Perspective: Global challenges for public health: dilemmas for leadership

Abstract

Public health concerns have moved up global and national agendas as the challenges of ageing populations, the epidemic of lifestyle-related disease and the recognition of the importance of the environment, including climate change, gain prominence in the public consciousness. Concerns about affordability of health care, provision of integrated services and creating sustainable environments occupy more media space and policy discussion, putting public health leaders under pressure. Questions about how they can respond effectively and what strategies they need to use take up pages of eminent text and the leadership pressures become more acute. Take, for example, the challenge of obesity. Across the world the rates of overweight and obesity continue to shock. The IASO/IOTF analysis estimates that approximately 1.0 billion adults are currently overweight (BMI 25–29.9 kg/m), and a further 475 million are obese. When Asian-specific cut-off points for the definition of obesity (body mass index >28 kg/m) are taken into account, the number of adults considered obese globally is over 600 million (International Obesity Taskforce). Globally, IASO/IOTF estimate that up to 200 million school-aged children are either overweight or obese; of those, 40–50 million are classified as obese. The consequence of obesity is reflected in the growing incidence of non-communicable diseases (NCD) which are now the commonest cause not only of mortality but also of morbidity – a growing burden in lowand middle-income countries – not just in affluent societies. Salty, sugary, low-fibre foods are consumed in large quantities, and at the same time, populations are becoming less physically active, more cars are polluting the atmosphere and work becomes more stressful. Whilst the burden on health services grows with escalating numbers of people diagnosed with diabetes, hypertension or heart disease, economies start to suffer from loss of productivity and higher numbers of days off work. The problem is now so apparent that it is recognised not only by the World Health Organisation but also by the secular United Nations. At a summit in 2012, called as only the second specific health summit, the first being on HIV/AIDS, national leaders committed