NCDs: Sleepwalking into a sick future
In my home country, Swiss citizens do not take kindly to the state trying to nudge them towards a healthier lifestyle. Be it smoking, alcohol, sugar in food or a lower level of salt consumption, they are quick to rant about the Taliban at the Federal Office of Public Health. Proposals for increased public health prevention fall at the first hurdle in Parliament. Even though people complain about rising healthcare expenditures and health insurance premiums, measures to foster a healthy lifestyle and diet are unpopular and spending on prevention is held in strict check.
However, evidence on the impact of lifestyle on non-communicable diseases (NCDs), such as cardiovascular illness, diabetes, lung problems and certain types of cancer, is overwhelming. It is in a way ironic that the enormous increase in NCDs is a downside of growing prosperity in developing countries especially. It is no coincidence that last week’s WHO Global Conference on Non-communicable Diseases took place in Montevideo, Uruguay is considered a role model among health experts because of its action plan on containing NCDs. The host, the 77-year-old cancer specialist President Tabare Vazquez, stands for this. He is breaking new ground in the fight against tobacco consumption, cracking down on tobacco ads and even won a big court victory over tobacco giant Philip Morris. The drinks industry is his next target.
Excessive alcohol consumption, unhealthy diet and increased physical activity were topics discussed at the summit in Montevideo. Policies tackling those issues are, however, more controversial than for smoking whose hazardous effects are uncontested. There are alarming numbers on the increase of obesity and type 2 diabetes from an unhealthy diet and insufficient physical activity, particularly in developing countries. Yet behavioural changes are hard to achieve. What’s more, we all feel an instinctive resistance against a nanny state which spoils our pleasure in eating sweets and salty food. What a doctor told me from his own experience a couple of years ago is true: Most patients find it easier to take a daily statin to combat high cholesterol levels than changing their diet and taking more exercise.
Nevertheless, countries are experimenting with taxation to control the consumption of alcohol and sugary or salty food. Such measures against the creeping NCD epidemic that accounts for three quarters of deaths cannot be imposed throughout the world – they need local support first and foremost. The contribution of the private sector such as the pharma industry is now viewed more favourably than it was a couple of years back. If barriers restricting access to essential medicines for treating diabetes, high blood pressure and cancer are to be reduced, public private partnerships are crucial.
So while the summit hit the news headlines for other reasons, its real and urgent message was the wake-up call to politicians from the likes of NCD Alliance’s Katie Dain (@KatieDain1). She painted a picture where in eight years, by 2025: “Well over 320 million people will have died from an NCD since today. That is the equivalent of the entire US population today, wiped out by one set of diseases. And over 120 million of those deaths will have been preventable”. She continued: “Governments are failing their populations and sleep walking into a sick future. How many more reasons do we need for taking action on NCDs?”
Regardless of the unity on summit recommendations and of the ambitions for next year’s High-level Meeting on NCDs, to be held under the auspices of the President of the UN General Assembly, one must be realistic: NCD strategies may be high on political agendas but when it comes to health budgets they are rarely a political priority.
This blog was first published in German on Basler Zeitung on 22 October 2017.