By Marty Logan
KATHMANDU, Dec 5 2023 (IPS)

If I asked you to name the world’s most deadly diseases I’m guessing that you might say HIV/AIDS, tuberculosis, cholera, maybe even COVID-19. In fact, those have all been major killers throughout human history – and some like TB continue to be so, especially in low-income countries.

But there is one group of diseases that is responsible for the deaths of more than two-thirds of people on earth. Let that sink in for moment. For every three people who die, two are killed by these illnesses, which are known as non-communicable diseases, or NCDs.

You probably know about many of them. NCDs include cancers, diabetes, cardiovascular diseases and strokes, lung diseases and mental and neurological illnesses. As the name implies, what sets NCDs apart is that they cannot be passed from one person to another.

Today we’re speaking with Maisha Hutton, executive director of the Healthy Caribbean Coalition, about the growing impact of NCDs on that region. For example, they are responsible for 80% of deaths in the Caribbean, and 40% of all premature deaths. Before COVID-19, one in three children in the region was overweight or obese – a major contributor to developing NCDs — which is one of the highest rates in the world; it might be even higher now, says Maisha.

Besides describing what NCDs look like in the Caribbean and what societies there are doing to tackle the epidemic, Maisha explains why it’s not fair, or correct, to label NCDs as ‘lifestyle diseases’. That’s because the environments where people live have been carefully designed to promote NCD risk factors including alcohol and tobacco use, physical inactivity and unhealthy diets.

A quick note about some terms that Maisha mentions: PAHO is the Pan American Health Organization. GDA, traffic light, and octagonal — or stop sign — are different types of warning labels for food packages. GDA stands for guideline daily amount (or guideline daily allowance).

A COVID-testing health care team in the community in Dominica. The 65th Health Research Conference in the Caribbean aims hoping to build on cooperation in health and arm policymakers with the latest research findings to tackle the region’s most pressing health challenges. Credit: Alison Kentish/IPS

By Alison Kentish
UNITED NATIONS, Jun 17 2021 (IPS)

In 1956, the Caribbean held its first major scientific meeting, organised by the Standing Advisory Committee for Medical Research in the British Caribbean. At the time, the Mayaro Virus, a dengue-like viral disease often called ‘jungle flu’ had just been identified as a new human disease agent by W.G Downs and G.H Wattley in Trinidad.

Fast forward six decades and this week, the Caribbean Regional Public Health Agency (CARPHA) is hosting the 65th Health Research Conference, in the backdrop of the COVID-19 pandemic, which has stretched public health institutions, upended businesses and crippled regional economies.

A pandemic that brought the world to its knees would spell hardship enough, but it is part of a triple threat that public health officials say demands evidence and research-based responses.

According to CARPHA, Non-communicable Diseases (NDCs) are the leading cause of death in the region and make up the greatest cost to health systems and economies.

Member states are also vulnerable to the environmental, economic and health impacts of a changing climate. With many small island states grappling with increasingly intense storms, the region is on the frontlines of the climate emergency.

“We cannot forget the La Soufriere Volcanic explosion, we have had flooding in Guyana, Dengue outbreaks, economic standstills, all at once. The public health challenges have been unceasing,” says Dr. Joy St. John, CARPHA Executive Director.

“So, this year’s research conference presentations are even more important, as we search for evidence to inform policy and programming, that combat climate change, in this new world COVID-19 is forcing us to create.”

“NCDs have also caused deaths among the younger persons with chronic disease. We are therefore happy that in 2021, the 65th conference, which is the longest-running in the Caribbean, will be distinguished by the scientific ingenuity and innovation of some of this world’s most resilient, and determined people — the people of the Caribbean.”

The four-day research forum which started on Jun. 16 will feature the latest health research findings from the Caribbean.

Organisers are hoping it will guide member states coping with the shocks of the ongoing COVID-19 Pandemic, but concede that even as the region leans heavily on research and science for recovery, push back remains. This includes what they describe as the ‘ever-present vaccine hesitancy.’

CARPHA has been tweaking its communication messages, hoping to win over those who are reluctant to get vaccinated.

“With the return to cruise tourism and some cruise lines not requiring immunisation of passengers, the speed of delivery of vaccines will be critical to slowing the disease as well as ‘variant-of-concern’ transmission. Economic downturn will not be halted if the Region is plagued by repeated outbreaks in the tourism sector. No one wants another regional lockdown 2.0,” said St. John.

Public health officials say successful vaccination campaigns are a cornerstone for reopening, but some states appear to be hitting an inoculation plateau.

Antigua and Barbuda is among the CARPHA member states recording success in its vaccination campaign. 59 percent of its adult population has received at least one dose of the AstraZeneca vaccine.

“Being responsive to vaccine demand, creating ease of access by utilising mobile services in the community in addition to static public vaccination sites in strategic locations. Heightened traditional media and social visibility including the use of influencers. We have weekly strategy meetings to respond to issues arising at various levels of the process,” Chair of the Public Education Sub-Committee of the National Coordinating Committee for the COVID-19 Vaccine Dr. Janelle Charles-Williams told IPS.

The conference is hoping to build on cooperation in health and arm policymakers with the latest research findings to tackle the region’s most pressing health challenges.

From a survey that seeks to understand the rationale for COVID-19 vaccine hesitancy, studies on diabetes, physical activity, cancer health services, maternal and child health, rainwater harvesting and lectures from renowned scientists, the goal is to also prepare for the next pandemic and bolster regional public health care systems.

“Although many Caribbean states have successfully avoided wide-spread transmission of COVID-19, I know the pandemic has hit you hard in other ways such as lower revenues from tourism. Even when/once the pandemic subsides, we know that you will still face many of the same health challenges you had before including climate change and non-communicable diseases,” World Health Organisation Director-General Tedros Ghebreyesus told the conference on Wednesday. 

Thirty-two research papers were presented at that first scientific meeting in 1956. That figure has grown to an average of 92 a year. CARPHA is hoping that cutting-edge research on the Caribbean’s trio of threats will spur evidence-based decisions on healthcare delivery and programming. 

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Excerpt:

Professor Robyn Norton, co-founder and Principal Director of the George Institute for Global Health. Credit: George Institute/IPS

By Neena Bhandari
SYDNEY, Apr 11 2017 (IPS)

Science and medicine were not subjects of dinnertime conversations in the Norton household in Christchurch, New Zealand, but Professor Robyn Norton grew up observing her parents’ commitment to equity and social justice in improving people’s lives. It left an indelible impression on her young mind.

