The rise of chronic noncommunicable diseases: an impending disaster
Dr Margaret Chan
Director-General of the World Health Organization
Excellencies, honourable ministers, distinguished delegates, ladies and gentlemen,
The rise of chronic noncommunicable diseases presents public health with an enormous challenge. For some countries, it is no exaggeration to describe the situation as an impending disaster. I mean a disaster for health, for society, and most of all for national economies.
We must not forget that the same so-called “modernization” that contributes to the rise of these diseases is being accompanied by a growing need for chronic care of mental illness. The burdens are numerous.
I would further suggest that the challenge of combating chronic diseases has some unprecedented dimensions.
For centuries, the microbial world has been the biggest threat to public health. Then came the vaccines, the miracle cures, and the gradual improvements in standards of living and hygiene that helped eliminate the diseases of filth.
These were public health matters. This was our domain. This was our job, and we got quite some spectacular results.
The battle to control noncommunicable diseases is a different kind of fight. Our standard job, things like getting essential medicines to people, taking care of them in hospitals, have become so massively demanding and so massively costly that they threaten the solvency of even the wealthiest health care systems.
Everyone agrees that prevention is by far the better option. But in this case, the policies that promote unhealthy lifestyles throughout entire populations are made in domains beyond the direct control of health.
We can compile libraries full of evidence about the dangers of tobacco and passive smoking, but others have to make the laws for tobacco control and enforce them.
We can tell the world that rates of obesity have nearly doubled since 1980, and we can count the costs to health. But we cannot police the products on the grocery shelves and school lunches or control the fact that the cheapest foods are usually the worst for health.
For many decades, public health has stressed the need for collaboration with other sectors, especially for prevention. For a very long time, these were friendly sectors, almost sister sectors, like education, the environment, water supply, sanitation, and a secure and safe food supply.
Today, many of the threats to health that contribute to noncommunicable diseases come from corporations that are big, rich and powerful, driven by commercial interests, and far less friendly to health.
Forget collaboration with the tobacco industry. Never trust this industry on any count, in any deal. Implement the WHO Framework Convention on Tobacco Control. Doing so can avert around 5.5 million deaths each year at a cost, in a low-income setting, of less than 40 cents per person. There is no other “best buy” for the money on offer.
People do not need to smoke, but they do need to eat and drink. Today, more than half of the world’s population lives in an urban setting. Slums need corner food stores that sell fresh produce, not just packaged junk with a cheap price and a long shelf-life.
Cities need the kind of design that encourages people to walk or cycle and enjoy physical exercise. Children need safe places to play. Patients need essential medicines, packaged and priced to encourage compliance.
Here is a question I would like to ask the food and beverage industries. Does it really serve your interests to produce, market, globally distribute, and aggressively advertise, especially to children, products that damage the health of your customers? Does this make sense in any mission statement with a social purpose?
We know that these industries are not homogenous. Some are taking measures to reformulate their products to reduce fat, sugar, and salt content and to modify their marketing practices. These are most welcome trends.
Ladies and gentlemen,
I have a final point. I strongly believe that the rise of chronic diseases calls for some serious thinking about what the world really means by progress.
Economic development and health development are not at all the same thing. Economic growth improves health only when the right policies are in place, policies that explicitly consider the consequences for health.
Diabetes, which is closely associated with obesity and urbanization, is already consuming nearly 15% of the national health budgets in some countries. Prevalence is skyrocketing in rich and poor countries alike.
What is the net gain if the benefits of modernization and economic growth are cancelled out by the costs, like medical bills, lost productivity, and premature death, of a preventable disease?
Unless they wake up, and take a hard look at policies across-the-board, some countries may very well see that the benefits of economic progress are quite literally cut up and devoured by a knife and a fork.
Rest assured, in this day and age, ever more sophisticated and costly medicines, devices, and technologies will not be able to save the situation. They will not avert an impending disaster. Only smart, farsighted policies can do this.