Tobacco Info

From Tobacco Info No. 8 - January 2012
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United Nations acknowledges pandemic of non-communicable diseases

 

Tobacco use one of four major risk factors

 

By Joe Strizzi

The United Nations General Assembly met in 2001 to sound the alarm on a global health epidemic known as HIV/AIDS. This was the first ever health summit held by the UN.

Ten years later, for just the second time in UN history, world leaders, delegates and health officials gathered in New York, in September, to discuss another potential health pandemic: non-communicable diseases, at a special High-Level Meeting of the General Assembly.

“Let there be no doubt,” said General Assembly president Nassir Abdulaziz Al-Nasser, “that non-communicable diseases have reached epidemic proportions,” adding that they were altering demographics, stunting development and impacting economic growth across the planet.

What are non-communicable diseases?

A non-communicable disease, or NCD, is a medical condition or disease that is non-infectious. NCDs are diseases of long duration and generally slow progression. They include heart disease, stroke, cancer, asthma, diabetes, chronic kidney disease, osteoporosis, Alzheimer’s disease and cataracts. While often referred to as chronic diseases, NCDs are distinguished by their non-infectious status. According to the World Health Organization (WHO), they are the number one killer in the world today, accounting for over 63% of all deaths.

Four types of non-communicable diseases – cardiovascular diseases, diabetes, cancers and chronic respiratory diseases – are the greatest cause of mortality in most countries. These four NCDs are largely preventable by means of interventions that address four risk factors: tobacco use, unhealthy diets, physical inactivity and harmful use of alcohol; factors that result in people dying, on average, before the age of 60 and that are responsible for over 80% of all deaths related to NCDs.

The WHO claims that deaths from NCDs will increase by 17% in the next decade. In Africa, the number will jump by 24%.

According to a Harvard University study, NCDs will, over 20 years, cost the global economy over $30 trillion ($30,000,000,000,000) or 48% of the global gross domestic product (GDP) of the year 2010.

Representing the Union for International Cancer Control, Jordan’s Princess Dina Mired, director general of the King Hussein Cancer Foundation, was the keynote speaker at the General Assembly. She stated that 360 million people would die from these diseases over the next decade, while one billion people would die from tobacco use alone this century.

“There are 36 million people dying every year – not possibly, not maybe,” she said. “The United Nations has the responsibility of delivering the right punch in this fight.”

Political Declaration

     The General Assembly, attended by more than 30 heads of state and government and approximately 100 senior ministers and experts, studied the Secretary-General’s report on the Prevention and Control of Non-Communicable Diseases. The report noted that NCDs have a global impact, surpassing that of communicable diseases (Note 1) in every region of the world except Africa, but where the rate of such diseases is quickly rising. By 2030, NCDs are projected to cause nearly five times as many deaths as communicable diseases worldwide.

According to the report, the burden of these diseases goes beyond the fact that those countries most affected are the most populated. Unplanned urbanization, ageing populations and the globalization of trade and product marketing, particularly for tobacco, alcohol and food, have led to a rise in the risk factors of such diseases. What’s more, it states that the lack of healthcare capacity and social protection systems means that NCDs are more likely to cause illness and death at an earlier age.

The UN report does go on to suggest that the incidence of these chronic diseases could be significantly reduced and they could, in fact, be prevented, saving millions of lives and untold suffering, through proven and affordable measures that are often complementary to global health efforts already in place.

Steps range from price and tax measures to reduce tobacco consumption to curbing the extensive marketing to children, particularly on television, of foods and beverages that are high in saturated fats, sugars and salts.

Following examination of the report, participants at the two-day meeting adopted a Political Declaration calling for a multi-faceted campaign by governments, industry and communities to develop the plans needed to curb the risk factors of the four major groups of NCDs by 2013.

“Our collaboration is more than a public health necessity. Non-communicable diseases are a threat to development and hit the poor and vulnerable particularly hard, driving them deeper into poverty,” said UN Secretary-General Ban Ki-moon during his address to the General Assembly, adding that millions of families are driven into poverty each year when a family member becomes too weak to work, or when the cost of medicines and healthcare treatments overwhelm the family budget.

The Secretary-General also called on businesses to do their part, affirming his strong belief that the power of industry can improve the world. “There is a well-documented and shameful history of certain players in industry who ignored science, sometimes even their own research, and put health at risk to protect their own profits.”

Ki-moon went on to say that there are many industry giants who have acted responsibly and that everyone needs to be held accountable to root out the “disgraceful actions” of the few.

Noting that the rising prevalence, morbidity and mortality associated with NCDs can largely be prevented and controlled through collective and multisectoral methods by all member states and other relevant stakeholders, the declaration highlighted the need for universal national health coverage and strengthened international cooperation to assist developing countries. Finally, it called on the WHO, as the specialized UN agency for health and the forerunner of the global health effort, to set up a comprehensive global monitoring framework and prepare recommendations for voluntary global targets before the end of 2012.

To that end, the Secretary-General made five recommendations with a view toward further progress.  First, to implement a comprehensive government approach to adopting population-wide interventions that address risk factors. Second, to undertake sustained primary healthcare measures, including prioritized modules describing essential interventions, along with palliative and long-term care, for those who already have NCDs or are at high risk of contracting them. Third, to strengthen the capacity of member states to monitor these diseases, as well as their risk factors and determinants, especially in lower-income countries. Social data disaggregated by gender was also encouraged. Fourth, to harness lessons learned from national HIV/AIDS, tuberculosis, and malaria programs in low and middle-income countries for effective integration of communicable diseases and NCDs into all health initiatives. Finally, prioritize the prevention and control of NCDs through commitments by governments, the private sector, civil society, the UN and other international organizations.