Her high school years coincided with the women’s movement reaching its peak. She got drawn into thinking about addressing women’s health issues and moved to Sydney, Australia to enroll in a Master’s in Public Health.Norton feels its time the global health agenda expands from a predominant focus on women’s reproductive organs to include women’s whole bodies — and the NCDs, such as heart disease, stroke, cancer, chronic respiratory disease and diabetes.

“It was a light bulb moment for me. At that time, women’s reproductive rights and the high rates of maternal and infant mortality were paramount in global and women’s health agendas, which in the next 30 years would result in significant improvements in maternal health. Since then the burden of disease has changed. Today, the single highest cause of death for women in every single country is non-communicable diseases [NCDs] and injuries,” says Professor Norton, who is the co-founder and Principal Director of the George Institute for Global Health, a not-for-profit medical research institute that aims to increase the provision of safe, effective and affordable healthcare worldwide.

In 1999, she co-founded the Institute with Professor Stephen MacMahon for three main reasons. First, a recognition that the global burden of disease had changed, particularly in lower and middle-income countries where NCDs and injuries were emerging as a leading cause of death and disability. Secondly, the expertise to manage the emerging epidemic of NCDs and injuries was not available in these countries. Thirdly, most of the global collaborations between the high income and low income countries were still focused on maternal and child health and under nutrition.

“Global health policymakers needed to acknowledge and address these issues. Our expertise in NCDs and injuries, along with working in low and middle income countries, made it the right time to set up the Institute. The Institute of Health Metrics and Evaluation study, which emphasised the growing importance of NCDs and injuries was release around the same time, providing a significant impetus for us to move forward,” says Norton, who is Professor of Global Health at the University of Oxford and Public Health at the University of Sydney.

The Institute founders chose to partner with the University of Sydney as they felt geographically Sydney would be a natural hub for collaborations, particularly in the Asia-Pacific region. Soon the Institute began collaborative partnerships for research in India.

“We realised that if we were to make a difference in the world, we had to be in a country with a huge population. India also fitted our original idea because it was going through a transition with triple burden of disease and changing demographics. It was starting to see under nutrition co-existing with over nutrition; infectious diseases beginning to co-exist with the growing incidence of cardiovascular diseases and strokes,” explains Norton.

The model of an external organisation partnering with colleagues in India to particularly address NCDs and injuries was a relatively new one for India. The Institute’s biggest challenge was to raise the importance of NCDs and the need to address the burden of these diseases, which account for seven of the top 10 killers of women, and 18 million women around the world die from them each year.

Norton feels its time the global health agenda expands from a predominant focus on women’s reproductive organs to include women’s whole bodies — and the NCDs, such as heart disease, stroke, cancer, chronic respiratory disease and diabetes.

This year marks the 10th anniversary of the George Institute in India. “We have laid the foundation in India for growing the institute with a larger critical mass and greater impact. We would like to produce research that impacts on policy and practice that ultimately leads to reduction in NCDs and injuries and greater access to healthcare for a larger proportion of the populace,” she adds.

Evidence shows that there is a lack of gender sensitive research, data and policy, which is impeding gender equity in health. The Institute has joined a global call for a gendered approach to the collection and utilisation of health data.

Says Norton, “As we deepen our understanding of how the human body works, we know that women and men respond differently to disease and to possible interventions. We are also beginning to understand that health systems respond differently to women and men such that both access to care and the quality of care differs. Yet, far too commonly, there is no delineation of gender in health data, and women are underrepresented in many scientific and clinical studies.”

To improve the health of women and girls in developing countries, Norton says, “We have to look at the leading causes of death and disability and then allocate resources into addressing those issues. We now know that seven out of 10 causes of death and disability for women in India are NCDs. It is critical to begin with making women understand the risk factors of NCDs and how best to prevent and manage those.”

She suggests restructuring the health services and utilising existing workforce by retraining them to integrate NCDs. “India has enormous resource in the cadre of Accredited Social Health Activists [ASHA], who have been focusing on improving the health of women during pregnancy. If we can look at ways of upskilling them then it is going to be incredibly important as part of the process of bringing more women into the health sector.”

The Institute has been researching innovative ways to provide greater access to high quality, low cost essential drugs in developing countries.

“The approach we are taking is three-fold. First, looking at ways to make generic drugs more widely available. Secondly, combining drugs, for example four pills into a single pill, to keep costs low and ensure greater adherence. Thirdly, training non-physician healthcare workers and equipping primary healthcare centres to provide quality care, so people have the confidence in their quality of care and realise that they don’t need to travel miles to a tertiary healthcare centre or pay lots of money to see a specialist for everyday illnesses,” she adds.

The other issue close to her heart has been road traffic injuries. She is the Chair Emeritus of the World Bank and the World Health Organisation supported Road Traffic Injuries Research Network, which is aimed at building research capacity and agendas to address the growing burden of road traffic injuries in low and middle income countries.

“It has been a tendency to think about road traffic injuries as an accident or an act of God rather than a health problem. We have to take the same scientific approach to injury as we have used, for example, to address heart disease. Injuries in many respects fall between the world of infectious diseases and NCDs. Ten percent of people die as a result of injuries worldwide and the burden of injuries mostly rests on adolescents and young pre-middle aged people,” says Norton.

She feels India needs to look at the data and causative factors, monitor it and then intervene, to address the causes of road traffic accidents.

“We know that speeding, drink driving, not wearing helmets, seatbelts and child restraints, are some of the key factors associated with road traffic injuries. If we focus on educating the public on those issues, along with introducing and enforcing legislation, it would make a huge difference in India. We need advocacy and leadership by governments, non-governmental organisations and academics, such as ourselves, to take these issues together,” she adds.

*Neena Bhandari is a Sydney-based journalist and president of the Foreign Correspondents’ Association (Australia and South Pacific).

A woman smokes a cigarette branded ‘Fortune’ at a campaign rally for Philippine President Benigno Aquino III, a smoker who has said he has no intention of quitting the habit. The Philippines has the second highest number of smokers in South-east Asia. Credit: Kara Santos/IPS

By Katie Dain
NEW YORK, May 26 2015 (IPS)

Governments are in the midst of tough talks in New York over the text of the Addis Ababa Accord, which is scheduled to be adopted at the end of the Third Conference on Financing for Development (FfD) , to be held in Ethiopia in July.

