Has somebody put a curse on the World Health Organisation? Every time it holds a conference to discuss the ‘epidemic’ of lifestyle-related diseases, a genuine public health crisis erupts. When it met in Moscow for a global conference on tobacco control in 2014, West Africa was hit by the worst Ebola epidemic in history. When the same conference visited Delhi in 2016, the city was engulfed by the worst smog for 17 years (it was so bad that when I saw the delegate from Action on Smoking and Health speak in London a week later, she was still coughing).
This week the WHO has been holding its World Health Assembly in Geneva. Right on cue, another epidemic of Ebola broke out in the Democratic Republic of Congo. While health bureaucrats fret about ‘non-communicable diseases’ in Geneva, health workers are trying to contain a communicable disease in Africa. It’s as if nature is trying to give the WHO a bit of perspective.
Fat chance. The WHO is all about non-communicable diseases these days. It says that 40 million of the 55 million deaths that occur around the world each year are caused by them. This, we are told, is a grave concern. The WHO’s billionaire funder and global ambassador, Michael Bloomberg, says: ‘For the first time in history, non-communicable diseases kill more people than communicable diseases around the world and unless we do something to encourage healthy choices and convince people to take care of themselves this problem is only going to get worse.’
But how big is ‘this problem’ in practice? Dying from a non-communicable disease is what happens when you avoid dying from infectious disease, starvation, road accidents, injuries, overdose, gunfire, poisoning, suicide and infant mortality. If you have to die of something, a non-communicable disease is the least worst option.
You might prefer to die of old age but that is not an option in the spreadsheets of the WHO. Nor is dying in your sleep or dying of natural causes. There must be a technical cause of death and, in rich countries, the chances are that it will be cardiovascular disease, respiratory disease or cancer, all of which are non-communicable.
You might think that the World Health Organisation’s job is to stop young people dying from communicable diseases in poor countries rather than worrying about old people dying from non-communicable diseases in rich countries. If so, you must be terribly old fashioned. The WHO has been morphing into a vehicle for #FirstWorldProblems for years.
It is a simple numbers game. The epidemic of non-communicable diseases is responsible for the greatest number of deaths and so that is what the WHO has decided to focus on. Never mind that ‘non-communicable disease’ is a ridiculously broad category. Never mind that an ‘epidemic’ of non-communicable disease is an oxymoron. And never mind that most of these deaths are not preventable in any meaningful way; at best, we might swap death from one non-communicable disease for death from another.
Mike Bloomberg says of non-communicable diseases: ‘People think they’re inevitable. They’re not inevitable. We can prevent most of them.’ Most of them? This is a bold claim, to say the least. It implies that at least 35 million of the 55 million deaths recorded each year could be avoided. Unless Bloomberg plans to unleash a deadly virus on the world, this is pure fantasy. NCDs are inevitable. They are part of the ageing process and the optimal mortality rate from them is 100 per cent.
In 2011, the WHO committed itself to a 25 per cent reduction in deaths from non-communicable diseases by 2025. Unlike Bloomberg, the agency confined its ambitions to premature deaths (ie. before the age of 70), but the target was still never likely to be met as growing numbers of people in developing countries lived into their 50s and 60s. Sure enough, it seems as if it will not be met and so the WHO is getting tough. The target has been raised to 30 per cent by 2030 and its grandly named High Level Commission on Non-Communicable Diseases issued a draft report last week on how to go about it. Its final report will be published next month.
In September, the third UN High Level Meeting on NCDs will meet in New York where it is hoped that heads of state will agree to implement a range of policies that will, in the fanciful words of the WHO’s Director-General, ‘stop this epidemic’. In practice, this means regulating the lifestyles of recalcitrant citizens with the usual assortment of first world nanny statism: sugar taxes, advertising bans, graphic warnings, raising the price of booze and fags, etc.
The WHO’s challenge is to present the lifestyle paternalism of rich nations as a priority for countries which continue to be ravaged by contagious diseases, infant mortality and violence. If childhood obesity is a much exaggerated threat in rich countries, it is a sick joke in places where people live hand to mouth. But if you redefine overweight and obesity as malnutrition, as the WHO has done, you can claim to be fighting ‘malnutrition in all its forms’ while campaigning to make food more expensive.
Another approach is to imply that NCDs disproportionately affect developing countries. According to the WHO, ‘over three quarters of NCD deaths – 30.7 million – occurred in low- and middle-income countries’ in 2015. This makes it sound as if poorer countries are bearing the brunt until you realise that, according to the World Bank, 6.25 billion of the world’s 7.6 billion people live in low- and middle-income countries. That’s 82 per cent, and it takes no account of the much higher death rate in low- and middle-income countries.
