DateJune 10, 2011
Secretary General Ban Ki-Moon
The United Nations
New York, NY 10017
Dear Secretary General Ban,
Non-communicable diseases (NCDs), particularly cardiovascular disease, chronic lung disease, cancer and diabetes, have emerged in recent years to become collectively the world’s number one killer. The High Level Meeting on this topic, organized for September 19-20 by the President of the United Nations General Assembly and staffed by the World Health Organization (WHO), provides a singular opportunity for U.N. agencies and member states to demonstrate leadership in their NCD surveillance and prevention activities. This meeting creates an unprecedented opportunity for an open exchange of ideas and planning for the best ways to care for and treat those who live with NCDs.
The private and public sectors must collaborate to tackle diseases which are sapping vitality across rich and poor countries alike. Addressing NCDs exclusively as “health” issues ignores the complex web of social and environmental determinants that dramatically influence vulnerability and access to care and treatment. For this reason, agencies across the U.N. system are engaging on the NCD issue.
The United Nations, and WHO in particular, has done a commendable job in eliciting the views of member states, U.N. agencies, nongovernmental organizations, academic institutions, private industry and individuals on this subject. The research on NCDs to date is quite helpful as we address this rising global health epidemic. Still, there is more to be accomplished. I would like to add the Public Health Institute’s voice to this discussion, and highlight several discrete linkages that, from the perspective of our organization, seem critical to a comprehensive understanding of NCDs. This has not garnered complete attention in any of the forums reserved to date for this subject.
Women and NCDs
NCDs collectively are the leading cause of death for women worldwide. Underlying social and economic disadvantages put many women at increased risk in efforts to avoid the four main NCD risk factors: tobacco use, unhealthy diet, physical inactivity and alcohol abuse. For example, new tobacco marketing campaigns target girls and women by associating tobacco use with femininity, sex appeal, beauty and independence. In addition, twice as many women as men suffer from malnutrition due in part to their relatively low status in some societies. Women and girls living with NCDs face unique challenges in access to affordable and effective early detection, diagnosis, treatment and care. Woman-specific cancers of the breast and cervix cause more than 3.3 million deaths annually. Approximately 85 percent of cervical cancer deaths occur in low-income countries, where access to vaccines, cancer screening and treatment are largely unavailable. Cardiovascular disease (CVD) is the largest killer of women worldwide. However, because CVD is inaccurately perceived as a male illness, many women don’t take simple steps to prevent it. Women suffer disproportionately from chronic respiratory diseases due to tobacco smoking, secondhand smoke inhalation, and exposure to high levels of indoor air pollution from cook stoves. For example, WHO in 2002 reported that even when exposed to similar levels of tobacco smoke, women are more likely to develop deadly respiratory illnesses, and to do so sooner than men.For these reasons, the United Nations and U.N. member states should acknowledge the special risks women face for NCDs and design appropriate mechanisms to assess women’s risks, prevent and treat NCDs in women.
Climate Change and NCDs
The present realities of our world, including rapid urbanization, water insecurity, air pollution and increased atmospheric concentrations of greenhouse gases, have contributed to the dramatic increase in NCDs. Many experts agree that ozone production and air pollution resulting from fossil fuel consumption negatively impact climate change and directly increase the risk of acute respiratory infections, chronic lung disease hospitalizations and death. Ozone depletion can also be linked to increases in skin cancer. Population centers with well-designed public transportation and food systems can reduce a community’s carbon footprint and help to increase physical activity and access to healthy food, thereby decreasing the incidence of obesity and CVD in residents.The United Nations could utilize its unique resources to effectively study the interactions between climate change and NCDs, using the available capacity of agencies that investigate climate change and those that study health, as well as work with partner institutions to advance knowledge and healthy practices.
Adolescents and Children
The world has made great strides in the past several decades helping children to survive longer. However, physical inactivity coupled with unhealthy diets put children increasingly at significant risk for NCDs. Over 42 million children under the age of five are either overweight or obese, which impacts their immediate health and also increases their risk of developing diseases such as diabetes, CVD and certain cancers as adults. Children all over the world are becoming targets of heavy marketing by food and drink companies, promoting select foods high in sugar, salt and fat, which can contribute to poor diet choices. Additionally, many young adults and children face an early risk of NCDs from tobacco smoke and alcohol abuse. It is estimated that worldwide, about 20 percent of children ages 13-15 smoke cigarettes or use other tobacco products, and nearly half of all children are exposed to secondhand smoke. These risk factors undoubtedly contribute to increased rates of acute respiratory infection, asthma and cancer. In 2002 alone, more than 1.2 million children under the age of 20 died from a non-communicable disease.The United Nations, a unique organization that has brought health to millions of children on the planet, must redouble its efforts to measure the risk to children of NCDs, prevent NCDs in children and determine the best ways to treat them if they become ill.
The Public Health Institute, an independent nonprofit organization dedicated to promoting health, well-being and quality of life, calls upon the United Nations and member states to acknowledge the important linkages that make women and children especially susceptible to NCDs. We also call upon the United Nations to consider the ways in which climate change is significantly affecting risk and the prevalence of NCDs. The Public Health Institute urges you to include mention of these subjects in the High Level Meeting outcome document, as well as to use the convening power of the United Nations to enhance cooperation among nations and civil society in making these public health connections in the surveillance, prevention, care and treatment of NCDs.Thank you for this opportunity to comment on this critical set of global health issues.
Mary A. Pittman, DrPH
President and CEO