Non-Communicable Diseases: Beyond International Health (I)

The global non-communicable disease (NCD) burden has taken centre stage on this year’s international health agenda. According to a recent UN Secretary-General’s report, 36 million people die annually from NCDs, amounting to 63 per cent of global deaths. Of those, nine million people die before the age of 60, and 90 per cent of deaths occur in developing countries. Such trends have socio-economic implications and pose prominent challenges to human security worldwide.

It appears that this year, the UN and its partner agencies are seeking to raise the profile of the NCD burden. So far, we have witnessed twomajor international events focused on NCDs: the WHO Global Forum on NCDs, the First Global Ministerial Conference on Healthy Lifestyles and Noncommunicable Disease Control in Moscow. Additionally, the UN High-level Meeting on Non-Communicable Diseases set to take place in New York from 19 – 20 September.  It is interesting to note that this is only the second time in the UN’s history that the General Assembly and heads of state and government have come together to discuss what has been touted “an emerging health issue with a major socio-economic impact” – the first was on HIV/AIDS a decade ago.

However, these efforts have also received their share of criticism. The draft statement on NCDs issued by the High-level Meeting was labelled weak and disappointing by the NCD Alliance, an international organisation comprising 2,000 health groups. They argued that the draft offered no new targets or commitments towards combating the four most common types of NCDs – cardiovascular diseases, diabetes, cancers and chronic respiratory diseases, or their four main risk factors – tobacco use, unhealthy diets, physical inactivity and harmful use of alcohol.

Furthermore, the tackling of NCD risk factors raises many questions related to the balance between trade and public health interests, particularly tobacco trade and consumption. Tobacco, a leading risk factor for almost all NCDs, is considered responsible for more than two-thirds of lung cancers, 40 per cent of chronic respiratory disease, and 10 per cent of cardiovascular disease.

Managing the tobacco issue is proving especially tricky for the United States, which is expected to uphold its credibility on global health while being the world’s largest tobacco exporter and seeking to maintain and enlarge foreign markets for their products. Diatribe in response has been aggressive:  some within the medical and political community have called to exclude tobacco from trade agreements altogether. Tobacco companies have also defended their interests, calling to eliminate tobacco tariffs, block large health warning labels on cigarette packs, and expand markets in low- and middle-income countries.

Although at first glance the NCD issue comes across as purely a health concern, upon closer inspection, a myriad of connected challenges, especially those related to trade, render the international management of NCDs a far more ambitious project than it appears. It remains questionable as to whether the optimistically-worded Moscow Declaration on NCDs, product of the Global Ministerial Conference, will pave the way to effective action. My next blog entry will assess the outcomes of the High-level Meeting within the context outlined here.