Opinion: 7 issues gaining momentum in global health

Students wear masks as they wait to be picked up during air pollution school closures in Bangkok, Thailand. Photo by: REUTERS / Athit Perawongmetha

Noncommunicable diseases — such as cancer, diabetes, lung, and liver disease — account for a staggering 7 out of 10 deaths worldwide. Confronting the leading risk factors that contribute to the majority of these diseases is a global challenge, but it is the key to preventing their unnecessary toll of death and disability worldwide — and ensuring that countries are on the right path to achieving the Sustainable Development Goal target of reducing premature deaths from NCDs by one-third by 2030.

As global attention to public health issues continues to gain momentum in 2019, here are seven issues and trends that will be critical to shaping the conversation on NCDs:

1. Air pollution will be addressed as a driver of NCDs and climate action

Air pollution is a leading risk factor for NCDs but is poorly addressed by the public health system. As public awareness and demand for climate action grow, so too will the recognition that emphasizing carbon emissions reduction strategies that result in improved air quality will yield timely public and political support. In 2019, expect to see movement toward incorporating air pollution strategies into NCD priorities.

The scale of this issue deserves a coordinated response from the health community: Globally, 9 in 10 people breathe polluted air every day. This exposure drives more than 4 million deaths annually, many from NCDs, and is comparable to other leading causes of NCDs currently recognized by the World Health Organization: tobacco use, alcohol use, poor diet, and lack of exercise.

If WHO adds air pollution to this list of leading causes, it will bring more attention to effective and inexpensive ways to reduce air pollution. These “best buy” strategies are especially important in low- and middle-income countries, where air quality is deteriorating and the majority of the world’s air pollution deaths occur.

WHO’s road map for an enhanced global response to the adverse health effects of air pollution can serve as a blueprint for its own and global ministries’ activities. The forthcoming Vital Strategies’ Urban Innovations Guide will serve as a framework for cities to rapidly take steps to assess and improve air quality.

Expect significant attention to air quality at the World Health Assembly in May, and in the lead-up to the 2019 Climate Summit during the U.N. General Assembly in September.

2. Taxes on unhealthy commodities will be key to financing NCD control

NCDs account for 70 percent of the total global burden of disease, but receive less than 2 percent of global aid. Securing adequate financing is fundamental to tackling NCDs. Potential solutions include increasing domestic spending from national governments and international donors, or tapping into existing budgets that address comorbidities — that is, areas where the effects of NCDs overlap with other conditions, such as tuberculosis or HIV/AIDS.

However, there is a need for a growing global momentum toward more widespread win-win taxes on unhealthy commodities such as tobacco, alcohol, unhealthy food, and even fossil fuels. Taxes like these both raise revenue to address downstream health impacts and help mitigate the use of these unhealthy products.

In the Philippines, these taxes have also been used to finance universal health care programs, another important global priority. Anticipate dialogue leading up to the U.N. General Assembly in September to drive more attention to this issue.

3. Calls for urgent action to improve food and nutrition will be front and center

The recent Lancet-EAT Commission and new publications from WHO have brought renewed visibility and attention to the question of how the world’s population will be able to count on a healthy, secure, and sustainable food supply. Policies and practices that improve nutrition and healthy eating go hand in hand with ensuring food security.

While hunger is still a crisis in parts of the world, obesity is increasingly threatening the health of millions — and an increase in high-calorie, low-nutrient diets around the world, combined with a sedentary lifestyle, have driven up global rates of heart disease, diabetes and other NCDs in the last couple decades.

Strong, straightforward, evidence-based food policies can make it easier for people to avoid unhealthy foods that cause deadly illnesses. One easy place for governments to start is by implementing policies to reduce unhealthy ingredients such as sodium, sugar and trans fat in the diet.

Anticipate that the 2018 launch of WHO’s REPLACE action package, which calls for the elimination of artificial trans fat from the global food supply by 2023, will spark more and more countries to take concrete steps toward improving their food supply and making their citizens healthier this year.

