A Sick Future

Non-communicable diseases (NCDs), often known as chronic diseases, such as heart disease, cancer, diabetes, asthma and other lung and respiratory diseases are the leading cause of death world-wide each year, causing 36 million deaths in 2008 and accounting for 63 percent of all deaths, 80 percent of them in poor nations where prevention programs are virtually non-existent and access to diagnosis and treatment is very limited. Experts say that over the next 20 years, this epidemic is projected to accelerate and that by 2030, the number of deaths from NCDs could reach 52 million a year. NCDs also account for half of all global disability, including blindness and amputations. Preventing these deaths -- or at least a good proportion of them -- isn't rocket science. Proven measures such as reducing smoking rates, improving diets, making simple drugs available and boosting exercise could knock a huge hole in that figure. Stopping a billion people from lighting up every day or providing cheap drugs like aspirin and statins to prevent heart attacks and strokes may be cost effective, but the payback won't be quick and it is unlikely to win many votes.

"The time horizon for the return on that investment is very long and beyond many political horizons. So it's difficult to get people to commit to these kinds of resources" says Gordon Tomaselli, president of the American Heart Association.

Ten years after committing to fight AIDS, the United Nations is taking on common chronic diseases -- in what is shaping up to be a bruising battle between big business, Western governments and the world's poor. Tobacco, food and drinks companies are in the firing line for peddling products linked to cancer, diabetes and heart disease, while politicians in the rich world are accused of failing to set firm targets or provide funds to tackle the problems. The fear is that big business has successfully lobbied rich governments to be only half-hearted in battling non-communicable diseases, or NCDs, despite predictions that they could cripple healthcare systems of developing countries.

"This is a once in a generation opportunity. We could save millions of lives here, and it's shameful and immoral that industry lobbying has put short-term profits in front of a public health disaster," Rebecca Perl of the World Lung Foundation (WLF) told Reuters. WLF has been involved in preliminary talks for several months. According to those close to the negotiations, a draft version of the political declaration that will form the cornerstone of the U.N.'s thinking on NCDs contains many platitudes but few tangible commitments.

World Health Organization director general Margaret Chan has described tobacco as "an industry that has much money and no qualms about using it in the most devious ways imaginable." With tobacco predicted to kill more than a billion people this century, if current trends persist, the public health lobby says if the U.N. meeting does nothing else, it should at least make a smoke-free world one of its central targets. Smoking alone causes one in three cases of lung disease, one in four cases of cancer, and one in 10 cases of heart disease. Japan Tobacco, for example, is 50 percent owned by the Japanese government, and the massive profits of U.S. cigarette makers bolster the U.S. economy. In China, home to a third of the world's male smokers, the combination of taxes and sales from China National Tobacco -- a wholly state-owned entity -- account for around 9 percent of the government's annual fiscal revenues.
Jaakko Tuomilehto, an epidemiologist at the University of Helsinki says "It's a crazy thing to have a product in the shops that kills every second consumer -- it's madness."

Boyd Swinburn, Professor and director, WHO Collaborating Centre for Obesity Prevention at Deakin University writes.
"Later this month the UN General Assembly will hold a high level meeting on global action on non-communicable diseases such as cardiovascular disease, diabetes and cancer, which are responsible for two-thirds of deaths worldwide. They will release an agreed declaration that is meant to pave the way to reducing the number of premature deaths from non-communicable diseases – or NCDs - the vast majority of which take place in poorer countries. Yet, despite this enormous burden, the governments of the rich countries are joining forces with tobacco, food, alcohol and pharmaceutical corporations to water down commitments that might flow from this meeting.

WHO and public interest groups hoped that agreements on targets and commitments would provide the boost to mobilisation on NCDs that a similar UN meeting achieved for HIV/AIDS a decade ago. This turned out to be a rather naive and optimistic hope. Since the proposed policies include smoke-free environments, restrictions on food marketing to children, increased alcohol tax and the promotion of generic medicines those multinational businesses see them as a threat to the sales of their products, and, as experience has shown, they do not take that threat lightly. (In Europe the food industry spent €1 billion opposing proposals for front-of-pack ''traffic light'' labels on their products.)

The rich countries, particularly the US and EU but also Australia, Canada and New Zealand, are active accomplices in watering down the draft UN statements.

Take for example a clause in earlier documents that related to what it calls the ''development and implementation of cost-effective ways to reduce saturated, transfats, salt and sugar in foods by discouraging the production and marketing of unhealthy foods''. With the help of Australia, Canada and US, that clause is now destined to be excised from the final document. A statement with commitments to tangible outcomes has long been tossed aside and been replaced with a much weaker political statement with all targets and accountability mechanisms removed."

Another unaddressed health problem

Every year, 13 diseases that affect a fifth of the world’s population are responsible for the loss of 56.6 million disability-adjusted life years and 534,000 deaths. But because these diseases only afflict the world’s most impoverished and powerless people, the international community has forgotten about them. Neglected tropical diseases (NTDs) are a group of parasitic worm and bacterial infections that together represent a huge disease burden. The seven most common NTDs are ascariasis, hookworm, trichuriasis, elephantiasis, river blindness, schistosomiasis, and trachoma. A 50 cent integrated package of rapid-impact medications has the ability to safely obliterate these seven diseases. Cheap therapeutics are available for other NTDs as well, but there is little funding for implementation.

Unlike HIV/AIDS, tuberculosis, and malaria, Neglected tropical diseases (NTDs) do not typically kill on their own, but they do lead to massive debility and poverty. Several NTDs also have the ability to either increase susceptibility to or worsen the course of the “big three” diseases — AIDS, tuberculosis, and malaria. Also unlike AIDS, NTDs lack a vocal afflicted but wealthy population to advocate for treatment. Many NTDs are ancient diseases that no longer threaten the developed world. NTDs are largely neglected by the media and donors because they have a lower death percentage, said Dr. Edward T. Ryan, director of the Massachusetts General Hospital’s Tropical Medicine program. “To a large extent, these are chronic diseases that disproportionately affect the most impoverished on the globe,” Ryan said. “They are often not on the radar screen of health funding agencies.”

Women with female genital schistosomiasis, a disease caused by the parasitic blood-fluke (schistosome) contracted by contact with contaminated freshwater, acquire problems ranging from infertility, to bladder cancer, to anemia and stunted growth in children. In addition, women also develop genital ulcers, and thus become much more vulnerable to sexually transmitted diseases, including HIV. A World Health Organization (WHO) working group concluded that there is a possible link between female genital schistosomiasis and HIV acquisition. “This is one of the biggest underlying reasons for HIV” said Dr. Peter J. Hotez, president of the Sabin Vaccine Institute and a leading global health expert. With as many as 45 million women infected with genital schistosomiasis, eradicating schistosomiasis has major implications for halting the spread of HIV as well. A person with an NTD caused by a parasitic worm infection has a greater chance of contracting tuberculosis, and this chance increases with the number of infections. Co-infection of hookworm and malaria causes severe anemia in children and pregnant women, and this contributes to almost half of all deaths due to malaria.

“For relatively small investments,” Ryan added, “major scourges of humanity can be addressed. In terms of cost-effectiveness, a number of experts would say this is very cost effective for the global community.”

SOYMB understands that the demand for a healthier society to be in effect a revolutionary demand, since health-damaging aspects of production cannot be removed in response to political reform.