Avoidable chronic diseases: the neglected global epidemic

1. Avoidable chronic diseases:the neglected global epidemic Corinna Hawkes Visiting Research Fellow International Food Policy Research Institute European Health Forum Gastein, October 6-9 2004

2. Chronic disease mortality European Health Forum Gastein, October 6-9 2004

3. Upward trend • Percentage of global mortality from leading chronic diseases increased from 46.3% since 1990 • Percentage predicted to increase to over 60% in 2020 European Health Forum Gastein, October 6-9 2004

4. Leading chronic disease mortality by WHO region European Health Forum Gastein, October 6-9 2004

5. Avoidable risk factors • Tobacco • Number of cigarettes smoked nearly doubled since 1960 • Alcohol • 19% increase in alcohol consumption since 1990 • Physical activity • More sedentary lifestyles • Diet • Increase in fats, sweetners, salt (diet / nutrition transition) European Health Forum Gastein, October 6-9 2004

6. Emerging threats: obesity 31.8% 19.6% 15.9% 10.3% 5.1% 0.3% European Health Forum Gastein, October 6-9 2004

7. Costs of chronic diseases • CHD: Costs UK over £7 billion per year (1999) • Diabetes: 6% of health care costs in Sweden (1998) • Obesity: Between 2%-6% of national health care spending in OECD countries (1998-2003) European Health Forum Gastein, October 6-9 2004

8. Response of key players European Health Forum Gastein, October 6-9 2004

9. 46 resolutions since 1956 Framework Convention on Tobacco Control (2003) Global Strategy on Diet, Physical Activity and Health (2004) World Health Organization European Health Forum Gastein, October 6-9 2004

10. WHO Expenditure – the good news • WHO spends more than any other agency on chronic diseases • US$ 44.2 million in 2002 • Increase since 1998 European Health Forum Gastein, October 6-9 2004

11. WHO Expenditure – the bad news • At WHO HQ, US$2.4 million on prevention and control of leading chronic diseases; US$1.1 million on risk factor prevention/ surveillance, diet, pa, CVD management • Overall, 3.5% of WHO expenditure on chronic diseases • 4.7% of WHO EURO budget ($US 3.2 million) European Health Forum Gastein, October 6-9 2004

12. Bilaterals and development banks • Official Development Assistance for health • US$ 2.9 billion in 2002 • 0.01% (US$ 3.2 million) to chronic diseases (44% from the UK and Sweden) • World Bank • US$ 4.2 billion health loans 1997-2001 • 2.6% (US$ 109.5) to chronic diseases European Health Forum Gastein, October 6-9 2004

13. UN health and development initiatives • Excluded from Millennium Development Goals • Excluded from WHO Commission on Macroeconomics and Health • Excluded from major UN initiatives (ILO, UNICEF, UNFPA) European Health Forum Gastein, October 6-9 2004

14. The challenge of development • Chronic diseases are associated with more economic development, not less • Life expectancy increases as incomes rise • BUT economic development brings with it risks for chronic diseases European Health Forum Gastein, October 6-9 2004

15. Example: the diet transition • TRADE • In India, trade policy reform of vegetable oil market in 1995 • India grew from a relatively small importer of edible oils to the world’s leading net importer by 1998 • Palm oil consumption rose from 0% in 1972/74 to 38% in 1999/2001 European Health Forum Gastein, October 6-9 2004

16. FOREIGN DIRECT INVESTMENT (FDI) • From the U.S… • Processed food companies: $36 billion in 2000, from $9 billion in 1980 • Food retailers: $13 billion in 1999, from $4 billion in 1990 • Restaurants: $5.7 billion in 1998 European Health Forum Gastein, October 6-9 2004

17. $54.7 billion FDI $74.3 million pa for chronic disease prevention and control* *From WHO ($44.2 million), ODA ($3.2 million), World Bank ($21.9 million) European Health Forum Gastein, October 6-9 2004

18. MARKETING • Targeted at children • Aims to convert non-users to users European Health Forum Gastein, October 6-9 2004

19. IMPACT ON GLOBAL DIETS • Food… • Availability • Price • Desirability • Sales • Consumption • Processes of economic development affect what people eat European Health Forum Gastein, October 6-9 2004

20. The policy challenge • Promoting healthy diets means challenging economic forces • How do we promote economic development on the one hand and challenge it on the other? • A barrier for policy development • E.g. WHO Global Strategy process • How to stem the rising tide of chronic diseases without discouraging global economic development? European Health Forum Gastein, October 6-9 2004

21. The policy message • Learn from environmental arena • Frame as an issue of sustainable development • From: • “Grow now and treat diseases later” to… • “Grow good economies with good health” European Health Forum Gastein, October 6-9 2004

22. Policy actions • Tackle underlying causes • Reach out to different sectors • Identify common interests • Balance competing agendas • Make markets work for chronic disease prevention • Win-win solutions for economic development and chronic disease prevention European Health Forum Gastein, October 6-9 2004

23. Making markets work • Agriculture and trade • Reform agricultural subsidy structures to promote risk-reducing foods • Build institutions to allow small producers to access the market for high value foods • Foreign investment • Develop a policy framework for FDI • New business models for transnational food companies European Health Forum Gastein, October 6-9 2004

24. Build evidence with targeted research • Health impact assessments of policies • How does food production, trade processing and distribution influence changing food consumption patterns? • What are the “win-win” solutions for both agriculture and healthy diets? European Health Forum Gastein, October 6-9 2004

25. Thank you! European Health Forum Gastein, October 6-9 2004