PHM-Exch> Report from WHO Global Forum on NCDs in Moscow

[Claudio Schuftan]

From: Patti Rundall <prundall at babymilkaction.org>

http://www.washingtonpost.com/world/who-takes-on-chronic-disease/2011/04/29/AF0GBEFF_story.html

WHO takes on chronic disease By Will Englund, Friday, April 29, 2:23 PM

MOSCOW — The World Health Organization focused for decades on infectious
diseases, but now it’s putting non-communicable diseases near the top of its
agenda <http://www.who.int/nmh/publications/ncd_report2010/en/>.

The fight against heart disease, diabetes, stroke, lung cancer and chronic
respiratory disease may not seem as heroic as the struggle against smallpox
or H1N1, but chronic illnesses account for 63 percent of deaths worldwide —
70 percent in the United States and 90 percent in Russia.

“And these are preventable,” said Margaret Chan, director general of WHO, at
a three-day series of meetings here this week devoted to chronic diseases.
“People don’t have to suffer. People don’t have to die.”

No tobacco and less sugar, fat and especially salt are WHO’s top targets;
reducing alcohol consumption and increasing exercise are right behind. Those
factors alone account for 25 million of the 36 million deaths attributable
to chronic diseases annually, according to WHO, and place a huge economic
burden on families and nations.

But a cigarette is not like a microbe: It can’t be eliminated by a doctor.
Fighting chronic diseases requires political decisions — in areas as
disparate as finance, regulatory policy, agriculture, education and trade —
and the will to see them through.

New Zealand farmers dumped “mutton flaps” — fatty cuts they couldn’t sell
elsewhere — on Fiji, until Fiji banned them. U.S. poultry producers marketed
turkey tails in Samoa, before the government there outlawed them. “We have
transnational companies which offload junk food on us,” said Neil Sharma,
Fiji’s health minister.

The cheapest food is the worst. “All our beggars are obese,” Sharma said.
“We’ve got to commit ourselves and say that’s not right.”

*Industry at the table*

Unhealthy food, and what to do about it, was the most sensitive topic at the
gathering here. Representatives of PepsiCo, Coca-Cola and Nestle joined the
discussions after a decision by WHO to allow the big international food
concerns a voice as the organization prepares an agenda for a U.N. meeting
in September. (Tobacco companies were deemed beyond the pale.) Prime
Minister Vladimir Putin talked about the need to enlist the business
community, as did Kathleen Sibelius, the U.S. secretary of health and human
services.

“Did anybody mention conflict of interest?” said Patti Rundall, policy
director for an British group called Baby Milk
Action<http://www.babymilkaction.org/>.
She and others say they worry that lobbying by companies that are part of
the problem will undermine WHO’s efforts.

Janet Voute, of Nestle, said the companies were unfairly blamed for
consumers’ choices, and Herve Nordmann, chairman of the Industry Council for
Development, a trade group, said that “the overfed are voluntarily overfed”
and urged more research into effective ways to exercise. Still, the three
firms here have joined with seven other big producers to form an
alliance<https://www.ifballiance.org/>that says it is committed to
reducing salt, sugar and fat in processed food
and restricting advertising aimed at children.

“Self-imposed voluntary action is a good first step,” Chan said. “Industry
needs to earn trust.”

Give them a chance, Sibelius said in an interview. “The voluntary approach
in the U.S. has begun to yield some pretty impressive results.”

It’s much quicker, for one thing, than getting legislation passed. But, she
added, “there’s definitely a role for regulation.”

*U.S. ‘behind the curve’*

Tobacco provides a model for that. New York City took regulatory steps
against smoking, said Thomas Frieden, head of the Centers for Disease
Control and Prevention and formerly New York’s health commissioner, and reduced
the number of smokers<http://www.nyc.gov/html/doh/nycquits/html/home/home.shtml>by
350,000 over six years. Uruguay has taken even stronger steps, he
said,
and cut the number of smokers there by 25 percent in two years.

Finland tried to reduce the amount of salt in food by seeking voluntary
commitments from manufacturers, with mild success, said Sirpa
Sarlio-Lahteenkorva, an official in the Finnish Health Ministry. But when
the government required salt labeling, consumption dropped sharply, she
said. The same happened when the government increased taxes on alcohol.
(Finland is the world leader in reducing deaths from non-communicable
disease.)

The government of Argentina leaned on the country’s bakeries and, without
resorting to formal measures, got them to reduce by nearly one-third the
amount of salt in bread over a few months, said C. James Hospedales,
coordinator for chronic disease at the Pan American Health
Organization<http://new.paho.org/>.
The big transnational companies are moving too slowly, he said, out of an
unfounded fear that they will lose customers. As long as reductions are done
in stages, consumers’ tastes quickly adjust, he and others said.

“It would be negligent for any country not to implement a salt reduction
plan,” said Graham MacGregor, a professor at the Wolfson Institute of
Preventive Medicine, in London, who helped lead a publicity campaign there
that persuaded manufacturers of processed food to cut salt by 30 percent
over three years. Cutting that much salt worldwide would save 2.5 million
lives a year, he said.

Sibelius said the United States was “late to the table” on non-communicable
diseases. “America’s really behind the curve, compared to some of these
countries, on smoking cessation,” she said. “We’re unfortunately leading the
way on obesity.”

The chronic nature of these illnesses helps to dissipate a sense of urgency
about addressing them. Yet high blood pressure kills four times as many
people around the world as HIV/AIDS, Frieden said — and it costs one
one-hundredth as much to treat.

About 90 percent of those younger than 60 who die from a non-communicable
disease are in developing countries, said Ala Alwan, an assistant director
general at WHO. If no action is taken, WHO expects chronic diseases to
increase 15 percent worldwide in the next 10 years, with much of that coming
in Africa, the Middle East and Southeast Asia. He said WHO hopes to have
lower mortality targets in place in time for the U.N. session in September.
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