Prevention is best option to tackle noncommunicable diseases
Dr Margaret Chan
Director-General of the World Health Organization
Your royal highnesses, excellencies, honourable ministers, colleagues in public health, ladies and gentlemen,
It is a great pleasure to address a group that represents so many parts of the world, so many associations and societies with disease expertise, and so many advocates for healthier lifestyles. It is equally encouraging to see the engagement of royalty, sister UN agencies, funding agencies, and leaders in health and development.
The diverse and high-level expertise represented in this room is itself a statement about how deeply we need to be concerned and how broadly we need to engage.
We have a problem. This is a big problem that looks destined to grow even bigger. Noncommunicable diseases, long considered the close companions of affluent societies, have changed places. Cardiovascular disease, cancers, diabetes, chronic respiratory diseases, and mental disorders now impose their greatest burden on low- and middle-income countries. Diseases once associated with abundance are now heavily concentrated in poor and disadvantaged groups.
To a large extent, this shift in the disease burden can be attributed to some powerful global forces that are shaping health conditions everywhere. Demographic ageing, rapid unplanned urbanization, and the globalization of unhealthy lifestyles are universal trends, but the consequences are not evenly felt. Developing countries have the greatest vulnerability and the least resilience. They are hit the hardest and have the least capacity to cope.
Though many noncommunicable diseases develop slowly, lifestyle changes are taking place with a stunning speed and sweep.
These trends have tremendous implications at a time when the international community is pursuing better health as a poverty-reduction strategy. The costs of chronic care can be catastrophic for patients as well as health systems, driving many millions of households below the poverty line each year.
When we think about the burden of chronic care, we face a second widely held assumption that no longer holds up under scrutiny. Deaths from noncommunicable diseases were long considered inevitable companions of the ageing process. We frequently heard their importance dismissed like this. Well, we all have to die from something, sometime. Maybe so, but not so early in life.
Of the estimated 35 million yearly deaths from noncommunicable disease, around 15.8 million, or 40%, are premature deaths from preventable heart attacks, strokes, diabetes, and asthma.
And it is not just deaths that count when we think about the burden of these diseases. Diseases like diabetes and asthma, often requiring life-long care, can have their onset in childhood. Hypertension and some cancers can occur in children and young adults.
Moreover, this is a world in which an estimated 43 million pre-school children are obese or overweight. Think of what this means in terms of life-long risks to their health and the life-long costs of care.
And one other thought: this could be the first generation of children, in a very long time, that has a life expectancy shorter than that of their parents. Think about what this means as a measure of our collective social and economic progress.
Ladies and gentlemen,
You are gathered here to mount a focused and forceful policy response to noncommunicable diseases. These are complex, multifaceted diseases tied to powerful global trends that are not easily reversed. Faced with such complexity, it is wise to simplify. You have done so.
NCDnet focuses on the big four diseases: cardiovascular disease, cancers, diabetes, and chronic respiratory disease. These diseases currently account for 60% of all annual deaths worldwide.
NCDnet focuses on the big four risk factors: tobacco use, unhealthy diets, physical inactivity, and the harmful use of alcohol. These risk factors are shared, which simplifies the operational approach, and they can be modified, which opens the prospects for prevention.
NCDnet also focuses on four biological risk factors: raised blood pressure, raised cholesterol, raised blood sugar, and a high body mass index. Again, this simplifies the operational approach to screening, early detection, and the targeting of interventions.
But let me state the obvious. Anything we can do to simplify the operational approach is so important because the challenges, like the diseases themselves, are huge.
Developing countries are still struggling with infectious diseases and weak health systems. They face grossly inadequate numbers of staff, shortages of medicines and funds, and a sometimes total lack of insurance schemes to protect patients from catastrophic health care costs. Weaknesses in public health services drive patients to the more costly, often unregulated private sector, even for routine care.
In large parts of the developing world, health systems are geared to the management of episodes of infectious illness, in which the patient either survives or dies. Needless to say, such health systems very poorly prepared to cope with the demands and costs of chronic care.
Prevention is by far the better option. We need to focus on population-wide measures that make it easier for people to adopt healthy lifestyles. To do so, we need to engage other sectors in a whole-of-government approach. To do so, we have to be prepared to meet some powerful opposition from some powerful lobbies. But it can be done.
Ladies and gentlemen,
We have a huge problem surrounded by huge challenges. But we also have a huge opportunity. We must be sure to seize it.
Public health has been here before, like in the early days of the HIV/AIDS epidemic, like with the early warnings that smoking was linked to lung cancer. We missed these opportunities. We have seen a big problem coming, but could not muster the resolve to address it, head-on, forcefully, before it got out of hand.
Today, we have a global strategy and an agreed action plan, with clearly defined strategies and responsibilities. We have the Framework Convention on Tobacco Control as a model for collaborative action that gets multiple sectors working together to prevent a leading cause of illness and premature death at its source.
The January Executive Board moved forward on two additional policy instruments. These define a number of flexible policy options, supported by measures of proven effectiveness and cost-effectiveness, for addressing the harmful use of alcohol and curbing the marketing of unhealthy foods and beverages to children.
We have backing from the Commission on Social Determinants of Health and from the renewed commitment to primary health care.
We have a solid body of evidence and experience. In terms of noncommunicable diseases, many developing countries are where affluent countries were some decades ago. As we know, many of these countries have mounted successful campaigns against heart disease and cancers. The sharing of these valuable experiences is another compelling reason for international and intersectoral collaboration through an initiative such as NCDnet.
Ladies and gentlemen,
I have a final point to make, and this concerns the issue of fairness. Blood pressure can be measured. Hypertension and high cholesterol can be controlled. Diabetes can be detected early and managed, whether pharmacologically or through diet.
Asthma can be managed. Cancer can be treated, sometimes cured. Cancer pain can be relieved, cheaply and effectively, in nearly all patients.
This is the human face of your agenda. Prevention is likely to bring the greatest gains. But unnecessary, unrelieved human suffering, for whatever the reason, must likewise compel us to take action.