UN High-Level Meeting Research Articles

Physical Inactivity: The “Cinderella” Risk Factor for Noncommunicable Disease Prevention

There is strong evidence demonstrating the direct and indirect pathways by which physical activity prevents many of the major noncommunicable diseases (NCD) responsible for premature death and disability. Physical inactivity was identified as the 4th leading risk factor for the prevention of NCD, preceded only by tobacco use, hypertension, and high blood glucose levels, and accounting for more than 3 million preventable deaths globally in 2010. Physical inactivity is a global public health priority but, in most countries, this has not yet resulted in widespread recognition nor specific physical activity–related policy action at the necessary scale. Instead, physical inactivity could be described as the Cinderella of NCD risk factors, defined as “poverty of policy attention and resourcing proportionate to its importance.” The pressing question is “Why is this so?” The authors identify and discuss 8 possible explanations and the need for more effective communication on the importance of physical activity in the NCD prevention context. Although not all of the issues identified will be relevant for any 1 country, it is likely that at different times and in different combinations these 8 problems continue to delay national-level progress on addressing physical inactivity in many countries. The authors confirm that there is sufficient evidence to act, and that much better use of well-planned, coherent communication strategies are needed in most countries and at the international level. Significant opportunities exist. The Toronto Charter on Physical Activity and the Seven Investments that Work are 2 useful tools to support increased advocacy on physical activity within and beyond the context of the crucial 2011 UN High-Level Meeting on NCDs.

NCDs--what's in an acronym?

This issue contains the first of a set of eight articles on the current state and future prospects for epidemiology in the different regions of the globe. WHO Western Pacific Region (WPR) leads the series, comprising countries as populous as China and as remote as Kiribati, which makes summarizing the burden of disease, epidemiological training, resources and research and predicting the future a real challenge. Perhaps surprisingly, WPR has the lowest agestandardized disability-adjusted life years (DALYs) rate of all WHO regions, and even in lowand middle-income countries of WPR, two-thirds of DALYs lost are attributable to non-communicable diseases (NCDs). In terms of risk factors the epidemiologic transition is well established—alcohol, tobacco and high blood pressure are the top three risk factors, contributing over 20% of DALYs lost. Published epidemiology output is highest per head of population for New Zealand and, inexplicably, Micronesia, although China heads the field in terms of absolute numbers of publications. The authors emphasize the importance of reorientation of epidemiology training and research towards NCDs—a theme that I expect will recur in subsequent articles. The editors are very grateful to Cesar Victora (President-elect, IEA), Ahmed Mandil (Treasurer-elect, IEA) and Neil Pearce (President, IEA) for guest editing this series. NCDs are a hot topic at present in the run-up to the United Nations High Level Meeting on NCDs in September 2011. The only previous one—for HIV/ AIDS—was a decade ago and is generally viewed as a triumph of global health action. There is a growing consensus about what needs to be done for NCDs— leadership, prevention, treatment, monitoring and accountability and international cooperation and funding, but an overwhelming agenda, splits by disease factionalism, and an adverse funding climate may limit what can be achieved. Epidemiologists can make an important contribution in preparing the evidence for the UN High Level Meeting as shown in this issue by Dalal et al. who take a look at what we know about NCDs in sub-Saharan Africa. Reviewing the available literature they found published community-based studies in only 13 out of 45 sub-Saharan countries amounting to 94 papers about heart disease, stroke, diabetes and cardiovascular risk factors. These studies confirmed the high prevalence of risk factors, particularly hypertension. In an accompanying commentary, Saidi Kapiga emphasizes the inter-relationships between infectious diseases and NCDs and argues for taking action and not just conducting more surveys. Peer reviewers commenting on a grant proposal I made to integrate NCD risk factor surveillance and treatment with AIDS services in sub-Saharan Africa said there was no convincing evidence that NCDs are of importance in this region. There is now. It remains to be seen whether ‘NCDs’ will become a household term in the same way as AIDS has been adopted despite few people knowing what the acronym stands for these days. NCDs are a mixed bag and as a descriptive term defining disease groups by exclusion is unsatisfactory. Moreover, with a third of all cancers in sub-Saharan Africa attributable to infectious causes, it makes aetiological nonsense to lump all cancers into the NCD group. ‘Chronic diseases’ is no better as a term. Many presentations of these ‘chronic’ diseases are actually very acute— myocardial infarction, diabetic ketosis, asthma attacks and many infectious diseases are ‘chronic’. As is becoming apparent in current dialogues, the inclusion or exclusion of specific diseases is causing friction— should mental health, epilepsy and arthritis be in or out? NCDs for the purposes of the UN High Level Meeting now include cardiovascular diseases, cancers, diabetes and chronic obstructive lung disease, because these diseases make a dominant contribution to burdens of disease and, to an extent, share risk factors. So, despite the problems, we persist with NCDs. Maybe we should just revert to ‘diseases’— they are all important, they all need a functioning health system, most are preventable and older people, in particular, often experience several of them at once. A recent publication of global prevalence and trends since 1980 in obesity, indexed by body mass index (BMI), provoked concerns about tsunamis of cardiovascular disease, despite remarkably low levels of obesity in India and China. But have we been using the wrong metric all this time? Abdullah et al. have used the Framingham cohort study which has updated measures of BMI every 2 years for almost 50 years. They find that the number of years lived with obesity is an independent, dose–response Published by Oxford University Press on behalf of the International Epidemiological Association

