World leaders place lifestyle choices and health back on the individual

26 Sep 2018

Global leaders have put the onus on individuals to reduce “lifestyle” diseases rather than cracking down on industry in a global declaration to be adopted at today’s UN High Level Meeting on Non-Communicable Diseases.

World leaders have side-stepped taking action against industries that fuel “lifestyle” diseases ahead of Thursday's United Nations High Level Meeting on Non-Communicable Diseases (NCDS).

Instead, the draft political declaration that governments are expected to adopt on Thursday stresses the need to “empower individuals to make healthy choices” and “invites” the private sector to take action against NCDs.

NCDs are responsible for 70% of the world’s deaths, with cancer, strokes, heart disease, diabetes and respiratory diseases being the biggest killers. Smoking, alcohol, diets high in sugar, trans-fat and salt, and lack of exercise are key drivers of NCDs.

Katie Dain, CEO of the NCD Alliance, which represents over 2,000 global civil society organisations in 170 countries, said the alliance “deplored the omission of policy measures such as the sugar, tobacco and alcohol taxes” from the declaration.

“The inclusion of language on ‘empowering individuals to make healthy choices’ fails to recognise that people cannot make healthy choices if the environments in which they live do not provide such choices,” she added.

Meanwhile, global public health organisation Vital Strategies also criticised the emphasis on “empowering individuals” rather than “regulation, legislation or other population-wide interventions to deter consumption of unhealthy products”.

Cutting smoking

In South Africa, for example, the prevalence of smoking was only cut once government imposed higher taxes on cigarettes and made it harder for people to smoke in public spaces. Years of “empowering” individual smokers with information about the dangers of smoker did very little to encourage people to quit.

Yet in the declaration’s clauses on tobacco and alcohol use, obesity and heart disease, its solution is to “empower individuals to make healthy choices”.

The declaration also “invites” industry to reduce the exposure and impact on children by limiting the marketing of unhealthy foods and beverages high in fats and sugar, rather than calling for government regulation.

“Voluntary schemes proposed by industry and its involvement in health policy formation are consistently found to benefit industry profits rather than health,” said Vital Strategies.

As with the political declaration on tuberculosis adopted on Tuesday, one of the biggest sticking points preventing countries from reaching consensus was over the patent rights of the pharmaceutical industry, which are often obstacles to getting cheaper medicine. Unsurprisingly, the USA was the pharmaceutical companies’ biggest supporter and an obstacle in the negotiations to anything perceived to threaten their interests.

Instead of charting a path to cheaper medicine, the declaration simply affirms the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which allows certain flexibility related to intellectual property in relation to essential medicines.

Medicine prices

The price of medicines for many NCDs, particularly cancer, is out of reach of poorer countries, but people living in low-income and middle-income countries – especially in sub-Saharan Africa, central Asia and eastern Europe – are the most likely to die from NCDs.

This is according to an analysis of deaths in 186 countries in 2015, which was published last week in the esteemed medical journal, The Lancet. The analysis was produced by “NCD Countdown 2030”, a collaboration between The Lancet, the World Health Organisation, Imperial College London, and the NCD Alliance.

Women living in Sierra Leone and Cote d'Ivoire were most at risk of dying of NCDs, while Lesotho and Swaziland featured in the 10 most risky countries for women, according to the study.

For men, Mongolia, Kazakhstan, Russia, and Fiji were the most risky countries, while South Africa was 17^th worst.

“Poverty, uncontrolled marketing of alcohol and tobacco by multinational industries, and weak health care systems are making chronic diseases a larger danger to human health than traditional foes such as bacteria and viruses,” said Professor Majid Ezzati, from Imperial College London, who led the study.

“Treatment of hypertension and controlling tobacco and alcohol use alone can prevent millions of deaths from cancer, heart disease, stroke and other NCDs. But there is also a need for affordable high-quality care to diagnose and treat chronic diseases as early as possible,” said Ezzati.

However, there are some positive aspects of Thursday's UN meetings.

“Fifty-nine heads of state are expected, up from zero at the previous meeting in 2014. And we’re seeing governments highlight exciting new innovations, such as Australia’s plain packaging for tobacco and South Africa’s sugary-beverage tax, that we hope will inspire other governments,” said Vital Strategies’ Jose Castro.

In addition, mental health and environmental health, particularly air pollution, also get a mention in the declaration unlike four years ago. DM

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