Noncommunicable diseases damage health, including economic health

Dr Margaret Chan
Director-General of the World Health Organization

Address at the High-level meeting on noncommunicable diseases, United Nations General Assembly
New York, United States of America

19 September 2011

Excellencies, Heads of State, Heads of Government, Ministers, Mr President of the UN General Assembly, Mr Secretary-General, Your Royal Highness Princess Dina Mired, distinguished delegates, ladies and gentlemen,

First, let me commend your leadership and courage in addressing and tackling noncommunicable diseases. I am honoured to address this session, and I am strong in my conviction that this meeting must serve as a wake-up call.

But not for the medical and public health professions. We are already wide awake, and with deep concerns. We know the statistics and the ominous trends that now encircle the globe. We know what lies ahead.

Right now, medical and health professionals see the patients, dispense chronic care, manage the complications and disabilities, write the medical bills, and agonize over the huge costs to families and societies. We plead for lifestyle changes and strict tobacco regulation.

But health ministries, acting alone, cannot re-engineer societies in ways that protect entire populations from the well-known and easily modified risks that lead to these diseases. And this is what needs to happen. This meeting must be a wake-up call for governments at their highest level.

This must be a watershed event, with a clear before and after. With ignorance, complacency, and inertia replaced by awareness, shock, and the right actions, right away.

Why must this responsibility fall on heads of state? Because the problem is too big and too broadly based to be addressed by any single government ministry.

Because the rise of these diseases is being driven by powerful, universal forces, like rapid urbanization and the globalization of unhealthy lifestyles. Because the response to these trends must come with equal power, with top-level power that can command the right protective policies across all sectors of government.

Ladies and gentlemen,

The worldwide increase of noncommunicable diseases is a slow-motion disaster, as most of these diseases develop over time. But unhealthy lifestyles that fuel these diseases are spreading with a stunning speed and sweep.

I can understand why some developing countries are being taken by surprise by the onslaught of these diseases. Their initial burden was greatest in affluent societies with strong R&D capacities to develop ever-better treatments.

When drugs are available to reduce blood pressure, lower cholesterol, and improve glucose metabolism, the situation looks somehow under control. This appearance is misleading and blunts the urgent call for policy change.

The root causes of these diseases are not being addressed, and widespread obesity is the tell-tale signal. Worldwide, obesity rates have almost doubled since 1980.

This is a world in which more than 40 million pre-school children are obese or overweight. This is a world where more than 50% of the adult population in some countries is obese or overweight.

Obesity is the signal that something is terribly wrong in the policy environment. Widespread obesity in a population is not a marker of failure of individual willpower, but of failure in policies at the highest level.

Processed foods, very high in salt, trans fats, and sugar, have become the new staple food in nearly every corner of the world. They are readily available and heavily marketed. For a growing number of people, they are the cheapest way to fill a hungry stomach.

The world certainly needs to feed its population of nearly 7 billion people. But it does not need to feed them junk food.

Just as you cannot hide obesity, you cannot hide the huge costs of these diseases to economies and societies.

These are the diseases that break the bank. Left unchecked, these diseases have the capacity to devour the benefits of economic gain. In some countries, for example, care for diabetes alone consumes as much as 15% of the national health care budget.

A recent World Economic Forum and Harvard University study estimates that, over the next 20 years, noncommunicable diseases will cost the global economy more than US$ 30 trillion, representing 48 percent of global GDP in 2010.

In large parts of the developing world, these chronic conditions are detected late, when patients need extensive and expensive hospital care for severe complications or acute events. Most care for these diseases is covered through out-of-pocket payments, leading to catastrophic medical expenditures.

For all these reasons, noncommunicable diseases deliver a two-punch blow to development. They cause billions of dollars in losses of national income, and they push millions of people below the poverty line, each and every year.

Ladies and gentlemen,

These diseases break the bank, but they are largely preventable through cost-effective measures. Some have an especially big pay-back.

For example, full implementation of the WHO Framework Convention on Tobacco Control would bring the single biggest blow to heart disease, cancer, diabetes, and respiratory disease.

I call on heads of state and heads of government to stand rock-hard against the despicable efforts of the tobacco industry to subvert this treaty. We must stand firm against their open and extremely aggressive tactics.

In terms of demand reduction, increases in tobacco taxes and prices are the most effective measure. They not only protect health. They bring in considerable revenue. The same is true for taxes on alcohol.

Salt in processed foods is a major reason why daily salt intake in most countries exceeds the WHO-recommended level. Salt reduction is one of the most cost-effective, feasible, and affordable public health interventions.

At the individual level, people at high risk of cardiovascular disease can be protected with a very low-cost regimen of generic medicines.

Ladies and gentlemen,

As I said, this high-level meeting on noncommunicable diseases must be a watershed event.

In the absence of urgent action, the rising financial and economic costs of these diseases will reach levels that are beyond the coping capacity of even the wealthiest countries in the world.

Excellencies, you have the power to stop and reverse the noncommunicable disease disaster. You have the power to protect your people and keep your development efforts on track.

Thank you.