Maria Luisa Chavez, the Chief of NGO Relations and the Department of Public Information, commenced the presentations by stating today’s briefing, entitled “Challenges and Opportunities for Preventing Non-Communicable Diseases: The Key to Achieving MDGs.” Ms. Chavez introduced the four NCDs that act as the greatest cause of mortality and disability worldwide: cardiovascular diseases, cancer, diabetes, and chronic lung diseases. 60% of all deaths worldwide are due to these diseases, and low & middle-income countries are getting the worst of it. Ms. Chavez believes NCDs have had a momentous impact on productivity and family resources, and that they have become a major threat to the economic and social development of these countries. To overcome this epidemic, we need to cut risk factors such as smoking and alcohol, and replace them with healthy diets and daily exercise plans. She concluded her introductory remarks by notifying participants of an upcoming High-Level meeting on September 19th – 20th this year, which will further explore the subject of NCDs in the health field. Then, she introduced a short clip entitled, “2011 UN-NCD Summit: The European Story,” which was shown at the Briefing, and produced by the World Health Organization (WHO.)
The video discussed the Oslo meeting of November 2010, which ministers, officials, and representatives from non-governmental organizations participated in to underline Europe’s key role in the fight against NCDs. Statistics involving societies, ending human suffering, preventing the spread of the four major diseases, needs, and lastly, challenges, were at the center of discussion. The clip came to a close by focusing on the South African city of Cape Town, a place facing an epidemic of increased NCDs as a result of changed lifestyles.
"People from low & middle-income countries are targeted by the tobacco industry; these countries are struggling to have basic healthcare systems, let alone the programs that address NCDs!"
The first speaker of the panel, Mr. Kiyo Akasaka, the Under-Secretary-General for Communications and Public Information, started his presentation by providing some statistical data: every year, NCDs are responsible for thirty-six million deaths worldwide, and the increasing number of NCD victims was twenty-eight million in developing nations, last year alone. Mr. Akasaka stressed that we have control over our diets and levels of exercise, and gave pointers on how drinking red wine and following a Mediterranean diet can help prevent cardiovascular diseases. Mr. Akasaka also shared a personal story about the negative consequences smoking has had on him over the years and the challenge of quitting his bad habit.
Mr. Akasaka concluded his portion of the panel discussion by emphasizing his willingness to work with NGOs in raising awareness and getting engaged in campaigns. He is planning to promote an action plan to prevent NCDs and making the September meeting informative and successful by organizing various seminars and meetings.
The next speaker, Josephine Ojiambo, Representative of Kenya to the UN, opened her presentation by expressing that eighteen of the thirty-six million deaths related to NCDs last year, were in fact preventable. These preventable diseases were not only the four main ones Ms. Chavez and Mr. Akasaka mentioned, but also illnesses such as connective tissue disorders and Alzheimer’s. H.E. Madam Ojiambo continued by deliberating about the role one’s environment plays in the causes of these diseases, apart from the individual. Some factors contributing to the rising number of NCD victims is gender-based (for example, certain diseases occur more often in females than males.); some are related to genetics; some are caused by one’s geographical location (for instance some places in Kenya have higher amounts of iodine in the soil); and some are caused by exposure to pollutants in the air such as smoke, radiation, and radioactive dust, which are leading sources of cancer. Today, Kenya is suffering under the NCD burden – there are higher numbers of people with cardiac diseases due to the consumption of wholesome grains and foods with elevated fat contents. With poor food choices, NCDs are seen not only in old people, but also among the young.
We have to remember that it is not just the individual who has to make the change, but it is a cultural change that has to be made.
H.E. Madam Ojiambo believes in the need for public health education on school-going children to get them to “manage and promote their own health.” She highlighted the need for early-screening diagnosis, especially on the subject of cervical cancer. PATH NGO was able to do these early-screenings in rural areas of Kenya, and they were so low-cost that they were able to use iodine to help fix slides after pap smears. Keeping this procedure in mind is important because E.S. is often not available due to cost-factors. On a different point, she summarized Breast Cancer Week in Kenya, an event in which women are encouraged to conduct self-examinations by advocates, rehab promoters, and survivors. Community groups and the private sector also play a vital role in nursing homes and hospices over the course of the battle against breast cancer. The third change H.E. Madam Ojambo believes Kenya is in need of is more diagnostic and treatment equipment for intervention, especially cardiac disease, diabetes, and cancer. On the subject of medics, Kenya is further challenged by the lack of quality generics. This is hard chiefly for the management of cancer, due to the high treatment costs for families; She is hoping to have more trained health workers and an adequate number of health facilities at a community level.
How does H.E. Madam believe Kenya will overcome these obstacles? Organizations and the government will put emphasis on primary health, such as the promotion of healthy lifestyles. Advocated by the NGO Community, they will strengthen health systems with government policy and increase investment in the health infrastructure. H.E. Madam. Josephine Ojiambo ended her speech with emphasis on how the management of NCDs must be carried out in an integrated manner, how education strategies must be taken up and accepted, and the engagement in research.
