World leaders at a meeting of the United Nations on Monday will agree a deal to try to curb the spread of preventable "lifestyle" diseases, amid concern that progress is already being hampered by powerful lobbyists from the food, alcohol and tobacco industries.
Cancers, heart disease, diabetes and lung conditions already cost rich countries dear in terms of the health bills and productive life span of their citizens. But the scourge of what the World Health Organisation calls the "non-communicable diseases" (NCDs) is rapidly spreading across all parts of the globe, fuelled by obesity as a result of bad diet and sedentary lifestyles, together with alcohol and smoking. These diseases were responsible for around 36m of the 57m global deaths in 2008, including about 9m before the age of 60 – and many are preventable.
While countries such as the UK have imposed smoking bans, taxed cigarettes and alcohol heavily and restricted junk food advertising to children, most developing countries have yet to address these issues – and the food and tobacco industries are accused of adopting marketing and production strategies there that would be unacceptable in Europe or in north America.
The scale and disastrous potential of these diseases has led the UN to call only its second high-level summit on a health issue on Monday – the first was over Aids in 2001. Months of negotiation have led to a draft declaration that will be signed at the summit. But while experts commend its tough depiction of the problem and its calls for all governments to take action, there is widespread concern that an absence of targets – the World Health Organisation (WHO) proposed cutting preventable deaths by 25% by 2025 – will reduce its impact.
"If you are in public health, this is a great step forward. I'm thrilled there is a high-level meeting," said Robert Beaglehole, emeritus professor at the University of Auckland, New Zealand, who was formerly director at the department of chronic diseases at the WHO.
But while the first part of the declaration said all the right things about the seriousness of the problem and the economic damage it will cause low- and middle-income countries, "the action statements are disappointingly weak", he said. "If you don't have a serious goal, how do you assess progress?" Without goals, he added, "accountability becomes a problem".
Ann Keeling, chair of the NCD Alliance, a global federation of disease-fighting organisations, has similar feelings. "It's incredible that we have got this far – that we have got to the UN at all. We're happy with the language [of the declaration]. What we're not happy with is that, having recognised the problem and talked about the need for more resources, it doesn't agree any time-bound commitments, or very few. Some were on the table at various stages and disappeared and a couple of important things are kicked into 2012."
Among the targets that failed to make it was a limit on salt consumption. Although much of the developed world has maximum daily recommended levels, a proposal by Norway to ask member states to bring down daily salt intake to 5g per person was blocked by the EU, Australia, Japan, the US and Canada.
Experts such as Graham MacGregor, professor of cardiovascular medicine at St George's in London and chairman of the campaigning group World Action on Salt and Health, think government negotiators were swayed by their own trade interests. "The EU is very much in the hands of the food industry, in our view," he said. It is not just the salt producers who have vested interests, but also manufacturers of food products that are high in salt such as bread."
While the declaration is strongly-worded on tobacco control, there are again no targets set. Critics say that while the US is tough on tobacco at home, its officials still feel obliged to support its tobacco exports – the US is the biggest exporter of tobacco in the world.
Concerns at behind-the-scenes lobbying have led to a vocal movement to address conflicts of interest at the summit and within any global strategy against NCDs. More than 100 organisations, led by those who have fought the marketing of the baby milk corporations in the developing world but including those working on food, alcohol, tobacco and essential medicines issues, called on the UN to recognise the difference between such campaigners and groups representing industry, and develop a code of conduct for engaging with those who had a commercial interest in the outcome.
They have had little success – the final declaration calls for all stakeholders "including the private sector and civil society" to engage "in collaborative partnerships to promote health and to reduce NCD risk factors" including through the promotion of healthy diet and lifestyles.
Keeling, of the NCD Alliance – some of whose member organisations are themselves criticised for accepting industry funding – says the controversy is unfortunate.
"We absolutely agree the private sector has to have a regulated or possibly no role in policy development," she said, but industry had to be part of the solution. While voluntary agreements to reduce salt, fat and sugar with food companies may have only a limited impact without regulation, she points to companies working in remote rural areas in poor countries that offer health benefits for their workers. Chevron, for instance, has "a large and important workplace programme on cardiovascular disease" in places in Africa where there is no state-run healthcare to speak of.
Nobody is seeking to minimise the seriousness of the problem. Among an avalanche of reports released before the summit is one from the World Bank, warning that these preventable diseases "increasingly threaten the health and economic security of many lower- and middle-income countries". Most cannot "treat their way out", it says. It cites the Ukraine, where a quarter of 18- to 65-year-olds have a chronic disease and with growing numbers of young people affected, the country could "lose the next generation".