UN High-Level Meeting on Non-Communicable Diseases: addressing four questions

Non-communicable diseases (NCDs), principally heart disease, stroke, cancer, diabetes, and chronic respiratory diseases, are a global crisis and require a global response. Despite the threat to human development, and the availability of affordable, cost-effective, and feasible interventions, most countries, development agencies, and foundations neglect the crisis. The UN High-Level Meeting (UN HLM) on NCDs in September, 2011, is an opportunity to stimulate a coordinated global response to NCDs that is commensurate with their health and economic burdens. To achieve the promise of the UN HLM, several questions must be addressed. In this report, we present the realities of the situation by answering four questions: is there really a global crisis of NCDs; how is NCD a development issue; are affordable and cost-effective interventions available; and do we really need high-level leadership and accountability? Action against NCDs will support other global health and development priorities. A successful outcome of the UN HLM depends on the heads of states and governments attending the meeting, and endorsing and implementing the commitments to action. Long-term success requires inspired and committed national and international leadership.

Priority actions for the non-communicable disease crisis

The UN High-Level Meeting on Non-Communicable Diseases (NCDs) in September, 2011, is an unprecedented opportunity to create a sustained global movement against premature death and preventable morbidity and disability from NCDs, mainly heart disease, stroke, cancer, diabetes, and chronic respiratory disease. The increasing global crisis in NCDs is a barrier to development goals including poverty reduction, health equity, economic stability, and human security. The Lancet NCD Action Group and the NCD Alliance propose five overarching priority actions for the response to the crisis--leadership, prevention, treatment, international cooperation, and monitoring and accountability--and the delivery of five priority interventions--tobacco control, salt reduction, improved diets and physical activity, reduction in hazardous alcohol intake, and essential drugs and technologies. The priority interventions were chosen for their health effects, cost-effectiveness, low costs of implementation, and political and financial feasibility. The most urgent and immediate priority is tobacco control. We propose as a goal for 2040, a world essentially free from tobacco where less than 5% of people use tobacco. Implementation of the priority interventions, at an estimated global commitment of about US$9 billion per year, will bring enormous benefits to social and economic development and to the health sector. If widely adopted, these interventions will achieve the global goal of reducing NCD death rates by 2% per year, averting tens of millions of premature deaths in this decade.

Cardiovascular Health in the Americas: Facts, Priorities and the UN High-Level Meeting on Non-Communicable Diseases

Population aging, smoking, unhealthy diet and physical inactivity, in the context of globalization and unregulated urbanization, explain the high prevalences of hypertension, hypercholesterolemia and diabetes in the Americas, making cardiovascular diseases the main cause of death. Moreover, cardiovascular diseases and their risk factors disproportionately affect the poorest people, obstructing antipoverty efforts and further deepening health and other inequities. The global crisis of chronic non-communicable diseases has reached such proportions that the UN General Assembly called a high-level meeting in September 2011 to address the issue as one of human development, aiming to stimulate political commitment to a concerted global effort to stem the pandemic. In reference to the Americas, this article reviews the burden of cardiovascular diseases and describes priorities for strategies and action in the region and their relation to the results of the UN meeting.

