Down from the UN NCD Summit
Who protects public health?
Governments, or transnationals?
After the UN Summit on NCDs: Briefing notes
This is the second of a series of news features following the UN high-level meeting on non-communicable diseases held at UN headquarters, New York, last month. These will focus on the implications and outcomes of the meeting, and on preparations for the next formal stages in 2012 and 2014.
Access report on the summit's Political Declaration here
Access pdf of last month's WN editorial on the summit here
Access pdf of WN commentary on the summit by Philip James here
Access pdf of the WN series of commentaries on the summit here
Access pdf of this month's WN editorial on the summit here
Public-private partnerships to prevent disease. Heads of government at a G20 meeting (left); Nestlé chairman Peter Brabeck-Letmathe in Davos (right)
54. Engage non-health actors and key stakeholders, where appropriate, including
the private sector and civil society, in collaborative partnerships to promote health
and to reduce non-communicable disease risk factors, including through building
community capacity in promoting healthy diets and lifestyles
UN High-Level Meeting on NCDs. Political Declaration, Clause 54
The news team reports. How was the Summit, or as we should perhaps get used to calling it, the HLM? If we were to set out here the impressions of all the Association members, friends and colleague who attended in New York, or else who watched some of the webcasts, we would fill a book. It should have been a movie, in the Robert Altman tradition, with a myriad realities intertwining.
One answer is that the event amounted to a range of peaks which included attractive and even swish 'side events'. One was a must-be-there PepsiCo 0800-1000 'breakfast panel' on the first day of the Summit. Another on the same day was an afternoon two-hour 'All Together: Collaborating to Fight NCDs' in the truly wonderful Millennium Plaza Hotel, put on by the International Food and Beverage Alliance. Another was an all-day meeting on 'Insights to Motivate Healthy, Active Lifestyles' for which the International Food Information Council Foundation was responsible.
So was the Summit a success or a failure? Almost anybody present could answer yes and also no. One worry, for all concerned with the improvement and protection of public health, has been and remains the positioning of those sectors of industry whose policies and practices conflict with those of public health. Executives from Big Pharma and Big Snack were, inevitably, present in force in New York. But more than that, a careful reading of the final Political Declaration shows that while much of its phrasing is admirable and some is really progressive, its content of actual concrete quantified measurable goals, is zero. Even on basic points like what actually constitutes healthy food systems, food supplies and dietary patterns, the Declaration says nothing or is studiously vague, as shown in this month's World Nutrition editorial.
A radical view, consistent with much of the facts and evidence ever since 2000 and even before, is that the shots on health and disease are now being called not by public bodies but by private bodies, as part of a general process of the privatisation of public health and public goods.
In New York, some representatives of transnational manufacturers of food and drink products were heard saying that they accepted that the private sector should be partners in the implementation of public health policy, but not in its formulation. In response, old hands pointed out the agenda for the prevention and control of chronic diseases has already been set by conflicted industry, or at least does not significantly impede the penetration of the transnationals into Asian, Latin American and even African markets, where the 'double-digit development' is. In this regard, clause 54 of the Political Declaration, in the highlighted text above, may turn out to mean all sorts of things, not least because 'civil society' now includes conflicted industry associations and even the manufacturers of drugs and alcoholic drinks.
The Association has decided to take a positive view of what others would regard as depressing and ominous: see Box 1.
The UN NCD Summit:
The Association's letter to Ban Ki-moon
Here are extracts from the Association's letter to UN secretary-general Ban Ki-moon, sent in late August. It was welcomed at the highest level. It is amended here to refer to the final Declaration approved by the UN General Assembly
The High-Level Meeting is clearly designed to lead on to rational and international policies and effective actions, supported, coordinated, and as appropriate implemented by relevant UN agencies and other international organisations, and national governments.
It is evident that the Political Declaration [is] a statement of general principles without operational detail.
Some of the central points made in the… Declaration are, however, of great importance and value. First and most basic, there is a proposed agreement for a unified approach to NCDs. This follows many years of work, including a series of UN reports, in which many members of our Association have been engaged.
