WHO grapples with chronic disease

Posted Sept. 16, 2011, at 4:40 p.m.
Associated Press photo

LONDON — Everyone knows what it would take to curb the global rise of chronic illnesses like heart disease, certain cancers and diabetes, but getting nations and their citizens to make the essential changes is more than daunting.

This week marks the first time the United Nations will tackle chronic diseases in a special summit in New York City, but it’s uncertain what the meeting will accomplish. There are no concrete targets and even if there were, there would be no teeth to enforce them. There’s no guarantee of money either.

On Sunday, the World Health Organization listed 14 solutions it says could save tens of millions of people. The price tag for all developing countries to adopt these measures is $11.4 billion every year — a figure hard to raise amid a financial crisis.

Noninfectious diseases kill about 36 million people every year, mostly in poor countries. In every region except Africa, these diseases kill more people than the ones that spread like AIDS and tuberculosis. But WHO projects that by 2030, chronic diseases will overpower the other ailments, including AIDS, even in Africa.

The draft document for the U.N. meeting recognizes “prevention must be the cornerstone of the global response.”

Yet there are no firm commitments to cut the number of deaths from chronic diseases or promises to bankroll efforts to combat the problem.

Ann Keeling, chair of the Non-Communicable Diseases Alliance, said real progress isn’t possible without a specific goal.

“If you don’t have a target, you don’t know where you’re going or whether or not you’re going to get there,” she said. Keeling said officials should set an overall goal, like reducing the number of preventable deaths by 25 percent by 2025.

Previous efforts for infectious diseases led to specific strategies, like the campaign to put 3 million people on AIDS drugs by 2005 or the malaria strategy to get bed nets to everyone who needs them by 2015.

In contrast, the U.N. chronic diseases document simply calls for options to be submitted by the end of 2012 and says another meeting will be held in 2014 to assess progress.

Still, all of the WHO recommendations are cheap, with an average cost of under $1 per person per strategy. They include things like:

  1. Raising taxes on tobacco and alcohol.
  2. Convincing food manufacturers and consumers to cut back on salt.
  3. Promoting public awareness about good diet and exercise habits.
  4. Providing generic drugs for people with diabetes and those at risk of heart attacks and strokes.
  5. Screening and early treatment of precancerous lesions to prevent cervical cancer
  6. Rolling out hepatitis B immunization to prevent liver cancer.

“Compared to some of the most cost-effective interventions in health like vaccines, these are a very good buy,” said Dan Chisholm, a WHO expert on the issue. He emphasized the agency’s role was only to draw up suggestions. “We can’t force countries to do anything.”

Even in rich countries, there hasn’t been much appetite to make major policy changes to fight chronic diseases. Europe has the world’s highest level of alcohol problems, yet in the wine-producing countries of Italy, Portugal and Spain, there is no tax on wine. In the U.K., health experts rail about the dangers of binge drinking and lament rising alcohol-related cirrhosis rates, but the government has so far refused to limit alcohol sales or hike taxes.

Fighting flab — obesity raises the risk for most chronic diseases — has been no easier. British chef Jamie Oliver recently called on the U.N. summit to make obesity a global human rights issue. Yet when Oliver introduced healthy lunches in a handful of British schools several years ago, children fought back by boycotting the cafeterias. Some parents even shoved hamburgers, pizza and french fries to hungry children through schoolyard fences.

Martin McKee, a public health expert at the London School of Hygiene and Tropical Medicine, said poor countries are even less willing to take on the alcohol, food and tobacco industries. “Developing countries are heavily lobbied by industry and often represent the corporate interest, not what’s best for their citizens,” he said.

In parts of Asia, the Middle East and eastern Europe, tobacco giants including Philip Morris have worked to weaken tobacco legislation and offered to write countries’ tax codes.

Last week, more than 140 health groups called on the U.N. to set guidelines to manage potential conflicts of interest in their dealings with the food and beverage industry. “Without such safeguards, policies and recommendations will invariably be weakened to suit the interests of powerful corporations,” the coalition said in a letter to the medical journal, Lancet.

Many countries are also unwilling to turn into nanny states that closely monitor their citizens’ eating, drinking and exercise. “Addressing (chronic diseases) requires behavior change and most countries are very bad at this because it’s so complicated,” said Sophie Harman, a global health expert at City University in London.

She said most countries would likely voice support for WHO’s chronic diseases solutions but she wasn’t convinced much more would be done.

“All countries say they need to tackle these issues,” she said. “But the implementation is difficult and then all you’re left with is the rhetoric.”

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