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Non-Communicable Diseases

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Neil A

on 12 February 2014

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Transcript of Non-Communicable Diseases

What are non-communicable diseases (NCDs)?
According to the WHO, NCDs are known as chronic diseases that are not passed down from person to person. Instead, they are of long duration and generally slow progression.
The four main types worldwide:
1) Cardiovascular disease (heart attacks and stroke)
2) Cancers
3) Chronic Respiratory diseases (COPD and asthma)
4) Diabetes

So what did our paper talk about?
“Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries”
At the 2011 UN high-level meeting on non-communicable diseases, the political declaration presented the case for prevention of NCDs in low-income and middle income countries. (Moodie, 2013)
Participants of the meeting agreed there is not a single factor that is solely responsible for the burden of NCDs. Therefore, this movement requires collaborations from many different sectors (Moodie, 2013).
The UN’s goal is to reduce premature mortality due to NCDs by 25% by 2025. (Moodie, 2013).
Where should they start?
Statistics from WHO
Tobacco use, physical inactivity, unhealthy diet and harmful use of alcohol increases the risk or can actually cause most NCDs worldwide.
Tobacco accounts for almost 6 million deaths every year (including over 600,000 deaths from exposure to second-hand smoke), and is projected to increase to 8 million by 2030.
About 3.2 million deaths that occur annually can be attributed to insufficient physical activity.
Approximately 1.7 million deaths are attributable to low fruit and vegetable consumption.
Nearly 80% of NCD deaths (~29 million) occur in low and middle income countries.
Low and middle income countries’ unfortunate ties with NCDs
“Almost all growth in the foreseeable future in profits from the sale of these unhealthy commodities will be in low-income and middle-income countries. – Moodie
Little, if any, growth is expected in high-income countries in the next 5 years because of the economic recession, strict tobacco-control policies and saturation of established markets with ultra-processed food and drink produces. – Moodie
The chart shows that tobacco, alcohol and several categories of packaged food (proxy for ultra-processed food and drink products) are rising most rapidly in low-income and middle-income countries. - Moodie
Low and middle income countries continued...
According to Skolnik (2012):
It is projected that by 2030, there will be a major epidemiologic shift towards non-communicable disease.
It is projected that diarrhea, malaria, and TB will not longer be the top 10 causes of DALYs lost in low income countries. Rather, depression, cardiovascular disease and chronic obstructive pulmonary disease will rise on the list.

Who might we blame for the rise in NCDs?
The term “industrial epidemic” has been used to described health harms associated with various goods including tobacco, alcohol, vinyl chloride, asbestos, cars and the food and drink industries.
In industrial epidemics, the vectors of spread are not biological agents, but instead are transnational corporations.
These corporate disease vectors implement sophisticated campaigns to undermine public health interventions.
In order to minimize the harmful effects of unhealthy industries on NCD prevention, the UN called for a substantially scaled up response from governments, public health organizations, and civil society to regulate the harmful activities of these industries. (Moodie, 2013)
It’s great that the UN is calling for a scaled up response BUT……
Can you think of examples where transnational industries/companies have implemented campaigns to undermine PH interventions?
Can this really be regulated?

Conclusion: Prevention and Control of NCDs
According to WHO:
A comprehensive approach is needed that requires all sectors, including health, finance, foreign affairs, agriculture and planning to work together and promote interventions to prevent and control NCDs.
Other ways to reduce NCDs are high impact essential NCD interventions that can be delivered through a primary health-care approach to strengthen early detection and timely treatment .
Evidence shows that such interventions are excellent economic investments because, if applied to patients early, can reduce the need for more expensive treatment.
Companies sponsor or conduct confounding studies that attempt to debunk harmful research.
For example:
Philip Morris International & the White Coat Project hired doctors to publish studies negating the link between tobacco smoke and harm.
Tobacco companies also create quasi-independent organizations to debunk research and suppress the publishing of papers.
Food and drink companies were 4-8x more likely to fund or sponsor research where the conclusions were financially beneficial to the companies.
The International Center for Alcohol Policies, an organization established and funded by large global alcohol producers, commissioned reports from scientists that resemble WHO documents.
These reports were “incomplete, not subject to traditional peer review, and either supportive of industry positions or emphasizing high levels of disagreement among scientists
To undermine tobacco control research, the US Tobacco Institute promoted partnerships with scientists. They hired researchers and disseminated health promotion strategies to mislead the public about the harmful effects of smoking.
Like the tobacco industry, the food and drink industry develops customers as young as possible, using tactics such as early-childhood health promotion schemes
SAB Miller and the International Center for Alcohol Policies have assisted governments in writing their national alcohol control policies in Bostwana, Uganda, Malawi, and Lesotho.
The four draft National Alcohol Policy documents were
“almost identical in wording and structure and that they are likely to originate from the same source”
were designed to “serve the industry’s interests at the expense of public health by attempting to enshrine ‘active participation of all levels of the beverage alcohol industry as a key partner in the policy formulation and implementation process." (Moodie)

3) Lobby politicians and public officials to oppose public regulation
Tobacco transnationals lobby policymakers and fund campaigns of politicians who support tobacco use. The lobbying power of alcohol and ultra-processed food and drink corporations is also substantial.
Between 1999-2001
Alcohol: $150 Million
Tobacco: $40 Million
Pepsi: $9 Million
4) Encourage voters to oppose public health regulation
Industries campaign for a restricted role of government, and against taxation and regulation.
Emphasize that tobacco use is an individual responsibility and raise arguments against so called nanny state governments.
In contrast, public health highlights the importance of social, economic, and political factors, and ethical considerations.

