Just a few weeks away, the U.S., Europe and Canada are now stalling to commit to actions, outcomes and timelines at the upcoming U.N. summit on non-communicable diseases (NCDs). Cancer, cardiovascular disease, chronic respiratory disease and diabetes threaten almost every nation's health and our global financial stability and growth. Now leaders of the world's most advanced nations are delaying, and may refuse, to commit to do much to prevent people from dying.
Brian Ward, policy advisor for the European Respiratory Society, said in an email to Medscape Medical News, "Despite the fact that the NCD burden is highest in Europe and the United States, these regions have also been very reluctant to commit any financial support to this UN process aimed at tackling the NCD epidemic."
I emailed Ann Keeling, chair of the NCD Alliance and CEO of the International Diabetes Federation (IDF), asking for her views on the situation. Negotiations are stalled, she told me, due to several target-oriented resolutions, including an outcome document with the overarching goal of cutting preventable deaths from NCDs by 25 percent by 2025. The resistance from the U.S., Europe and Canada, she wrote, is a resistance to targets because targets mean review, accountability and resources in action.
The resistance is also an insistence that we are on the Pay-Later Plan: Just as the world's debt continues to escalate for so many costs we have failed to contain, we are now adding the costs of avoidable deaths, ill health, productivity loses and economic stability to our ledger. Why are our nation's leaders voting once again to shut their eyes to the inevitable consequences?
Recently I wrote about the IDF's campaign asking Americans to urge President Obama to attend the summit; now the question is, according to Keeling: no matter who's occupying a chair, without the commitment of these three world powers, will anything get done to "not sleep walk into a sick future"?
Keeling also states that rich nations fear they will have to foot much of the bill for tackling a chronic disease epidemic in poorer nations, and they are reluctant to commit to this when their economies are in turmoil. But such fears, she says, are short-sighted. In her email to me, she wrote:
In an interconnected world the cost of the NCD burden will start to slow economic growth for everyone. It's simple. China, which right now is still experiencing strong economic growth despite the global financial crisis hitting Europe and the U.S.A., has very high rates of NCDs, over 92 million people and rising. One in 10 of the adult population now has diabetes in China, and a large percentage of these people will not be able to work a normal productive life. If Chinese consumers have to spend their disposable income on managing chronic illness, they will have less to spend on goods and services produced in Europe and America.
Business executives and shareholders, are you listening? This will directly cut into your earnings and return on investment. In America, where shareholder value determines most business decisions, it goes against all common sense not to make halting non-communicable diseases a priority. If our government commits to measurable outcomes for the summit, it is supporting the future health and growth of American businesses.
In her email to me, Keeling also wrote that:
America, Canada and many in Europe have invested heavily in overseas aid to low income countries to lift those countries and their people out of extreme poverty. We have seen real gains in many parts of the world in economic and human development measured against the Millennium Development Goals (MDGs). However, NCDs spreading fast in low-income countries are imposing a dual burden on fragile health systems as governments still battle AIDS, malaria, tuberculosis (TB), maternal and child mortality.
Diabetes, for example, is driving up to 15 percent of new cases of TB in India. AIDS-related cancers are spreading fast in Africa. It makes no sense to invest in health systems that save a man's life from AIDS but allow him to die of cancer. There is a high risk that much aid money spent on health will be wasted in the longer term if health systems do not address NCDs, as well as infectious diseases.
Watch this interview with Ann Keeling by Manny Hernandez, founder of the social media site TuDiabetes:
With President Obama engulfed in the U.S.'s financial woes, it's easy to say, "Let's concentrate our attention and finances at home on jobs," yet something else he said early in his presidency is also true: health care will bankrupt us if it, and we, don't change. Furthermore, we can no longer think that what happens in one corner of the world is just happening over there; it impacts the collective economy in which we all live.
"NCDs right now are in everyone's backyard, and what is a problem in someone else's backyard soon has an impact on everyone else," Keeling told me.
IDF President Jean-Claude Mbanya, M.D., Ph.D., who will address the delegates at the annual meeting of the European Association for the Study of Diabetes on Sept. 13, says, "We have the evidence, cost-effective solutions and with the Summit we have the political opportunity."
Non-communicable diseases cause more deaths worldwide than all other diseases combined, and many of these deaths can be prevented through lifestyle and government policy changes, says the World Health Organization (WHO). The following are simple, available, cost-effective solutions that the WHO cites to prevent and manage NCDs:
- Primary prevention of NCDs, in conjunction with early diagnosis and treatment through the primary health care services, is the best way to provide "effective" and "equitable" NCD care.
- Eliminating the major risk factors -- tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol -- can help prevent NCDs.
- Simple lifestyle changes, such as improved diet, increased physical activity and smoking cessation, can prevent 80 percent of heart diseases and stroke, 80 percent of Type 2 diabetes and over 30 percent of cancers.
- Just 150 minutes of moderate physical activity a week or its equivalent is estimated to reduce the risk of ischaemic heart disease by 30 percent, the risk of diabetes by 27 percent and the risk of breast and colon cancer by 21 to 25 percent.
- NCDs such as cancers, if detected early, can be treated effectively. The later an NCD is detected, the more difficult and expensive it is to treat.
"Without global goals or targets, this is not going to fly. What gets measured gets done," said Margaret Chan, Director-General of the World Health Organization.
Why is it that First Lady Michelle Obama leads the "Let's Move" initiative, yet we see no tangible evidence of it anywhere for most Americans? Why don't policy makers move more subsidies from unhealthy foods to healthier foods like fruits and vegetables? Why doesn't legislation encourage more programs like the Diabetes Prevention and Control Alliance, a UnitedHealth Group partnership with YMCA and Walgreens to help people avoid the devastating consequences of unmanaged diabetes, and help contain America's health care costs? Why aren't our elected politicians asking these questions?
Sept. 19 is the first high-level U.N. summit since 2001, when the U.N. summit met to curb the crisis of HIV/AIDS, creating a Declaration of Commitment, actions to guide and sustain the global response to AIDS.
What we need now is a declaration of commitment from our world leaders to curb the rise of non-communicable diseases now.
"It feels as if they're [the U.S.A., Europe and Canada] burying their heads in the sand hoping this is going to go away, and it's not," Ann Keeling wrote to me. "Diabetes is a global problem, and some of the measures that need to be taken just cannot be done at national levels. And let's not forget in addition to the economic arguments, accidents of geography and birth location should not determine which children live or die from something like type 1 diabetes when we have the knowledge and means to treat it."
No, accidents of birth and access to medicine and health care and political tap dancing should not decide who lives or dies -- not in Africa, Australasia or Appalachia, and not on our watch.
Riva is the author of "50 Diabetes Myths That Can Ruin Your Life and the 50 Diabetes Truths That Can Save It" and "The ABCs of Loving Yourself with Diabetes." Visit her website Diabetes Stories.com.
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