As we noted in an online response to the ongoing NCD debate, people like me who are involved in non-communicable diseases welcome the plans for a UN summit on NCDs with elation and trepidation: happy that at last attention will be focused on the prevention and care of chronic conditions but at the same time afraid of what will be the final outcome of this attention. Fear seems to be winning out now.  So far, there have been no strong commitments to the expected outcomes of the NCD summit.

Efforts have been made to simplify NCD prevention and control measures to increase acceptability and probability of success.  But simply attributing the increasing prevalence of NCDs to physical inactivity, obesity and the increasing use of health-risk products without due consideration to their deeper epigenetic origins may erroneously condition the mind to think that these diseases are mere products of sloth and gluttony; thus the wider social implications of the ballooning numbers of NCDs may be overlooked.  In-depth analyses can show that some NCDs can be indirect measures of existing health programs such as antenatal care, under-5 growth and development, and reproductive health. More than that, particular NCDs can be reflections of social and economic (mal)development and (in)equity. To resort to uni-dimensional solutions such as consumer-initiated voluntary reductions in intake of deemed harmful products borders on the laughable.

Especially in my world where people living in poverty oftentimes have no choice but to subsist on rice and salt; where a bottle of sugar-rich drink is cheaper than safe drinking water; where sodium-rich food comes out with a government agency’s seal of approval and labelled with claims that these are fortified with vitamins and minerals; where, at times, we serve as “dumping sites” for goods no longer acceptable in the first world; where cigarettes can be bought on the streets per piece; where a young child can buy liquor at the corner store; where drugs are levied additional excise taxes while most of the healthcare expenses come from out of pocket and access to basic health care services is a problem; where policymakers are over-dependent on international health directives…

NCDs have multifactorial origins which should be addressed through multi-sectoral approaches involving a variety of players. While cooperation will be the key for a number of stakeholders including those trying to protect the interests of other health programs, head-on collisions with certain industries may be inevitable.  Will any of the donor countries, development agencies, and funders be man enough to stand up and fight for true NCD prevention and control on September 19 & 20?  This is indeed a daunting and demanding task that takes more than immunization drives, or donating multivitamin preparations and antimicrobials, or distributing insecticide-treated nets and condoms.  Certain sacrifices will have to be made.   However, if properly acted upon, the results of the NCD summit will redound on many other aspects reflecting man’s general health and total well-being.

Now, think about this: “…deception is like boiling a frog. Drop it in scalding water and it will leap out immediately. But start cold and it will never notice the rising temperature.  You can fool people all the time…It just takes patience: inching the temperature up, degree by degree, until the victim is cooked.” (Mac Donald, The Mind Game, 2000)  Owing much to an insidious nature, such is the way NCDs and their numerous risk factors work.  Until when are we willing to be deceived?

Grace Marie V. Ku

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