The United Nations wants to increase action to curb what is becoming a global epidemic.
At the United Nations, this month has witnessed reflections on resilience and revenge since 9/11, 10 years ago, and Palestine's campaign for recognition as a state. Less exciting, but looming larger in the reality of world wellbeing, is the problem of non-communicable diseases, a collective term for cancers, heart disease, diabetes and chronic lung disease.
Only for the second time in its history did the UN General Assembly debate a health issue, agreeing on September 19-20 to increase action, worldwide, to curb the spread of these chronic diseases. NCDs have been the leading causes of death in the developed world for many years. However, the spread of these conditions to all countries now represents a global epidemic.
NCDs were responsible for about 36 million of the 57 million deaths in the world in 2008, including about nine million in people younger than 60. Many of the deaths could have been prevented with measures to reduce obesity, to stop smoking and to avoid the abuse of alcohol and other drugs.
Obesity, tobacco, alcohol and drugs are risk factors for NCDs, sometimes described as ''lifestyle diseases''.
It is important, however, to recognise that lifestyle is often the product of environments over which many of us have little control.
In Canberra, for example, the opportunity to walk and be physically active could be improved with greater access to public transport. Widespread dependence on cars may thus be environmentally determined rather than a freely made, personal choice.
Physical inactivity is a major contributor to obesity, while readily available energy-dense foods (such as sweet fizzy drinks and deep-fried takeaways) may be even more significant as causes of this pre-cursor of much NCD.
Healthy public policies that address the complex problem of obesity would include taxation and other measures to reduce socioeconomic inequalities, and action against climate change: these issues have common causes and solutions. Health departments will need the cooperation of agriculture, education, finance, planning, trade and transport ministries, so political leadership will be essential.
Australian Health Minister Nicola Roxon directed her remarks at the UN meeting to this country's continuing efforts to reduce smoking, including Australia's intention to proceed with plain packaging of cigarettes. Tobacco is the leading cause of preventable death, and a clear target: any intake is potentially harmful, so cessation is the goal, pure and simple. Australian efforts will continue with leadership from our new Preventive Health Agency.
While the agency's website also shows a focus on tobacco, the wider-ranging determinants of overweight and obesity could be even more challenging. For example, an identification of positive activities to counter these determinants will require more than the ''Swap it don't stop it'' campaign. The ''likeable but overweight'' hero of this campaign is encouraged to swap from ''big to small'' (portion control); from ''often to sometimes'' (treats should be less frequent); from ''fried to fresh'' (nutritional quality); from ''sitting to moving'' and from ''watching to playing'' (physical activity). This ''nudging'' approach seems to avoid intrusions on choice.
However, making healthy choices easier by structured social and regulatory change is likely to have a greater effect than leaving choice to the individual.
Therefore, international agencies, governments at all levels, the private sector and health professionals will all need to support and add to individual efforts.
Agencies are working on standards. The regulation of food and beverage marketing to children is a critical example. The World Health Organisation will work on targets, for review at the UN in a year's time: Australia and other countries need clear targets for the reduction of NCDs in coming years. As diseases pay little heed to international borders, an effective response to NCDs will require a continuing global approach.
Regular, accurate assessment of the burden of disease will track progress and the impact of interventions.
The private sector should promote reductions in sugar, salt and unhealthy fat, as it ensures that food labelling, packaging and health claims also meet high standards. Industry should also contribute to the efforts made by governments to assess progress.
While tobacco use and cardiovascular disease epidemics have shown some reversibility, it is not yet clear how well the obesity problem will respond to public health measures.
Prevention, therefore, remains a priority, coupled to the ethical, healthcare imperative to continue to assist those with early and advanced NCDs.
Health professionals should all be offering evidence-based support for the prevention and management of NCDs.
Our society needs much greater understanding of the continuum of prevention, early diagnosis and treatment.
Without this, health systems may not cope with the accelerating NCD epidemic in years to come.
* Charles Guest has an adjunct appointment at the Australian National University. He visited the World Health Organisation this month.
source: canberratimes
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