Over the last few weeks, the pace of developments in non-communicable disease (NCD) news has been heady. So much is happening it is hard even for those of us in the NCD community to keep up. But even in the midst of so much news, one item stood out head and shoulders above the rest: the publication of this important article in The Lancet earlier this month: Priority actions for the non-communicable disease crisis (Beaglehole et al, The Lancet April 6, 2011).
A scholarly and thoughtful article with an impressive list of authors, its distinctive feature is how it cuts through the clutter and lays out five clear, actionable steps countries can take to reduce the burden of NCDs. The authors tell us that they chose these five for their health effects, cost-effectiveness, low costs of implementation, and political and financial feasibility, and then clearly lay out the benefits for each action.
In order, they are as follows, through for the purpose of this post we are focusing on the top three:
- Tobacco control
If the UN High Level Meeting results in renewed resolve to accelerate the full implementation of all aspects of the Framework Convention on Tobacco Control (FCTC) it would help achieve by 2040, a world essentially free from tobacco. This action could prevent 5·5 million deaths over 10 years in 23 low-income and middle-income countries. Benefits will be realized very quickly, as reductions in exposure to tobacco smoke will reduce the burden of cardiovascular disease within one year and reduce health expenditures.
- Salt reduction
Reduction in salt consumption will lead to lower blood pressure, one of the main risk factors for stroke and heart disease. They say that reducing salt consumption by only 15% in the population (through mass-media campaigns and reformulation of food products), could avert up to 8·5 million deaths in 23 high-burden countries over 10 years.
Tobacco and salt reduction are the top priorities because they are highly feasible, cost effective, immediate in impact and cheap to implement.
- Improved diets and physical activity
Consumption of foods high in saturated and trans fats, salt, and sugar, the paper points out, is the cause of at least 14 million deaths or 40% of the deaths from NCDs each year. Physical inactivity causes about 3 million deaths each year. Together physical inactivity and poor diets cause about half of the deaths from NCDs. Promoting physical activity and foods low in saturated and trans fats, salt, and sugar is priority #3 because important pressures have to be overcome and strong government intervention is needed. The main interventions include mass-media education campaigns, taxes for high-fat and high sugar foods, better food labeling, and regulatory restrictions for the marketing of unhealthy food products especially to children and young people.
- Reduction in hazardous alcohol intake
- Access to essential drugs and technologies
We are encouraged that prevention is central in this paper – and that four of the five recommended actions are measures for NCD prevention through lifestyle changes. This is exactly the work in which Arogya World is engaged. We have taken it on as our mission – changing the course of chronic disease, one community at a time, through advocacy and prevention.
By far the most important document on NCDs that has come out in the last year or so, this article is one that will be referenced over and over again by governments, policy makers, think tanks, NGOs, healthcare providers and the public health community.
One of the most important points made in the paper is how affordable these measures are. “Implementation of priority interventions does not need a new global fund,“ the authors say. That is hugely reassuring because in the current economic climate making the case for a new Global Fund for NCDs would have been nearly impossible. They argue that the two most important actions—full implementation of tobacco control and salt reduction—are affordable in all countries with a cost of about US$0·20 cents per person per year in China and India.
We believe this paper will serve as a how-to guide for policymakers from around the globe, and inform to a great extent, the Outcomes Document from the UN High-Level Meeting this September.
Two other noteworthy documents released this month that will undoubtedly also inform the UN NCDs Outcomes Document are:
- The Youth Manifesto
This set of 7 asks and 7 commitments comes from an impressive group of young professionals. The Young Professionals Chronic Disease Network includes doctors and public health experts, big names in their own right, who see NCDs as the social justice issue of their generation and are determined to do something about it.
- Global Leadership, Local Solutions: Mobilizing for NCDs
This statement from the Global Health Council’s NCD Roundtable adds value by outlining ways countries can integrate NCD services into their health systems. This statement is distinctive in that it represents the voice of the global health community as a whole including NGOs working in the NCD space and those that aren’t, as well as industry.