The pandemic may be behind us, but the world still has the jitters about infectious diseases. Covid has left its mark; flu is identified as the next looming terror. Yet when the World Health Organization declared a public-health emergency over mpox last month, the response has been depressingly unjust. None of the African countries affected by the outbreak of a new variant of mpox have received any of the promised vaccines.
Unfortunately, it seems too much of the world considers that if the poor are out of sight, they are largely out of mind. Yet it is the west that is shaping the poor world’s health crises. Its companies push calorie-heavy processed foods and its governments insist on fiscal austerity. The biggest cause of premature death around the world is not infectious diseases, but chronic conditions such as cancer, diabetes and heart disease. So-called non-communicable diseases (NCDs) are responsible for three-quarters of all deaths in the world. Of the 41 million total, 17 million are premature – before the age of 70. The heaviest toll is exacted in low- and middle-income countries, where 86% of all the premature deaths from chronic diseases occur.
And deaths from NCDs are going up. When you look at what the 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 sort of fat. There will still be people who say falling foul of these lifestyle threats is the individual’s fault, but in poor countries where greedy corporations are seeking new markets and there’s little to no education about what’s good for you, the argument is even more specious than it is in rich Europe or the US.
The WHO now talks of the “commercial determinants of health” and, to its credit, has been outspoken about the damage the market can cause, for instance in small island states where most food has to be imported. There need to be curbs on companies’ ability to market and advertise. Countries require money to take on the corporations, but also to run health systems to treat the increasing number of people falling ill with chronic diseases. The irony is that living longer may not mean living healthier.
Just 2% of global funding for health goes into tackling NCDs. But investment repays itself many times over. A 2018 WHO report – Saving Lives, Spending Less – calculated that implementing “best buy” measures to control NCDs – from increasing taxes on tobacco and alcohol to reducing salt, providing drugs for people who have suffered 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 $350bn in economic growth. Every $1 invested in these best buys would yield $7 by 2030.
Six years on, the reasoning hasn’t changed, although it risks being drowned out by post-pandemic noise. In June, the WHO and the World Bank organised a financing dialogue for NCDs ahead of next year’s UN general assembly meeting on their prevention and control. Self-interest as well as decency should encourage funding for programmes that stabilise poorer nations’ health. Cash for NCDs doesn’t have the appeal of eradicating a disease, but it can prevent the family disaster that is the loss of a breadwinner or parent, with all the social and economic consequences that carries with it.
