The high level UN Summit on Non Communicable Diseases (NCDs), due to be held in September 2011 in New York, is the second such High Level Meet (HLM) on a global health issue—the first one held 10 years ago was on HIV/AIDS. The outcome of this meeting is expected to create the political momentum to galvanize funds and commitments for prevention and treatment interventions in resource poor settings in developing countries, where morbidity and mortality due to NCDs is increasing rapidly.
NCDs (namely cardiovascular disorders, cancers, chronic obstructive pulmonary disease, and diabetes, as listed by WHO) account for over 60% of global deaths annually. They affect not only the poor/marginalized sections and the old, but the rich and young as well. As opposed to communicable diseases, the onset of NCDs is gradual, treatment is prolonged and a lifelong care is involved. They may often not be solely the result of unhealthy life styles, as there are other social determinants which are the ‘cause of the causes’ of NCDs. Poverty, illiteracy and unemployment exacerbate tobacco/alcohol use. Physical exercise, as well as substance abuse, is a function of leisure which is becoming increasingly accessible to the wealthy. Declining public spaces also reduce the opportunity for physical exercises to some extent. The rise in mental illnesses is linked with instability in livelihoods and the excessive pressure to compete in the rat race. The prevailing socio economic conditions, existing physical environment, and the poor status of healthcare systems—all contribute towards the growth of NCDs.
This HLM presents a unique opportunity to cement global and national commitments on preventing and treating NCDs. But it is imperative for this global action plan to take into account the experiences of community and health groups, involving them in negotiations and implementations. Keeping this in mind, regional consultative workshops are being held in different parts of India to feed into the national workshop to be held later in Delhi, to eventually facilitate a dialogue with the Indian Health Ministry, which is going to play a key role in the negotiations at the Summit. In this context, Universities Allied for Essential Medicines (UAEM), in association with MSF Campaign for Access to Essential Medicines, recently organized a one day workshop to deliberate upon key issues of the NCD Agenda. Representatives of groups (including CNS and Asha Parivar) working on right to health, HIV, cancer, tobacco control, access to health services, and life style issues took part in the brainstorming, keeping in mind the needs of those who, at the grass roots level, are the most affected.
At the outset, it was felt that the currently defined four disease cluster of NCDs is too narrow, as 60% of the diseases lie outside this spectrum. Amongst illnesses outside the ambit of NCD, asthma is under mentioned, and so is mental health which accounts for 14% of the global disease burden. 450 million people currently suffer from neuropsychiatric illnesses; 800,000 people commit suicide and 86% of these are in the Lower Middle Income Countries (LMIC). In fact, mental health is associated with all the four NCDs-- 50% of all cancer patients suffer from mental illness, and those with clinical depression have a two and a half times greater risk of coronary death. Depression is very common in people living with diabetes, and mentally depressed/stressed people are twice as likely to smoke, and become easy prey to a host of diseases.
The latest draft political declaration of the forthcoming HLM emphasises more on health promotion and prevention and less on treatment access. There also seem to be fewer commitments for financial and technical assistance, and an absence of time bound targets and follow up mechanisms. Donor investments and lower prices of drugs/diagnostics are essential to make them affordable to all. We need to look more at the morbidity, disability and premature mortality due to NCDs, rather than the number of deaths, as true indicators of NCDs. Addressing the stigma and discrimination associated with NCDs will go a long way in resolving the issue.
It was recognized by all that this entire exercise needs to be carefully protected from industry interference. We need clearly defined measures (similar to Article 5.3 of the FCTC, which forbids the tobacco industry to take part in health policy making, except as an observer) to prevent national health policies to be dominated by the interests of pharmaceutical, tobacco and food companies. Instead, there has to be a more meaningful involvement of civil society and affected communities. In NCD parlance, pharmaceutical companies are projected as the ‘good guy’. There is a strong fear that these will push for a resolution which will ratchet up what needs to be treated. Lest we forget, more medicine is not necessarily better medicine. It is must be remembered that the four NCDs constitute 50% of the pharma companies’ market. So we have to guard against the NCD agenda being hijacked by pharma and private insurance companies-- for the latter, NCDs again offer a huge lucrative market.
The tobacco companies’ pressure tactics on governments to dilute anti tobacco measures are only too well known. Even in a country like India, which has ratified the FCTC, the government has gone on record to admit that mandated changes in health pictorial warnings on tobacco packs got delayed /diluted, due to tobacco industry lobbying. Tobacco giants over the world are suing governments for their anti tobacco measures, by finding loopholes in clauses in FTAs and IPRs to their advantage. While recognizing the need to shun junk/ unhealthy food, regulations on the food industry are almost nonexistent in most countries.
So there is an urgent need for a binding declaration which makes governments accountable to have a genuinely good and robust treaty to curtail the debilitating impact of NCDs. Domestic policies should build up domestic capacities. The way forward at international level is to incorporate in the declaration explicit language for the use of TRIPS flexibility and against unfair IP enforcement (so that government policies for the welfare of the nations’ health are not challenged); evidence based treatment protocol; and concrete proposals for facility of technology transfer. At the national level, the approach has to be based upon, and integrated with, the existing health systems (which must be strengthened), with a view to put clear treatment protocols in place and make affordable diagnostic/ medical services available to all.
It is hoped that the final declaration of the HLM would incorporate a more realistic approach to social determinants of NCDs; expand their scope to include mental health as a primary component; have explicit guidelines for not jeopardizing treatment access (by way of resource crunch, and/or misuse of trade agreement clauses); and have a clearly defined relationship with the private sector, so that industry interference does not sabotage the entire exercise which is being undertaken for the welfare of the world citizens, especially the marginalized sections of society.
(The author is the Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She is also the Director of CNS Gender Initiative and CNS Diabetes Media Initiative (CNS-DMI). She has worked earlier with State Planning Institute, UP. Email: firstname.lastname@example.org, website: http://www.citizen-news.org/)