Health: Non-communicable Diseases

Lord Rea Excerpts

Thursday 6th October 2011 Lords Chamber

[Lord Rea]

My Lords, I congratulate the noble Baroness on returning to the Benches; she has shown that it will be greatly beneficial to all of us by the quality of the speech that she has just given. I would also very much like to congratulate the noble Lord, Lord Crisp, on securing this debate so soon after the recent high-level conference on NCDs that we have been talking about. If your Lordships will forgive me, I am going to use the abbreviation for brevity and to save tongue-twisting.

This topic has been growing in importance for more than 50 years, since communicable diseases came more under control. NCDs are now the major public health problem of the developed world. More recently, as the noble Lord, Lord Crisp, has pointed out, there has been a major increase in these diseases in the developing world, where they now cause around 60 per cent of deaths, which in total numbers greatly exceed NCD deaths in developed countries because of their greater populations. A higher proportion of these deaths in developing countries occur in people under 60 than in the developed world. The rapid increase of NCDs in the developing world was the main stimulus for the UN conference two weeks ago.

I come to this debate from a background in UK general practice but with a particular interest in public health. This was triggered by a three-year stint working with children in Nigeria where I came face to face with the importance of the environment and particularly nutrition in giving rise to childhood disease and high mortality—of course, in that case from communicable disease. I declare an interest as current chairman of the all-party Associate Parliamentary Food and Health Forum and as a trustee of the respected National Heart Forum, an NGO that brings together more than 50 organisations with an interest in the prevention of heart disease. Because the risk factors which lead to cardiovascular disease are very similar to those underlying most NCDs—smoking, faulty diet and lack of exercise—the National Heart Forum has recently widened its remit to embrace NCDs other than heart disease. It has published numerous reports, tool-kits and interactive programmes to help NCD prevention activities throughout the world, and two members of the National Heart Forum team were delegates at the New York conference.

NCDs are age-related diseases; they are degenerative in nature, but they do not affect everyone. Some people and populations develop these diseases much earlier than others. Some of these differences are due to increased genetic susceptibility; for instance, people of South Asian origin are particularly prone to diabetes and heart disease and those of West African origin are more likely to have high blood pressure when exposed to the typical Western diet of high salt, sugar and saturated fat. The external risk factors that favour their development are well known, as many noble Lords have pointed out, and affect many more people than the genetic causes. As has also been pointed out, these can be reduced or eliminated—in other words, these diseases are largely preventable.

Apart from the basic three risk factors I mentioned earlier—physical inactivity, faulty nutrition and smoking—other conditions that result from these factors are themselves risk factors; for example, as well described by the noble Lord, Lord McColl, obesity results from a combination of faulty diet with, to a lesser extent, lack of exercise. Obesity is a risk factor for some forms of cancer and particularly for type 2 diabetes, which often leads to cardiovascular, kidney and other diseases; high blood pressure can lead to stroke and heart disease. In the developed world, mortality rates from NCDs have come down considerably, partly through preventive measures, particularly tobacco control legislation, but also because it is now possible to palliate and control many of these conditions, though not to cure them, because of their degenerative nature. So we are left with many if not most of our older citizens, including quite a high proportion of your Lordships’ House, on some form of medication or living with a prosthetic limb or organ. This is very expensive and a major reason why the costs of the National Health Service continue to escalate.

In the past, heart attacks and stroke—or apoplexy, as it was known—were the preserve of the well fed and wealthy: but not any more—in fact the reverse is the case. The better off and better educated you are, the less likely you are to suffer from an NCD. If you do, it will hit you later in life than those at the other end of the social scale. They provide a prime example of health inequality.

This is even more the case in low and middle-income countries where diabetes and its complications are probably the most common form of NCD. There, the costs of treatment are borne mainly by sufferers themselves or their families as state health budgets are meagre. NCDs are therefore important contributors to poverty, as well as vice versa, and have a major economic impact. The reasons for the rapid escalation of these diseases in the developing world are well encapsulated in the words of Jean Claude Mbanya, the new Cameroonian president of the International Diabetes Federation. He said:

“We have moved away from our traditional cultures towards a Western lifestyle associated with prosperity. It is good, but it brings a trend to be more sedentary, not eat the right foods, not exercise enough, and to drink and smoke more”.

The political declaration agreed by the UN summit two weeks ago describes the problem with impressive thoroughness as well as the action needed in its 65 paragraphs and 36 sub-paragraphs. It correctly concentrates on prevention, emphasising the need for a comprehensive approach and, as the noble Lord, Lord Crisp, said, the need to create “equitable health-promoting environments”. It draws attention to the WHO’s framework convention on tobacco control, its global strategies on diet, on physical activity and health, and on reducing the harmful use of alcohol and its recommendations on the marketing of foods and non-alcoholic beverages to children. To my mind, its main benefit is that it flags up the importance of NCDs and puts them firmly on the international agenda. What I regret is that it does not come up with any suggested targets to stimulate action, such as the millennium development goals. That is put off to a future date. Some of the action suggested could well be taken to heart by our own Government—of course, some of it is. For instance, paragraph 43(f) includes the words:

“Research shows that food advertising to children is extensive, that a significant amount of the marketing is for foods with a high content of fat, sugar or salt and that television advertising influences children's food preferences, purchase requests and consumption patterns”.

That research was carried out in this country by Professor Gerard Hastings at the request of the Food Standards Agency.

Another paragraph suggests that Governments should:

“Promote … interventions to reduce salt, sugar and saturated fats, and eliminate industrially produced trans-fats in foods, including through discouraging the production and marketing of foods that contribute to unhealthy diet”.

Unfortunately, under pressure from industry, it does not mention how these interventions are to be made. Long experience in public health, backed by research, shows that voluntary agreements with industry or commerce to act in this way are usually ineffective. But our Secretary of State, Andrew Lansley, appears sincerely to believe that bringing industry on board through Responsibility Deals is the way to do it. This is a course of action that one delegate likened rudely to “letting Dracula advise on blood bank security”.