From New York to Cannes:
Baby Steps in the Battle against Non-communicable Diseases

John Kirton and Laurette Dubé
Globe and Mail, September 21, 2011

A two-day United Nations summit on the prevention and control of non-communicable diseases – its very first one – has just ended in New York with a whimper rather than a bang.

The heads of state and government, senior ministers and experts who attended the meeting took some baby steps to get started but far too few to address the urgency and magnitude of the challenge the world now confronts. Led by the “big four” – cardiovascular diseases, cancer, diabetes and chronic lung diseases – NCDs caused 36 million deaths, or about two-thirds of the global total, in 2008. A joint study by Harvard Public Health and the World Economic Forum estimates that NCDs will cost $47-trillion from 2010 to 2030.

Because the big four NCDs share the main risk factors of unhealthy diet, physical inactivity, tobacco use and harmful use of alcohol, a list of “best buys” interventions developed by the World Health Organization – such as reducing tobacco, salt and trans fats and improving education and universal access to basic medicines and technologies – could counter the NCD pandemics for a price to governments of only $11-billion a year. But the leaders in New York did not buy this bargain.

Their cash-strapped governments, health systems and businesses, still recovering from the continuing financial crisis, are all in intense fiscal consolidation mode. More important, the problem and its cure seem much too broad. The NCD pandemic is not caused by an identifiable virus but from the same technological and economic progress that has enabled major population growth and helped address significant health problems of the past. These problems are now overshooting the limits of human biology, as the NCD pandemic is spreading faster among the poor than the rich. It’s critical to bridge today’s divide between health-system capacity-building and the many facets of agricultural and economic development.

Needed now is a full-fledged whole-of-government and whole-of-society approach that accounts for the complexity of individuals’ motivations and behaviour and of the social, economic and health-care professions, organizations and systems that support individuals in health, disease and everyday life. In New York, the leaders mouthed these fine phrases and principles. But they put neither new money nor a credible strategy on the table to back them up.

They did much less for global health than they did at their UN summit in New York last year, in the immediate wake of the worst financial crisis since the Great Depression. At the G8 Muskoka summit in June of 2010, G8 leaders and others started by mobilizing $7.3-billion in new money for maternal, newborn and child health (MNCH). At the UN summit three months later, the full global community raised the total to $40-billion. They also added the innovative Commission on Information and Accountability for Women and Children’s Health, co-chaired by Prime Minister Stephen Harper and Tanzanian President Jakaya Mrisho Kikwete, to ensure that the promised money was actually delivered, deployed and produced the intended results.

Even without a down payment, the UN NCD summit can still adapt the Muskoka MNCH model. Those outside governments can ensure countries’ compliance with their summit commitments and action by the many economic actors involved, ranging from consumers themselves to the farms, factories, retailers, schools, media and other industries whose everyday practices must be transformed.

The next opportunity to act comes in early November, at the G20 summit in Cannes. It’s tailor-made to address and advance the prevention and control of NCDs. The G20 summit governs critical interconnected economic, development and health issues through a comprehensive, coherent approach. It must control NCDs and thus soaring health-care costs to meet the commitments made at the 2010 Toronto summit to cut their fiscal deficit in half as a share of GDP by 2013 and to contain the global sovereign debt crisis erupting in Europe, too.

In November of 2010, the G20 launched the Seoul Development Consensus with NCDs built in. The French G20 host is now focusing on food and agriculture and mounting Business 20 and Young Entrepreneurs summits to bring the capacity of these critical communities to bear. All G20 leaders thus have a compelling reason to act at home and have the resources and responsibility to act abroad on NCDs.

Many G20 leaders missed the summit in New York. But all will assemble at Cannes, able to address this human health crisis in slow motion that has become a key component of an escalating financial crisis.

John Kirton is a professor of political science at the University of Toronto and the co-director of the G20 Research Group at the Munk School for Global Affairs. Laurette Dubé is the James McGill Chair of Consumer and Lifestyle Psychology and Marketing at the Desautels Faculty of Management of McGill University and the scientific director of the McGill World Platform for Health and Economic Convergence.

Source: Globe and Mail, September 21, 2011. See also "Modern Pandemic Requires Radical Switch in Thinking," by John Kirton and Laurette Dubé, Montreal Gazette, September 21, 2011.