However at last report, negotiators continued to downplay a powerful mechanism that governments could use to help achieve and finance the Sustainable Development Goals (SDGs) that will replace the Millennium Development Goals (MDGs) in September: tobacco taxes.Tobacco use killed 100 million people in the 20th century and, if trends do not change, it will kill one billion people this century.

According to a recent estimate, increasing specific excise taxes on tobacco worldwide, in order to double prices, would raise about 100 billion dollars per year in revenues, in addition to the approximately 300 billion that the World Health Organization (WHO) estimates governments already collect on tobacco.

Tobacco use is the world’s leading preventable cause of death, and the one risk factor common to four major non-communicable diseases (NCDs): cancers, cardiovascular and lung disease, and diabetes.

Tobacco use killed 100 million people in the 20th century and, if trends do not change, it will kill one billion people this century. The proposed SDGs recognise the devastating impact of NCDs and the tobacco use risk factor, and set targets for reducing the deadly impacts of both.

Fear of trampling on governments’ right to decide on taxation is reportedly at the heart of the negotiators’ reluctance to recommend taxation in general as a way to generate funding for sustainable development.

Yet, 180 of the world’s governments have already agreed that tobacco taxation is an important tool to both generate revenue and save lives. Meeting as the Parties to the WHO Framework Convention on Tobacco Control (FCTC), these governments have even agreed on guidelines that set out how to tax tobacco as effectively as possible.

Notably, these guidelines, to the FCTC’s Article 6, represent the first time that governments have agreed on what makes – and what doesn’t make – good tobacco tax policy.

Raising tobacco taxes, and subsequently tobacco prices, is good for health because it reduces the amount of tobacco consumed in three ways:

• Some existing smokers quit entirely;
• Some people, mostly teenagers, are deterred from starting to use tobacco;
• Some people continue to use tobacco, but reduce how much they use each day.

As a result, tobacco sales decline; however the revenue generated by the higher taxes on the remaining products sold more than makes up for lower sales. That is why increasing tobacco taxes is a win-win for governments: good for health and good for the bottom line.

Most of the revenue would initially be generated in rich countries, as taxes and prices there are much higher to begin with, but developing countries could still raise substantial revenue.

For example, the Philippines hiked specific excise taxes in 2013, raising the average price per cigarette pack by 48 percent. Sales declined and the number of smokers dropped from 28.3 percent of adults in 2009 to 25.4 percent in 2013, while government revenue from tobacco taxes more than doubled from 702 million dollars in 2012 to 1.5 billion in 2013 .

To be effective, tobacco tax increases must be accompanied by other measures, as FCTC Article 6 guidelines point out. Governments should also:

• Implement the simplest, most efficient tax systems;
• Make regular adjustments so that tobacco products become less affordable over time;
• Tax all tobacco products consistently to avoid substitution;
• Phase out tax-free and duty-free products; and,
• Set long-term policies, which could include a tax target.

Parties to the FCTC are not alone in recognising the potential of tobacco taxation. In their recent paper on financing for sustainable development, Jeffrey Sachs and Guido Schmidt-Traub praise tobacco taxes:

“Consumption taxes on tobacco products have been shown to have a very positive impact on reducing tobacco use and improving health. Higher tobacco taxes are particularly effective at reducing consumption by vulnerable populations, particularly youth. In many countries, tobacco taxation is also an important source of government revenue and is dedicated to tobacco control activities, hospital services and other health prevention or promotion services.”

The authors also refer to a 2011 report that Bill Gates presented to a meeting of G20 leaders.

In the executive summary Gates wrote: “Among the revenue proposals I have examined, tobacco taxes are especially attractive because they encourage smokers to quit and discourage people from starting to smoke, as well as generate significant revenues. It’s a win-win for global health.”

Gates continued: “Tobacco taxes are already ubiquitous. Ninety percent of countries have some form of them. And they work. In Thailand, as cigarette taxes rose from 1994 to 2007, revenues doubled even though the number of smokers went down significantly.”

The Sustainable Development Goals provide the roadmap for creating a healthier, more equitable and prosperous world, and as such are extremely ambitious. Considerable resources will be needed for these goals to be realised in the next 15 years.

Already endorsed by a large majority of the world’s governments, and with a clear road map for implementation, tobacco taxation should be highlighted in the Addis Ababa Declaration as an effective domestic tool for financing sustainable development.

Edited by Kitty Stapp

Excerpt:

By José Graziano da Silva
ROME, May 5 2015 (IPS)

In the last half-century, people’s lifestyles have changed dramatically. Life expectancy has risen almost everywhere, but this has been accompanied by an increase of so-called non-communicable diseases (NCDs) – such as cardiovascular diseases, cancer, respiratory diseases, and diabetes – causing more and more deaths in all corners of the world.

José Graziano da Silva. Credit: FAO/Alessandra Benedetti

My distinguished colleague Dr Margaret Chan, Director-General of the World Health Organization (WHO), has called the worldwide rise of NCDs a “slow-motion catastrophe”. If NCDs were once considered the scourge of the developed world, this is no longer true; they now disproportionally affect low- and middle-income countries where nearly three-quarters of NCD deaths – 28 million per year – occur.

Much of the rise of NCDs can be attributed to unhealthy diets. WHO estimates that 2.7 million deaths every year are attributable to diets low in fruits and vegetables. Globally unhealthy diets are estimated to cause about 19 percent of gastrointestinal cancer, 31 percent of ischaemic heart disease, and 11 percent of strokes, thus making diet-related NCDs one of the leading preventable causes of death worldwide.

In other words, diet determines health – just as bad diets can lead to disease, healthy diets can contribute to good health.

But what exactly is a healthy diet? This is a difficult question. Generally, a healthy diet must provide the right nutrients in the right balance and with sufficient diversity, limiting the intake of free sugars to less than 10 percent of total energy requirements, and keeping salt intake to less than 5 grams per day.“There is no one-size-fits-all healthy diet. A healthy diet must be affordable, based on locally available foodstuffs, and meet cultural preferences”

However, there is no one-size-fits-all healthy diet. A healthy diet must be affordable, based on locally available foodstuffs, and meet cultural preferences. For over 20 years, FAO, together with WHO, has worked with governments on national Food-Based Dietary Guidelines: short, science-based, tips on healthy eating, in accordance with local values, customs and tradition.