"The issue of tobacco management is never forgotten and is very high on the agendas because it is one of the key killers."
The third speaker, Dr. Karen Sealey, PAHO/WHO Special Adviser on UN Matters and Partnerships, informed listeners that her presentation would be on those four NCDs that have been identified for initial attention. She believes these are not simply “individual life-style” diseases, but rather that individuals have the final choice in an environment that makes it possible for them to make the best choices. Then, she proceeded to provide more statistical information about NCD-related deaths and rates of obesity among people with diabetes. Nine out of ten deaths from NCDs occur before the age of sixty, an equivalent of about nine million people. In Barbados, 23.9% of the population is obese, and 50% of all women in the Caribbean are overweight.
Then, Dr. Sealey focused on the problems of alcohol & tobacco: there is a 22% tobacco use in the UK, and 15.2% among Australian women. Tobacco use by mothers reduces the birth-weight of children and lowers life quality and expectancy. By spending their money on alcohol and tobacco, these women do not have enough income left over to feed their children. Then, Dr. Sealey talked about NCDs’ effects on poverty on the household level as well as the economic burden it carries on a national level. People from low & middle-income countries are targeted by the tobacco industry; these countries are struggling to have basic healthcare systems, let alone the programs that address NCDs! Therefore, many households are losing income due to these factors.
Dr. Sealey stated that 2008-2010 member states have the building blocks of policy and programming that has been influenced by the cost-effective evidences of the practices of the developed and developing nations. This evidence is important for governments to see that there is a crisis and to monitor progress over time. Once again, she emphasized the importance of providing an enabling environment in order to help individuals make the right choices, and that “we need to have making the right choice the easy choice.” Selling affordable foods to encourage people to adopt healthy diets, building parks to motivate persons to exercise, and creating smoking programs that would be available to communities, are included in her plan towards building a goal-achieving environment. Governments have to provide basic primary health systems that give people access to universal needs and technologies. She tenaciously believes that they have to work across the globe to do that, and in our need to bring the prices of certain drugs to come down through working together (such as for cancer medications and those for high levels of CVDs.) To bring her presentation to a close, she discussed the WHO’s role in preparations and what is still yet to be done.
Ms. Kiti Kajana, Advocacy Manager at NCD Alliance, began her lecture by sharing stories about losing a loved one to lung cancer and taking care of the sick whilst growing up in Albania. The NCD Alliance, formed in 2009, is made up of four federations, and represents 900 associations from 170 different countries. They have worked with Livestrong and the American Cancer Society, and are looking forward to implementing the WHO’s plans in the near future. Ms. Kajana wants governments to be accountable and measured on NCD plans, a global commitment to prevent the preventable, globally agreed approaches to NCD treatments, and to look at the continuum of the disease - not just prevention and treatment, but all the way to retaliation.
Lotoya Williams, a breast cancer survivor shared her personal recollections about what it was like to live with the disease. Since both her grandmothers had it, the news came as no surprise after feeling a lump on her breast at age fourteen. Fortunately for Ms. Williams, her friends and family members supported her on her way to recovery, and she was able to overcome the new challenges the disesase presented in her day-to-day life.
Question & Answer Session:
Q: What is being done and what steps are being taken between the idea or eradicating of risk factors and treating the end stage disease? Because the body needs to be treated before a full-blown cancer, or diabetes, or heart disease is seen. What sorts of natural hygienic measures like Chiropractic care are being looked at in ways that are inexpensive and sustainable around the world?
A: (Dr. Sealey): As I said before, governments are being supported to deal with all of the issues, not just the NCDs v. Communicable Diseases - CDs, not just Developmental v. other issues, so by identifying these stressors, governments know where to channel their resources. Secondly, is the emphasis on primary healthcare; included in that is using both community and traditional resources. We have to remember that many countries still use traditional medicine, and for example we have adopted acupuncture as a form of one of these complementary medicines. We are going to be challenged to develop the interventions in collaboration with communities, and to endure we address the cultural side of this problem as well. We have to remember that it is not just the individual who has to make the change, but it is a cultural change that has to be made. I think it would be important for associations to think of how in fact the solutions of coming together of partnerships on a national level as well as on a community level can be best done.
Q: You’ve emphasized a life-course approach including younger people as well as older people. We appreciate the emphasis on prevention but we also believe treatment, care, and management, are equally important, particularly given that elderly people become disproportionately burdened and impoverished by NCDs. I’m wondering, why has there been a de-emphasizing of older people at the beginning of these reports?
