Friday, 7 September 2012

On those who find non-communicable diseases a greater priority than infectious ones

The story is here. I find it quite hard to understand how anyone can prioritise non-communicable diseases over most urgent health problems. They don't spread, unlike communicative diseases. Surely this must be an important consideration. Other health related issues at the seminar under discussion were hunger, water and armed conflict.

All of these provide more immediately life-threatening scenarios, not only for individuals but also for families and communities. I can't seem to use that phrase now without reflecting how it has been over-used by people discussing top-down social management policies but these things are real in the wider world. Water and food shortages and infrastructure damaged by warfare all present more dangers to lives, including young lives (those of breadwinners).

Non-communicative diseases do not endanger the lives around sufferers in the same unpredictable way as communicable diseases. I am not trying to diminish their seriousness for those afflicted but when thinking of aid budgets and whole populations it surely makes more sense to treat illnesses that can be passed on to others, and to resolve food and water problems before tackling non-communicative diseases.

An economist, Rachel Nugent, fails to convince laureates at the Copenhagen Consensus that NCDs should swallow up most of the hypothetical aid budget. Richard Smith of the BMJ gives her account of what happened, and has a dim view of the laureates' conclusions about the most important spending priorities:
They ranked “Bundled micronutrient interventions to fight hunger and improve education” top, and the next four priorities were all about countering infectious disease. Vaccination against hepatitis B (9), drugs for patients with heart attacks (10), and salt reduction (11) all, however, came in the top 16 that would be funded. The polypill came in at 19 and tobacco taxation, the top choice of Nugent’s team, at 22. 
Why they chose these 16 is not explained, but a sense that they thought of some people, particularly children, as more deserving seemed to be one explanation. It certainly wasn’t only the numbers that decided them, said Nugent. When you listen to them ask questions, she continued,  you realise that they aren’t that different from anybody else. They are driven by anecdote, and there is always a bias towards the status quo, which  favours action on infectious disease over NCD.
The idea that infectious diseases might require resources more urgently than infectious ones is written off as some kind of immature knee-jerk tabloid sensationalist response and a 'bias to the status quo'. And where did the idea of deserts have anything to do with it ... surely the point is to limit damage within communities and this means tackling health problems that are likely to spread quickly.

Another issue with non-communicable diseases is that they are usually blamed on lifestyle factors. As we can see from Morton Satin (comments on the BMJ piece) there is dispute about the information given to the laureates about salt consumption, and Nugent's proposal about tobacco tax certainly also has a dogmatic route. (She claims that there is historic evidence that raising taxes produced health dividends – even if there is truth in this claim, it doesn't mean it is replicable in perpetuity.)

The C3 website, of which Richard Smith is an unpaid trustee, shows its activities in relation to preventative health, for example the workplace page, which tells us that C3 has many corporate partners including Unilever. Unliver has a whole page dedicated to it at Corporate Watch, which mentions its bad environmental record as well as various exploitative practices, before going on to explain its strategy to campaign on healthy eating in order to offset criticism of its unhealthy food output. Mars is another corporate partner of C3 on occupational health, and local readers will remember how it disowned the practice of deep-frying Mars bars.

My acquaintance with C3 is less than 12 hours old. But I am suspicious of the emphasis on non-communicable diseases while other more deadly perils persist.

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