UN meeting for non-communicable diseasesBMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d5762 (Published 13 September 2011) Cite this as: BMJ 2011;343:d5762
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We should be more weary of prioritising diseases by numbers of death.
Behind the growing interest in non-communicable diseases (NCD) is less
philanthropic love of the health of the world than an agenda of disease
advocacy for medical industrial interests. Mortality of NCD or other
causes of death (OD) are not independent processes. In general, people can
only die of NCD at older ages if they survived other causes of death at
younger ages: infectious disease mortality, maternal mortality and
mortality of 'non-natural' causes (war, accidents and suicide). The burden
of NCD is conditioned by OD. The cheapest way of keeping the burden of
NCD small, is to keep mortality by OD high. OD kills preferentially the
young and the poor, two compelling reasons to keep OD higher on the public
health priority list than NCD.
In the life table of the 'old' EU (without Eastern Europe), close to
90% die after their 65th birthday and 75% after their 75th birthday. If we
take away injury, suicide and perinatal mortality, and if we correct for
smoking and alcohol related causes of death, few people die before their
65th birthday. The common cause of death in low mortality countries is old
age. Increasing health at old age is a worthy aim, but that is only
possible for those who reach old age. The main preventable causes of death
are at younger ages, and are OD, smoking, alcohol and despair.
If we study the history of Europe, we find one single main cause of
good health. Contrary to medical opinion, the epidemiological transition
was caused by the empowerment of the people.(1) It needed the political
power of the masses to force politicians and industry to invest in clean
water and sewers. It testifies of the arrogance of the elite, that we
think that poor people needed the wisdom of doctors to tell them that
living in the filthy conditions of Victorian cities was not good. In
modern European history, life expectancies in EU regions are still divided
by the Iron Curtain.(2) Mortality in Eastern Europe is dominated by
smoking, alcohol and deep despair, caused by historical powerlessness in
former dictatorships. That shifts the blame from unhealthy individuals to
unhealthy states. Again, it shows our arrogance to think that people will
get better from our money. Aid to development supports unhealthy states in
many ways.(3) People are not beggars, they don't need charity. They need
the power to govern their own life in the pursuit of happiness and to
change national policies accordingly. That is a message not welcome to
many UN members or to the them supporting aid industry.
(1) Szreter S. The population health approach in historical
perspective. Am J Public Health 2003;93(3):421-31.
(2) Bonneux LG, Huisman CC, de Beer JA. Mortality in 272 European regions,
2002-2004. An update. Eur J Epidemiol 2009;25(2):77-85.
(3) Easterly WR. The white man's burden: why the West's efforts to aid the
rest have done so much ill and so little good: Penguin Group USA, 2006.
Competing interests: No competing interests