United Nations releases draft strategy for noncommunicable diseases.

encouraging “whole-of-society” efforts, strengthening national policies, reducing risk factors, increasing international cooperation and improving research and monitoring lie at the core of a draft United Nations (UN) plan to prevent and control noncommunicable diseases (NCDs). The draft “outcome document” will be the basis for the high-level UN summit on noncommunicable diseases to be held in New York City, New York, from September 19–20, which many health experts hope will be a turning point in the fight against illnesses that annually kill tens of millions of people around the world. “I have been working on NCDs for decades, and what is happening this year is very exciting. It’s unprecedented,” says Dr. Puska Pekka, director general of the National Institute for Health and Welfare in Helsinki, Finland. “For the first time, NCDs are becoming high on the global political agenda.” A UN report says 36 million people died from noncommunicable diseases such as cardiovascular diseases, cancers, chronic respiratory diseases and diabetes in 2008 (www.who.int /nmh /events/2011/introduction_doc.pdf). Even worse, NCDs are rising rapidly, particularly in developing nations. By 2030, the report states, the number of annual deaths from noncommunicable diseases is projected to reach 52 million, exceeding deaths attributed to communicable, maternal, perinatal and nutritional diseases. The draft document is “fairly neutral” but will provide a good basis for real political discussion, says Pekka. He hopes, however, that meeting participants will also discuss why such a small portion of global health funding goes toward preventing and controlling diseases that kill so many people. “There is a big, big mismatch, and they should say something about that,” says Pekka, who from 2001–2003 served as director of NCD prevention and health promotion for the World Health Organization (WHO). Traditionally, the majority of funds donated to developing nations by their richer cousins have been earmarked to fight infectious diseases such as tuberculosis, HIV/AIDS and malaria. The reason Western countries have largely been passive in fighting NCDs remains “a bit of a mystery,” suggests Pekka. Perhaps richer nations are acting in their own interests, he says, tackling infectious diseases in other lands to prevent them from reaching their own borders. “There are a number of possibilities,” says Pekka. “Another is that there is still a wrong picture of people in the developing world — that they all live in the jungle and only infectious diseases are a problem.” The global neglect of NCDs is particularly frustrating to some health experts because the risk factors are so well known — smoking, poor diet, lack of physical activity, alcohol abuse — and effective solutions exist. “Much of this devastating loss of human life can be avoided at relatively low costs,” says David Stuckler, a lecturer in sociology at the University of Cambridge in the United Kingdom. “We know which costeffective measures can work. We have a political problem of getting them started.” There are several possible reasons why politicians have been slow to engage in the fight against noncommunicable diseases. One is opposition to certain measures to reduce risk factors from large, multinational corporations. Policies to dramatically reduce sugar or salt intake, for example, are not often popular with food companies that make sugary beverages and salty snacks. Efforts to reduce smoking, particularly in growing markets in developing nations, rarely sit well with tobacco companies. News CMAJ