This year in the Americas, 4.5 million people will die of chronic, non-communicable diseases (NCDs) such as heart disease, cancer, hypertension, diabetes, and obesity. While the countries of the region have made great strides over the past two generations in decreasing death rates from infectious diseases—they are no longer the leading causes of death in all but five countries —today 250 million people suffer from non-communicable diseases. These conditions, today even emerging among children and adolescents, cause premature death and great human suffering.
They also cost billions of dollars in direct and indirect costs. Chile’s annual dialysis bill, due mostly to diabetes and hypertension, totals a whopping $200 million. Studies in the Caribbean estimate the economic impact of diabetes and hypertension alone adds up to 5 to 8 percent of GDP. In the United States, the impact of heart disease exceeds $300 billion.
The situation is serious, tragic, and almost entirely preventable. The risk factors for NCD’s are well known: tobacco use, harmful use of alcohol, unhealthy diets, and physical inactivity. Still, the root causes of NCD’s are complex, driven by twenty-first century social and environmental conditions that affect how people in the region live, work and play. Similarly, while prevention strategies exist, they require lifestyle changes across a range of areas (diet, exercise, habits) and the cooperation of different sectors to be effective. Unfortunately, this sort of cooperation has been lacking.
But Something Is Being Done
On December 3, 2009, the Pan-American Health Organization (PAHO), the world’s oldest regional health organization, and the regional office of the World Health Organization (WHO), created the Partners Forum to mobilize effective cross-sector action against NCDs. Announced by PAHO Director Dr. Mirta Roses in September 2009, the Partners Forum seeks to actively engage a broad range of sectors and partners “to prevent over three million deaths, reduce suffering and the upward cost spiral, and improve productivity through joint action over the next 10 years.” The Partners Forum has developed committees for a set of topical areas, such as healthy diets, to address NCDs. These committees, comprising representatives from a variety of sectors, are currently in the process of developing specific projects.
The list of founding collaborators of the Partners Forum reflects the breadth of experience and expertise that will be necessary to halt the growth of non-communicable diseases. In addition to the WHO, this NCD-fighting coalition includes the Pan American Health and Education Foundation, the International Business Leaders Forum and the World Economic Forum. Individual participants include representatives from the worlds of business, academia and civil society—all of which have a role in addressing the various fronts that must be attacked to reduce NCDs, from public awareness to policy, to business practice to scientific and medical research.
The idea of public-private partnerships (PPPs) has become a bit of a trend in the region. Countries across the hemisphere have come to embrace these partnerships as an efficient way to mobilize human and financial resources for public goods. Most of these points of collaboration between business and state, though, focus on infrastructure or services like education. PAHO’s Partners Forum tries to build new partnerships in the field of health and combating non-communicable diseases. The effort works to bring together PAHO member states with nongovernmental organizations and for-profit businesses in a broad regional campaign to develop joint projects and promote public awareness of the issue.
This may sound easy. It isn’t. The Forum’s most important task will be to build trust among its members, many of whom have for too long either preferred to play the blame game or failed to acknowledge their responsibilities on NCDs.
Reducing sodium consumption offers an example of what a health-based PPP could look like—and the complexity of harnessing the necessary stable of actors to affect change. Studies around the world have shown that a high-sodium diet may contribute to high blood pressure in certain individuals and increase the risk of heart disease. A PAHO-convened experts group has issued a policy statement calling for reducing dietary salt intake in the Americas. To move beyond policy to effective action, however, requires a combined effort.
For their part, governments will need to examine consumption patterns to identify the primary sources of salt in national diets. The food industry will need to reformulate products to reduce salt. Health NGOs will have to monitor and advise government and industry’s progress and begin a public campaign to ensure that the public balances the need for sodium as an essential nutrient against the potential risks of high-sodium diets.
If the research, the reformulated products or the public education are lacking, the salt reduction effort will fail. The Partners Forum offers a platform and an opportunity for all parties to sit down together to design an effective strategy and toolkit of actions for the region.