A: (Dr. Sealey): Indeed, we know from experience from the other epidemics of this global magnitude, that there has to be a balance between treatment, prevention, and rehabilitation. The emphasis on prevention is to help developing countries in particular, recognize that there are cost-effective ways of prevention, because there was a myth that NCDs were a disease of developed countries and that individuals could manage them by themselves. But we now know, for pennies, we can have programs that reduce communities’ salt and fat intake…so that was one of the things behind prevention. The second thing is that we know treatments can be very expensive if we let people’s health get to this stage. So the idea o life-course has been brought to the attention of the people like the fact that children who are malnourished have greater propensity to obesity than children who are not malnourished. They are not two disconnected factors. We have to look at all of the factors along the life-course. With respect to the elderly, there are three major global drivers for this epidemic. One is the globalization of information and lifestyle. Aging is also one of the global drivers. It’s not that the elderly have been forgotten – in fact we recognize that all these young people are going to get old – so the goal we want to achieve is to delay the onset of these diseases. So treatment, care, and access to medicines play a critical part.
Q: My fear is that some important NCDs in Africa, particularly sickle-cell disorder, will be forgotten. This is a disease that can be prevented and addressed so I think we can take this opportunity to look at it and the panelists here can explain how we can do that. My second point is that MDG 6 also addresses all the diseases so NCDs should come in the MDG 6 as well.
A: (Kiti Kajana): In the declaration that came out from the Afro-consultation, sickle cell anemia was put forward, as were hemoglobin disease. It is a huge regional concern but I can’t speak to inclusion in the final outcome document. Something to keep in mind is that the declaration that came out of Rasavil can potentially serve as a platform in Africa.
A: (Dr. Sealey): I want to highlight what happened at the African Regional consultation, and there are some regional focuses that must be identified. We can have the core NCD diseases that are being looked at globally and each region may have another one that they may wish focus on at that regional level, and add it. Also, if we improve laboratory services across the board for NCDs, I think we will automatically improve the care for other diseases (such as sickle-cell anemia.) There will be many co-benefits of this, and this will be monitored as we go forward.
Q: Sometimes when migrants arrive in this country, they are healthier than when they live here 20-30 years and develop obesity, diabetes, hypertension, etc due to unhealthy eating habits and little exercise. Because NCDs are increasing all over the world, is it a myth that migrants are really healthier when they first come here? Or are poor diets everywhere, in terms of food and no exercise?
A: (Dr. Sealey): I don’t have any data to determine whether the people who migrate to other countries in the world are healthier in this global phenomenon, but I do know that there is a significant migration and health program, and soon, NCDs will be included in it. The hope is that eventually the migrant population is going to be educated and hold on to and build on the healthy practices.
Q: I’ve looked at the draft for the Russian meeting and I did not see any of the “low-hanging fruits” that Mr. Akasaka described with simple exercise actions and healthy eating. Nor, in fact, have I seen anything pertaining to the International Olympic Committee’s tobacco-free Olympics. Is there any outreach to the IOC about the issue of the low-hanging fruit?
A: (Kiti Kajana):I wish I could speak more to your question but as a civil society representative, all I can do is push for some of our “asks” and hope for inclusion. I haven’t heard any talk about the inclusion of the Olympic Committee but there is a very good system from the WHO about tobacco control. The issue of tobacco management is never forgotten and is very high on the agendas because it is one of the key killers.
Q: How can all NGOs do more to help in this cause? I don’t see the concrete things that we can do right now. Will there be a website stating the concrete steps to make these efforts really work?
A: (Kiti Kajana): First on the global level, I would say please participate in informal hearings. The NCD Alliance is open to all NGOs, so they can join the common-interest group and can be briefed and be sent materials on a weekly basis. A key thing that has come out of many discussions is the push for countries to form their own NCD alliances, which is really important. In the US, for example, there is a preventive health partnership that is comprised of the American Cancer Society, American Diabetes, and American Heart. WHO does amazing work and we are hoping to have a website that can provide civil society with information about what comes out of the June meeting.
Q: I am impressed with the way we have to change our life-styles, but my children go to the grocery store to buy “green” things and their bills become twice what mine are. How do we do this so that companies give us the kind of food that we need to eat?
A: (Dr. Sealey): This is one of the issues it will take partnerships at a local level and partnerships on a global level. Some reasons in terms of the “greening” of the food, lies in supply and demand, which raises prices. But if incentives are provided to the produces, as they are provided to manufacturers, in the sense that policies are re-oriented towards the need of a healthy diet, we think there will be a change in terms of the cost. Governments will provide incentives for the kind of change we need to see take place. But this will call for partnerships – not just regulations.
Q: The US government makes a lot of money from the taxes that the tobacco and alcohol industries throw off. I’m concerned that we think the government will really give up that kind of money for us to be healthier. Should we be marching and picketing? Or is there anything we could really be doing?
A: (Kiti Kajana): One thing you can push for is for the US to ratify FCTC which has not happened yet, and even though there are amazing initiatives in the US, state by state, and American Cancer Society (ACS) has been heavily involved in that, overall the US has not ratified for tobacco control.
A: (Dr. Sealey): I think the role of the NGO sector here is the role of the “watchdog.” So the NGOs’ role is to bring this to the floor, talk about it, and develop a movement to pressure governments to identify other ways of development and economic growth. If you have chapters in the developing countries among those 900 associations that Kiti referred to, please help them to lobby because they don’t always have the capacity to do the kind of lobbying that resulted in the decline of tobacco and alcohol use in the US.