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Steve Fouch

Making Poor Choices: are commercial concerns wrecking our health?

Steve Fouch is CMF Connections Manager, and formerly worked in community nursing, HIV & AIDS and palliative care. He serves on the International and European regional boards of Nurses Christian Fellowship International.
The views expressed do not necessarily reflect those of CMF.

Cancer, diabetes, heart disease, lung diseases, and strokes are the major causes of death and disability in the developed world. However such non-communicable diseases (NCDs) could also be the next big health issue to appear on the global agenda – but it’s proving hard to get real global interest and response going. In South-East Asia alone, NCDs kill 7.9 million people each year – some 55% of all deaths in the region. (NCD deaths in Asia as a whole are expected to increase by 21% over the next decade.)

Western diets high in fat and sugar, low in fibre and micro-nutrients are becoming a growing problem in developing nations, along with smoking and excessive alcohol consumption, and sedentary lifestyles.  It seems that in a drive to ‘develop’ the developing world, we have exported a lot of our worst habits. And why not? They are after all hugely profitable.

The tobacco and alcohol industries are growing, but facing falling demand in the West, they are looking to the emerging markets of Asia and Africa to keep fuelling that growth.  50% of all male smokers are in the developing world – and that number is growing.

Alcohol is responsible for two million deaths per year or one in 25 of all deaths worldwide, while tobacco kills more than 5 million people annually, accounting for about 8.8% of all global deaths, 4.2% of all disabilities, and approximately 30% of all cancers. If current trends continue, tobacco will kill seven million people annually by 2020 and more than eight million people by 2030, about 83% of whom reside in low- and middle-income countries.

It is not just the early deaths caused by these conditions – it is the consequences of years of deteriorating health and expensive treatment that can worsen or even cause poverty.  Make no mistake, NCDs are exacerbating global poverty and suffering all round.  They are also largely preventable.

The UN is holding one of its high level meetings next month (12-19 September in New York) to look at ways of addressing more effectively on a global scale this growing, but still largely under-reported pandemic. The only other time the UN has brought together heads of state, health ministers, NGOs and other civil society groups to address a major health issue in this manner has been around HIV & AIDS.

But, as the British Medical Journal has pointed out there are already several factors threatening to neuter any resolutions for global and national action arising out of the meeting.  ‘In the run up to the U.N. summit on non-communicable diseases there are fears that industry interests might be trumping evidence-based public health interventions….Many hope that this meeting will force [NCDs] into the spotlight just as the first health-related U.N. summit did for AIDS a decade ago…but with only weeks to go before the summit … discussions have stopped on the document that forms the spine of the summit.’

While there are deep divides among UN member states (on key issues such as access to essential medicines and vaccines, and the control of risk factors, resources and strategies to prevent and control NCDs) there’s another major problem. The ‘powerful sway that the tobacco, alcohol and food industries have over international governments and how this impedes effective health policy,’ (BMJ)

WHO Director-General Margaret Chan has also warned that many threats to health come from powerful corporations, driven by commercial interests.

In short, there is simply too much money to be made in marketing our vices worldwide.  But when the average income in India is $2,000 per annum and the annual cost of treating diabetes is $3,000 (and vastly more for cancer treatment), it is obvious that the poor are just going to die young because they will never be able afford treatments for chronic conditions.  So prevention, addressing the lifestyle issues, is the only way forward.

We don’t have big name celebrities getting behind tackling diabetes, cancer and heart disease in the developing world – they have not attracted the worldwide sympathy and celebrity glamour that has helped raise the profile of HIV and AIDS for instance. Yet the prevention message is simple – don’t smoke, drink less, eat healthily, get some exercise every day.  Sadly, the marketing budgets of the food, alcohol and tobacco industries far outweigh health promotion budgets. Until these companies can be persuaded to change their marketing strategies and investment policies, NCDs will continue to become the biggest threat to health and wellbeing in the days ahead.

Posted by Steve Fouch
CMF Head of Allied Professions Ministries

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