This week the member states of the World Health Organization are meeting in Geneva to agree on a Global Monitoring Framework for noncommunicable diseases (NCDs). Meeting participants discussed indicators and targets that could be used to assess progress towards achieving the goal of reducing preventable deaths from NCDs by 25 percent by 2025. Also participating in the meeting was the NCD Alliance, a network of more than 2,000 civil society organizations from more than 170 countries. The Global Action Plan and the Global Monitoring Framework on NCDs are a result of the United Nations High-Level Meeting of the General Assembly on NCDs held in New York City in September 2011.
The discussions at the meeting in Geneva focused on what to measure. As shown below, WHO has set 2025 targets as shown in the column on the left and then proposed additional indicators as shown in the middle column. The NCD Alliance has recommended some additional indicators, shown in the column on the right.
These targets and indicators mark an important step forward in controlling NCDs. As Cary Adams, the Chair of the NCD Alliance noted in Geneva , the “commitment to measuring our progress and setting realistic and achievable goals, supported by the investment required, will…make a real difference to those of us who have or will develop NCDs in our lifetime. “
But monitoring changes in health status and health behavior related to NCDs and government NCD prevention policies may not be enough to achieve the stated goals. As several experts have acknowledged, the business and political practices of the alcohol, tobacco and food industries play a critical role in the development of NCDs.[i][ii][iii] Without changes in these practices, it will be difficult to reduce premature deaths. To encourage the discussion of indicators and targets for such monitoring, I suggest some provocative goals for the monitoring of corporate practices.
- Reduce expenditures on marketing alcohol, tobacco and unhealthy foods by the top 10(or 20 or 50) global producers of each of these products by a fixed percentage each year. The alcohol, tobacco and food industries are heavily concentrated with the top firms controlling a significant portion of market share.[iv][v][vi] Since research evidence shows that more marketing leads to more consumption of these products associated with NCDs,[vii] less marketing could reduce exposure to this negative influence.
- Reduce corporate expenditures on lobbying and campaigns contributions for the top 10(or 20 or 50) global producers of alcohol, tobacco and unhealthy food by a fixed percentage each year. Tobacco, alcohol and food corporations have used their political and economic clout to undermine public health protections and to create an environment that allows them to promote behaviors and lifestyles associated with NCDs. [viii][ix][x] Restricting their ability to externalize the costs of the NCDs associated with their products and to thwart the democratic principles of one person one vote could help to prevent premature deaths, reduce government expenditures on health care and restore more democratic processes.
- Require tobacco, alcohol and food companies to commission an independent health impact assessment of any new product or practice and to make the assessment publicly available.
Each year, these companies introduce thousands of new products and practices. Often, however, the adverse health impact is not recognized for years. Requiring companies to hire independent researchers to complete health impact assessments according to uniform standards prior to exposing the population to such practices or products and to make such reports public could discourage companies from releasing into the market inadequately tested products.
How could such targets be monitored? The World Health Organization and other global bodies, the NCD Alliance and its network of NGO partners, national governments and other bodies could each play a role in setting targets and monitoring this indicator. Global organizations could limit participation in international forums to those organizations who achieved targets. Institutional investors could invest in companies that met targets and disinvest from those that did not. National governments could favor companies meeting targets for procurement contracts and penalize those that failed to meet the targets. They could also offer subsidies or tax breaks to companies that achieved targets. Some nations may choose to make these guidelines mandatory, especially for practices implicitly or explicitly designed to increase consumption of unhealthy products by children and young people.
In the current political climate, these proposals will of course elicit intense opposition from corporations and their allies. But 50 years ago the current measures in place to control tobacco use would have been unthinkable. Effective public health officials need to compromise but before they compromise, they have to be able to articulate public health goals that are based on the evidence and have the potential to fulfill the mandate to protect population health. Unless public health professionals, researchers and advocates begin discussing now how to take action to end the corporate practices that contribute to the preventable illnesses and premature mortality that NCDs impose, 50 years from now we’ll still be lamenting the steady increase in the health burden and economic costs imposed by NCDs.
[i] Beaglehole R, Bonita R, Horton R, et al., and the NCD Alliance. Priority actions for the non-communicable disease crisis. Lancet. 2011;377(9775):1438-47.
[ii] Magnusson RS. Rethinking global health challenges: towards a ‘global compact’ for reducing the burden of chronic disease. Public Health. 2009;123(3):265-74.
[iii] Lien G, DeLand K. Translating the WHO Framework Convention on Tobacco Control (FCTC): can we use tobacco control as a model for other non-communicable disease control? Public Health;125(12):847-53.
[iv] Jernigan DH. The global alcohol industry: an overview. Addiction. 2009 Feb;104 Suppl 1:6-12.
[v] Eriksen M, Mackay J, Ross H. Chapter 18 Tobacco Companies in The Tobacco Atlas 4th Edition pp. 56-57
[vi] Stuckler D, Nestle M. Big food, food systems, and global health. PLoS Med.2012;9(6):e1001242.
[vii] Stuckler D, McKee M, Ebrahim S, Basu S (2012) Manufacturing Epidemics: The Role of Global Producers in Increased Consumption of Unhealthy Commodities Including Processed Foods, Alcohol, and Tobacco. PLoS Med 9(6):e1001235.
[viii] Brownell KD (2012) Thinking Forward: The Quicksand of Appeasing the Food Industry. PLoS Med 9(7):e1001254.
[ix] Freudenberg N. The manufacture of lifestyle: the role of corporations in unhealthy living. J Public Health Policy. 2012 May;33(2):244-56.
[x] Gilmore AB, Savell E, Collin J. Public health, corporations and the new responsibility deal: promoting partnerships with vectors of disease? J PublicHealth (Oxf). 2011;33(1):2-4.