September 21st, 2011

Battle of commercial interests confound fight against noncommunicable diseases

Washington Post

Behind two days of talks at the United Nations and a unanimously adopted 13-page document about the need to fight noncommunicable diseases around the world is a fierce struggle between commercial and health interests that has only just begun.

Some of the issues, and some of the partisans, are the same ones at the heart of two other huge health campaigns in the past 20 years — the battle against smoking and the effort to bring AIDS drugs to poor countries. But the stakes here are much bigger, given the number of lives and sums of money at play.

That’s because noncommunicable diseases — heart disease, stroke, cancer, diabetes and emphysema — are deeply entangled with important global industries, not only tobacco but also food, pharmaceuticals, advertising, transportation and construction. And they are the globe’s biggest health problem, responsible for 63 percent of all deaths each year, with incidence growing steeply in the low-income, rapidly urbanizing nations of the world.

At issue are two questions: Will assaulting obesity-driven ailments require attacking the food companies the way assailing tobacco companies has driven efforts against smoking? What is the responsibility of rich countries, and the pharmaceutical companies located in them, to improve medical care in poor countries, where 40 percent of deaths from noncommunicable diseases occur before age 60?

The food industry, which is responsible for much of the sweet, salty, high-fat food that experts view as a problem, for the moment is considered a “partner” in the new campaign. It will not be treated as a pariah industry like tobacco, whose companies are barred from meetings like this.

The 13-page “Political Declaration” under intense negotiation since June and adopted Monday contains more than a dozen “partner” references. It telegraphs a message that voluntary changes in salt, fat and calories in food and in marketing directed at children are the preferred route to slowing the rise in obesity, hypertension, high cholesterol and inactivity that underlies many of the diseases.

It is a position that has left many activists unsatisfied.

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