Healthy meals do not always taste or look the same. Take, for example, the Mediterranean and Japanese diets: very healthy and completely different.

The Mediterranean diet revolves around the consumption of legumes, cereals, fruits and vegetables, olive oil, fish, and moderate consumption of dairy products (mostly cheese and yogurt). It emphasises unprocessed, plant-based foods, such as fruits and vegetables, in addition to the consumption of beans, nuts, cereals and other seeds; olive oil is the main source of (unsaturated) fat.

Japanese cuisine, on the other hand, is often associated with sushi (raw fish with rice), and sashimi (fresh raw seafood). The Japanese diet emphasises at least seven ingredients: fish as a major source of protein; vegetables including daikon radish and sea vegetables; rice; soya (tofu, miso, soya sauce); noodles; fruit; and tea (preferably green).

The Japanese and Mediterranean diets are examples of healthy diets. They use a great variety of ingredients; they are rich in plant foods including vegetables and fruit, legumes and fibres; they are modest in red meat; and they utilise many natural herbs and spices instead of salt to flavour food.

Both diets are linked to peoples and cultures as much as to their natural environment: it therefore comes as no surprise that both the Mediterranean diet and the Japanese diet have made it onto UNESCO’s World’s Intangible Cultural Heritage list.

The health benefits of the Japanese and Mediterranean diets are promising. Japanese enjoy one of the longest average life spans in the world – 87 years for women and 80 for men. In Mediterranean countries such as Italy and Spain, women have a life expectancy of 85 years. The figure for Italian men is 80 years, the same as their Japanese counterparts. All of them are above the average of high-income countries: 82 years for women and 76 years for men.

Medical research also indicate that that the Japanese diet leads to the lowest prevalence in the world of obesity – only 2.9% for Japanese women – and other chronic diseases like osteoporosis, heart ailments and some cancers. On the other hand, the Mediterranean diet, if followed for a number of years, is known to reduce the risk of developing heart disease, cancer, hypertension, Type 2 diabetes, Parkinson’s and Alzheimer’s disease.

In sum, adhering to a healthy diet helps you to not only to live longer, but also to have a better quality of life. Conversely, a bad diet causes malnutrition and can expose you to a range of NCDs.

A modern paradox is that many countries – including developing countries – suffer from undernourishment on the one hand, and obesity and diet-related diseases on the other. And while FAO’s chief concern is to eradicate hunger in this world, we cannot separate food security from nutrition. FAO – together with our U.N. agencies – considers food and nutrition security a basic human right.

In all cases, the cost of malnutrition goes beyond the health of the individual: it affects society as a whole in terms of public health costs and loss of productivity, and, therefore, is an issue that must be addressed through public and coordinated action.

Last year’s Second International Conference on Nutrition (ICN2), organised jointly by FAO and WHO, sent a clear message in that direction. The two outcome documents of ICN2, the Rome Declaration on Nutrition and the Framework for Action that commit world leaders to establishing national policies aimed at eradicating malnutrition and making nutritious diets available to all.

A key message from ICN2 is: governments have a central role to play in creating a healthy food environment to enable people to adopt healthy dietary practices. Yes, it is consumers who choose what to eat, but it is the government’s role to provide the enabling environment that encourages and makes healthy choices possible. (END/COLUMNIST SERVICE)

Edited by Phil Harris   

The views expressed in this article are those of the author and do not necessarily represent the views of, and should not be attributed to, IPS – Inter Press Service. 

Excerpt:

According to the World Health Organisation (WHO), there will be between 1.5 and 1.9 billion smokers worldwide in 2025. Credit: Marius Mellebye/CC-BY-2.0

By Diana Mendoza
ABU DHABI, Apr 2 2015 (IPS)

The numbers are in, and there’s not much to celebrate: every year, about six million people die as a result of tobacco use, including 600,000 who succumb to the effects of second-hand smoke.

Whether consumed by smoking or through other means, tobacco is a deadly business, and while usage statistics vary drastically across countries, time periods and age-groups, one thing is plain to policy makers all over the world: tobacco is going to be a huge development challenge in the coming decade.

“In tobacco and smoking, we see death and disease. The tobacco industry sees a marketplace." -- Matthew Myers, president of the Campaign for Tobacco-Free Kids
According to the World Health Organisation (WHO), “Tobacco is the only legal drug that kills many of its users when used exactly as intended by manufacturers.” Smoking in particular, and other forms of tobacco use to a lesser degree, has been found to increase the risk of non-communicable diseases (NCDs), including chronic respiratory conditions, cardiovascular illnesses, and cancers of all stripes.

Already the global burden of NCDs is tremendous, accounting for the most number of deaths worldwide. Some 36 million die annually from NCDs, representing 63 percent of global deaths. Of these, more than 14 million people die prematurely, before the age of 70.

In a bid to stem this rampant loss of life, governments all over the world have signed numerous treaties and protocols, including the WHO Framework Convention on Tobacco Control (FCTC), which presently boasts 180 states parties covering 90 percent of the world’s population.

One of the convention’s goals is to achieve a 30-percent reduction in tobacco use among people aged 15 years and older by 2025.

By some calculations, the international community is moving slowly but surely towards this target. For instance, a new WHO study released last month found that in 2010 there were 3.9 billion non-smokers aged 15 years and over in WHO member states (or 78 percent of the population of 5.1 billion people over the age of 15).

The number of non-smokers is projected to rise to five billion (or 81 percent of the projected population of 6.1 billion people aged 15 and up) by 2025 if the current pace of tobacco cessation continues, the report said.

According to a study published last month by the UK-based medical journal, The Lancet, the prevalence of tobacco smoking among men fell in 125 out of 173 countries surveyed, and the smoking rate among women fell in 156 countries out of 178, in the 2000-2010 period.

But while these trends are positive, a closer look at the data shows that at current levels of progress, only 37 countries worldwide, or just 21 percent of all member states, stand ready to meet the Global Action Plan for the Prevention and Control of NCDs 2013-2020.

In fact, according to the WHO, there will be between 1.5 and 1.9 billion smokers worldwide in 2025, representing a potential health crisis of severe proportions.

Catching them young – killing them young?

