David Nabarro, MD
New York, USA. David Nabarro is the UN Secretary General's Special Advisor on Sustainable Development and Climate Change and he is running for Election as the next Director General of the World Health Organization.
Governments and health insurers find that increasing numbers of people need care for their NCDs and seek ways to cope with this rising demand. They wonder how best to reduce the numbers of their people with NCDs, and how to make reductions happen in practice. People, their societies, and their governments turn to different organizations for help. The World Health Organization sets the standards for what needs to be done and suggests how the standards can be achieved. There are big challenges with making this happen because the underlying causes of NCDs are woven into people’s lifestyles and are not easily reduced. It is not at all like removing the bacteria that cause an infectious disease. The consequences of this NCD epidemic are on the rise and affect individuals, their societies and economies of their nations. How can the principles and practice of public health best be used to reduce these consequences?
First – prevent people getting an NCD. Have them work out why they are at risk and then encourage them to remove the risk factor from their lives. Make sure the people most at risk are heard when risk reduction efforts are being planned. Bring them together with different organizations that have an interest in NCD Movements. Encourage joint action that is based on the best evidence of what’s wrong, and of what works. A shared purpose, agreed frameworks for action and partnering are needed for impact at scale. Second – make sure that people with NCDs are diagnosed early and get the best possible treatment so as to slow the progress of the disease (and, ideally, stop it).
Why are people at risk of NCD? Many studies have come out with similar conclusions. NCDs are on the rise because people are exposed to tobacco smoke (6 million deaths per year), because their physical activity levels are low (3.2 million deaths per year), because of excessive alcohol consumption (1.6 million deaths per year), because of excess salt consumption (1.7 million deaths per year), and because of excess calorie consumption. These risk factors increase the likelihood of people being overweight, having raised blood pressure, or having high levels of sugar or fat in their blood.
There are proven ways to reduce exposure to the risk factors and to reduce the consequences for people’s health. They have been systematically applied in some contexts – examples include action to reduce saturated fats in people’s diets, or programmes to reduce people’s access to, and opportunities to use, tobacco. However, there is a long, long way to go. NCDs are causing a global health emergency.
A Government that is committed to helping people maintain good health will encourage different sectors to work together so as to reduce risk. Typically this involves cooperation between branches of government involved in food and agriculture, employment, education, transport and finance. It involves engaging civil society groups, especially those most at risk, and businesses alongside scientists. This approach has to be led by political leaders as it requires cross government working. It also requires a mutual commitment to accountability – everyone acting in ways that will reduce risk and minimise consequences of NCDs.
Extract from David Nabarro's reflections. Click here for COMPLETE ARTICLE