The independent resource on global security

On non-communicable diseases and security

Over one hundred years ago, as Britain was sending troops to fight in the Crimean and Boer Wars, over one-third of men who tried to enlist were turned away for health reasons, many due to malnutrition and undernutrition.  One hundred years later, some countries find themselves asking if their troops are too fat to fight.  Nutrition has also played a role in another sort of security concern: mortality trends from H1N1 ('swine flu') outbreaks in 2009 have also led scientists to call for more research into the role that obesity and associated non-communicable diseases, such as diabetes, may play as risk factors for complications or deaths from pandemic influenza.

Focussing on the role nutrition and non-communicable disease (NCD) plays in a nation’s ability to train and deploy troops or considering it in devising pandemic preparedness plans is importantbut it misses the wider security challenges of non-communicable diseases. NCDs account for 60% of all deaths globally and 80% of these deaths occur in low and middle-income countries.  NCDs are also extremely expensive, in terms of the costs of absenteeism, productivity losses and treatment. The World Health Organization (WHO) estimates that the losses in national income from heart disease, stroke and diabetes in $18 billion in China, $11 billion in the Russian Declaration, $9 billion in India and $3 billion in Brazil. This financial burden is growing, which means countries are utilising resources to deal with the effects of these diseases, rather than much cheaper prevention efforts – and don’t have healthy citizens to contribute to society and to the economy.

Noting this global threat, on the 19th and 20th of September 2011, the United Nations (UN) General Assembly convened a High-level meeting on the Prevention and Control of Non-communicable diseases; this is only the second time that a General Assembly has held a meeting on health, the first being on HIV/AIDS in 2001. Usually, health is dealt with under the auspices of the WHO, as it is the UN’s specialised agency for health. Yet many health ministers, particularly those from a number of Caribbean countries, felt that this issue was of such concern that it needed attention from outside the health community as well, and thus pushed for it to get onto the General Assembly’s agenda.

According to the UN, tobacco use, alcohol abuse, an unhealthy diet, physical inactivity and environmental carcinogens are the main risk factors for NCDs and although NCDs are often referred to as “lifestyle” diseases, this blog would like to stress the lack of choice and options for some who suffer from or are at risk for NCDs. For example, in many parts of the world, it is simply not safe to go for a jog around the block, whether for fear of robbery, assault or even landmines and mortar shells; this is also a gender issue, with physical activity often being more difficult for women due to norms around acceptable behaviour and clothing as well as personal safety. Also, indoor air pollution, from ‘traditional’ cooking stoves or open fires and smoke from heating contributes to chronic respiratory disease. Finally, a recent article in the Guardian (UK) highlighted the issue of child labour in the tobacco industry and the resulting nicotine poisoning from which many of these children suffer.

In an interview with the Public Broadcasting Corporation (PBS) in the UN, Ann Keeling, Chair of the NCD Alliance, an umbrella organisation of NGOs and private sector supporters, raises the question of human rights. She points out that although insulin was discovered nearly a century ago, people are still dying today. NCDs are a security issue in that they affect a country’s productivity, development and institutions through abseentism, premature death and resources spent on treatment, rather than prevention. They are also a threat to human security in that, as Keeling notes, NCDs are a human rights issue. More than 80% of diabetes deaths are in low and middle-income countries. These three million people each year (roughly) should be contributing to their family, community and county, not dying of a preventable and treatable disease.

The resolution adopted by the General Assembly at the end of the meeting was thorough in that it recognised the complex factors contributing to NCDs and acknowledged the relevant actors and pathways for addressing NCDs. What it lacked however were clear outcomes and targets. As some have pointed out, diplomacy can be quite dull and there was little space for debate in the formal proceedings, which consisted of rehearsed and repetitive speeches with little substance. More specifically, many of civil society’s concerns over potential conflicts of interest in collaborations between governments and the private sector (especially the food and beverage industry) were not fully addressed. However, the true value of the event was that it provided the opportunity to raise awareness of how NCDs present a threat to development and securing health for all.