The… Declaration… states that the determinants of NCDs include social, economic and environmental factors. This also is an insight of fundamental importance that creates the firmest foundation for public policies.
To be effective, the general principles need to be translated into operational documents. The development of these documents is properly the responsibility of member states, supported by the relevant technically qualified UN agencies, with WHO, FAO and ECOSOC playing central roles. The operational documents need to include:
• Quantified targets, staged and monitored over a substantial period of years. The WHO expert working group paper proposing targets for NCD outcomes is a step in that direction. To these should be added coherent goals and timelines for dealing with the underlying and basic causes of NCDs.
• The appropriate quantified targets and goals needed to make policies operational, will vary in different regions and countries, with member states' actions guided by documented evidence of successes at both a national and regional level.
• Experience with tobacco and alcohol shows that substantial improvements in public health require the use of local, national and international laws, statutory regulations and standards designed to protect the public interest and public goods.
Also the SUN rises
K2 to the UN NCD Everest, was the all-day meeting the day after the Summit, at which David Nabarro, Ban Ki-moon's special advisor on food security and nutrition, (seen below, left) masterminded the new SUN )Scaling Up Nutrition) rise. There will be much more on SUN published on this website and in World Nutrition, in due course. Enough to say now that as an occasion, the event was awesome, and clearly the culmination of a vast amount of work done to convince movers and shakers within the UN system, and in governments throughout the world, that the time really has come to give nutrition its rightful place in public policies. We were impressed.
Ascenders. David Nabarro (left) masterminds the SUN rise. Princess Mired speaks for civil society. Michael Bloomberg speaks out for New York City
The issue with the summit itself, is that rather like ascents of Everest, the amount of preliminary fixing needed to make the final push work, make these occasions so elaborate that the proceedings themselves are a formality. Two introductory speakers characterised the Summit as a 'health care' event, which may have accounted for the very strong presence of pharmaceutical corporation executives, accustomed to doing business with WHO in addressing deficiency and infectious diseases.
Charitable observers admitted that the speeches made on behalf of the big 'round tables' (again, see the WN editorial on this topic) with one exception rated very low on any charisma scale. The leader of round table 1, from the UK government, said there were 'insufficient statistical data' and what was needed was 'targeted strategies on key risk factors'. The speech on behalf of round table 2, from a Hungarian government minister, said that the Summit Declaration was 'an integral part of sustainable socio-economic development'. The third leader, from St Kitts Nevis, spoke of the need for 'collective understanding' and of the 'integration of NCDs with other international instruments'. Well, yes. Happily, the overall representative of civil society was the sparkling and effective Princess Mired of Jordan (above, centre), director-general of the King Hussein Cancer Centre, representing the Union for International Cancer Control.
Mayor Bloomberg's example
For us the star of the formal proceedings was the final keynote plenary speaker, Michael Bloomberg, the multi-billionaire Mayor of New York, who also runs his own Bloomberg Family Foundation whose chief commitment is to public health. When Mayor Bloomberg talks about prevention and control of obesity and chronic diseases, he talks about what he has actually done, as the head of the biggest municipal government in the US.
He spoke energetically, in plain language. 'Improving public health has long been one of my passions' he declared. And in New York? Between 2001 and 2008, life expectancy up by 18 months. Vigorous use of law to create smoke-free bars, restaurants and workplaces. New York smokers down from 21 to 14 per cent. Restaurants obliged to post calorie counts. New street vendors granted licenses only if they sell fruit and vegetables. Traffic engineered so as to change the social and physical environment in the city to make streets safer. While Michael Bloomberg as New York City mayor was in a sense the host of the meeting, and an obvious choice as final speaker, the choice was bold also. As Mayor of New York City, he understands and acts upon the first duty of government, which is to use the law to increase the freedoms and enjoyment of the people, and to protect public health and public goods. He is a reason to be cheerful.