4. Cities will continue to be laboratories for NCD prevention strategies

Half of the world’s population lives in cities; by 2050, that proportion is expected to rise to about two-thirds. While global health efforts often focus on national and international policies and actions, cities are increasingly demonstrating their potential to drive scalable innovations.

Cities are uniquely positioned to reverse the growing trend of death and injury from NCDs through local action and policy.

From Devex’s miniseries on cities and NCDs: Montevideo's menu for reducing sodium intake

In Uruguay’s capital city, restaurants must offer some food with no added salt.

For instance, global public health efforts to address cardiovascular disease could take a note from local initiatives such as in Montevideo, Uruguay, where recent sodium-reduction regulations require 10 percent of all menus items to have no salt added. A companion public media campaign has called attention to the link between salt consumption and heart disease.

Also, in China, more than half a dozen cities have moved forward to ban smoking in public places. Initiatives like these make for effective models for national and international action on NCD prevention. Expect to see more momentum through city-driven programs and policies implemented in the coming year.

5. Momentum for alcohol control will grow

Although the harmful use of alcohol causes 3 million deaths each year and contributes to more than 5 percent of the world’s illnesses, 76 countries still lack national alcohol policies and alcohol consumption is greatly underrecognized as a public health issue.

In 2018, WHO launched SAFER, a new alcohol policy package that is designed to guide a growing effort to tackle the death and disability that arise from the harmful use of alcohol. SAFER outlines the top five, high-impact, evidence-based alcohol policy interventions governments should enact in order to reduce NCDs as well as communicable diseases, violence, and injuries.

Look out for more tools and guidance from WHO as well as advocates to encourage countries to implement SAFER, beginning serious conversations in many nations about taking a stronger public health approach toward alcohol policy.

6. Access to medicine will remain contentious

There’s no question that medicines can save lives, but only if they get to the people who need them. Unfortunately, high costs and trade restrictions that can limit the use of less expensive, generic drugs can make it harder for people to access medications for easily treatable conditions such as hypertension, the world’s leading killer.

WHO's controversial next steps to improve access to medicines

Addressing access to medicines has been at the center of debates at WHO’s board meetings for several years, often causing heated exchanges between countries and other stakeholders. This year is no exception.

Left untreated, such conditions become full-blown disease that is much harder and more expensive to treat. Count on this issue being a hot topic this year, with much dialogue kicked off by the debate about the pricing of cancer medications at the WHO Executive Board meeting in Geneva.

7. Debate on reducing commercial influence on health policies will heat up

As governments and public health practitioners increasingly focus on NCD prevention, there will be increasing debate about how to engage with vested corporate interests, particularly tobacco, industrialized food, alcohol, and even the fossil-fuel industries. These companies’ commercial interests are often in conflict with strong regulations that can reduce leading NCDs such as cancer, diabetes, and heart disease.

These industries would prefer that governments let them regulate themselves and have enormous political and financial power to delay or deter policy initiatives. For example, policies that restrict online marketing could limit advertising that encourages underage drinking, but the alcohol industry argues instead for its own voluntary regulations.

Though advocates are striving to prevent such industries from joining the policy table, this year expect these industries to continue to push back strongly and try to influence WHO to weaken goals for its intervention strategies — along with any language that limits industries’ role when it comes to formulating global policy.

Globally, we will not achieve targets set by the SDGs without significant effort to ensure these issues are resolved positively for governments and public health. 2019 presents an important opportunity for governments and civil society to either move forward toward improving public health and meeting the 2030 Sustainable Development Agenda, or fall short in their obligations to protect people from preventable death and disability.

Working in partnership, the global health community can ensure that 2019 paves the way toward a future where millions of the world’s people live longer, healthier lives.

About the author

  • Castro

    José Luis Castro

    José Luis Castro serves as President and CEO of Vital Strategies and leads The International Union Against Tuberculosis and Lung Disease. Vital Strategies, headquartered in New York City with offices and staff throughout the world, is an international public health organization whose programs strengthen public health systems and address the world’s leading causes of illness, injury and death.