Would it really change things if the UN meeting on NCDs had been a success?

We've been away, so we're late following up on the story of the UN meeting on non-communicable diseases (NCDs) (which we first blogged about here). The meeting of 'high-level' representatives of many nations was convened to address the issue of diseases that aren't often on the agenda of poor countries, where infectious diseases are usually considered the major health problems -- chronic diseases like heart disease, diabetes, respiratory diseases and cancer, largely the effects of tobacco use and alcohol abuse, poor diet, inactivity, and other lifestyle factors. These are major causes of morbidity and mortality in industrialized nations, and have been for decades, but are now becoming much more prevalent in the rest of the world, where of course health care amelioration is much scarcer than it is in the 'developed' world.

The meeting took place in New York on Sept 19 and 20, and by many accounts, was not a roaring success. But then, given the conflicts of interest represented there, this isn't a surprise, and indeed was the predicted result.

According to a piece in Family Practice News,

In the consensus document, known as a political declaration, UN members pledged to promote the reduction of salts and sugars; to eliminate trans fats in foods; to increase access to affordable, quality-assured medicines and technologies; and to strengthen health care systems so they can address NCD prevention and treatment.

The UN also endorsed WHO efforts to combat smoking, to improve diet and physical activity, to reduce the harmful use of alcohol, and to halt the marketing of unhealthful foods and beverages to children.

The UN Secretary-General Ban Ki-moon urged UN representatives at the meeting to carry out the provisions of the document and to "bring NCDs into our broader global health and development agenda."

But, goals were made voluntary rather than regulatory, because representatives of the food industry had been invited to participate.   

Instead of compulsory targets, the UN tasked the WHO to establish a comprehensive global monitoring framework and to prepare recommendations for voluntary global targets before the end of 2012, as well as to report initial progress in 2013, enabling a lack of accountability that the editorial authors deemed "a missed opportunity."

And an editorial in The Lancet concludes,

Ultimately, events in New York were underwhelming. An opportunity to create political cohesion to tackle the biggest health challenge facing future generations has been missed. Although the declaration sets out the scale of the challenge, it lacks ambition and is more a politically correct declaration than a political declaration of war. Individual countries must now take bold steps to accelerate their responses beyond the slow timetable the UN proposes if real progress is to be made.

Ok, so let's agree that conflicts of interest kept any real teeth out of the UN declaration that resulted from this meeting (which you can read here). But even if it did have teeth, would disease reduction goals, goals with deadlines, actually be attainable?  And, do we know that if, say, the food industry were required to reduce salt in processed food by, say, 25% that this would in fact make a difference in prevalence of stroke and heart disease? 

Further, if the declaration required that diabetes be reduced by some set amount, how would countries accomplish this? It's not as though medicine isn't trying to prevent or cure these problems now. Certainly the food industry has a vested interest in convincing people to drink sugary sodas and eat fat and salt laden foods, but this isn't the whole problem. People would still have to change their behaviors; eat less, move more, and we don't know how to make this happen.

So, it would have been nice if this meeting had produced a forceful document with public health goals that countries could commit to if for no other reason than that it's good for everyone to agree on the direction they should be going in. But without the knowledge of how to meet those goals, this would have been yet another document not worth the paper it was written on.

The problem is both epistemological and political.  Here in the US (and presumably in other well-off countries) the NIH has proclaimed a series of goals (Healthy People 2000;  No More Health Discrepancies 2010; and so on).  They sound great, and perhaps are nobly envisioned.  But they are also largely marketing techniques to keep the population believing that they are doing major things to improve health, reduce racial and other societal discrepancies related to health, and so on.  Bureaucrats have hearts, too, and perhaps want to achieve these kinds of things.  But it is even harder in international organizations with little actual power, such as the UN, than it is for the NIH (that never comes really even seriously close to these program goals).

The problems of inequity are difficult enough in the world, but there are always vested interests of all kinds that resist real reform.  It would be nice if what is actually achieved could, at least, be more substantial than it is, even if the realities are that complete achievement of ideals is never possible.