Health: Non-communicable Diseases

Lord May of Oxford Excerpts

Thursday 6th October 2011 Lords Chamber

[Lord May of Oxford]

My Lords, I join with others in expressing my appreciation to the noble Lord, Lord Crisp, for initiating this debate, which, as others have noted, is very timely. I also think that I can confidently speak for the Cross-Benchers collectively in saying how warmly we welcome the noble Baroness, Lady Hayman, to our ranks. We are honoured and delighted to have her.

Five years ago I had the privilege of giving the opening address of the international meeting on parasitology. In that, I joined with others in emphasising the need for communicable diseases to go beyond their then focus on the big three—tuberculosis, HIV and malaria—to move on to the neglected communicable diseases of poorer countries; that is, diseases of poverty. There has been welcome progress in that area.

As this debate reminds us, the fact remains that roughly two-thirds of annual deaths today come from non-communicable diseases, 80 per cent of which are in poorer or middle-income countries—that is, four in five deaths. The recent high-level summit is the UN’s first meeting on non-communicable diseases. Perhaps more interestingly, it is only the second meeting it has ever had on diseases, the first being several years ago on HIV.

The meeting emphasised many of the complexities and issues. There is no question that non-communicable diseases are a big problem in poorer countries but just how big they are is not quite so clear. For one thing, the number of deaths from NCDs, which is emphasised by the World Health Organisation and many earlier speakers, tells only part of the story. Perhaps more relevant is the age at which disease strikes, the morbidity or mortality. Whether they are communicable or non-communicable is a more important statistic. When one looks at that statistic, the fact remains that communicable infectious diseases, especially HIV/AIDS in sub-Saharan Africa, remain the biggest burden in most poorer countries.

Several speakers parsed the word epidemic. To talk of an epidemic of NCDs clouds the fact that the rise in such deaths derives more from demographic changes— from populations increasing and people living longer—than from other factors, such as obesity and smoking, important though they are. Fifty years ago, the average life expectancy on this planet of a child born was 46 years. Today, it is a little more than 64 years. We cannot relate intuitively to the notion that average life expectancy is 46 years because half a century ago the gap between the developed and the developing world in life expectancy was 26 years, whereas today it has shrunk to a still disgraceful 12 years.

In this time, that shrinking simply means more older people, which means more deaths from NCDs. Projecting the trends we have today into the future is not easy. In a moment I will express some rather harsh opinions on the outcome of the summit, but one of the useful things that it did—at least, I hope it has—was to call for better monitoring and better data collection, which is welcome and appropriate.

Despite all these complexities and uncertainties, many people have pointed out some of the effective and important things that we could and should be doing to diminish the surge of non-communicable diseases in poorer countries. For one thing, the noble Baroness, Lady Masham, called for more research on NCDs. As a researcher, I would never fail to endorse a call for more research. One of the interesting facts about NCDs is that essentially all biomedical research is on diseases of the rich. A rough estimate is that some 90 per cent is on non-communicable diseases. The good thing is that as a result we have many drugs that are both cheap and effective against some NCDs. Particularly for heart problems, statins and aspirin have made a big difference in the developed world and are little used in the developing world. That is one opportunity.

We have heard some good and important facts about risk factors and what can be achieved by banning smoking in work and eating places. Taking such successes from the developed world into the developing world is not easy. In the lobbying that preceded this meeting, it was distressing to find tobacco lobbies from the developing world opposing implementation of the sorts of things that, despite their protests, we have managed slowly and haltingly to implement here. The active promotion by elements of the food industry of eating habits that lead to obesity—and thus increase the incidence of NCDs such as diabetes, heart problems and the things we have heard about—is already proving a rather intractable problem in the developed world. The noble Lord, Lord Crisp, was right in expressing some satisfaction in the good examples that we have set and our proud record of helping not just ourselves but others, but even in our own country encouraging self-regulation of the food industry is simply not working.

I amplify some of the good remarks made by previous speakers, particularly the noble Lord, Lord McColl. There is an authoritative recent book by a chap called David Kessler, who was the head of the United States Food and Drug Administration—the FDA—and dean of the medical school at Yale. It is rather a gloomy book with an upbeat title, The End of Overeating. I recommend it. With forensic precision, it documents some of the ways that the high levels of salt, fat and sugar in processed foods have come about and the consequent damaging effects on health, and even suggests that, like smoking, there are elements of addiction in some of these additives. It also documents how the attempts to address this problem are opposed by skilled lobbies, using many of the techniques and indeed some of the organisations that battled against regulating smoking.

Coming back to the UN summit, I will read a brief account of what went on before it convened from the journal Science:

“The game plan was for diplomats to craft a political declaration that their leaders would endorse in New York City, spelling out the extent of the problem and concrete actions”.

It goes on to say that what has emerged is,

“a watered-down document that is long on talk and conspicuously short on actions, with little guidance on who should do what to combat NCDs”.

It then goes on to say that, leading up to the meeting, the World Health Organisation identified four priorities, as we have heard: cancer, diabetes, cardiovascular disease and respiratory disease. It continues:

“The report also named four major risk factors: smoking, unhealthy diet, lack of physical activity, and alcohol abuse. Health advocacy groups called for the world’s governments to address them by … committing to targets such as reducing salt consumption or instituting tobacco taxes by a certain date … But a leaked 5 August draft of the declaration showed other interests getting in the way. According to sources who saw”,

it, including,

“editors at The Lancet, the British Medical Journal”,

and others, the successive modification shows how any,

“solid commitments were ‘systematically deleted, diluted and downgraded’”,

by the developed countries, including our people. It goes on:

“They were replaced with ‘vague intentions to “consider” and “work towards”’”.

In summary—I will read so as not to make it more verbose—we certainly need to move beyond the encouraging successes in the campaign against the big three infectious diseases and the promising extensions to other neglected diseases of the poor. We must include action against the incidence of avoidable deaths from non-communicable infections in the developing world. As others have emphasised, international summits and aid are important. Ultimately, it will devolve to national Governments.