By Emily Hoch
On Monday, as locals flock to successive showings of Contagion, the United Nations General Assembly will meet in New York for its second ever high-level meeting on health, on the comparably mundane topic of non-communicable diseases (NCDs): heart and chronic respiratory disease, diabetes, and cancer, among others. With all the high-drama causes out there, it might seem odd that the U.N. is focusing its attention on what are typically considered codas to the lives of the rich and the elderly. But NCDs have become a universal threat. They kill three in five people a year, and 80 percent of the victims in 2011 will live in developing countries. Roughly a third will be younger than 60. Even larger numbers of people are living disabled by these illnesses.
As such, low- and middle-income countries are facing what demographers call a double burden: Policymakers must balance prevention and treatment of diseases typical of the young and impoverished, such as diarrhea, pneumonia, and malaria, with stemming an NCD pandemic that the World Health Organization predicts will increase deaths by 15 percent by 2020. And despite the announcement today that Ely Lilly will donate $30 million to developing-country diabetes research, only 3 percent of all development assistance for health (worth a total of $22 billion) is dedicated to NCDs.
The only other U.N. General Assembly meeting on health was the 2001 session on HIV/AIDS, a turning point in the struggle to curtail that pandemic. Since 2001, billions of dollars have been spent on HIV/AIDS prevention and treatment, and almost every country includes an action plan for HIV/AIDS in their policy framework. The biggest achievement of the HIV meeting was the establishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has been lauded for reducing the human burden of these maladies while improving efficiency and country-level leadership.
A Declaration of Commitment on NCDs is likely this time around, too, and countries, activists, and corporations have found common ground on low-cost interventions. But real action is likely years away. While many in the global health community want to expand the Global Fund's mandate or to establish funds for other causes, neither of these options is likely. Experts have concurred that a new institution or funding pledge might distract cash-strapped governments from key tasks, such as strengthening overall health systems and regulating risk factors, including changes in the food and beverage industry. Instead, the United Nations will probably encourage member states to insert line-items for NCDs in their health budgets, develop national NCD plans, and take a strong stand on prevention.
Even there, the challenges will be considerable. In nearly every country, the sale and distribution of tobacco, alcohol, and unhealthy foods -- key risk factors for NCDs -- is big business. Governments dependent on tax revenue from the sale of these products may be hesitant to compel their citizens to change their lifestyles. China recently passed its first smoking ban, for example, but the state-owned China National Tobacco company generated $76 billion in taxes and profit for the country in 2010. Russia, the number three beer-consuming nation (after China and the United States), delayed any attempts at improving behavior by only recently classifying beer as alcoholic. And in Brazil, where 40 percent of the population is overweight and 10 percent is obese, the government has been accused of welcoming Nestle plants and micro-distribution networks that specialize in fatty and salty foods. So while the U.N. meeting next week is a significant step forward, as with losing weight, these changes will take years (if not decades) to implement.
Emily Hoch is an associate in Eurasia Group's global health practice.
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