Faced with the need for fiscal belt-tightening, French ministers provoked the ire of Coca-Cola last week when they proposed a way to fill the government’s pockets while helping to tackle their citizens’ growing waistlines.
In a move that sparked threats of an investment freeze from the US soft drinks company, they pledged to raise taxes on sugary drinks from the start of 2012, with the aim of “nudging” people to consume less while raising €120m ($166m) a year, at least part of which would be spent on public health measures.
The action is the latest in a series of assertive measures adopted by governments around the globe seeking to tackle the growing economic and social burden of “non-communicable diseases” (NCDs), a theme to be debated for the first time by world leaders at the UN on Monday.
The host city, New York, has been one of those at the forefront of a series of imaginative programmes, banning trans-fats in food and smoking in public places, compelling restaurants to display calorie counts on menus, issuing public health warnings on sugary drinks and promoting innovative building designs that encourage people to take the stairs rather than escalators or lifts.
Yet, while long seen as illnesses of the industrialised world, the “big four” non-communicable killers – cardiovascular diseases, cancers, chronic respiratory illness and diabetes – are now also responsible for the majority of deaths in the developing world, outstripping infectious diseases such as HIV and malaria everywhere except in parts of Africa.
Jean-Claude Mbanya symbolises the trend. When he joined the ranks of Cameroon’s handful of diabetes doctors three decades ago, his clinic had just a few patients. Today, he looks after 8,000. His rising workload – and his election as president of the International Diabetes Federation, representing patients worldwide – highlight just how far “lifestyle” diseases and the risk factors behind them have spread beyond rich countries.
“We have moved away from our traditional cultures towards a western lifestyle associated with prosperity,” he says. “It is good, but it brings a trend to be more sedentary, not eat the right foods, not exercise enough, and to drink and smoke more.”
The latest estimates from the World Health Organisation suggest 36m of the 57m deaths globally in 2008 were caused by NCDs, with the vast majority in developing countries, where they disproportionately affect people under 60.
They already cost some countries more than 7 per cent of gross domestic product, according to a review issued this week by the World Bank. It also highlights that many of these deaths could be prevented, given that they have four main causes: tobacco use, alcohol consumption, unhealthy diet and lack of physical activity.
Measures to tackle these causes are at the heart of the draft UN political declaration due to be formally approved.
In the negotiations over the past few months health advocates struggled to maintain its tough language, although last-minute interventions reinstated the importance of taxes and marketing controls to reduce smoking, despite resistance from some tobacco-producing countries.
Ann Keeling, chief executive of the NCD Alliance, which represents non-governmental organisations specialising in tackling the diseases concerned, says: “All is not lost. There are some extremely strong statements in the text that would have been almost inconceivable two years ago.”
Yet, she highlights the removal in the declaration of any specific targets, such as a draft commitment to reduce salt consumption.
A decade ago, the only previous UN high-level meeting focused on disease, HIV in that case, led to a strongly worded statement that started a revolution in funding and treatment around the world.
Today, many question whether the much tougher economic conditions and the far broader and more complex issues around NCDs will make progress more difficult. Even with all the funding and focus given to HIV since the millennium, prevention has proved much slower and more difficult to tackle than treatment. Analysts caution that while the latter requires funding and medical support, the former involves complex psychological changes in behaviour and factors beyond individuals’ control, such as working conditions, town planning, agriculture and the environment.
Richard Smith, who runs Ovations, an organisation tackling the problems in developing countries, says: “Have you ever met anybody in the street or at a dinner party who knows what NCDs stands for and why they matter? We have a long way to go.”
Professor Peter Piot, head of the London School of Hygiene and Tropical Medicine and former head of the UN’s Aids agency, says: “Even though I’m an HIV guy, I’m convinced that non-communicable diseases are the biggest threat to global health. This may be the straw that breaks the camel’s back of health services.”