Johanna Ralston, CEO, World Heart Federation
While we have been talking a great deal in recent months about the intersection of health and foreign policy, through the planning for the UN meeting and the ways in which our members have been targeting not just ministers of health but also ministers of foreign affairs in their advocacy, the discussions around cardiovascular disease and non-communicable diseases (NCDs) and trade have been less apparent. Yet trade can play a critical role and the World Heart Federation, through its role with the NCD Alliance, recently had the opportunity to participate in a high level meeting on the topic, at the World Trade Organization in Geneva.
Panel at the 5th High Level Symposium on Global Health Diplomacy
The 5th High Level Symposium on Global Health Diplomacy, organized by the Graduate Institute of Geneva at the WTO, assembled leaders from some of the top health and trade agencies in the world including the Directors General of the WTO, WHO and WIPO and the Executive Directors of UNAIDS, the Global Fund, and GAVI, among others. While the different panels highlighted some of the challenges faced at the intersection of health, trade and foreign policy, I was invited to bring to the conversations the issues related to NCDs and trade, with a particular focus on prevention and NCDs, including tobacco control, food policy and essential medicines. At the end of the session, our panel was summed up perfectly– it is time that the dichotomy between infectious and non-communicable diseases is toppled. For both, the prevention agenda is the trade agenda.
Sustainability will be at the core of our ability to deal long term with NCDs and to continue to address communicable diseases. Reports estimate that 9 billion people will populate the world in 2050. We have now surpassed 7 billion and that 7th billion person is more likely to die of an NCD than anything else. When we look at some of the key factors affecting health, one of the most significant is our built environment –or lack thereof – which is inherently political. Globalization and urbanization have brought with them many opportunities. Yet they have also facilitated access to many of the risk factors leading to NCDs – increased exposure to tobacco, unhealthy foods and alcohol – while also limiting access to many things needed for our health and wellbeing – safe spaces for activity, quality and affordable medicines, and access to health care workers. All in some way or another related to trade and foreign policy.
One point that was referenced only briefly is that of food – an area in which all of the above mentioned organizations will have a significant role to play. As we have seen the shift from rural to urban, we have witnessed more individuals surviving infectious disease related illness and more people with access to food. And yet, there are some startling facts out there. There are nearly 925 million people living with hunger and over 1.5 billion people obese. The conventional thinking is that these are separate issues, with undernutrition characteristic of low income countries and overnutrition a problem of high income countries . Yet, those most at most at risk are the poorest populations WITHIN each country, regardless of the country’s GDP, and often affecting the same populations – ie, undernutrition is increasingly recognized as another risk factor for overnutrition because of conditions associated with the former that are still poorly understood. Both over and under nutrition are battles being lost by the most vulnerable socio-economic groups in the world.
Within some of the most prosperous countries, such as the US, well over 10 percent of the population lives in poverty. As we make strides in addressing hunger, we seem to be creating a crisis of nutrition – studies show that prenatal exposure to under- nutrition leads to both impaired glucose levels and coronary heart disease later in life. While for those populations facing over-nutrition, the same is true. Conditions associated with increased urbanization also contribute to nutritional challenges – there may be more calories available in urban settings, but these are often not proportionally nutritious. Access to health – whether it be safe and affordable drugs, nutritious food, or health care workers – is the most glaringly difficult for the poorest populations. So what is the connection? Are there connections?
I say yes. Good health – sustainable health – depends on nutrition, which depends on agriculture; and agriculture is changing significantly. As climate change on the one hand and increasingly large agribusiness on the other change the food supply chain, the link between food source and consumer is more tenuous . Between farm and fork, there are many players – particularly if you live in urban centers. As we focus on producing as much food as possible, we are missing the crucial element of nutrition – which is getting lost in production lines. Is providing food – even if substandard – enough?
When I think about the players that came together to discuss trade, I can’t help but feel that the same issues will be raised in a decade, but not about medicines – about food. Lack of access, lack of partnerships, a dire need for leadership and sustainable solutions are needed now to ensure that we prevent future dilemmas in addressing health disparities. What are measures we can take now to ensure that addressing food insecurity and a sustainable food supply also take into account the quality of nutrients and taste, so that successes in reducing undernutrition are not eclipsed by challenges of overnutrition later on?
To read more about the link between urbanization and cardiovascular disease, look for our upcoming report (link to executive summary).