Last month some 3,000 tobacco control advocates closed the 16th World Conference on Tobacco or Health (WCOTH) here in Abu Dhabi, capital of the United Arab Emirates (UAE), with appeals to world leaders to crack down on the tobacco industry’s campaign to lure young people into the habit.

Among other demands, activists and experts pressed governments to enforce bans on massive advertising campaigns, which many see as a gateway to what could become a lifetime of smoking.

In 2008, the WHO reported that 30 percent of young teens worldwide aged 13 to 16 smoke cigarettes, with between 80,000 and 100,000 children taking up the habit each day.

The organisation estimates that half of those who start smoking in their adolescent years will continue smoking for the next 15 to 20 years of their life, lending credibility to the widely held fear that when tobacco use starts young, life might also end young.

From the music and fashion industries to food and sports, the multi-billion-dollar tobacco industry is finding marketing and advertising opportunities to attract scores of potential young consumers, since their curiosity and tendency to experiment have long marked them as a key ‘target’ group.

“In tobacco and smoking, we see death and disease. The tobacco industry sees a marketplace,” said Matthew Myers, president of the Campaign for Tobacco-Free Kids, a leading US-based tobacco control campaign organisation.

In a statement released back in January, Myers alleged, “The tobacco industry spends 8.8 billion dollars a year – one million dollars an hour – on marketing, much of it in ways that make these products appealing and accessible to children.”

“They also use all means – legal and illegal – to sell their deadly products, deceive the public and policy makers by attempting to appear credible and trustworthy, and use lawyers, lobbyists, and public relations firms to undermine good government and the will of the people,” Myers said during the WCOTH last month.

From rock concerts to sporting events and from cafes to nightclubs, where young people of a higher income bracket typically socialise, cigarettes are readily available, making it difficult to avoid the pull of peer pressure.

Experts say young women, especially those who are economically independent, also fall into the category of an emerging market for the tobacco industry, as they seek fresh outlets for expressing their newfound freedom.

Myers cited Russia, where 25 percent of young women between 18 and 30 years old have taken up the habit, and China, where the equating of cigarette smoking with high fashion is evident in the country’s major cities like Beijing and Shanghai.

Neither Russia nor China is expected to meet the smoking component of the global NCD target by 2025.

Although Russia could witness a decrease in the number of smokers from 46.9 million in 2010 to 36.6 million in 2025, and China is slated to slash its smokers from 303.9 million in 2010 to 291 million in 2025, the rate of decrease in both countries is too low.

The situation is particularly dire in China, where an estimated 740 million suffer from exposure to second-hand smoke. The WHO estimates that 1.3 million die here each year from lung cancer, accounting for one-third of lung cancer-related deaths globally.

Judith Mackay, senior adviser of the World Lung Foundation, said Asian women in particular are being targeted by the industry because of the number of developing countries and fast-growing economies in the region with large young female populations.

“For developing countries in this region, the style of advertising in the 50s has come back – portraying smoking among young women as cool and sexy,” she said during a press conference in Abu Dhabi.

A 2010 report by the George Institute of Global Health stated that Asia and the Pacific were home to 30 percent of all smokers in the world, with India and China contributing hugely to these numbers.

In a bid to help member countries meet the smoking component of the NCD target, the WHO introduced a set of measures called MPOWER, encapsulating efforts to monitor tobacco use, protect people from tobacco smoke, offer help to those seeking to quit the habit, warn about the dangers of tobacco use, enforce bans on advertising, promotion and sponsorship, and raise taxes on tobacco products.

Such measures will not be easily implemented but as WHO Director-General Margaret Chan pointed out, “It’s going to be a tough fight but we should not give up until […] the tobacco industry goes out of business.”

Edited by Kanya D’Almeida

Increasing people's consumption of fresh produce and daily exercise are part of preventing a non-communicable disease crisis in the Pacific Islands. Credit: Catherine Wilson/IPS

By Catherine Wilson
SYDNEY, Feb 11 2015 (IPS)

The rapid rise of non-communicable diseases (NCDs) in the Pacific Islands, which now cause 75 percent of all deaths, is one of the greatest impediments to post-2015 development, health ministers in the region claim.

The Western Pacific has the world’s highest regional prevalence of diabetes, an NCD disease that is exacerbated by unhealthy eating habits, obesity and sedentary lifestyles, according to the International Diabetes Foundation. National prevalence rates have reached 25 percent in the Cook Islands, 29 percent in Tokelau and 37 percent in the Marshall Islands.

“Many amputations are done in our Pacific hospitals each day and people are losing their vision constantly due to diabetes." -- Spokesperson for Fiji-based Pacific Disability Forum (PDF)
Experts are increasingly concerned about the impact of the disease on the rate of disability, particularly the amputation of limbs and visual impairment, which threatens to undermine efforts to reduce poverty and inequality.

In Papua New Guinea, a southwest Pacific Island state that is home to over seven million people, “diabetes is increasing its prevalence in the general population, including children 12 years and younger, and the amputation of limbs is known among adults as young as 23 years,” Gerard Saleu, senior nursing officer at the country’s Institute of Medical Research, told IPS.

“Diabetes is certainly having an impact on disability in the region where not everyone can afford wheelchairs or walking and visual aids,” he added.

There has been a marked rise in NCDs in the Pacific Islands since at least the 1970s, experts say.

The incidence of Type 2 diabetes in Apia, capital of the South Pacific Island state of Samoa, rose from 8.1 percent to 9.5 percent in men and 8.2 percent to 13.4 percent in women between 1978 and 1991.

Considerable blame has been placed on the lure of globalised consumer-based lifestyles in a region with a long history of subsistence living, and the increasing influx of imported processed foods, high in fat and sugar content.

Local diets originally based on fresh fish, vegetables and fruit now include a high intake of instant noodles, packaged biscuits and carbonated drinks. Less than 10 percent of adults in Kiribati, Nauru, Marshall Islands, Papua New Guinea and the Solomon Islands eat a sufficiently nutritious diet, while more than 60 percent are obese in American Samoa, Tokelau, Cook Islands and Tonga, according to the Secretariat of the Pacific Community (SPC).

Increasing urbanisation has accelerated people’s susceptibility to NCD risk factors, including decreased daily physical activity. In Fiji, one study revealed that diabetes afflicted an estimated 11.3 percent of women living in urban centres, compared to 0.9 percent in rural areas.

