Heart Disease, Diabetes to Take Center Stage at U.N.
A doctor measures the blood sugar level of a patient with diabetes. Photo by Carsten Koall/Getty Images
For only the second time in history, the U.N. general assembly will hold a high-level meeting on a health issue later this month. On the agenda: the global problem of non-communicable diseases including diabetes, cancer and heart ailments. The last time such a meeting was held was in 2001, and the U.N. was addressing HIV/AIDS.
Member country representatives have been hammering out a non-communicable disease declaration, or action plan, which will get final approval when heads of state and government meet Sept. 19 and 20. The process has hit delays and setbacks, including resistance from some member countries to setting hard targets for reducing disease. On Wednesday, the draft was completed and tentatively agreed upon, reported the NCD Alliance, a group representing international federations for cardiovascular disease, diabetes, cancer, and chronic respiratory disease.
NCD Alliance Chair Ann Keeling spoke with the NewsHour about the result, and the work still ahead (answers have been edited for length):
NewsHour: What can we expect to see in this agreement, and does it meet the level of commitment you were hoping for?
Ann Keeling: I think what we see in the document is some very strong language on non-communicable disease issues and on the solutions. We are very pleased to see that — two years ago it would have been unthinkable that we could have got that sort of understanding and coverage of NCDs, so the whole summit process has really moved NCDs into a different place on the global health agenda.
The fact that we’ll have heads of state signing off on that strong statement is very positive, so that’s the good news.
What the document won’t have is one strong overarching target, and we were hoping for a global mortality target [such as the WHO recommendation of cutting preventable deaths from NCDs by 25 percent by 2025] because basically if you don’t have a target, you don’t know what you’re aiming for you’ll never know if you got there and there can’t be proper monitoring or accountability.
There won’t be any indicators or targets for important issues for us, like the provision of essential medicines.
There is [no commitment] on resources. We didn’t expect at this point, in the middle of a global financial crisis that there was going to be new money on the table, and we fully understand that. But what we’ve been trying to do through this process is help governments understand that if they prevent NCDs and if they invest in early diagnosis and treatment they will save money.
The point of getting heads of government to the table is to get the political commitment to go forward. So we’ve got strong language but not the time-bound commitments that we need.
Without new resources, without hard targets in this document, what will it take to start to turn the tide on NCDs?
I think what will really turn this epidemic around is really what turns AIDS around, which is when the people with these diseases stand up and demand the right to health and the right to universal access to medicines that they need. I think at the moment, generally people with NCDs are not yet mobilized in the way that people with AIDS have been mobilized and I think that movement is growing.
I think what we will see in the future is people with these diseases standing up and saying this is a human rights abuse. When I look at diabetes, the main treatment drug for diabetes, insulin, was discovered 90 years ago and yet there are children dying in low income countries today because they don’t have access to insulin. It is a complete outrage. What we don’t have yet around NCDs is that sense of outrage but we see that building.
Why is the U.N. looking at non-communicable disease at this time?
The reason we asked for a global meeting was that these issues have been discussed at the World Health Assembly by health ministers for quite some time, and they weren’t getting the prominence that they needed. In general there has been a complete blindness to the growth of these diseases to the point where they got to epidemic level.
There are now more that 300 million people in the world with diabetes and that number will rise to 500 million and above before we can even begin to turn it around. And the figures for the other NCDs are similar. We are at crisis point. Many of these issues that need to be sorted out are beyond the nation state, so when we look at issues like the global food system and how we make sure that we get everybody not only enough to eat, but healthy food to eat.
We needed a global action plan on all of this, and that’s why we wanted heads of state to come to the table, in order to get the political will.
Is there good understanding among the public that non-communicable diseases are global issues?
No. There are a whole lot of myths around NCDs, and one of the major myths is that they only affect the rich and the elderly. Because a lot of people, even those working in the global health business are very surprised to be told the extent of the numbers — when we tell them that four out of five cases are now in low and middle income countries. So it’s not that high income countries have got rid of [these conditions], it’s just that its spread.
What are some of the ways countries could reduce their NCD burden?
There are a couple things they should all do. First off, look at what they can do in terms of primary prevention. They should be looking at anything they can do in terms of the built environment and the way cities are designed, what happens in school, to encourage an active lifestyle.
Secondly they should be looking very closely at what they can do to encourage healthier food, looking specifically at the marketing of food and alcohol to children, that’s something that all countries can look at and do something about right now because childhood obesity is a huge issue and rising.
They should be looking at how they are spending money inside their health systems. They should be looking at investing upfront in early diagnosis and treatment as an investment and a measure for good health.
We need governments to be investing in public awareness campaigns because the public also have a duty to be looking after their own health and doing whatever they can to prevent NCDs, because the majority of NCDs can be prevented or delayed. And delaying the onset of an NCD like diabetes from maybe 40 to 60 will have a huge impact on the cost of that disease for the individual and the health system [and] also the quality of life.
So there are actions that every government could take, and we would ask every government now to raise tobacco taxation up to the level the WHO recommends.
Are there any specific recommendations in the document on things like junk food or cigarettes?
We’ve been trying to encourage governments to raise domestic revenue particularly through tobacco taxation. So we have statements on resources in there on tobacco taxation, but not as strongly as we would have wanted.
There are some strong statements on prevention, around food content. But we would have liked some targets in there.
There was at one point in the negotiations a target on the reduction of salt in food. That was on the table but that got lost and it’s not in the final document so that’s a shame.
Our feeling is that the private sector, the food and beverage industry in particular has gone some way with voluntary regulations. Some companies like Pepsi Co. have gone quite some way, removing salt, fat, sugar from their food, but it will never go far enough without regulations.