In large part, as is turning out to be the theme of the week on MT, this has to do with industry pushing back. Yes, the impact of non-communicable disease on morbidity and mortality, not to mention national economies, are great (as Deborah Cohen says in the piece, "One estimate is that $84bn (£51bn; €59bn) of economic output will be lost between 2005 and 2015 as a result of non-communicable diseases"), but the effects on industry of curtailing the use of sugar, salt, processed foods and so forth are of more concern to powerful industry interests. And they are doing what they can to ensure this meeting fails.
As Cohen writes,
In the run up to the UN summit on non-communicable diseases, there are fears that industry interests might be trumping evidence based public health interventions. Will anything valuable be agreed?The hope had been that, at the very least, with the spotlight on non-communicable diseases, the meeting would make them more visible generally, turning this into a teachable moment in terms of disease prevention. But, pressure from the food industry is making it unlikely that governments are going to sign onto the commitment of resources for the health education campaigns that would be required to follow up.
At a UN meeting in New York for representatives of charities and the public (called “civil society” in global health) in June—staged to allow advocates to have their say on the final political declaration [prepared before the meeting convenes]—many of the tabled speakers came from groups either representing industry or funded by industry. Speakers included representatives of the International Federation of Pharmaceutical Manufacturers and Associations, the International Food and Beverage Alliance, and the World Federation of the Sporting Goods Industry. A list of those attending the September summit on behalf of civil society also includes representatives of industry, the BMJ has learnt. GlaxoSmithKline, Sanofi-Aventis, and the Global Alcohol Consumers Group are included within the official US delegation. And drinks companies Diageo and SABMiller are coming from the UK.And, there is conflict between the 'G77', the group of lower income states, who argue for the reduction of saturated fats in processed products, and the US, Canada, Australia, and EU, responding to pressure from the food industry. At best, industry is willing to accept voluntary cutbacks.
Bill Jeffery, from International Association of Consumer Food Organisations, says that the UN and WHO need to put up firewalls between their policy making processes and the alcohol and food companies “whose products stoke chronic diseases” and the drug and medical technology companies “whose fortunes rise with every diagnosed case.”
There are political issues as well. Money invested in NCDs is money diverted from infectious diseases and maternal and child health, and this is being resisted by many African countries, for whom NCDs are a less pressing issue, to date.“If national leaders embrace lame vendor-friendly voluntary ‘solutions’ instead of effective regulations governing advertising, product reformulation, package labelling, government procurement, and VAT reforms, public health and national economies will strain under the burden of NCDs for generations to come,” he said.
Now, whether or not it makes any material difference what the UN pronounces on this subject is a valid question. Goals put forward by such bodies are often little but words. But, the fact that industry seems to be pushing hard to prevent even words from being put forward suggests that they at least think UN action might be more than just a document at the end of the day.
It's not that any of these interests are necessarily invalid. The food industry has a right to profit from their products, and likewise the alcohol and tobacco industries. A lot of people make their living working in such industries, and countless people enjoy their products. But it is also true that food and alcohol consumption patterns lead to very large health-care bills, and we all one way or another have to foot that bill, so the industry is not the only entity with a legitimate interest in the discussions. What the relative costs and benefits are, and who should bear them, or how, are part of the equation, or should be. Fair apportionment could be based on item-specific taxes, behavior-based health care premiums, or whatever. But they should be based on considering the whole situation.
The results of a meeting on preventing and reducing non-communicable diseases should concern just that, and not be derailed (or pre-railed) by other, competing interests before the results are even presented. If governments ultimately decide that industry interest trumps public health, fine (well, in our view, not fine, but governments do have to weigh competing interests), but at least it should be clear that that's what happening. Instead, when, according to Cohen, "PepsiCo have secured the prime side-event slot at the UN meeting: a breakfast event from 8-10 am on the morning of the summit", and industry is helping mold the final product, public health interests don't t even get a clear shot.