The onset of diabetes, when the pancreas fails to produce enough insulin to regulate blood sugar levels, can lead to blood circulatory problems and damage to the nerves, heart, eyes and kidneys. This heightens the risk of blindness, stroke and amputation of limbs, commonly feet and lower legs.

Globally, NCDs, including diabetes, account for about 66.5 percent of all years lived with disability.

“Many amputations are done in our Pacific hospitals each day and people are losing their vision constantly due to diabetes,” a spokesperson for the Fiji-based Pacific Disability Forum (PDF) told IPS.

In the Pacific Islands, up to 47 percent of diabetes sufferers experience loss of sight and an estimated 17 percent require amputations, reports the Pacific Islands Forum.

From 2010-2012, the main referral hospital in Fiji, home to over 881,000 people, performed 938 diabetes-related lower limb amputations. Most amputees were aged 45 years and over, but more than 100 were in the 25-44 age group.

Meanwhile the main hospital in the South Pacific Island state of Tonga, home to some 103,000 people, witnessed a 400-percent increase in these amputations over the past decade.

The subsequent loss of mobility, decline in economic participation and increase in household medical expenses is entrenching hardship and inequality, especially for those families that are already economically disadvantaged.

For many islanders with disabilities, “most public buildings are not accessible, employers do not have reasonable accommodation in the workplace and many are unable to work, which is a lost income for the family,” said the spokesperson for the PDF.

While awareness of and political will to address the needs of disabled people, who comprise about 17 percent of the Pacific Islands population, is growing, they continue to be “among the poorest and most marginalised members of their communities…with limited access to education, employment and basic social services, which leads to social and economic exclusion and perpetuates poverty,” according to the United Nations Development Programme (UNDP).

In Fiji, for instance, an estimated 89 percent of people with disabilities are unemployed.

There is also an absence of rehabilitation services to assist those with diabetes-related impairment to cope with new physical and psychological challenges in their daily lives, the PDF reports.

The devastating toll that NCDs are inflicting on the lives of Pacific Islanders, in turn denying them better human development outcomes, is matched by the unaffordable economic burden on public health services.

The cost of dialysis for diabetes-related kidney failure in Samoa was 38,686 dollars per patient per year in 2010-11, with the total cost to government equal to more than twelve times the nation’s gross national income, reports the World Bank.

With Pacific Island governments currently funding up to 90 percent of national health services, there is little, if any, capability for them to increase health expenditure to address an NCD epidemic.

Pacific health ministers are driving a focus on prevention and calling for a scale-up of actions and investment in prevention and control strategies with a ‘whole-of-government and whole-of-society’ approach.

That means scrutinizing food industry practices in the interests of better public health. Samoa, Nauru and the Cook Islands have now introduced taxes on food and drinks with high sugar content and eleven countries in the region have developed plans to reduce salt levels in foods.

Non-governmental organisations, such as the Pacific Network on Globalisation, have also expressed concern about the impact of international trade agreements, which, in the aim of liberalising trade, can increase the influx of cheap, imported, but unhealthy foods and beverages and disadvantage local food producers.

But lifestyle interventions are also needed to change consumer and exercise habits among people of all ages, including children.

Saleu, the nursing officer for Papua New Guinea’s Institute of Medical Research, said that in PNG, some awareness about NCDs and education for prevention is being done among the general population, but in line with the view of regional health authorities, current resources and preventive efforts still fall short of matching the scale of the crisis.

Edited by Kanya D’Almeida

Local women's NGO, Vois Blong Mere, campaigns for women's rights in Honiara, capital of the Solomon Islands. Credit: Catherine Wilson/IPS

By Catherine Wilson
SYDNEY, Jan 28 2015 (IPS)

Women now face a better chance of surviving breast cancer in the Solomon Islands, a developing island state in the southwest Pacific Ocean, following the recent acquisition of the country’s first mammogram machine.

But just a week ahead of World Cancer Day, celebrated globally on Feb. 4, many say that the benefit of having advanced medical technology, in a country where mortality occurs in 59 percent of women diagnosed with cancer, depends on improving the serious knowledge deficit of the disease in the country.

"While cancer is included on the NCD [non-communicable diseases] list, very little attention and resources are specifically addressing women and breast cancer awareness." -- Dr. Sylvia Defensor, senior radiologist at the Ministry of Health and Medical Services in Fiji
“Breast cancer is a health issue that women are concerned about in the Solomon Islands, but adequate awareness of it among women is not really prioritised,” Bernadette Usua, who works for the local non-governmental organisation, Vois Blong Mere (Voice of Women), in the capital, Honiara, told IPS.

Rachel, a young 24-year-old woman living with her two children, aged three and five years, in one of the country’s many rural villages, did not know what breast cancer was when she detected a lump in her breast in August 2013.

But the lump grew larger prompting her to travel to Honiara several months later to see a doctor.

“She went to the central hospital and was advised to have her left breast removed, but due to the little knowledge that she and her husband had about what it would be like, both were afraid of the surgery,” Bernadette Usua, who is Rachel’s cousin, recounted.

“So they just left the hospital without any medication or other assistance, and went home,” she continued.

Rachel tried traditional medicine available in her village, but the cancer and pain became more aggressive. Usua remembers next seeing her cousin in July of last year.

“She was sitting on her bed night and day with extreme pain, unable to lie down and sleep. But she was still brave as she nursed herself, washed herself and cooked for her children. She cried and prayed until she passed away in September,” Usua recalled.

Breast cancer is the most common cancer in women worldwide and in the Solomon Islands, where it accounted for 92 of more than 200 diagnosed cases in 2012. But its incidence in the developing world, where 50 percent of cases and 58 percent of fatalities occur, is rapidly rising.

Low survival rates of around 40 percent in low-income countries, compared to more than 80 percent in North America, are due mainly to late discovery of the disease in patients and limited diagnosis and treatment offered by under-resourced health centres.

Last year Annals of Global Health revealed that of 281 cancer cases identified in women in the Solomon Islands in 2012, 165 did not survive, while in Papua New Guinea and Fiji fatalities occurred in 2,889 of 4,457, and 418 of 795 diagnosed cases, respectively.

Insufficient public knowledge about the disease is an issue across the region.

