Time to align: development cooperation for the prevention and control of non-communicable diseases
BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l4499 (Published 31 July 2019) Cite this as: BMJ 2019;366:l4499
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Sun Tsu warned “if you don't know your enemy, be warned that you might lose.” Accordingly, Collins and colleagues’ call for coordinated global action to catalyse effective national responses to non-communicable diseases” (1) may be as little effective as previous ones. A quarter century ago, in the early 1990s, the Journal was the first core clinical journal to use the term Non-Communicable Diseases, the Lancet was the second a little later. (2-5)
Happily, viral or bacterial epidemics are no longer main issues. However, the term Non-Communicable Diseases seems a wolf in sheep’s clothing to misrepresent the burden of the modern epidemics whose agents are tobacco, alcohol, processed foods (with salt, fat or sugar), killing people on a large scale. The host-reservoir is the industry. The vector for transmission is a brilliant, but devastating, social marketing which has almost a free ride. Why can’t we call a spade a spade and use the term “Commercially Communicable Disease” for industrial pandemics?
Collins and colleagues’ conclusion highlighted “WHO good and best buys … the WHO Framework Convention on Tobacco Control” and stressed the “potential benefits of health taxes”. However, the Convention is almost toothless and results have not come.(6,7) Indeed, increases in taxes are rarely dissuasive and repeated and most effective measures for tobacco control are deliberately overlooked though comprehensiveness of public policies is a prerequisite for success: no country has yet banned menthol or reduced nicotine content cigarettes.
Responsibilities are complex. On the one hand, the industry is doing its job when selling products which are allowed to be marketed. On the other hand, pointing the finger of blame only on governments is also wrong. In France, since 1998, a group of healthcare professionals, the wise men (although now there are women) have been questioning candidates for the French presidency about their public policies (including “NCD”) and publishing responses with an evaluation.(http://www.securite-sanitaire.org/) In 2017, French citizens elected the one ranking just before the last.(http://www.securite-sanitaire.org/reponses2017/LeMonde11avril.pdf)
1 Collins TE, Nugent R, Webb D, Placella E, Evans T, Akinnawo A. Time to align: development cooperation for the prevention and control of non-communicable diseases. BMJ 2019;366:l4499.
2 Li N, Tuomilehto J, Dowse G et al. Electrocardiographic abnormalities and associated factors in Chinese living in Beijing and in Mauritius. The Mauritius Non-Communicable Disease Study Group. BMJ 1992;304:1596-601.
3 Anonymous. Shanghai declaration on non-communicable diseases. WHO Directors of Non-Communicable Disease Collaborating Centres and Key Officials. BMJ 1993;306:588.
4 LaPorte RE. Global public health and the information superhighway. BMJ. 1994;308:1651-2.
5 Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet 1997;349:1269-7.
6 Braillon A. The Framework Convention on Tobacco Control. Lancet 2016 May 7;387:1907.
7 Hoffman SJ, Mammone J, Rogers Van Katwyk S et al. Cigarette consumption estimates for 71 countries from 1970 to 2015: systematic collection of comparable data to facilitate quasi-experimental evaluations of national and global tobacco control interventions. BMJ 2019;365:l2231.
Competing interests: No competing interests
While it is true that donor countries contribute greatly to health financing and sustainable development of low-income countries, many of which cannot meet their needs only with the nation's public resources, it is also true that in these countries there is a large index of corruption generally. Although the contribution of donor countries to other low-income countries is substantial, it is not sufficient due to the fact that corruption in these countries intercepts a large part of the funds allocated to health, including funds for non-communicable diseases.
One way to make good use of the resources provided for health by donor countries would be the implementation of anti-corruption policies that guarantee a good use of resources, thus avoiding the diversion of money to third parties for personal purposes. The money would be appropriately invested in other fields including health, improving the quality of life of all inhabitants, without exclusion of people with non-communicable diseases.
Competing interests: No competing interests
NCDs have already become a big challenge in the real world, multiple measures and strategies should be taken to defeat them. Re: Collins TE, et al. BMJ. 2019;366:l4499. doi: 10.1136/bmj.l4499.
Non-communicable diseases (NCDs) including cardiovascular diseases, cancer, chronic obstructive respiratory diseases, diabetes and psychological diseases are becoming the pandemia of the third millennium and the leading cause of mortality for both sexes throughout the world. In this issue, Collins TE et al (1), again called on global active alignment for the prevention and control of NCDs. People at high risk of NCDs should modify their NCDs risk behavior, make best use of available external economic and social support and determine the success of NCDs interventions (2).
Though the increasing importance of NCDs has been validated by the three United Nations General Assembly high level meetings on NCDs prevention and control (in 2011, 2014 and 2018) and the 2030 agenda targeting for one third reduction of premature mortality from NCDs by 2030 (3), however until today much has been discussed and less done. NCDs have not attracted enough attention in many countries, especially in those low and middle income and fragile countries. According to its adverse outcomes, NCDs not only can influence national security, but also play an important role in sustainable development.
It’s well documented that preventive and control actions for NCDs include health education, smoking cessation, healthy diet, regular physical activity (4), updated medical security policies, graded diagnosis and treatment and therapy on NCDs. National and international cooperation and communications among government regulatory bodies, public institutions, media, medical insurance systems, protection of intellectual property and the best utilization of modern science and technology are all important for the realization of the 2030 agenda (1,3).
Dr. Zhu Yanrong
MD PhD Chen Zhong (zhongchen7498@hotmail.com)
Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital East, Shanghai, P.R.China
Aug 10, 2019
Competing interests: no competing interests.
References:
1 Collins TE, Nugent R, Webb D, et al. Time to align: development cooperation for the prevention and control of non-communicable diseases. BMJ. 2019;366:l4499. doi: 10.1136/bmj.l4499.
2 Ferroni, P. Editorial: Non-Communicable Diseases: Gender Differences in Therapy. Curr Med Chem. 2017;24(24):2559-2560.
3 WHO. Global health estimates 2016: deaths by cause, age, sex, by country and by region, 2000-2016. World Health Organization, 2018.
4 Kelishadi R. Life-Cycle Approach for Prevention of Non Communicable Disease. Adv Exp Med Biol. 2019; 1121:1-6.
Competing interests: No competing interests