Tobacco control efforts

The tobacco control ‘wins’ in the summit’s Political Declaration include accelerated implementation of the WHO Framework Convention on Tobacco Control (see boxhead-bottom right), although without mention of the treaty’s guidelines; recognition of the “fundamental conflict of interest” between the tobacco industry and public health; reference to tobacco taxation as an effective and important means of reducing tobacco consumption; a tie-in to the development agenda recognizing the key role of prevention; multiple mentions of the impact of  NCDs  on development; and acknowledgement of insufficient resources.

“Including reference to the FCTC in the Political Declaration will help lay down the terms of how governments will allocate their resources. The same is true for private organizations,” said Rob Cunningham, who was in New York on behalf of the Canadian Cancer Society. “The FCTC has been a revolutionary driving force behind tobacco control in the developing world,” he continued, adding that tobacco control is a best buy as it affects all four major chronic diseases, with tobacco control the cheapest and most successful route in combating these diseases due to the ability to increase revenue by raising taxes on cigarettes and other tobacco products. While there is no commitment of resources, the Political Declaration mentions the need to “promote all possible means to identify and mobilize adequate, predictable and sustained financial resources... and to consider support for voluntary, cost-effective, innovative approaches for long-term financing of NCD prevention and control.” It also made reference to the “continued inclusion of NCDs in development cooperation agendas and initiatives” and mention of national ownership of aid priorities.

Smoking prevention attracted much attention in many countries, including strategies for reducing tobacco use, describing action taken on the taxation, advertising and regulation fronts and the banning of smoking in public spaces.

Some of the efforts by developing countries were quite innovative. New Zealand’s Justice Minister, Simon Power, said the country aimed to be smoke-free by 2025. Australia’s Minister for Health and Ageing, Nicola Roxon, displayed a prototype for its plain packaging legislation, which later received Royal Assent on December 1, to a round of applause. She told the Assembly that Big Tobacco was fighting desperately to put a stop to their efforts, but that the government was resolved to move forward.

However, some of the efforts in the developing world were, for them, quite cutting edge as representatives from these countries outlined their plans to control tobacco use. Delano Bouterse, President of Suriname, speaking on behalf of the Caribbean Community (CARICOM), noted that they developed a strategic plan of action including minimum health standards for tobacco. Agnès Binagwaho, Minister of Health for Rwanda, told the Assembly that her country used tobacco taxes to fund welfare services for its population and had started clinics to detect and fight cancer.

WHO Director-General Margaret Chan furthered UN Secretary-General’s statement regarding the immorality of some big businesses by targeting the tobacco industry. She called on the heads of government to stand “rock hard” against the “despicable” efforts of the tobacco industry and their highly aggressive tactics by increasing tobacco taxes and prices to reduce demand, protect health and provide governments considerable revenue. She added that, while some might argue that income from the sale of tobacco and unhealthy foods are indispensable during an economic downturn, this short-sighted view is belied by the significant long-term costs.

Actions speak louder than words

Rudyard Spencer, Health Minister for Jamaica, expressed some disappointment with the declaration, stating that it provided a good platform for ongoing discussion on NCDs, but that it did not advocate more decisive action that would commit the international community to increased and sustained resources to achieve its goal.

Ban Ki-moon challenged member states to step up their own accountability for carrying out the declaration, suggesting, “If this document remains just a set of words, we will have failed in our obligation toward future generations. But if we give this Political Declaration meaning through multiple, concerted and tough actions, we will honour our responsibility to safeguard our future.”

Note 1: Communicable diseases are also known as infectious diseases, clinically evident illnesses, with characteristic medical signs and/or symptoms of disease, resulting from the infection, presence and growth of pathogenic biological agents in an individual host organism, such as HIV/AIDS.

 

The Framework Convention

The WHO Framework Convention on Tobacco Control (WHO FCTC) is the first treaty negotiated under the auspices of the World Health Organization. The WHO FCTC is an evidence-based treaty that reaffirms the right of all people to the highest standard of health. It represents a paradigm shift in developing a regulatory strategy to address addictive substances. In contrast to previous drug control treaties, the WHO FCTC asserts the importance of demand reduction strategies, as well as supply issues.

The world treaty was developed in response to the globalization of the tobacco epidemic. The spread of the tobacco epidemic is facilitated through a variety of complex factors with cross-border effects, including trade liberalization and foreign investment. Other factors such as global marketing, transnational tobacco advertising, promotion and sponsorship and the international movement of contraband and counterfeit cigarettes, have also contributed to the explosive increase in tobacco use. The core demand reduction provisions in the WHO FCTC are contained in articles 6-14: non-price, price and tax measures to reduce tobacco use, namely: protection from exposure to tobacco smoke; regulation of the contents of tobacco products; regulation of tobacco product disclosures; packaging and labelling of tobacco products; education, communication, training; public awareness; banning tobacco advertising, promotion and sponsorship; and demand reduction measures concerning tobacco dependence and cessation.