The third week of September in New York City is when many pledges are made by governments gathered at the United Nations (UN), corporations meeting at the Clinton Global Initiative (CGI) and by NGOs and academics who are able to gain access to either the UN or CGI. I will give a sense of where Noncommunicable Diseases (NCDs) and their risks emerged as interests.
The week started with over 3,00,000 people marching across New York in order to ask world leaders heading to New York to focus action of climate change. I joined a group from Novo Nordisk and an inspiring group of sustainability investors for part of the march. The view of NCDs from the streets came mainly from NGOs concerned about the indirect impacts of unhealthy consumption on deforestation (through land clearance to grow palm oil or raise cattle), the impact of urban personalized and motorized transport (which displaces walking, cycling and public transport) and of the impact of agriculture’s contribution to greenhouse gasses and water use.
Strikingly, I saw no posters making the case that unhealthy consumption drives diabetes, heart disease and many cancers, and heard no voices of patients with these conditions calling for action to prevent or adapt to climate change. Health NGOs have a long way to go if they seek to have health and NCDs be integrated into the powerful voices calling for action on climate change. It is as simple and as difficult a task as that.
In contrast, Wellcome Trust hosted a session on sustaining health that highlighted solid evidence on emerging negative trends as part of their ongoing efforts to invest in research able to have impact for a health perspective. The big messages seemed to be that our biggest direct threats to health before 2050 will come from extreme temperatures, and that those most likely to suffer are those suffering today from weak health systems and inadequate access to water and sanitation. Beyond 2050s, we will all feel the heat.
The framing of the role of NCDs was similar to the voices from the streets - unsustainable and unhealthy consumption underpins climate change and NCDs risks. The opposite was poorly stressed though. Small changes in diets (starting with reducing meat and palm oil intake) could lessen the harm in future.
Sessions packed with academics and UN officials were rich on analysis, on calls for more research, more declarations, and more meetings. They were weak on igniting urgency, action or effective advocacy.
Across town at the CGI several action-oriented announcements made it clear that leading companies are investing in and taking action in partnership with NGOs, other companies and research groups to have an impact. Over the last few years these have covered efforts to build networks of tobacco free workplaces globally led by multinationals and supported by the American Cancer Society (ACS). Many efforts to address cancer prevention (including expanding access to vaccines to prevent cervical cancer), diabetes programs that bring insulin to low income settings and physical activity programs in schools were discussed. Most of the initiatives included evaluations of impact. And many included actions in the US and developing countries.
President Clinton is personally engaged in many such initiatives, cajoling corporations to do more and getting them to do so! A new initially US based pledge brought together all beverage manufacturers in a commitment to cut calories across all their brands by 20% over the next few years-a pledge that builds on his past efforts to have calories in beverages sold in schools cut by 90% in recent years.
While the UN talks and deliberates—as it must- new partnerships between companies and NGOs are taking practical steps to prevent and better manage NCDs. Much more is needed. The current funding base for NCDs in most developing countries remains inadequate. But it is unlikely that checks will be written for NCDs in ways they are for infectious diseases and under-nutrition.
I see a different model of support emerging that includes two aspects, one that includes all employers recognizing the value of investing in effective workplace and employee-family health programs. If done well, they will have an impact on the morale, retention and productivity of companies as they lead to lower corporate and personal healthcare costs. And a second that uses market forces more effectively to address NCD prevention and control, leveraging core products and services of many companies in ways that makes their engagement in NCD prevention sustainable.
However, it requires a change in mindset within the current UN/government leadership that understands the limits of governments and their abilities to improve health alone.