What\u2019s the mood among delegates on the eve of the UN summit on non-communicable diseases as they gather in hotel bars and the confusion of side events in New York City?<\/p>\n
Well, earlier in the day I went on a hike through Central Park with about 50 others in an event organised by the NCD Alliance to publicise that 300 million people are now caught up in the global diabetes epidemic. We waved helium balloons and cars honked in support from 5th Avenue. My walking partner was Allison Schauwecker, a graduate of international relations now working for a company which makes a weekly television show on US cable television for diabetic patients. It pulls in millions of viewers every week. Allison, diagnosed with Type 1 Diabetes when she was 25, carried a small bag of sweets \u201cin case I go low.\u201d\u00a0<\/p>\n
We all wore blue t-shirts emblazened with the slogan \u201cOutrage.\u201d Is there a mood of outrage among the policy advocates here? Not really.\u00a0There is quiet relief that\u00a0lobbying by NGOs has had\u00a0some effect on the final draft of the political declaration to be signed by 192 member states tomorrow. Witness the pledge to eliminate industrially produced trans fats in food, an acknowledgment that taxing tobacco actually works and reduces consumption (thank you, Norway for really pushing on that one) and, for tobacco at least, the recognition of the conflict of interest between industry and public health.<\/p>\n
But there\u2019s disappointment too: at the lack of concrete goals – crucial if health ministers want to leverage cash for NCDs from their national treasuries; there is little to nothing on curbing the harm of alcohol; the business interests of food, pharmaceutical, and alcohol companies are only checked with a light hand – the whole document is littered with acknowledgements that industry has an important role \u201cwhere appropriate.\u201d And there\u2019s very little about improving access to drugs, no GAVI-like deals in the offing to prevent \u201cstock outs\u201d of oncology and diabetes drugs in countries like Kenya, which happens when the money runs out and the supply chain fails. Unlike the last UN health summit a decade ago, for HIV\/AIDS, this declaration won\u2019t be ratified by the security council, just by the general assembly. In short, it lacks clout.<\/p>\n
The private sector is here in force, from side events organised by PepsiCo, Novo Nordisk, and Pfizer, to name just three. I keep hearing that the private sector has come in much earlier and quicker into the NCD field, compared to HIV\/AIDS. They won\u2019t be late at the table again.<\/p>\n
At a World Bank cocktail reception last night I spoke to\u00a0an executive from Medtronics, the world\u2019s largest medical technology company. He told me the company had spent more than \u00a37m this year alone in the run up to the summit, raising \u201cawareness\u201d of the need to treat NCDs to authorities in poorer countries, and training nurses in places such as Madras, India, and Rwanda. The home page on the company\u2019s website this week exclaims that \u201cMedtronics is taking on the global NCD challenge.\u201d<\/p>\n
It\u2019s not difficult to get the NGOs to sound off about conflicts of interests. Much rarer is to hear any straight talking from government officials or WHO officials. One lone voice yesterday was the Hungarian health minister at a New York Academy of Medicine event. Mikl\u00f3s Sz\u00f3cska ignited the event with his remarks: \u201cYou have to understand how exposed poorer countries like Hungary are to the influence of multinational companies. People in my country still see smoking Marlboro and drinking Coca-Cola as an expression of freedom. We need clarity in the handling of the private sector.\u201d Turning to the WHO he said: \u201cYou should not be encouraging member states to go into inappropriate partnerships. We have very little money so it\u2019s hard to resist companies who offer to commercially sponsor health programmes. We are very exposed to their influencing techniques. We desperately need new investment models.”<\/p>\n
Is there anything left to play for? Double the number of countries expected\u00a0have applied to speak over the next few days, now at least 60, although few are likely to be newsworthy. I\u2019ve been told to watch out for Australia and the EU statements. \u201cIt\u2019s all theatre now\u201d said one Washington-based lobbyist, suggesting the political declaration is a done deal.<\/p>\n
And are member states expected to commit any funding in these financially straightened times? The latest draft has been watered down so countries just need to \u201cexplore the provision of predictable and sustained resources,\u201d to fight NCDs. However, the latest economic analysis, released last night by the WHO, is compelling. It shows that scaling up an intervention package to prevent and treat NCDs in low to middle income countries costs less than $12 billion a year. Staggeringly cheap when you consider that the World Economic Forum estimates economic losses due to NCDs of nearly $500 billion a year. If governments claim there is no money to fund this $12 billion, why do they leave billions of dollars on the table by keeping tobacco taxes so low? The NCD Alliance were yesterday handing out fake $1 billion dollar notes. The stunt was to show that a 1% increase in tobacco taxes worldwide would raise $1 billion or more.<\/p>\n
For those in need of good news, a plan to develop goals and develop metrics is emerging. There is a lot of talk, for example, about making\u00a0the reduction of\u00a0NCDs worldwide a new Millennium Development Goal, once some of the current ones expire. And if nothing else, this declaration does represent a strongly worded description of the scourge of chronic disease worldwide. \u201cI really believe it\u2019s the beginning of the end for NCDs,\u201d said an NCD Alliance spokesperson.<\/p>\n