Lots of talk, little action from crucial UN summit on deadly diseases - Sydney Morning Herald
Anushka Patel
September 22, 2011Police manned a maze of barricades around midtown Manhattan this week at the UN summit on non-communicable diseases, but I saw no protesters agitating about the need for action against the illnesses most likely to kill them.
The last and only other time the UN convened such a high-level meeting on a global health issue - the HIV/AIDS summit in 2001 - protesting AIDS activists, endorsed by Bono and Radiohead, made world headlines. It seems cardiovascular disease, diabetes, chronic respiratory illness and cancer are not yet sexy enough (although celebrities such as Jamie Oliver and Lance Armstrong did come to the party).
As is usual for a high-level UN meeting, the outcome of the summit was negotiated over many months in advance. The resulting political declaration was substantially watered-down from the call to action originally proposed. Many of us were disappointed at the decision this year not to include mental illness, even though it is expected to account for about one-third of the total $US47 trillion cost to the global economy of non-communicable diseases (NCDs) over the next 20 years, according to World Economic Forum estimates. Most disappointingly, the document lacks the specific targets that were so prominent in the political declaration that followed the HIV/AIDS summit 10 years ago.
NCDs pose a major threat to global health and economic development. They cause 36 million deaths a year. They are the leading cause of premature death and disability in Australia and cause about two-thirds of adult deaths worldwide, of which one-quarter are premature and 80 per cent occur in low- and middle-income countries.
There is clear evidence that, with time, NCDs occur more commonly among the poor and are a common cause of tipping households into poverty. As economies develop, diets change with greater consumption of more processed foods high in sugar, saturated fats and salt. Work-related physical activity declines sharply, often in built neighbourhoods not conducive to exercise. In addition, people in poorer communities tend to develop cardiovascular disease at much younger ages, leaving destitute dependants.
During the summit, speaker after speaker (generally heads of state or health ministers) reiterated the mantra - the situation is very bad, will get worse, urgent action needed. But without measurable outcomes to make governments accountable in the battle against these largely preventable diseases, how will the summit declaration translate to the action that is urgently required? Civic society representatives made passionate pleas to follow up with clear targets, such as a 25 per cent reduction in NCD deaths or limiting daily salt intake to less than 5 grams per day by 2025.
Nevertheless, important positives will emerge from the summit. At last, there is unequivocal acknowledgement of the gravity of the unfolding NCD epidemic (although the political declaration explicitly avoided the use of that term) and of the inadequacy of the resources devoted to it.
The summit document does recognise the need for whole government, multi-sectoral approaches to tackle NCDs. The sectors that will need to be involved in developing solutions include trade, climate change, environmental science, agriculture, food manufacturing and urban planning.
The declaration, while acknowledging the need to work with relevant industries, calls for immediate action towards a zero target of tobacco use. Australia's commitment to this through the plain packaging initiative was particularly well received in the speech by the Health Minister, Nicola Roxon.
Fortunately, we already know a lot about how to prevent and treat chronic disease in individuals. Changes in lifestyle as well as long-term use of preventative drugs have proven effective. The challenge that remains is to implement this knowledge through a range of interventions that might include legislation and taxation, urban redevelopment and planning, health education and promotion, strengthening health systems and adopting new clinical approaches to NCD prevention and management.
As welcome as this summit was, it is hard to imagine it generating the political commitment, financial investment and momentum towards access to affordable medications that came out of the HIV/AIDS summit a decade ago. A global fund like the one that has since raised $22.4 billion in 150 countries to fight AIDS, tuberculosis and malaria still seems far off for this suite of largely preventable but deadly diseases.
Dr Anushka Patel is a cardiologist, chair of chronic and critical conditions at the George Institute for Global Health and associate professor at the University of Sydney.
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