“Currently public health education and promotion is focussing heavily on the control of NCDs [non-communicable diseases] as a whole. While cancer is included on the NCD list, very little attention and resources are specifically addressing women and breast cancer awareness,” said Dr. Sylvia Defensor, senior radiologist at the Ministry of Health and Medical Services in Fiji, a Pacific Island state home to over 880,000 people.

In the Solomon Islands, mammograms, or x-rays of the breast, will now be free to all female citizens who comprise about 49 percent of the population of more than 550,000. This is after installation of digital mammography equipment, funded by the national First Lady’s Charity, in Honiara’s National Referral Hospital.

Dr. Douglas Pikacha, general surgeon at the hospital, explained that mammograms were vital to early detection of breast disease and the saving of women’s lives through early treatment, such as surgery and chemotherapy.

Mammography is considered the most effective form of breast cancer screening by the World Health Organisation (WHO), with some evidence that it can reduce subsequent loss of life by an estimated 20 percent, especially in women aged 50-70 years.

But with more than 80 percent of the population residing in rural areas and spread over more than 900 different islands, Josephine Teakeni, president of Vois Blong Mere, is deeply concerned about the fate of many women who are located far from the main health facilities in the capital. An estimated 73 percent of doctors and all medical specialists in the country are based at the National Referral Hospital.

She says that reliable breast cancer screening and diagnosis is urgently needed in provincial hospitals if the mortality rate is to be reduced. Most patients must travel an average of 240 kilometres to reach the National Referral Hospital, commonly by ferry or motorised canoe, given the prohibitive expense of internal air services.

There is also a critical shortage of health care workers in the country with 0.21 doctors per 1,000 people and Teakeni claims that “while waiting for an operation the delay can result in full advancement of the cancer and death.”

However, there is a further challenge with almost half of all women diagnosed with breast cancer refusing a mastectomy, which involves the partial or entire surgical removal of affected breasts, even though it may result in the patient’s recovery, the Ministry of Health reports.

“Many prefer traditional treatment to mastectomy because they believe it is more womanly to have their breast than to live without it,” Pikacha said.

The high risk of cancer mortality is another factor impacting gender inequality in the Pacific Island state where entrenched cultural attitudes and widespread gender violence, experienced by 64 percent of women and girls, hinders improvement of their social and economic status.

Teakeni believes that an urgent priority is dramatically improving “awareness among women about the signs and symptoms of breast cancer, and even simple tests that women can do themselves, such as checking the breast for lumps while having a shower,” as well as the importance and impact of medical treatment.

Still, the installation of the new mammogram machine gives women on this island something, however small, to celebrate.

Edited by Kanya D’Almeida

By 2030, 80 percent of deaths from tobacco will be in the poorest countries in Asia, Africa and South America. Credit: Bigstock

By Laurent Huber
GENEVA, Jul 7 2014 (IPS)

Undeniably, the Millennium Development Goals (MDGs) helped lift specific health concerns onto the global agenda.

For example, maternal mortality, which is addressed in MDG 5, declined 45 percent from 1990 to 2013, while deaths of children under five (MDG 4) dropped from 12.4 million to 6.6 million worldwide from 1990 to 2012, (both statistics from the World Health Organisation).If trends do not change, by 2030 NCDs will be the leading global cause of disability.

Despite those impressive advances, the world is facing new development challenges. For this reason, the Sustainable Development Goals (SDGs) that will replace the MDGs in 2015 must expand the list of health goals to include non-communicable diseases (NCDs) – the world’s #1 killer.

NCDs account for 60 percent (35 million) of all deaths. They include cancers, cardiovascular and lung disease, and diabetes, but they are not – as many people believe – ‘lifestyle’ diseases afflicting old people in rich countries. The largest burden – 80 percent, or 28 million deaths – occurs in low-middle-income countries (LMICs), making NCDs a major cause of poverty and an urgent development issue.

If trends do not change, by 2030 NCDs will be the leading global cause of disability. In addition, between 2011 and 2031 the diseases would have cost the world economy 30 trillion dollars, the equivalent of 98,400 dollars for every person in the United States.

Tobacco is the leading risk factor for NCDs. One hundred million people died from tobacco-related disease in the 20th century, and unless the global community acts decisively, one billion people will die in the 21st century. By 2030, 80 percent of deaths from tobacco will be in the poorest countries in Asia, Africa and South America.

In 2011, world leaders assembled for the first time at the United Nations to discuss the growing NCDs epidemic. The Political Declaration they issued concluded that the burden of NCDs “undermines social and economic development throughout the world”.

It noted that NCDs strike people in LMICs during their prime working years, and that close to half of all NCD deaths in these countries occur below the age of 70, and nearly 30 percent under age 60. As well, most NCDs deaths are preceded by long periods of ill health.

These illnesses, and early deaths of families’ main income earners, result in loss of productivity, which drags down economic growth and development.

Social determinants, such as education and income, influence people’s vulnerability to NCDs and exposure to risk factors. Individuals of lower education and economic status are increasingly exposed to NCDs risks and are disproportionately affected by them. For example, in countries such as Bangladesh, India and the Philippines, tobacco use is highest among the least educated and poorest segments of the populations.

At the same time, having an NCD may also contribute to social inequalities. The financial burden associated with these diseases increases the risk that families will be unable to send children to school and, under-educated, the risk grows that those children will live in poverty for the rest of their lives.

What can be done? There are four modifiable risk factors for the main NCDs: unhealthy diets, physical inactivity, harmful use of alcohol and tobacco use. While work continues to adopt global tools to tackle the first three factors, there is consensus on how to fight the tobacco epidemic.

In 2003, the world’s governments adopted the WHO Framework Convention on Tobacco Control, the first modern-day public health treaty. It contains a number of measures that Parties commit to implement, including: smoke-free public spaces, pictorial health warnings on packages, price and tax measures to increase the price of tobacco – which discourages consumption – and complete bans on tobacco advertising.

Today the FCTC has 178 Parties, representing nearly 90 percent of the world’s population. In the battle against NCDs, “There is no other ‘best buy’ for the money on offer”, said WHO Director-General Margaret Chan in 2011.

Recognising the potential of global tobacco control, the Political Declaration of the 2011 NCD Summit:

• Urged greater efforts from countries to implement the FCTC;
• Called on countries that are not Parties to the FCTC to accede to the Convention;
• Noted the importance of tobacco taxation as a strategy at the national level;
• Recognised the irreconcilable differences between the tobacco industry and public health policy.

