TThe pandemic may be over, but the world is still nervous about infectious diseases. Covid has left its mark; influenza is seen as the next looming terror. But when the World Health Organization explained a public health emergency over mpox last month, the response has been depressingly inequitable. None of the African countries affected by the outbreak of a new variant of mpox have received any of the promised vaccines.
Sadly, it seems that too many people in the world believe that when the poor are out of sight, they are largely out of mind. Yet it is the West that is shaping the health crises of the poor world. The corporations of the West are pushing high calorie processed foods and its governments are pushing for cuts. The biggest cause of premature death worldwide is not infectious diseases, but chronic diseases such as cancer, diabetes and heart disease. So-called noncommunicable diseases (NCDs) are responsible for three-quarters of all deaths worldwide. Of the 41 million total, 17 million were born prematurely – before the age of 70. The heaviest toll is taken in low- and middle-income countries, where 86% of all premature deaths from chronic diseases occur.
And the number of deaths from NCDs is increasing. When you look at what experts like to call the risk factors, that’s hardly surprising. These include tobacco, alcohol, air pollution, inactivity and diets high in salt, sugar and the wrong kind of fat. There will still be people who say they are doing wrong by doing these things lifestyle threats is the fault of the individual, but in poor countries, where greedy corporations are looking for new markets and where little to no education is given about what is good for you, the reasoning is even more specious than in wealthy Europe or the US.
The WHO now speaks of the “commercial determinants of health” and, to its credit, pronounced about the damage that the market can do, for example in small island states where most food has to be imported. There should be restrictions on the ability of companies to market and advertise. Countries need money to take on the companies, but also to run health systems to treat the increasing number of people who are getting sick with chronic diseases. The irony is that living longer does not necessarily mean living healthier.
Only 2% of global health funding goes to tackling NCDs. But the investment pays for itself many times over. A 2018 WHO report – Save lives, spend less – calculated that implementing “best buy” measures to control NCDs – from raising taxes on tobacco and alcohol to reducing salt, providing medicines to people who have had a heart attack or stroke, and vaccinating girls against HPV, which causes cervical cancer – would save 8.2 million lives in low- and lower-middle-income countries by 2030 and generate $350 billion in economic growth. Every $1 invested in these best buys would yield $7 by 2030.
Six years later, the reasoning has not changed, although it risks being drowned out by the post-pandemic noise. In June, the WHO and the World Bank hosted a financing dialogue for NCDs ahead of next year’s UN General Assembly on their prevention and control. Self-interest and decency should encourage funding for programs that stabilize the health of poorer countries. Money for NCDs may not have the appeal of eradicating a disease, but it can prevent the family catastrophe that comes with losing a breadwinner or older, with all the social and economic consequences that entails.