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The global challenge of non-communicable diseases

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Professor Rob Moodie, Professor of Public Health, Melbourne School of Population Health

Associate Professor Harry Minas, Global and Cultural Mental Health Unit, Melbourne School of Population Health

Professor Mike Daube, Director, Public Health Advocacy Institute

The unwillingness of governments to adequately regulate tobacco and alcohol and to educate people about the health risks posed by poor diet and inactivity was contributing to the rapid spread of non-communicable diseases to industrialising countries, the AMA National Conference was told.

In a policy session that set the scene for ensuing discussions about aspects of global health, Melbourne School of Population Health faculty members Professor Rob Moodie and Associate Professor Harry Minas, along with Public Health Advocacy Institute Director Professor Mike Daube warned that rapid industrialisation in Asia, Africa, South America, the Middle East and other parts of the world was bringing with it the unwanted scourge of lifestyle-related diseases.

Professor Moodie said that in the two decades to 2010, heart disease had emerged to become the wold’s most prevalent disease, and stroke had risen to be third most common, displacing killers such as diarrhoea, respiratory infections and pre-term birth complications.

The mounting death toll from heart attacks and strokes had been associated with rapid increases in the consumption of alcohol, tobacco, sugar and unhealthy fats in developing countries.

In the 12 years to 2009, Professor Moodie told the Conference, alcohol consumption in low income countries had grown at an annual rate of almost 3 per cent, compared with just 1.1 per cent in wealthy nations, while the discrepancy regarding tobacco use was even more marked – growing by 2 per cent a year in developing countries at a time when its consumption had virtually stagnated in the developed world.

Increasing affluence had also brought with it unhealthy changes in diet. People in low income countries were guzzling an extra 5.2 per cent of soft drink and 2 per cent of processed foods each year – about double the growth rate in high income nations.

Driving the point home, Professor Moodie revealed that in Indonesia 40 per cent of boys aged between 13 and 15 years smoked, as did almost 70 per cent of men. By comparison, among Australian men, the smoking rate has dropped to around 20 per cent.

Professor Moodie and Professor Daube told the Conference the consumption of tobacco, alcohol, soft drinks, packaged foods and other harmful products in developing countries was being driven by corporations armed with massive marketing budgets and decades of experience in pressuring policy makers and consumers while at the same time sidelining public health initiatives.

Professor Daube showed just how big such promotion efforts were. He cited Nielsen research showing that $150 billion – a quarter of all global advertising expenditure – was spent on promoting food, fast food alcohol and tobacco last year.

Underlining what was at stake for such companies, in Australia alone tobacco and alcohol between them generated around $14 billion of revenue each year, Pofessor Daube said.

Professor Moodie said such companies were investing heavily in low income countries, attracted by the opportunities for growth unencumbered by few, if any, public health measures, citing Phillip Morris’s recent $190 million upgrade to its manufacturing facilities in Indonesia.

Advertising was just part of the armoury such companies brought to bear, he said.

“Failure to prevent NCDs is a political, not medical, failure,” Professor Moodie said. “Alcohol and ultra-processed food and drink industries use strategies similar to the tobacco industry to undermine effective public health policies by biasing research findings, co-opting policy makers and health professionals, lobbying against regulation…[and] blatantly ignoring codes of conduct”.

Associate Professor Harry Minas, of the Global and Cultural Mental Health Unit at the Melbourne School of Population Health, told the Conference that until recently the importance of mental health as part of the effort against NCDs had been overlooked, but that was beginning to change.

People with mental illness generally smoke more than the general population, and are significantly more likely to die from heart disease and respiratory disorders, but the scarcity of mental health specialists and a lack of political interest had meant the incidence of NCDs among the mentally ill had generally been overlooked, Professor Minas said.

He said the country could not afford to continue to overlook the suffering caused by NCDs among those with mental health problems.

Professor Daube said the success of tobacco control efforts in Australia to date provided a guide to what to do and what could be achieved.

He told the Conference that success did not come quickly or easily, and depended on people and groups forming coalitions, fostering consensus, devising comprehensive policy prescriptions and articulating clear messages.

Those taking on the tobacco, alcohol and fast food industries needed to understand how governments operated, work with media, lobby to curb industry marketing and expose the tactics of opponents of regulation.

Adrian Rollins