While much of the world's attention focused on the UN debate about Palestinian statehood this week, the General Assembly took up another issue that garnered less media scrutiny, even though its outcome could prevent millions of premature deaths in coming decades. On September 19th and 20th, 30 heads of State and 100 other senior ministers and experts met at the UN General Assembly's first high level summit on non-communicable diseases (NCDs) to discuss how to reduce the burdens of such conditions as diabetes, heart disease, cancer and chronic respiratory diseases.
These conditions cause about 35 million deaths a year, of which 80 percent occur in low and middle-income countries and one quarter among people younger than 60 years. By 2030, NCDs will cause more than three quarters of all deaths in the world. While the UN has previously recognized HIV, tuberculosis and malaria as threats to economic development and global security, this was the first time the UN acknowledged that non-communicable disease also jeopardized economic well-being.
The NCD summit was an important step in shaping a coordinated global response to these conditions but unlike infectious diseases, where few organizations profit directly from their spread, powerful industries depend on encouraging consumption of products like tobacco, alcohol, unhealthy food and automobiles that have fueled epidemics of non-communicable diseases. Thus, the summit previewed the great public health battle of this period. On one side are the public health professionals, advocacy organizations and local officials who have to cope with the rising tide of NCDs fueled by the growing consumption of tobacco, alcohol and unhealthy food. On the other are industries built on the model of profiting by promoting unhealthy lifestyles and products.
Participants in the UN meeting recognized this conflict. In his remarks, UN Secretary-General Ban Ki-moon observed that "there is a well-documented and shameful history of certain players in industry who ignored the science - sometimes even their own research - and put public health at risk to protect their own profits." He went on to note that "there are many, many more industry giants which acted responsibly", sounding a conference theme that disease promotion was the work of a few bad apples.
In the lead up to the conference, industry lobbyists worked hard to persuade wealthy nations to look out for business interests. According to the Washington Post, a confidential summary of the negotiations on the summit's political declaration showed that US negotiators threatened to scuttle the document if it even raised the issue of using trade agreements as a vehicle for protecting public health. The Canadian Medical Association charged that Canada had been instrumental in removing a passage that would have limited the impact that food and alcohol corporations have on health policies and in failing to address trade-related barriers to global health.
A main issue dividing meeting participants was whether the 2001 Doha Declaration, which allowed low income countries to compel drug companies to allow generic drugs for use in their own countries, could be applied to drugs for NCDs. The Doha amendment refers to HIV, TB, malaria "and other epidemics", language that led one activist to observe that this agreement "was not meant to be so narrowly interpreted... it was intended to address all public health crises." Jay Taylor, a vice-president of The Pharmaceutical Research and Manufacturers of America, explained the opposing position to the Post, "Compulsory licenses are intended to be used to address health emergencies and to provide urgent access in situations where there is little or no availability of existing effective medicines. This situation is clearly not the case in the context of the growing burden of noncommunicable diseases." Tellingly, the summit's final statement does not use the word epidemic, even though the number of diabetes cases, for example, increased from 300 million worldwide in 2009 to 366 million in 2010.
Two other key issues led to conflict. The first was who should participate in the meeting. Industry insisted that "all sectors" of society should be represented while public health advocates argued industry participation was inappropriate. One hundred forty three non-governmental organizations from around the world created the Conflicts of Interest Coalition and urged that the NCD summit and other forums for policy development should be "free from industry involvement" because of the "obvious conflicts of interest of interests associated with food, alcohol, beverage and other industries that are primarily answerable to shareholders."
A second debate was whether international standards of corporate conduct should be voluntary or mandatory. Business favored voluntary codes, arguing companies were better equipped to implement standards and that mandates threaten jobs and economic growth. Public health activists pointed to the scientific evidence that voluntary standards rarely lead to meaningful changes in corporate behavior.
At the end of the meeting, many participants expressed disappointment. While the summit acknowledged "the fundamental conflict of interest between the tobacco industry and public health", no such statement was made about the food, alcohol, automobile or pharmaceutical industries. Unlike tobacco, these industries also produce products that contribute to health, but in recent decades they have increasingly followed the playbook of the tobacco industry: making campaign contributions and lobbying to oppose public health regulation, aggressively promoting unhealthy products in low and middle income nations when wealthy countries regulate their practices, and distorting scientific evidence that implicates their products in global epidemics.
In the final analysis, industry succeeded at the summit in avoiding direct challenges to its role in promoting disease and national governments refused to set specific targets for NCD reduction, a prerequisite for coordinated global action. These outcomes make it hard to be optimistic that the meeting opened a path for more forceful action to take on the world's leading killers.
On the other hand, the UN meeting did show the potential for a global movement to challenge corporate influences on health. A few world leaders spoke out forcefully. Torphong Chaiyasan, the Deputy Minister of Health for Thailand, told the meeting that "many large companies contributed to the non-communicable disease problem and continue to try to weaken public health policy." The organizations that signed on to the Conflict of Interests Statement represent tens of thousands of health activists from around the world. "I am very, very optimistic about the creation of a social movement. The evidence is clear that it can be done," George Alleyne, a physician who once headed the Pan American Health Organization, told the Washington Post earlier this week. Today corporations have more resources and power to shape health than this emerging movement,but the future health of the world depends on changing that equation.