WHO takes on chronic disease

By Will Englund, Published: April 29

MOSCOW — The World Health Organization focused for decades on infectious diseases, but now it’s putting non-communicable diseases near the top of its agenda.

The fight against heart disease, diabetes, stroke, lung cancer and chronic respiratory disease may not seem as heroic as the struggle against smallpox or H1N1, but chronic illnesses account for 63 percent of deaths worldwide — 70 percent in the United States and 90 percent in Russia.

“And these are preventable,” said Margaret Chan, director general of WHO, at a three-day series of meetings here this week devoted to chronic diseases. “People don’t have to suffer. People don’t have to die.” No tobacco and less sugar, fat and especially salt are WHO’s top targets; reducing alcohol consumption and increasing exercise are right behind. Those factors alone account for 25 million of the 36 million deaths attributable to chronic diseases annually, according to WHO, and place a huge economic burden on families and nations.

But a cigarette is not like a microbe: It can’t be eliminated by a doctor. Fighting chronic diseases requires political decisions — in areas as disparate as finance, regulatory policy, agriculture, education and trade — and the will to see them through.

New Zealand farmers dumped “mutton flaps” — fatty cuts they couldn’t sell elsewhere — on Fiji, until Fiji banned them. U.S. poultry producers marketed turkey tails in Samoa, before the government there outlawed them. “We have transnational companies which offload junk food on us,” said Neil Sharma, Fiji’s health minister.

The cheapest food is the worst. “All our beggars are obese,” Sharma said. “We’ve got to commit ourselves and say that’s not right.” 

Industry at the table 

Unhealthy food, and what to do about it, was the most sensitive topic at the gathering here. Representatives of PepsiCo, Coca-Cola and Nestle joined the discussions after a decision by WHO to allow the big international food concerns a voice as the organization prepares an agenda for a U.N. meeting in September. (Tobacco companies were deemed beyond the pale.) Prime Minister Vladimir Putin talked about the need to enlist the business community, as did Kathleen Sibelius, the U.S. secretary of health and human services.

“Did anybody mention conflict of interest?” said Patti Rundall, policy director for an British group called Baby Milk Action. She and others say they worry that lobbying by companies that are part of the problem will undermine WHO’s efforts.

Janet Voute, of Nestle, said the companies were unfairly blamed for consumers’ choices, and Herve Nordmann, chairman of the Industry Council for Development, a trade group, said that “the overfed are voluntarily overfed” and urged more research into effective ways to exercise. Still, the three firms here have joined with seven other big producers to form analliance that says it is committed to reducing salt, sugar and fat in processed food and restricting advertising aimed at children. “Self-imposed voluntary action is a good first step,” Chan said. “Industry needs to earn trust.”