Modern Pandemic Requires Radical Shift in Thinking

John Kirton and Laurette Dubé
Montreal Gazette, September 21, 2011

On Tuesday in New York City, world leaders ended the first United Nations summit on the prevention and control of non-communicable diseases, signing on to a UN pact that seeks to reduce the 36 million deaths caused by NCDs each year. The "big four" NCDs — cardiovascular diseases, cancer, diabetes and chronic lung diseases — share four risk factors associated with western-style socio-economic development: unhealthy diet, physical inactivity, tobacco use and harmful use of alcohol.

A joint study by Harvard Public Health and the World Economic Forum estimates that NCDs costs will cost $47 trillion over the period 2010 to 2030. It also notes that a list of "best-buy" interventions developed by the World Health Organization to counter the pandemics could be implemented with an estimated cost to governments of $11 billion per year. These include reducing use of tobacco, salt and trans fats, and improving education and universal access to basic medicines and technologies.

Challenges lie ahead, though, in that governments, health systems and businesses have yet to recover from the continuing financial and economic crisis. Thus, advanced countries are likely to keep resisting further global funding to combat NCDs. Innovative financing mechanisms will be needed to close the gap.

Moreover, prevention of NCDs pushes the boundaries of what world leaders have dealt with in global health matters. The pandemic is not caused by a discrete, identifiable virus. Instead, it stems from the same technological and economic progress that has enabled major population growth and helped address significant health problems of the past. These now appear to have turned against us.

The transition from traditional society and subsistence agriculture to a western-type diet, lifestyle and environment, which took more than 300 years in rich countries, now occurs in only a few decades in poorer ones. Thus, most of the levers for addressing the NCD pandemic lie outside formal health systems. These, in developed and developing countries alike, already take up the lion's share of national gross domestic product, while the budget devoted to prevention is minimal. The UN summit could mark a start toward shifting innovation pipelines and policy-making toward better convergence between health and economic activity.

Very appropriately, leaders of many countries, and the political declaration itself, call for whole-of-government and whole-of-society approaches for addressing the NCDs pandemic. The next steps are to ensure compliance with such a call by the many health and economic actors involved, including consumers and health systems, as well as the farms, factories, retailers, schools, media and other industries whose everyday practices must be transformed. Global agencies and member national governments must learn how to be "commanders in chief," imposing mandatory regulations that define boundaries and rules for consumers and all stakeholders: providers of public goods and services; stewards of public resources; businesses; and civil-society organizations.

To follow up the UN summit, the forthcoming G20 summit in Cannes, France, on Nov. 3 and 4 must address NCDs. The G20 must control NCDs, and the soaring health-care costs that they cause, if it is to meet the commitment of its June 2010 summit in Toronto to cut members' fiscal deficit in half as a share of GDP by 2013 — and now to calm the debt crisis erupting in Europe.

All G20 leaders have a compelling reason to act at home, and the resources and responsibility to act abroad, on NCDs. At Cannes, they can address together a slow-motion health crisis that has become a key component of an escalating financial crisis.

Laurette Dubé is James McGill Chair of consumer and lifestyle psychology and marketing at the Desautels Faculty of Management of McGill University and is the scientific director of the McGill World Platform for Health and Economic Convergence. John Kirton is co-director of the G20 Research Group at the Munk Centre for Global Affairs at the University of Toronto.

Source: Montreal Gazette, September 21, 2011. See also "From New York to Cannes: Baby Steps in the Battle against Non-communicable Diseases," by John Kirton and Laurette Dubé, Globe and Mail, September 21, 2011.