non-infective diseases
which often have underlying unread infective and in-festive basis too.
Competing interests: No competing interests
That the UN Summit on AIDS ten years ago was already a success even
during its planning stages is just one of the glaring differences between
NCDs and AIDS, or almost any other health issues with existing programs
for that matter.
From a certain perspective, the care for NCDs is generally
unexciting. Aside from some forms of cancer, there is no race for cure;
only the long, arduous, unpredictable, and often costly trek of case
management to control the conditions, and people afflicted of NCDs will
eventually die of their disease. A utilitarian versus libertarian debate
may lead one to conclude that people with NCDs will only cause further
strain on already heavily-burdened health systems and economies, thus it
is better not to care for them anymore in the hope that they will die
sooner and ease some of the burdens that they impose.
Prevention of NCDs by addressing certain risk factors as was proposed
in the NCD Alliance outcome document
(http://www.ncdalliance.org/sites/default/files/resource_files/UN%20High-...) is equally unexciting. The maximum
benefits of the efforts - decreasing prevalences of NCDs - may no longer
be reaped during the lifetime of those who will advocate, initiate and/or
fund any NCD control or prevention programs. From a business point of
view, the seeming balance between the "hand that doles out the food" with
"the hand that takes away the food" becomes lost when dealing with the
care and prevention of chronic diseases. Donors will not get a good deal
of tangible returns from their investments on NCDs; what takings would one
expect if the main strategies would be increasing physical activity and
reducing use or intake of harmful or health risk products? Compared to
AIDS, TB, or malaria to cite a few, there will probably be less
involvement of (commercially-inclined) industries who are usually tapped
to deliver a number of goods related to these disease programs and to
embark on related researches which in turn may produce more marketable
goods. Conversely, commercial industries might suffer from profit losses
if the calls for reformulation, higher taxes and more strict regulations
are enforced. If this happens, they will reflect their losses on society.
This leads to the argument that donor countries will likely tend to lose
more than what they are willing to give if they support strategies such
as strict regulations and restrictions of health risk products. It seems
that the prevention and control of NCDs ask too much, and the word
"altruism" is yet to be personified.
Very sadly, the only conclusion that could be drawn now seems to be
that both control and prevention of NCDs are not lucrative for these
people; and inequities will always reverberate from inequalities that
arise within and between societies because of this.
Competing interests: GMVKu is a member and one of the spokespersons of the Network 'Switching International Health Policies and Systems' (SWIHPS), an international network of individuals and institutions to disseminate and exchange information, expertise and practice to contribute to stronger health systems and improved policy making. The network has a strong thematic focus on the organization of care for chronic diseases in low income countries. The secretariat of the network is hosted by the Institute of Tropical Medicine Antwerp, Belgium.In addition, GMVKu was diagnosed with diabetes mellitus type 2 at the age of 30, She has been able to control her NCD for the past 11 years without any occurrences of life-threatening complications or co-morbidities; and has been a useful member of the society with a number of contributions especially in the field of Family & Community Medicine in the Philippines. Currently, she is involved in the organization of community-oriented primary care for diabetes in several sites in the Philippines.
UN Summit on Non Communicable Diseases - Too late and too little
Harmful effects of Tobacco and Alcohol were known to the ancient
Hindus 6000 years back. Two modern religions (Islam and Christianity)
started nearly 2000 years ago, also looked down upon these two as evils.
History will never forgive us for turning a blind eye to the miseries of
billions of humans who have died miserably only to give livelihood to few
million and allow hundred odd business houses to amass vulgar profits.
HIV, Terrorism, Natural Disaster, Global warming etc together kills less
than those killed by tobacco and alcohol but they caught the attention of
world much earlier. I am sorry for being impolite. I work with patients
and their families who are ultimate victims of this state-supported
genocide. Dead bodies of my patients and cries of their dear ones always
haunt me.
Of the four causative agents of the NCDs, Tobacco and Alcohol are
predominantly "industry driven" where as the other two (unhealthy diet and
lack of exercise) are predominantly "behavior driven". The control of
"industry driven" factors requires one sensible Head of State and he/she
can save millions of lives. Whereas, to change the behavior one needs to
work with millions to save one life. It is logical that changing the
behavior of the Head of State will have a far reaching impact than
attempting to reform their subject. It is ridiculous that Bhutan is the
only nation that has banned tobacco. It always baffles me why tobacco
control pundits are always afraid to use the word "ban or eradicate" when
the same is the "selling point" for the communicable diseases. How can a
massive group of powerful leaders and intellectuals look dwarfs against a
bunch of shrewd business people? Opium has been banned despite being the
raw material for several crucial pain killers and life saving medicine.
Tobacco has no usage what so ever except causing death and disability but
continues to be a profitable consumer good. People outside are suspecting
seriousness of UN in preventing the NCDs and they believe that it is only
making a platform for the medical and biomedical industry to make a
killing.
Tobacco is the "weapon of mass destruction". Do we have the courage
to invade those countries that protect and patronize it? It is unfortunate
that most nations have decided to give priority to revenue over the
suffering of their countrymen. Why cannot we put sanctions on those
countries that do not follow the basic tenets of the NCD prevention? I am
sure that political patronage will disappear if World Bank and other
similar funding agencies link the disbursal of funds to positive actions
to prevent NCDs.
We are losing thousands of lives every day....it is a matter of
urgency. We have discussed this issue ad nauseam for several decades, now
it is time for affirmative action. I sincerely urge every Head of State
present here to change their outlook towards tobacco and alcohol ......it
may kill their own children and grandchildren tomorrow.
Competing interests: No competing interests