Ethical tensions in dealing with noncommunicable diseases globally.

Perspectives Noncommunicable diseases pose an increasingly high burden of disease that threatens economic and social development , yet cost-effective health interventions exist. World leaders recognized the compelling case for action with the declaration at the United Nations high-level meeting on noncommunicable diseases in September 2011. Since that meeting, the World Health Organization (WHO) has been developing a Global Monitoring Framework and the United Nations Secretary-General is preparing to report to the 67th session of the General Assembly in September 2012 on ways to tackle noncommunicable diseases across different sectors. This paper aims to inform these debates by reviewing the declarations that resulted from WHO regional meetings held in preparation for last September's high-level meeting (Table 1). We identified four " ethical tensions " that must be resolved. These tensions are not exhaustive or mutually exclusive but provide a framework for debate. Effective action on noncommunicable diseases involves addressing multiple human rights, such as the right to information to make informed choices about diet and activity (e.g. food labels that people can understand), the right to bodily integrity (e.g. freedom from exposure to secondhand smoke); and the right to health (including access to essential medicines). These human rights may conflict with corporate rights, such as the right of pharmaceutical companies to exploit patents or express freedom of speech (through marketing). Human rights language featured much more prominently in United Nations declarations on the human immunodeficiency virus (HIV) than those on noncommunicable disease. The European Region was the only one to argue that " Member states need to... respond effectively and equitably to the health-care needs of people with NCDs [noncommunicable diseases] as part of the fundamental human rights of every human being ". 3 There has been no reference to essential medicines in any of the regional declarations, despite evidence of the benefits of cheap generic drugs, such as the polypill. Political leaders face difficult decisions about where to invest resources along the causal chain of disease. They must care for those already ill but also tackle the underlying causes of the diseases. Five of the seven regional documents mention the importance of action on social determinants. For example, the Brazzaville declaration noted how " ... risk factors and the systems put in place to deal with the conditions in which people live are shaped by political, social, behavioural, environmental and economic determinants ". 4 Others did not use the term …