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Felicia M. Knaul Headshot

Including Non-Communicable Diseases in the Rio+20 Dialogue on Sustainable Futures

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Co-written with Felicia Marie Knaul

The upcoming Rio+20 Conference ( June 20-22, 2012) is a pivotal moment for leaders across the world to come together to find solutions to many of the issues that plague the planet. The conference will focus on important issues core to sustainability, including decent jobs, energy, sustainable cities, food security and sustainable agriculture, water, oceans, and disaster readiness.

An ambitious agenda, to be sure. But if the aim of Rio+20 is to create a better future, we're missing an enormous opportunity to address one of the biggest challenges we're facing today. Non-communicable diseases (NCDs) are the leading cause of death in the world, 80 percent of these deaths occur in developing countries, and the incidence of NCDs, especially among the poor, is growing at a rapid rate.

NCDs include heart disease, cancer, diabetes and chronic lung diseases, and are acknowledged by the U.N. and world experts as one of the greatest health and development challenges of the century. Further, there is overwhelming evidence to show that NCDs debilitate whole populations and a sick population cannot make progress on global sustainability.

NCDs must be at the forefront of any discussion on sustainability, for there can be no bright future without good health. We are pleased that some language on health and NCDs is being considered for inclusion in the Rio+20 Outcomes Document, but NCDs must be a bigger part of the Rio+20 conversation and beyond, lest they undermine the groundbreaking work for sustainability that is being done today.

We strongly believe that NCDs, and appropriate measurable targets, must be included in the next iteration of the Millennium Development Goals (MDGs), whatever their post-2015 form because, as Dr. Margaret Chan Director General of WHO has said, "what gets measured, gets done." Our generation has taken a couple of bold steps forward already -- the world acknowledged the devastating impact of NCDs in the U.N. Political Declaration adopted unanimously by all member states at the UN High Level Meeting on NCDs in September 2011. In May 2012, we committed at the World Health Assembly to reduce the mortality from NCDs by 25 percent by 2025. This gives us incredible hope that we will, in our lifetimes, begin to make a dent in the NCD crisis.

NCDs are a real threat to development and indeed, a formidable foe. These diseases create a vicious cycle that works against a sustainable future. Poor health drives people into poverty, while poverty results in rising rates of NCDs. Lack of education, poor diet, and lack of exercise are major contributors in the acquisition of non-communicable diseases. People in poverty are more likely to smoke, eat poorly, and be exposed to the risks that lead to illness. To create a sustainable world, we must ensure that people smoke less, eat healthier foods and increase their physical activity levels. According to the World Health Organization, these efforts can prevent 80 percent of heart disease and diabetes, and 40 percent of cancers.

Smart solutions to the growing NCD crisis must include a focus on women. Healthy, thriving women create healthy, thriving families and communities. There is growing evidence that NCDs are an integral part of maternal health, and we are learning that helping women have healthy pregnancies and normal birth weight babies may help reduce diabetes and cardiovascular disease in future generations. Women also are disproportionately impacted by NCDs, whether as caregivers, because they become ill themselves, or because of discrimination in accessing care. Many women in developing countries cook daily over open flames, and as a result are at higher risk of Chronic Obstructive Pulmonary Disease and cancer.

How can we allow millions of people every year -- mostly women and children in low and middle income countries -- to die because of activities as essential to health as everyday cooking? Surely this is a threat to sustainability worth discussing on a global scale.

Further, survival should not be a matter of geography or income. Yet, preventable death and suffering from chronic illness is increasingly concentrated among the poor. Many of the required interventions to end this injustice are low-cost and would strengthen health systems in ways that would provide long-term benefits. Equal access to healthcare is core to sustainable futures.

Concerned about the enormity of the problem, we ask governments, industry, and civil society to work together, in a whole-of society approach, making innovative use of existing resources and technologies, strengthening health systems, reducing inequities in treatment and care, and leveraging the power of prevention.

The time to act is now. The time to stop preventable suffering and death is now. The time to help women and children is now. The time to put an end to the dramatic health inequity of NCDs is now.

Dr. Nalini Saligram is Founder and CEO of Arogya World
Dr. Felicia Knaul is Associate Professor at Harvard Medical School and Director of the Harvard Global Equity Initiative

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