Freshly published as of 7 hours ago on BMJ as a feature article! The previous BMJ link and the picture above will take you to a toll-free copy of my article provided by BMJ. If it’s too long, check out the synopsis of my piece below.
This week the World Health Assembly (WHA) is happening at the World Health Organization (WHO) headquarters in Geneva, Switzerland. This is an annual meeting where all the heads of 194 Member States in the WHO come together to discuss important health topics. On the top of their agenda this year, as it was last year, are non-communicable diseases (NCDs).
When you think of global health, you may first think of malaria, HIV, tuberculosis, and other infectious killers that have been in the limelight thanks to NGOs like the Bill and Melinda Gates Foundation. What has actually surpassed all of these in recent years are chronic diseases, or NCDs, like cancer, diabetes, lung disease, and cardiovascular disease. In fact, in 2008, NCDs accounted for 63% of the deaths in the world, with 80% of them occurring in developing countries. Chronic diseases are no longer diseases of the rich, stemming from risk factors like alcohol, tobacco, obesity, and smoking. Globalization has spread all of these risk factors to the corners of the world, and now we are seeing their effects on health.
Treating NCDs are not easy. For example, you cannot give a vaccine for prevention or antiretrovirals for treatment. Treating chronic diseases is exactly what the name implies – a chronic process. Without the proper healthcare infrastructure in place, how can we expect chronic care to occur in developing countries? Even in America, we struggle with heart disease which is the number one killer in the country.
All of this means that NCDs are not an easy fix and they are steadily becoming one of the biggest health problems of our time. The WHO is spearheading the effort to design specific targets to meet to attack NCDs based on their risk factors, such as reducing alcohol intake, salt intake, tobacco smoking, and fat intake, among others (9 total targets). My piece focuses on the evolution of the targets since September 2011, when NCDs were first brought to the world’s attention at a UN Summit held in New York City. It turns out the targets have been changed time and time again because each country harbors different political agendas, and the final list of targets and indicators is the result of a year and a half of negotiations and compromise. Throw industry influence (think of the powerful lobbyists working for the alcohol or food and beverage giants) into the mix and you get an added layer of complexity.
As it is with most papers, the most important points of the piece are in the tables, which detail each change in the targets (Table 1) and also country specific sentiment about each target (Table 2). It was personally very interesting to me to see how each region reacted to targets. The US, no surprise here, was very against monitoring alcohol, food, and beverage. That should come as no surprise when you think of how much revenue American alcohol, food, and beverage companies generate.
At the World Health Assembly this week, the heads of all the Member States will vote on the final list of targets and indicators to track in the fight against NCDs. Stay tuned for what their decision reveals about how we will attack this growing epidemic in the next decade.