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Global NCD Agenda

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Call To Action

The tobacco control community must work closely with the broader movement addressing the global non-communicable disease (NCD) crisis; moreover, tobacco control proponents must stand together with other public health communities to lift the fight against NCDs to the very top of the global health and development agendas.

Share of deaths due to non-communicable diseases (NCDs); 2010

As economic development continues rapidly and as transnational tobacco, alcohol, food, and beverage companies aggressively promote unhealthy choices, non-communicable diseases (NCDs) such as cardiovascular disease, stroke, diabetes, chronic lung disease, and cancer are becoming more important as causes of global morbidity and mortality. NCDs have surpassed communicable diseases (e.g. HIV, malaria, tuberculosis, diarrhea, pneumonia) as the leading causes of death in all but the lowest-income nations. Even in low-income countries, deaths from NCDs are rapidly approaching those of communicable disease. Tobacco is a driver of the development of most of the leading NCDs, including chronic lung disease, cardiovascular disease, stroke, cancer, and diabetes.

In 2011, world leaders gathered in New York for a United Nations high-level meeting to give NCDs new prominence in the health and development agendas. Private sector firms and trade associations tried to undermine strong action, and lobbied for self-regulation. Yet, with strong support from civil society, member states unanimously approved a declaration that acknowledges that fighting these diseases is a global priority requiring urgent action.

Multiple initiatives evolved after the United Nations summit, including formulation of the WHO Global NCD Action Plan, a set of nine specific targets toward preventing major NCDs by addressing their major risk factors. A key target is a 30% reduction in tobacco use prevalence by 2025 (see The Endgame).

The tobacco control community pioneered tools to limit markets for unhealthy commodities. Companies that profit from the sales of alcohol, sugary beverages, and foods with high fat, sugar, and salt content—all major NCD risk factors—use strategies similar to those of the tobacco industry. Proven and effective tobacco control measures, such as marketing bans, packaging and labeling regulations, and taxation, can also be used in addressing those other major NCD risk factors.

Sources

Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2224-60.

Institute for Health Metrics and Evaluation. GBD 2010 Heat Map: University of Washington; 2013 [cited 2014 July 28].

ITC Project, World Health Organization, World Heart Federation. Cardiovascular harms from tobacco use and secondhand smoke: Global gaps in awareness and implications for action. Waterloo, Ontario, Canada and Geneva, Switzerland. 2012.

Ezzati M, Henley SJ, Lopez AD, Thun MJ. Role of smoking in global and regional cancer epidemiology: current patterns and data needs. International journal of cancer Journal international du cancer. 2005 Oct 10;116(6):963-71. PubMed PMID: 15880414. Epub 2005/05/10. eng.

Institute for Health Metrics and Evaluation. GBD Cause Patterns, 2010: University of Washington; 2014 [cited 2014 August 20].

Beaglehole R, Bonita R, Horton R, Adams C, Alleyne G, Asaria P, et al. Priority actions for the non-communicable disease crisis. Lancet. 2011 Apr 23;377(9775):1438-47. PubMed PMID: 21474174. Epub 2011/04/09. eng.

WHO. Global status report on noncommunicable diseases 2010: WHO; 2011 [cited 2014 July 11].

Dora C, Haines A, Balbus J, Fletcher E, Adair-Rohani H, Alabaster G, et al. Indicators linking health and sustainability in the post-2015 development agenda. Lancet. 2014 Jun 9. PubMed PMID: 24923529. Epub 2014/06/14. Eng.

WHO. WHO report on the global tobacco epidemic 2013. WHO; 2013 [cited 2014 Oct 14].

Johnson T. UN High-Level Meeting on NCDs: One Year Later. Council on Foreign Relations. [cited 2014 Jul 18].

Lincoln P, Rundall P, Jeffery B, Kellett G, Lobstein T, Lhotska L, et al. Conflicts of interest and the UN high-level meeting on non-communicable diseases. The Lancet. 2011 Nov;378(9804):e6.

American Cancer Society. Meeting the Targets: Encouraging Country-level Action to Make Cancer and Other Chronic Diseases a Global Priority. Atlanta, GA; 2013.

