Early in his term as the new World Health Organization’s Director
General, Dr. J.W. Lee reminded the world of the issues we face in the
21st Century: ‘‘Non-communicable diseases and injuries account
for a growing share – now about 60 – of the burden of disease
worldwide.’’ Despite that reality, the WHO is best known for
work on infectious disease — ridding the world of smallpox, working
toward eradication of polio, and responding to other emerging diseases,
such as SARS.
Nonetheless, epidemiological evidence suggests non-communicable disease
(NCD) risks and the associated burden of disease in both developed and
developing countries is not only the major challenge for the current
WHO, but for the next generation and century. Non-communicable conditions,
including cardiovascular diseases, diabetes, obesity, cancers and respiratory
disease, account for 56.5 million deaths annually. With 12 million people
killed by heart attacks and strokes annually and nearly 4 million by
hypertensive and other heart conditions, the reality strikes home. However,
the antecedent risk factors continue to rise portending a trend with
no end in site: More than one billion adults worldwide are overweight,
with at least 300 million clinically obese. An estimated 177 million
people are affected by diabetes, the majority by type 2 diabetes; two-thirds
live in the developing world.
The reasons for the increases in non communicable disease worldwide
are not entirely clear. The trends suggest the impact of NCDs will increase
as populations in low-and middle-income countries age, due to falling
birth rates and effective control of infectious diseases. High caloric
diets, sedentary lifestyles and social/cultural factors play a major
role. Despite such ominous numbers, up to 80 of coronary heart disease,
90 of type 2 diabetes cases and one third of cancers can be avoided
by changing to a healthier diet, increasing physical activity and stopping
smoking.
The impact on children is of special concern. According to the U.S.
National Center for Health Statistics, 15 of children in the United
States between the ages of 6 and 18 were obese in 2000, up from 6 in
1980. The numbers of overweight and obese people continue to increase
in developing countries, with a concomitant increase in the preventable
burden of death, disease and suffering. In Europe, the trend is alarming
with over 28 of the Greek population obese, with England close behind
at nearly one in four females and Germany at one in five women. While
the U.S. Centers for Disease Control and Prevention presaged this epidemic
in an approach to this issue with a Nutrition and Physical Activity
effort years ago, little actual impact can be demonstrated. There is
no greater challenge for this generation than to figure out a way to
reverse the trend that may make their children destined to a shorter
life expectancy than their parents. This is a
multifaceted challenge that does not just end with messages to decrease
caloric intake or increase exercise. It also should not solely rely
on medical or surgical interventions to treat a preventable problem.
The new WHO Global Strategy on diet, physical activity and health in
development in 2004 can be an important first step. An innovative approach
to dealing with chronic diseases and risks within the health care setting
is necessary including the links between mental and physical health,
social issues, and related co-morbidities. It is a mistake to believe
that a global strategy can impact locally without a fundamental recognition
of the problem and a holistic approach to the solution. Safer environments,
school health policies with enforcement, food processing, entertainment,
medical counselling and interventions, and other such diverse venues
will be a necessary hallmark to reverse the trend.
To effectively combat this scourge, one must develop a health competence
that includes prevention of non communicable disease with appropriate
preventive measures such as weight, physical exercise and non-use of
tobacco. Furthermore, a functioning system that includes screening for
disease and early treatment should engage, multiple stakeholders including
professional and other charities, voluntary and non governmental organizations,
the private sector (including food, pharmaceuticals, sports, health
polity, retailers, advertisers and media), UN agencies and academic
and research groups.
With a price tag of $100 billion per year price tag in health services
for obesity in the US, an exigent response is necessary. In addition
to obvious ideas such as federal funds for playgrounds, along with bicycle
paths and parks, physical education and fitness in the schools should
be supported and enforced. An example could be set by the new Governor
of California, Arnold Schwartzenegger, who has heralded physical fitness
throughout his non-political career to address the issue and invest
in the health of the next generation. In the US, many states have mandatory
physical education; in California, the number of hours per week is limited
and sporadic. According to Gregory Critser in Fat Land, How Americans
Became the Fattest People in the World, as little as 20 of the physical
education time in middle and high schools (12–18 year olds) in
California schools is spent ‘‘in motion.’’ This
is but one example of a system in vast need of reformation.
Obviously, we all live in a world – we are told – threatened
by the daily terrors principally with infectious disease and the 21st
Century bioterrorism. The health security of the world however, is developing
chronic, non communicable disease with little recognition of its consequence.
We need an all-out response with policy, communication and medical intervention
to reverse the trend of ‘‘success’’ with lifestyle
and technological food intervention leading to obesity that detracts
rather than enhances health. All of us as health communicators need
to identify the issue, analyze the causes in both real and theoretical
terms, present and advocate for viable policy options, develop quality
lifestyle and medical alternatives, and finally help galvanize action
at the highest level to promote population health. The ethical responsibility
is great, and we all play a role to advance health in the 21st Century.
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Scott C. Ratzan MD, MPA, MA is Editor-in-Chief of the Journal
of Health Communication: International Perspectives. He also is
Vice President, Government Affairs, Europe for Johnson & Johnson
with academic appointments at George Washington University School of
Public Health, Tufts University School of Medicine, Yale University
School of Medicine, The College of Europe, and University of Cambridge.
