School Kids in Tanzania

NCDs, UHC, and Global Presumptions

Today we’re at the WHO for the WHA learning all about NCDs and UHC. Alphabet soup for lunch. Obesity? It was hiding behind the chia seeds at the breakfast buffet. Noncommunicable diseases (NCDs) and universal health coverage (UHC) are big priorities at the 72nd World Health Assembly (WHA) in Geneva today. But within the global scope of the World Health Organization, these acronyms can have very different meanings for the United Republic of Tanzania and the United States of America.

Nonetheless, these disparate countries have one thing in common. The biggest global driver of NCDs – the growing chronic disease of obesity – has disappeared into the weeds of presumptions and myths.

The Growing Alliance Against NCDs

NCD Alliance 5x5 Framework GraphicWHO seems to be recdoubling its efforts to address the growing global burden of chronic diseases. The 2018 UN Political Declaration on NCDs marked a transition to a 5×5 approach to NCDs – five core diseases and five core risk factors. So the NCD Alliance summarizes them in a tidy graphic.

But if you’re looking for obesity, you have to dive into the details of the declaration, where it gets a passing mention as a “concern.” Even there, it’s more of a marker for children who aren’t getting the opportunity to grow and develop in a healthy environment. However, it includes nothing to acknowledge that obesity itself is the chronic NCD that connects all five of the NCDs the UN is targeting. Sigh.

UHC

Good health is a fundamental human right. We’re hearing this phrase repeatedly today. And certainly, Universal Health Coverage will play a key role in defeating NCDs. But for millions of people with obesity – especially severe obesity – coverage for their health needs is out of reach. Bias and stigma make it possible for policymakers to rationalize excluding the needs of these people from coverage decisions.

Even in a country with an advanced health system – such as the U.K. – you will find people with severe obesity treated shabbily.

Unfinished Business

The work of the WHO and the NCD Alliance on NCDs is important and impressive. But for those of us working to overcome the health effects of obesity, much work remains. We need more objectivity about obesity as a critically important noncommunicable disease. We need more curiosity about this disease that we barely understand. And we need evidence-based policies to reduce its impact. Fortunately, the World Obesity Federation is actively advocating for these values.

Click here for more on negotiating for progress within the World Health Assembly.

School Kids in Tanzania, photograph © Fanny Schertzer / Wikimedia Commons

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.


 

May 20, 2019

9 Responses to “NCDs, UHC, and Global Presumptions”

  1. May 20, 2019 at 7:58 am, Joe Gitchell said:

    Thanks, Ted–and keep the pictures coming, too.

    A few points:

    I would observe that tobacco smoking also, tragically, unites all five diseases in the 5X5 graphic.

    “Tobacco use” is featured more prominently than “obesity” as a risk factor, true. But is the fact the current convention for many in positions of authority is to conflate and confuse tobacco, smoking, and nicotine, actually making listing “Tobacco Use” worse than not listing obesity? Is sowing confusion worse than ignoring?

    I’m not sure that I like either answer to my last question!

    Joe

    Disclosures
    My employer, PinneyAssociates, provides consulting services on tobacco harm minimization (including smokeless tobacco and vapor products) to RJ Reynolds Vapor Company and RAI Services Company, subsidiaries of Reynolds American Inc. Reynolds American Inc. was purchased by British American Tobacco in July 2017. I also own an interest in intellectual property for a novel nicotine medication that has not been developed or commercialized.

  2. May 20, 2019 at 8:34 am, Ted said:

    On the plus side, Joe, at least the infographic references tobacco use and not “nicotine use.”

  3. May 20, 2019 at 10:07 am, Mary-Jo said:

    Thanks for this summation, Ted. So glad you’re there. It’s still frustrating that obesity is not articulating more clearly, but, indeed, there seems to be bias and stigma, but mainly, still a fear to address it more directly because with countries that have long-standing universal healthcare, with the prevalence and incidence so high now, healthcare officials feel it could overwhelm the systems. When more data keeps coming re: costs of NCDs directly linked to not treating obesity effectively, hopefully, the focus will come. As for tobacco, I oft recall a professor I had during my epidemiology studies in Rotterdam continually making his point to us HCPs to not do anything about smoking as it will decrease the burden of costs from smoking related diseases when more people die early from choosing to smoke. He calculated that even if we treat morbidity for affected people through their early 70s, it would be cheaper than caring for all the ex-smokers and those still trying to stop.

  4. May 20, 2019 at 11:30 am, Allen Browne said:

    Ted,

    The picture is great – worth a thousand words. It appears bias and stigma and lack of knowledge is pushing obesity under the chia seeds. Keep squawking. Thanks for your efforts.

    Allen

  5. May 20, 2019 at 1:20 pm, Harry Minot said:

    So-called “obesity” is, in fact, sometimes communicable.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4517116/

  6. May 20, 2019 at 1:38 pm, Ted said:

    Correct, Harry. And in some fashion, it may be transmitted in social networks: https://doi.org/10.1056/NEJMsa066082

  7. May 21, 2019 at 12:35 am, David Brown said:

    Interesting article, Harry. It says, “The exact mechanisms leading to the development of obesity through these viruses are unknown.”

    Some clues as to what sort of mechanisms lead to the development of obesity may be related to the increase in the omega-6 content of the food supply. I suggest you read this article about metabolic syndrome. https://www.intechopen.com/books/glucose-tolerance/importance-of-dietary-fatty-acid-profile-and-experimental-conditions-in-the-obese-insulin-resistant-

    Next, watch this presentation by Eran Segal. https://www.youtube.com/watch?v=0z03xkwFbw4

    Lastly, read this 2011 Review by Olav Christophersen and Anna Haug. You will find that the mechanisms have been thoroughly investigated and elucidated. But the findings have not been publicized. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3031257/

  8. May 21, 2019 at 6:13 pm, Stephanie said:

    I’m not a scientist, nor health care professional but as far as I can tell obesity is NOT a disease. There are more additives in our food today that contribute, but it’s about eating habits. I’m 67 years old and when I was growing up I never saw so many over weight as I see today.

    Respectfully

  9. May 21, 2019 at 6:55 pm, Ted said:

    Stephanie, the physiology of adipose tissue regulation isn’t working right when someone truly has obesity. That’s why it is a disease.