The most compelling force behind the new willingness to join efforts is simply that old ways of doing business haven’t worked. The failure to collaborate and tackle head-on the multifaceted causes of NCDs has meant that the disease burden continues to increase—and along with it the costs in productivity and public resources. Forum members recognized this explicitly in the Commitment to Action. The commitment effectively laid out that no one group can do it alone, stating that governments “need the support of the private sector and an empowered civil society.” Businesses require “supportive government policies to level the playing field,” and informed consumers and markets that can support healthy choices. And civil society needs responsible government policies as well as a private sector that can make “healthy lifestyles easy and attainable.”
The first step in this “all of society” approach has been to raise the issue of NCDs on the public policy agenda. Not surprisingly, chronic diseases have long been a topic of discussion among health ministries. In 2006 and 2007, PAHO’s Directing Council of Health Ministers approved the “Regional Strategy for Chronic Disease Prevention and Control, Including Diet, Physical Activity and Health in the Americas.” The strategy customized the WHO’s global approach to the NCD issue for the Americas. Demonstrating that they were ahead of the curve on this topic, the ministries of health in the region have also organized the CARMEN network (the acronym for the unwieldy official name of Collaborative Action for Risk Factor Prevention and Monitoring of E-NCDs) to monitor and evaluate NCD policies and train public health professionals in skills to prevent and control NCDs. The network stands as one of the first efforts to catalyze collaboration between health ministries and public health schools on this vexing issue.
But as the human and financial costs of NCDs mount, addressing this multifaceted scourge requires more than just the health ministries. Other government agencies, like the ministries of finance, labor, industry, and trade—not to mention heads of state and government themselves—need also to step up to the plate by understanding and publicly discussing the effect of NCDs on the region’s productivity, creativity and competitiveness.
Fortunately, there is already a strong example of executive leadership in the region. In 2007, CARICOM convened the Heads of Government Summit on Chronic Diseases. Summit participants encouraged an interagency approach toward NCD prevention and control and recognized that, as heads of government, they had a key and critical role to play. Their Declaration of Port of Spain was a 15-point statement in which the heads of state agreed to encourage greater cooperation both across CARICOM and within their own governments.
Recently, CARICOM members took their commitment to a new level by advocating for a special UN summit on NCDs. It was the first time that a regional group had called for international attention to the matter. And they received a fair hearing. The UN has called for a meeting in September 2011 to discuss the problem, especially for populations and governments in middle- and lower-income countries. CARICOM’s efforts were recognized at the 63rd World Health Assembly, held in Geneva this past May. Preparations for the UN-NCD summit will begin in earnest this fall, and events will be held throughout the year to ensure the broadest possible high-level attendance.
In addition to continuing to raise the topic at regional meetings, in the months leading to the UN Summit, PAHO’s Partners Forum is also working to direct attention to and expand existing health initiatives. It’s an implicit recognition that governments are already beginning to work in this area and that expanding existing initiatives should not mean reinventing the wheel or creating international programs or interventions. For example, many national, provincial and municipal governments have already established model nutrition programs in schools. Many businesses already have healthy workplace and lifestyle education programs for their employees and their families. And many NGO’s already have programs that educate and mobilize communities to demand facilities that make physical activity accessible to citizens of all ages.
In these cases, the added value of the Partners Forum will be to communicate and scale up best practices across the region. One key action here will be to highlight successes as an incentive to reward the good efforts of governments, businesses, groups, and individuals. The Pan American Health and Education Foundation, as one of the founding partners of the Forum, for example, has an excellent platform for highlighting achievements to combat NCDs at its annual awards dinner, held in September as part of the Council of Ministers meeting.
As important as NCDs may be in Latin America and the Caribbean, it’s worthwhile to remember that the region faces a host of other health-related challenges. Communicable diseases, including some of the neglected tropical diseases, remain an issue. Maternal and child health is still a challenge. In all of these cases, advances for poor and minority populations have lagged behind. And many countries of the hemisphere face the double burden of overweight/obesity co-existing with malnutrition.
Clearly, the best talents of all sectors need to be directed against this panoply of health issues. Beginning with NCDs, PAHO’s Partners Forum can take an important step in the right direction.