WHO takes on chronic disease
By Will Englund,
MOSCOW — The World Health Organization focused for decades on infectious diseases, but now it’s putting non-communicable diseases near the top of its agenda.
The fight against heart disease, diabetes, stroke, lung cancer and chronic respiratory disease may not seem as heroic as the struggle against smallpox or H1N1, but chronic illnesses account for 63 percent of deaths worldwide — 70 percent in the United States and 90 percent in Russia.
“And these are preventable,” said Margaret Chan, director general of WHO, at a three-day series of meetings here this week devoted to chronic diseases. “People don’t have to suffer. People don’t have to die.”
No tobacco and less sugar, fat and especially salt are WHO’s top targets; reducing alcohol consumption and increasing exercise are right behind. Those factors alone account for 25 million of the 36 million deaths attributable to chronic diseases annually, according to WHO, and place a huge economic burden on families and nations.
But a cigarette is not like a microbe: It can’t be eliminated by a doctor. Fighting chronic diseases requires political decisions — in areas as disparate as finance, regulatory policy, agriculture, education and trade — and the will to see them through.
New Zealand farmers dumped “mutton flaps” — fatty cuts they couldn’t sell elsewhere — on Fiji, until Fiji banned them. U.S. poultry producers marketed turkey tails in Samoa, before the government there outlawed them. “We have transnational companies which offload junk food on us,” said Neil Sharma, Fiji’s health minister.
The cheapest food is the worst. “All our beggars are obese,” Sharma said. “We’ve got to commit ourselves and say that’s not right.”
Industry at the table
Unhealthy food, and what to do about it, was the most sensitive topic at the gathering here. Representatives of PepsiCo, Coca-Cola and Nestle joined the discussions after a decision by WHO to allow the big international food concerns a voice as the organization prepares an agenda for a U.N. meeting in September. (Tobacco companies were deemed beyond the pale.) Prime Minister Vladimir Putin talked about the need to enlist the business community, as did Kathleen Sibelius, the U.S. secretary of health and human services.
“Did anybody mention conflict of interest?” said Patti Rundall, policy director for an British group called Baby Milk Action. She and others say they worry that lobbying by companies that are part of the problem will undermine WHO’s efforts.
Janet Voute, of Nestle, said the companies were unfairly blamed for consumers’ choices, and Herve Nordmann, chairman of the Industry Council for Development, a trade group, said that “the overfed are voluntarily overfed” and urged more research into effective ways to exercise. Still, the three firms here have joined with seven other big producers to form an alliance that says it is committed to reducing salt, sugar and fat in processed food and restricting advertising aimed at children.
“Self-imposed voluntary action is a good first step,” Chan said. “Industry needs to earn trust.”
Give them a chance, Sibelius said in an interview. “The voluntary approach in the U.S. has begun to yield some pretty impressive results.”
It’s much quicker, for one thing, than getting legislation passed. But, she added, “there’s definitely a role for regulation.”
U.S. ‘behind the curve’
Tobacco provides a model for that. New York City took regulatory steps against smoking, said Thomas Frieden, head of the Centers for Disease Control and Prevention and formerly New York’s health commissioner, and reduced the number of smokers by 350,000 over six years. Uruguay has taken even stronger steps, he said, and cut the number of smokers there by 25 percent in two years.
Finland tried to reduce the amount of salt in food by seeking voluntary commitments from manufacturers, with mild success, said Sirpa Sarlio-Lahteenkorva, an official in the Finnish Health Ministry. But when the government required salt labeling, consumption dropped sharply, she said. The same happened when the government increased taxes on alcohol. (Finland is the world leader in reducing deaths from non-communicable disease.)
The government of Argentina leaned on the country’s bakeries and, without resorting to formal measures, got them to reduce by nearly one-third the amount of salt in bread over a few months, said C. James Hospedales, coordinator for chronic disease at the Pan American Health Organization. The big transnational companies are moving too slowly, he said, out of an unfounded fear that they will lose customers. As long as reductions are done in stages, consumers’ tastes quickly adjust, he and others said.
“It would be negligent for any country not to implement a salt reduction plan,” said Graham MacGregor, a professor at the Wolfson Institute of Preventive Medicine, in London, who helped lead a publicity campaign there that persuaded manufacturers of processed food to cut salt by 30 percent over three years. Cutting that much salt worldwide would save 2.5 million lives a year, he said.
Sibelius said the United States was “late to the table” on non-communicable diseases. “America’s really behind the curve, compared to some of these countries, on smoking cessation,” she said. “We’re unfortunately leading the way on obesity.”
The chronic nature of these illnesses helps to dissipate a sense of urgency about addressing them. Yet high blood pressure kills four times as many people around the world as HIV/AIDS, Frieden said — and it costs one one-hundredth as much to treat.
About 90 percent of those younger than 60 who die from a non-communicable disease are in developing countries, said Ala Alwan, an assistant director general at WHO. If no action is taken, WHO expects chronic diseases to increase 15 percent worldwide in the next 10 years, with much of that coming in Africa, the Middle East and Southeast Asia. He said WHO hopes to have lower mortality targets in place in time for the U.N. session in September.