$24.7 million

Brownell KD, Warner KE. The perils of ignoring history: big tobacco played dirty and millions died. How similar is big food? Milbank Q 2009; 87: 259–94.
Lesser, L. I., Ebbeling, C. B., Goozner, M., Wypij, D., & Ludwig, D. S. (2007). Relationship between funding source and conclusion among nutrition-related scientific articles. PLoS Medicine, 4(1), e5.
Jernigan DH. Global alcohol producers, science, and policy: the case of the international center for alcohol policies. Am J Public Health 2012; 102: 80–89.
Moodie, R., Stuckler, D., Monteiro, C., Sheron, N., Neal, B., Thamarangsi, T., ... & Casswell, S. (2013). Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. The Lancet, 381(9867), 670-679.
Skolnik, R. (2011). Global health 101. Jones & Bartlett Publishers.
What is the leading cause of mortality globally?
Future Challenge
Number of people with new cases of non-communicable diseases will grow in low and middle income countries
aging population, urbanization, globalization, and lifestyle changes
Non-communicable diseases are chronic, number of people with these diseases will rise

What is the most effective way to address the disease burden caused by unhealthy commodities?
First Model: Voluntary Self-Regulation
Argues that market forces, driven by informed individual choice, correct for negative results caused by high consumption of unhealthy commodities.
Default approach of many countries and the UN.
Also the preferred approach of the industry.

Article view: argues this is not evidence based

In 1970, Poland had the highest rate of smoking in the world
3/4 of polish men smoked daily
Probability of 15 y/o reaching their 60th birthday was significantly lower than other countries, with incidence of lung cancer among the highest in the world
Problem: tobacco good source of revenue for the government so did not disclose negative consequences

First research report highlighting the link of smoking to the alarming rise of lung cancer in polish citizens.
Dissemination of this knowledge lead to:
Polish Anti-tobacco Society
Joint effort with WHO and other international institutions against cancer
30% increase in taxes, warning labels, and ads completely banned in 2000
Result: Since 1991, more than 2.5 million polish citizens have permanently snuffed out their cigarettes.

Second Model: Public-Private Partnerships
Based on the belief that association with industry leads to greater success than does acting independently.
Supporters of this view claim that people need to eat and drink, that not all processed foods are unhealthy, and that partnership with industry might lead to reformulation of some products to less unhealthy compositions.
3 year partnership between the International Diabetes Federation and Nestlé, which was announced in April, 2012.
Little objective evidence that public–private partnerships deliver health benefits
Many in the public health field argue that they are just a delaying tactic of the unhealthy commodity industries.

At least some products will contain less trans-fat or less salt
Benefits more seen in high-income countries where more than 60% of total intake comes from ultra-processed foods
In low to middle income countries, it helps industry market as “sodium-reduced” or “low calorie”, but is still devoid of nutrients
Likened to tactics of tobacco industry
Introduction of filtered and low-tar cigarettes
Low-calorie, artificially sweetened products

Goals: avoid evidence-based approaches (such as restriction of availability and advertising), pricing policies designed to promote healthy food,
Articles: Industries must profit. Sales will be unchanged.

Third Model: Regulation and Market Intervention
Specifically recognizes the conflicts of interest between promotion and protection of public health and the corporations that profit from unhealthy commodities.
10% increase in cig tax can lead to 8% reduction in demand for cigaretts (low- middle income countries tend to tax at lower rates) - skolnik

What do you think is the best strategy to tackle non-communicable diseases?

Skolnik proposes the following 5 priority areas that should be addressed in the low-middle income countries:
Tobacco: Accelerate the implementation of the Framework Convention on Tobacco Control. (Protocol to eliminate illicit trade in tobacco products signed by 54 parties of WHO).
Salt: Promote greater population awareness and voluntary action by food industry to reduce salt consumption
Obesity, unhealthy diet and physical inactivity: Promote greater knowledge and take measures on taxes, food labeling, food subsidies and food marketing to reduce overconsumption and consumption of unhealthy fats. Encourage consumption of fresh fruits and vegetables and of physical activity.
Harmful alcohol intake: Increase alcohol taxes, ban advertising and restrict sales.
CV disease: Promote the use of proven drugs for high risk individuals
Conclusion (cont.): Areas that need addressing
CVD caused 16.4 million deaths in 2001 and now leading cause of death in the world!

High Income Countries = 30 % of all deaths
Low and Middle Income Countries = 28 % of all deaths

Non-Communicable Diseases
Ronneil Aviles
Jeannie Duong
Jonathan Lee
Andrew Lansley’s “nudge” to obesity
“It's perfectly possible to eat a bag of crisps, to eat a Mars bar, to drink a carbonated soft drink, but do it in moderation, understanding your overall diet and lifestyle. Then you can begin to take responsibility for it.”
The Marie Sklodowksa-Curie Memorial Cancer Center and Institute of Oncology
“When the history of the world’s attempt to address obesity is written, the greatest failure may be collaboration with, and appeasement of, the food industry”.
– Brownell
Generally good, but biased toward Public Health methods used.
Article doesn't explain how it defines "low-middle income countries."
Article is biased against companies.
Full transcript