Fighting chronic disease
The Bulletin interview with Catherine Le Galès-Camus.
Dr Catherine Le Galès-Camus earned her PhD in Economics from the University of Paris in her native France in 1981. She joined the French National Institute for Health and Medical Research the following year, where her areas of research were measuring people’s quality of life and their lifestyle preferences, the economics of disease prevention and an economic appraisal of medical technology. Before joining WHO, she was a scientific adviser to the Director-General of Health in France, where she was responsible for defining French public health objectives for 2004–08. She was appointed Assistant Director-General of WHO’s Noncommunicable Diseases and Mental Health cluster of departments in July 2003.
Raising awareness is key to fighting chronic diseases, mental illness and injuries. Many health ministers of WHO’s 192 Member States place this group of diseases and conditions high on their public health agendas. The challenge now is to persuade other ministers to come on board and put health first.
Q: What is the mission of the Noncommunicable Diseases and Mental Health cluster?
A: Many people working for development agencies and many stakeholders in public health are often surprised to hear that these diseases are responsible for more than 70% of mortality worldwide. We raise awareness and help countries to develop appropriate policies. We promote health, provide global leadership and develop support for countries to reduce the huge toll of noncommunicable diseases.
Q:What are the simple, inexpensive forms of promotion and prevention of health risks to fight chronic disease?
A. There is great diversity among noncommunicable diseases but they have common risk factors. Preventing these risk factors means you can tackle a whole range of diseases. For example, if you ban tobacco advertising and levy taxes on cigarettes — these are very cheap and effective measures — you reduce tobacco consumption and can tackle cancer and cardiovascular disease among many others. It’s a win–win strategy. With road safety, it’s important to raise awareness about the importance of wearing helmets and seat belts, and for countries to develop laws to limit speed and on drunk driving.
Q: Are there many countries without these kind of interventions?
A: Yes unfortunately. But we need to convince countries that they can make a difference with many cheap but effective interventions. We are developing tailored packages for countries, for example, on nutrition. In a number of countries you find people with malnutrition and others who are overweight or obese. We provide a comprehensive policy package to help such countries address the whole spectrum of nutrition-related problems.
Q: How are you tackling the growing burden of cancer, diabetes and heart disease in developing countries, where lifestyles are catching up with western lifestyles at an alarming pace?
A: We need to get noncommunicable diseases, mental health and injuries higher on the agenda. That means that we need to provide evidence that these are a problem in developing countries. There needs to be very good quality information on the epidemiological situation. Second, we need to develop policy that can easily be implemented; for example, the WHO Framework Convention on Tobacco Control, the Global Strategy on Diet and Physical Activity, the World report on road traffic injury prevention, etc. We have already been able to develop most of these policies. The next challenge is to convince countries they can implement them without compromising other efforts.
Q: How do you persuade governments to address chronic disease risk factors such as high blood pressure, obesity and inactivity in regions where many people live on less than US$ 1 a day?
A: Chronic diseases constitute 60% of the global burden of disease. No country can have sustainable development without controlling these diseases. It’s not a problem that only affects rich people. We have growing evidence to show that these conditions are affecting the most vulnerable groups of the population — the poor — the people who left rural areas to move to the city, who left behind their family and their way of life. These are the most exposed and often they don’t have access to health care. There is no need to convince ministers of health. The problem is that many of the solutions — banning tobacco advertising and raising taxes on tobacco products — are not fully under the responsibility of the ministers of health. Our challenge is to involve a range of stakeholders, including the private sector, communities, civil society and individuals.