Photo: The author speaks at a World Health Assembly side event.
This essay was written by Kathy Shats, Associate Legal Director at the Global Health Advocacy Incubator. It appeared originally on the Global Health Council blog.
Despite making only a small appearance on the official agenda of the 72nd World Health Assembly, NCDs featured heavily in both member-state and civil society sponsored side-events – with one striking difference – the meaning of prevention. While governments emphasized prevention through healthcare systems, there was little mention of population-level prevention policies, such as regulation.
The greatest burden of NCDs comes from modifiable risk factors – tobacco use, unhealthy diet, physical inactivity and alcohol use – and it’s long been recognized that many of these can be addressed through strong public health laws. These “low-hanging fruit” or “best buys” are cheap and effective, and countries that pass tobacco control laws, trans-fat bans or sugar taxes see population-level results. It makes sense – investing in population-level prevention is the most effective way to address chronic disease caused, in most cases, by the activities of the tobacco, soda, alcohol and food industries. Strong regulation of unhealthy products and corporate practices is the most important way to address these commercial determinants of health.
This message came across very clearly at NCD side events where civil society was in the majority. Advocates and researchers emphasized the importance of advocating for strong laws, and celebrated the successes of the countries that had passed them – familiar topics for many of us working in the field.
On the other hand, how the concept of NCD prevention was approached at the member-state organized side-events was tangibly different. Although the term “prevention” was echoed throughout, most government delegates described it as investing in preventative services such as patient screenings, early detection and treatment of chronic disease, education and outreach, and through primary health care. These are critical services, and necessary if we are to achieve Universal Health Coverage (UHC). Unfortunately, with NCDs killing 40 million people each year and the World Health Organization estimating that the NCD Sustainable Development Goal targets will be the most expensive for low and middle-income countries to reach, they are not enough. In that light, it is striking is that the majority of countries did not even mention using the much cheaper, proven, evidence-based legal interventions to address any of the modifiable risk-factors.
The exceptions were countries that have already benefited from such interventions, such as Uruguay and Russia, both of which have had tremendous success with strong tobacco control laws. They discussed strategies to address food and alcohol in ways that drew from this experience.
Perhaps this year’s WHA theme of UHC prompted governments to focus on prevention solely through the lens of the healthcare system. Or perhaps the corporations that would be subject to these regulations had a role to play (as they had in 2018 when sugar policies mysteriously disappeared from the WHO’s best buy interventions).
In any case, the public health community must do more to make the message loud and clear: preventative population-level policies to address NCDs are cost-effective and have been proven to work. Most importantly, this message must live on past WHA side-events and meetings and make its way into domestic public health policy-making.