Monday, September 26, 2011

Dracula In Charge of Blood Bank Security

The United Nations held a special summit recently to discuss a Public Health problem which is poised to affect all four corners of the world and nearly every country: Non-Communicable Disease (NCD). The United Nations has met in the past to conduct planning meetings and summits, like the one in 2001 which focused on fighting HIV/AIDS globally. But this summit was a bit different, because the focus was not malaria, HIV or Tuberculosis, but non-communicable or preventable disease. According to the World Health Organization (WHO), non-communicable disease is "poised to kill three in five people worldwide, and cause great socioeconomic harm within all counties, particularly developing nations" (WHO, 2011). That is a global public health threat as real as the "black plague" which killed one third of the world's population centuries ago.
With European, Eastern and American financial markets on shaky ground as it is, we certainly do not need a global health threat to send stocks and consumer confidence over the edge.  But, that is very well what we could be facing if these public health issues are not addressed straight on. According to NPR news station KPLU in Seattle, WHO Director-General Margaret Chan states that “Left unchecked, these costly diseases have the power to devour the benefits of economic gains, sending millions of people below the poverty line” (KPLU, 2011). She goes on to say that “when a problem like obesity is so widespread throughout a population, the cause is not a failure of individual willpower, but a failure of political will at the highest level.” (KPLU, 2011). Given the dire implications laid out by the WHO, the United Nations decided to act in conjunction with media, academia, medical professionals, special interest groups, pharmaceutical companies to develop a preliminary plan of attack which could save money and lives. Unfortunately, according to post-summit reports of the summit, the final result is less than stellar.

Addressing the cost of action and the cost of in-action is necessary to weigh how important this issue is to public health. The International Diabetes Federation (IDF) was lobbying at the U.N. Summit to gain money for "a disease it estimates costs $465 billion annually to treat" (KPLU, 2011). The IDF estimates that "In two years, the global estimate of people with diabetes -- a disease mostly associated with obesity -- jumped 28 percent to 366 million" (KPLU, 2011). It is important to decipher that in many of those cases, the IDF (may be) referring to Type II Diabetes which is preventable via exercise and proper diet. Other diseases, such as heart disease can be treated for as little as $1.20 a day, according the the WHO (KPLU, 2011). According to the Malta Independent Online, "the price tag for all developing countries to adopt these measures is $114.4 billion every year-a figure hard to raise amid a financial crisis" (Malta Independent Online, Sept. 26, 2011).

"Non- communicable diseases like cancer, diabetes, and heart and lung disease that the World Health Organization says will cost the global economy more than $30 trillion over the next 20 years" (Bloomberg News, Sept. 26, 2011) .
What's the hold up then? Why wouldn't we be educating the public (globally) about nutrition and exercise and thereby reducing the costs of preventable disease and death around the world? It sounds like a "no brainer." The short answer is lobbying from corporations...

Tom Paulson of KPLU notes that this will be an uphill fight all of the way.  "Part of the problem is that many chronic diseases are lifestyle” diseases — lifestyles that a lot of corporations want us to buy into" (KPLU, 2011). Much of what the United Nations is purposing changing are dietary choices that we make as consumers. Encouraging people to eat less salt or give up smoking is one thing, but asking the corporations who produce these products to willingly change their ways for the public good is something else entirely. 'It's kind of like letting Dracula advise on blood bank security,' said Jorge Alday, associate director of policy with World Lung Foundation, which lobbies for tobacco control. 'There's important expertise there, but you have to question the motive'" (Bloomberg News, Sept. 26, 2011). Mr. Alday makes a good point. If part of the United Nations solution is to encourage industry to police itself, then good luck! And something that is not lost on public health proponents, like Shiriki Kumanyika of the University of Pennsylvania School of Medicine. "Companies are going to have to either kill this or change what they're's a direct affront to the current way of doing business" (Bloomberg News, Sept. 26, 2011).  

Food product and pharmaceutical industry is beginning to feel the heat to act. According to KPLU, Doctors Without Borders, New York Times, The Guardian (UK Newspaper) and the Obama administration have all been calling on major food and drug players to find new ways of making their money on the general health of consumers (KPLU, 2011). But all of this so-called pressure from these high powered public health circles may not have any meaningful impact on industry. From what I have read from several sources reporting on the UN Health Summit, there is no meaningful change expected in the near future. "There are no concrete targets and even if there were, there would be no teeth to enforce them. There’s no guarantee of money either" (Malta Independent Online, 2011).

The WHO published a Noncommunicable Diseases Country Profiles report (2011) which gives a complete picture of the state of affairs which the U.N. discussed. While the WHO notes in the introduction of the report that NCD's are a problem for nearly every country, the breakdown in mortality is not evenly distributed. The WHO reports that "63% of the 57 million deaths that occurred in 2008...the majority of these deaths -36 million - were attributed to cardiovascular diseases and diabetes, cancers and chronic respiratory diseases" (WHO, 2011). That is a huge swath of people dying from preventable causes which are also costly to treat.  But the WHO also notes that while NCD death is an emerging problem in developing countries, that it is a reality in the wealthiest of countries currently. "In most middle- and high-income countries, NCDs were responsible for more deaths
than all other causes of death combined, with almost all high-income countries reporting the
proportion of NCD deaths to total deaths to be more than 70%"
(WHO, 2011). And that "Premature deaths under 60 years for high-income countries were 13% and 25% for upper-middle-income  countries" (WHO, 2011). 

Foreign Affairs expert James M. Lindsay wrote an entry on the Council on Foreign Relations blog, regarding the United Nations Health summit. Mr. Lindsay writes that he is disappointed by the lack of resonant response from the global community. As Mr. Lindsay writes it, "After all, the BRICS (Brazil, Russia, India, China, and South Africa) account for 43 percent of the world’s population and about 45 percent of current growth but face high burden of NCDs" (Council on Foreign Relations, 2011). He also wrote that he had drafted a report to share with some Chinese Politicians. He was rebuffed by the Chinese, who felt that his assessment of the situation was "not big enough." Mr. Lindsay responded that "if a problem that claims 85 percent of the deaths in China is not big enough, what else is?" (Council on Foreign Relations, 2011).

To me, this is the million, if not billion dollar question. The United Nations had a special, 2-day summit concerning this important public health issue. Dozens of countries, hundreds of representatives from a myriad of organizations and industries, all to declare that this is a real problem, but that we just don't have any answers. Is it too hard? Is it too expensive? Whatever it is, we will find out soon enough when we pay the highest price for inactivity.

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