Delamothe T. Letter to an unknown health minister. BMJ. 2011 Sep 21;343:d6004.

Sharing the tools

Packaging regulations, a method employed to control tobacco use, can also serve to deter people from consuming other unhealthy products.

Existence of a global health treaty (WHO FCTC) as well as effective national and sub-national legislation make tobacco control a model for addressing other pressing NCD-related issues that require better regulations, including harmful use of alcohol and unhealthy diet.

Resources

Sources

Wipfli HL, Samet JM. Moving beyond global tobacco control to global disease control. Tobacco control. 2012;21(2):269-72.

Tobacco and NCDs

Risk factors for the leading non-communicable diseases worldwide

Tobacco use is a shared risk factor for the four leading non-communicable diseases in the world, causing 6.3 million deaths.

Resources

Sources

WHO. Note by the Secretary-General transmitting the report of the Director-General of the WHO on the progress achieved in realizing the commitments made in the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases (NCDs). Geneva: WHO; 2013 [cited 2014 July 7].

Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2224-60.

Institute for Health Metrics and Evaluation. GBD 2010 Heat Map: University of Washington; 2013 [cited 2014 July 28].

Tsugane S, Sasazuki S, Kobayashi M, Sasaki S. Salt and salted food intake and subsequent risk of gastric cancer among middle-aged Japanese men and women. British journal of cancer. 2004 Jan 12;90(1):128-34. PubMed PMID: 14710219. Pubmed Central PMCID: PMC2395341. Epub 2004/01/08. eng.

Wang XQ, Terry PD, Yan H. Review of salt consumption and stomach cancer risk: epidemiological and biological evidence. World journal of gastroenterology : WJG. 2009 May 14;15(18):2204-13.

Aaron KJ, Sanders PW. Role of dietary salt and potassium intake in cardiovascular health and disease: a review of the evidence. Mayo Clinic proceedings. 2013 Sep;88(9):987-95. PubMed PMID: 24001491. Pubmed Central PMCID: PMC3833247. Epub 2013/09/05. eng.

Li XY, Cai XL, Bian PD, Hu LR. High salt intake and stroke: meta-analysis of the epidemiologic evidence. CNS neuroscience & therapeutics. 2012 Aug;18(8):691-701. PubMed PMID: 22742770. Epub 2012/06/30. eng.

Strazzullo P, D’Elia L, Kandala NB, Cappuccio FP. Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies. BMJ (Clinical research ed). 2009;339:b4567. PubMed PMID: 19934192. Pubmed Central PMCID: PMC2782060. Epub 2009/11/26. eng.

“NCDs are one of the MAJOR CHALLENGES to sustainable human development in the 21st century, and therefore must be central to the post-2015 development agenda.” -Tezer Kutluk, President-Elect, Union for International Cancer Control, 2014

“Today, many of the threats to health that contribute to noncommunicable diseases come from corporations that are big, rich and powerful, driven by commercial interests, and far less friendly to health. Forget collaboration with the tobacco industry. Never trust this industry on any count, in any deal. Implement the WHO Framework Convention on Tobacco Control. Doing so can avert around 5.5 million deaths each year at a cost, in a low-income setting, of less than 40 cents per person. There is no other “best buy” for the money on offer.”-Dr. Margaret Chan, Director-General of WHO, 2011

“There are certain things that microbes don’t do: microbes do not lobby politicians to allow them to continue to spread; they don’t spend billions of dollars to convince people that it’s cool to be infected; they don’t fund scientists to say it’s not so bad to get that infection or re-brand themselves as ‘light’ bacteria that might be less harmful…” -Dr. Thomas R Frieden Director, Centers for Disease Control and Prevention, First Global Ministerial Conference on Healthy Lifestyles and NCD Control, Moscow, April 2011

“Mars is concerned that the introduction of mandatory plain packaging in the tobacco industry would also SET A KEY PRECEDENT for the application of similar legislation to other industries, including the food and non-alcoholic beverage industries in which Mars operates.” -The Mars Corporation to the UK government, 2012

One of the proposals for the 2011 UN NCD declaration included international restrictions on tobacco advertising. This point was rejected by delegates from some Western countries with strong tobacco industry presence and policies to protect their own citizenry.

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