The data leave no doubt that insofar as NCDs are a ‘problem’, they are principally a problem for the rich world. They accounted for 89 per cent of deaths in the United Kingdom in 2014. In Italy, Spain and Austria, the rate was 92 per cent. Every wealthy country shows a figure of 80-95 per cent. In the poorest countries, NCDs are responsible for less than 50 per cent.
If tackling non-communicable disease is a priority, it seems that we have much to learn from the poorest African nations. The Democratic Republic of the Congo offers a beacon of hope with just 23 per cent of deaths attributed to NCDs. Its efforts to beat NCDs with the weapons of tuberculosis, HIV, malaria, influenza and road accidents have been largely successful. Its most recent outbreak of Ebola has only killed 28 people at the time of writing and will not materially affect the statistics, but every little helps.
Impressive results have also been seen in Chad, where NCDs only account for 21 per cent of deaths, as well as Sierra Leone (26 per cent), Niger (25 per cent), Zambia (23 per cent) and the Central African Republic (20 per cent).
But the undisputed world leader is Somalia where just 19 per cent of deaths are attributed to NCDs. Somalia tops the table for deaths from tetanus, diarrhoea, malnutrition, whooping cough and measles. As a result, it has been difficult for the lifestyle-related diseases of old age to exert much of a grip.
The near-eradication of tetanus and tuberculosis in rich countries is proof that communicable diseases can be stamped out through the use of vaccines, medicines and healthcare. No such solutions exist for non-communicable diseases, and the policies endorsed by the WHO to ‘beat NCDs’ are risibly inadequate for the impossible task it has set itself. It is almost pathetic to see the organisation that wiped out smallpox endorsing taxes on fizzy drinks as an ‘effective intervention’. Taxes on alcohol and advertising restrictions on food have had virtually no effect on health in rich countries and would be an irrelevance, if not an insult, in countries where most alcohol is unlicensed and people can barely get enough to eat.
The WHO’s policies on NCDs, from sin taxes to divestment from fossil fuel shares, represent the trivial concerns of a western elite using the agency’s good name to pursue juvenile political activism. There has been plenty of evidence of this at the World Health Assembly in recent days. Take Afghanistan, for example. Plagued with violence and with the third highest rate of infant mortality in the world, it is just the kind of place that needs medical assistance from the WHO, but as far as delegates at the conference are concerned, the real problem is big corporations selling food.
Transnational companies arriving in #Afghanistan (special advisor to Minister of Health). #BigFood knows no borders. What is responsibility of global community to help countries prevent #NCDs? Role of @wto in prioritising health over trade? #nutritionhubsun #wha71 pic.twitter.com/MmZZ6WErym
— Mike Kalmus Eliasz (@mike_eliasz) May 23, 2018
Caffeinated soft drinks are also a big worry…
FP/Afghanistan: fragile countries & need engagement w private sector to advance, but have concerns about influence, for example on dealing w the issues around energy drinks in the market. Need help to manage this? #NCDs #NutritionDecade #enoughNCDs #nutritionHubSUN #WHA71
— NCD Alliance (@ncdalliance) May 23, 2018
In another meeting, a slide was used to show the increasingly popularity of processed food in low- and middle-income countries (LMICs). These are the countries in which ‘vulnerable people’ live, apparently. Among the devilish products on offer are yoghurts, cheese, baked goods, soup and ‘milk products’. Won’t someone think of the children?
Sale of processed food growing in LMICs, precisely where #vulnerable people live. We have had #enoughNCDs. Stop exessive promotion of processed foods to children. #beatNCDs @USCGlobalHealth @ncdalliance #UHC #HealthForAll #WHA71 @DrTedros @SaniaNishtar Thank you for focus on NCDs pic.twitter.com/Ln9I6ihuzy
— Maunil K Desai (@drmkdesai) May 22, 2018
Absurd though much of this is, the WHO and its retinue of ‘civil society’ groups might argue that they are doing no harm by attempting to tackle non-communicable diseases. Although it is delusional to think that NCDs can be eradicated, it cannot be denied that some of them are related to lifestyle and some of the deaths can be postponed even if they cannot be prevented.
But this is to ignore the question of resources. The WHO reminds us constantly that it is short of money. With millions of people, many of them children, dying from horrific contagious diseases that can be easily prevented, where is the sense in a cash-strapped UN agency, which has no power to tax or legislate, spending its resources turning itself into a glorified lobby group?
The WHO was specifically created to tackle communicable diseases. Until the day that malaria, tuberculosis and other such scourges are eradicated, its founding mission must take precedence over the relatively petty concerns of first world ‘public health’ campaigners. As I argued in my book Killjoys, only a moral cretin could fail to see the distinction between a health hazard which kills people at a young age through no fault of their own and one which shortens life by a few years as a result of lifestyle choices that are freely made. Every dollar spent by the WHO on the latter is a dollar that could be spent on the former. The dreadful epidemics that seem to erupt whenever the WHO holds an international jamboree serve as a reminder of where its priorities should lie.