Building on the Declaration, in May 2013 the World Health Assembly endorsed the Global Action Plan for the Prevention and Control of NCDs, 2013-2020. It includes a target for cutting tobacco use: a 30 percent relative reduction in smoking prevalence by the year 2025.

A stand-alone goal, Attain healthy lives for all, has been proposed for the SDGs. Its sub-goals include: “By 2030 reduce substantially morbidity and mortality from non-communicable diseases (NCDs) through prevention and treatment…” and “Strengthen implementation of the Framework Convention on Tobacco Control in all countries who have ratified the Convention and urge countries that have not ratified it to ratify and implement it”.

Including NCDs and the FCTC in the development goals that will be announced by the UN General Assembly in 2015 will also ensure that battling the tobacco epidemic becomes a national priority, and prevent millions of premature deaths.

Laurent Huber is Director of the Framework Convention Alliance.

A tsunami is looming on the horizon and the world is unprepared for it. This one won’t be a massive wall of water but a tidal wave of disease – and experts say the international community needs to act fast to keep it from crashing.

“Non-communicable diseases (NCDs) – cancer, heart disease, diabetes and chronic respiratory diseases, among others – have become the leading cause of death worldwide,” Jeffrey Sturchio, senior partner at the U.S.-based consulting firm Rabin Martin, told a conference organised by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) on World Cancer Day in Geneva.

“Some 36 million people die from (NCDs) every year, 80 percent of them in low and middle income countries – a figure that will increase by 17 percent in the coming years and by 25 percent in Africa,” he added.

Tuberculosis and malaria, in comparison, kill one to two million people around the world every year.

“The disease burden is shifting to NCDs, but since developing countries still have to fight infectious diseases, they face a double burden,” Sturchio warned.

However, developing countries do not appear to be paying adequate attention to the impending crisis.

“In 2010 HIV/AIDS was responsible for 3.5 percent of deaths worldwide, malaria for 1.5 percent, cancer for 12.6 percent and heart diseases for 14 percent,” Cary Adams, chief executive officer of the Union for International Cancer Control, told IPS on the sidelines of the conference on Feb. 4.

These statistics alone should be sufficient for governments to put NCDs high on their list of national priorities. “But in sub-Saharan Africa, HIV/AIDS caused 13.3 percent of deaths, malaria 6.7 percent and cancer 4.5 percent”, he said, which explains why African health ministers keep putting cancer on the back burner.

“But the (reality) is, the problem will double in the next 15 years. There is a tsunami of NCDs approaching and we need to tackle it today,” Adams stressed.

To tackle this “tsunami”, four health federations – the International Diabetes Federation, the Union for International Cancer Control, the World Heart Federation and the Union against Lung Disease and Tuberculosis – came together to form the Non-communicable Diseases Alliance. With a network of over 2,000 non-governmental organisations based in over 170 countries, it seeks to amplify the voice of civil society in the global debate on NCDs.

The Alliance was also instrumental in pushing the United Nations General Assembly to organise, in September 2011, a high-level meeting that officially declared NCDs a “challenge of epidemic proportions”, which, if it is to be addressed, requires the cooperation of governments, civil society and the private sector.

“This is not an easy thing to do,” Adams, who chairs the NCD Alliance, conceded to IPS. “We have tried to work on a common agenda and find consensus, but some NGOs would not talk to us because we engage with the private sector. We try to embrace the private sector without compromising on integrity and independence and everything we do is based on science.”

Still, the mobilisation has borne some fruits. Five years ago, non-communicable diseases were barely on the agenda. The U.N.’s political declaration and a series of follow-up activities built tremendous momentum, resulting in a plan of action that stretches to 2025, with clear targets such as reducing NCD-related deaths by 25 percent in that time frame.

But financial resources are stretched thin, and it is unlikely that the funds needed to launch a massive global campaign will be readily available.

“The reality is that in the last 20 years, tens of billions of dollars in official development assistance have gone to developing countries, mainly (to fight) HIV/AIDS, and it is unrealistic to think that the same will happen again,” Sturchio admitted.

It will therefore be necessary to capitalise on existing investments and reallocate some of the resources already in circulation, he said.

“Hundreds of HIV clinics were created across sub-Saharan Africa that can also be used for NCDs. When patients come to these clinics, they can also be tested for other infections or provided with vaccines,” he suggested.

For Margaret Kruk, a professor at Columbia University’s school of public health, primary care must be reconceptualised to tackle NCDs in low and middle-income countries.

“In theory, many NCD services can be provided in primary care, like primary prevention of hepatitis B, immunisation, smoking cessation, cholesterol and glucose testing, mammography and opportunistic screening for depression,” she said.

“But primary care in (developing) countries is not able to meet NCD challenges. The patient is not seen in a holistic way.”

She added that the challenge is most severe in sub-Saharan Africa, where, for the last half a century, national health plans have been oriented towards the “traditional killers” like infectious diseases, and have also focused heavily on maternal and child health.

This is partly due to the fact that the eight Millennium Development Goals (MDGs) laid out by the United Nations Millennium Summit in 2000 placed a great deal of emphasis on these “preventable causes of death”.

But as the 2015 deadline for achieving these targets draws closer, priorities will have to be re-examined.

Adams believes that one of the Alliance’s most important tasks over the next two years will be to make non-communicable diseases central in the post-2015 international development process.

Indeed, relatively simple public policy measures can go a long way in reducing NCDs – such as pushing people to consume less sugar and salt, eat less fatty foods, give up smoking and exercise more.

Already developing countries are becoming conscious that they don’t need additional funding for those measures. But when it comes to drugs, costs are much higher in developing countries than in the United States, for example.

From the manufacturer to the wholesale distributor, to the intermediaries and the clinics, monopolies, taxes, regulations and administrative hurdles push the price of medicines up to prohibitive rates in the global South.

The Southern African Development Community and the East African Community have undertaken initiatives to harmonise regulations at the regional level, but for Sturchio these are not enough: “Countries must be able to make sovereign decisions on the medicines they use, but today a lot of duplications make the supply chain inefficient.”

He does not believe intellectual property issues constitute an obstacle to stemming the wave of NCDs.

“Most of the medicines needed to treat NCDs are off patent,” he told IPS. “The challenge is to find ways to bring them to the people. Hundreds of medicines (to treat cancer) are very inexpensive and yet unavailable.”