The private sector, international development and NCDs

This article addresses an area that has been largely underserved by the development community, and one in which there is a particularly good opportunity for the private sector to take a lead in making a difference to employees, customers and local communities: chronic, non-communicable diseases (NCDs). It highlights the extent of the epidemic of NCDs in developing countries, sets out the 'business case' for the private sector to act on NCDs, and gives examples of initiatives by business to ensure that the healthy choice really is an easier choice for employees, consumers and local communities. It makes the case that, to be genuinely sustainable, businesses should be addressing health as a core part of what they do and, by working in partnership - as called for by the Millennium Development Goals - they can make a real difference and become part of the solution. Identifying ways in which this can be done should form a key part both of planning for, and action after, the UN High-level Meeting on NCDs, to be held in September 2011.

Mobilising the world for chronic NCDs

The Lancet's third Series on chronic diseases and development, starting today, comes at a crucial crossroads in the fight against non-communicable diseases. In 9 months' time, the world will have a historic opportunity to give these diseases the recognition and response they deserve when UN member states gather in New York for the first UN High-level Meeting on non-communicable diseases in September, 2011. 1 Department of Public Information, UNPress conference on General Assembly decision to convene Summit in September 2011 on non-communicable diseases. http://www.un.org/News/briefings/docs/2010/100513_Diseases.doc.htmDate: May 13, 2010 Google Scholar Raising the priority of preventing chronic diseases: a political processChronic diseases, especially cardiovascular diseases, diabetes, cancer, and chronic obstructive respiratory diseases, are neglected globally despite growing awareness of the serious burden that they cause. Global and national policies have failed to stop, and in many cases have contributed to, the chronic disease pandemic. Low-cost and highly effective solutions for the prevention of chronic diseases are readily available; the failure to respond is now a political, rather than a technical issue. Full-Text PDF Health, agricultural, and economic effects of adoption of healthy diet recommendationsTransition to diets that are high in saturated fat and sugar has caused a global public health concern, as the pattern of food consumption is a major modifiable risk factor for chronic non-communicable diseases. Although agri-food systems are intimately associated with this transition, agriculture and health sectors are largely disconnected in their priorities, policy, and analysis, with neither side considering the complex inter-relation between agri-trade, patterns of food consumption, health, and development. Full-Text PDF Tackling of unhealthy diets, physical inactivity, and obesity: health effects and cost-effectivenessThe obesity epidemic is spreading to low-income and middle-income countries as a result of new dietary habits and sedentary ways of life, fuelling chronic diseases and premature mortality. In this report we present an assessment of public health strategies designed to tackle behavioural risk factors for chronic diseases that are closely linked with obesity, including aspects of diet and physical inactivity, in Brazil, China, India, Mexico, Russia, and South Africa. England was included for comparative purposes. Full-Text PDF Prevention and management of chronic disease: a litmus test for health-systems strengthening in low-income and middle-income countriesNational health systems need strengthening if they are to meet the growing challenge of chronic diseases in low-income and middle-income countries. By application of an accepted health-systems framework to the evidence, we report that the factors that limit countries' capacity to implement proven strategies for chronic diseases relate to the way in which health systems are designed and function. Substantial constraints are apparent across each of the six key health-systems components of health financing, governance, health workforce, health information, medical products and technologies, and health-service delivery. Full-Text PDF Monitoring and surveillance of chronic non-communicable diseases: progress and capacity in high-burden countriesThe burden of chronic, non-communicable diseases in low-income and middle-income countries is increasing. We outline a framework for monitoring of such diseases and review the mortality burden and the capacity of countries to respond to them. We show data from WHO data sources and published work for prevalence of tobacco use, overweight, and cause-specific mortality in 23 low-income and middle-income countries with a high burden of non-communicable disease. Data for national capacity for chronic disease prevention and control were generated from a global assessment that was done in WHO member states in 2009–10. Full-Text PDF