Richard Smith: Waiting for Putin

Richard SmithAlong with about 600 other people, 90 of them health ministers from all over the world, I spent two hours recently waiting for Vladimir Putin, prime minister of the Russian Federation, to arrive at a meeting in Moscow. It was dull but did give us “NCD nuts” a chance to catch up with each other and tweet copiously. I’m not used to these global gatherings, and the tedium of the wait and the general disorganisation made wonder about their value.

The meeting was the First Global Ministerial Conference on Healthy Lifestyles and Non-communicable Disease (NDC) Control, and it is part of the elaborate build up to the United Nations High Level Meeting on NCDs, which will happen in New York in September.

Moscow is a surprisingly beautiful, huge, expensive, and highly complex city. Nothing, including crossing the road, is easy, and many of its inhabitants are not interested in helping you. Having said that, I have to report that a public health expert, a keen reader of the BMJ, not only helped me find a taxi to my hotel (about a fifth of the price of the conference hotel) but also came with me. The way to hail a “taxi” in Moscow is simply to walk into the street and put your hand out. Almost immediately a car will stop and—if you can agree a price—take you to where you want to go. Hardly anybody speaks any English, and visitors are warned not to take a taxi in the street for fear of abduction.

I arrived at the meeting at the World Trade Centre this morning to find two queues about 30 yards long. I joined one and after about 20 minutes made it into the hotel, where, although I registered yesterday, I wasn’t on the list of attendees. After much muttering among young men in suits I was ushered through the electronic security screen. The meeting should have started 30 minutes earlier, but when I got upstairs dozens of people were chatting while hundreds sat in the hall among about 30 cameras.

We sat and sat, and the meeting finally started about an hour late with the announcement that the agenda would have to be juggled. I then listened to a series of speeches from very important people who repeated each other and tried to reach for phrases that would be memorable and express the gravity of the problem. I didn’t learn anything new.

After an hour of this we broke for coffee. There were many mates there from the global health bandwagon, and we chatted about this and that, including the bathos of the royal wedding and the tragedy of Barack Obama having to release his birth certificate—two empty issues that preoccupy a world that mostly has no idea what an NCD is.

Then it was back to waiting for Putin. After about an hour a buzz went through the cameramen, and Putin appeared. It’s hard not to be impressed by setting eyes on a successor to Lenin, Stalin, and Gorbachev, although most of what he said was tosh. It didn’t matter. He could have simply read a letter from his aunt. What mattered was that he had come and blessed our meeting with his star power.

His presence did, however, allow Margaret Chan, the director general of WHO, to say that she hoped she would see him at the meeting in New York. He put his hands to his neck, which optimists thought meant he would come. I wasn’t so sure, and nor, I learnt later, was the vice-minister of health of China. After a few quips about ice hockey, Putin left—and we all had to wait at least 10 minutes with the doors closed.

By this time we were an hour and half late, and the remaining morning session was moved to the afternoon, and we all went for lunch.

My cynical tone might suggest that I think such a global meeting worthless, but they are, I’m sure, essential and unavoidable. I think of the doctor I met in a Kenya a month ago who has masterminded a programme for identifying and treating 125 000 people with HIV/AIDS and who said he had no interest in global meetings. Now he wants to treat those with hypertension but has no drugs. He and others working on the frontline will only be able to advance their work if there is global agreement on the need for action. Indeed, he was able to treat his patients only because of PEPFAR (President’s Emergency Plan For AIDS Relief), and he’ll only be able to treat the patients with hypertension if global momentum can be established.

You can’t have effective programmes at lower levels without action at the global apex, but global meetings are an exhausting and messy process and not for everybody, including me.

Competing interest: RS is the director of the UnitedHealth Chronic Disease Initiative. UnitedHealth Group is a for-profit organisation, but its chronic disease initiative is a philanthropic programme. UnitedHealth paid RS’s expenses for attending the meeting, but he facilitated a meeting of ministers on behalf of WHO.