For the first time in human history, more people around the world are dying from noncommunicable diseases, such as heart disease and cancer, than communicable ones, such as malaria and polio. This change occurred in higher-income countries at some point in the middle of the last century. In lower-income countries, the shift is just a few years old.
The way we think about mortality, however, has not kept up with this new reality. We tend to accept these deaths as unavoidable. They’re not. Changing this false perception is critically important to saving millions of lives across the globe.
Every year, noncommunicable diseases (NCDs) kill nearly 40 million people; 17 million of those deaths occur before age 70. In fact, seven in 10 of all deaths each year are the result of noncommunicable diseases, which include strokes, diabetes and chronic respiratory diseases. Add in injuries and the total represents more than three-quarters of all deaths annually. Many of these are preventable, but the world’s governments — including that of the United States — have not made stopping them a priority.
This problem is especially acute in low and middle-income countries. Only 1 per cent of global health funding is aimed at preventing noncommunicable diseases in these countries, even though NCDs make up 67 per cent of deaths.
In fact, we know that with modest actions, governments can reduce the likelihood that their citizens will fall victim to nearly every category of disease and injury. This is why Bloomberg Philanthropies concentrates its resources on cities — because local officials are in the best position to tackle our greatest challenges.
Here are some of the areas in which relatively small steps can save an enormous number of lives.
n Follow the Data:
Nearly two-thirds of all deaths in the world go unreported, and millions that are reported lack a documented cause of death. How are elected officials and health-care leaders to target their resources on the leading causes of death without good data on what those causes are, or whether their interventions are working?
The truth is, if you can’t measure it, you can’t manage it. That is why we started our Data for Health programme, co-funded by the Australian government. Data for Health is working with 19 countries, representing more than a billion people, to close the data gap on births and deaths. It’s our hope that the lessons we learn about collecting data will spread around the world and help governments better understand how to save more lives.
n Tobacco Control:
The tobacco industry spent decades misleading the public about the dangers of smoking and fighting efforts to reduce it. When we proposed an indoor smoking ban in New York City, the industry went full tilt to defeat it. The industry lost; the ban proved highly effective and popular; and cities, states and countries worldwide have since adopted similar bans. Whether it’s smoking bans, tobacco taxes or regulations on packaging, the industry continues to fight any effort by governments to adopt policies that are proven to reduce the use of their product.
One in 10 deaths around the world is caused by smoking. Most occur in developing and middle-income countries where tobacco companies have shifted their marketing, lobbying and legal efforts. With smoking on the decline in the US and much of Europe, the industry is targeting the poor and using its deep pockets to bully governments from enacting life-saving public-health measures.
We’re helping these governments stand up for their people through the Anti-Tobacco Trade Litigation Fund, which we created with the Gates Foundation. The fund supports governments such as Uruguay, which last year fended off a tobacco-industry lawsuit arguing that its graphic package warnings ran afoul of international trade laws. The case was dismissed in 2016 by a World Bank tribunal, handing Uruguay a major victory and establishing a critical precedent.
Elsewhere, Romania passed a comprehensive tobacco control law; Shanghai and Shenzhen put in place comprehensive smoke-free laws; the Philippines and Bangladesh began displaying new graphic tobacco package warnings; and Colombia and Ukraine both raised tobacco taxes. It was not a good year for the tobacco industry.
We have committed almost $1 billion (Dh3.67 billion) to our tobacco-control programme and helped save 30 million lives. When we started in 2007, 11 countries had gone smoke-free. Today, the number stands at more than 50, covering nearly 1.5 billion people.
n Obesity Prevention:
A common reaction to public health interventions aimed at combating obesity is that government shouldn’t be involved and that people should be allowed to make their own choices — and if they become obese and develop a disease as a result, that’s their fault. Leaving aside the fact that taxpayers bear a large burden for these illnesses, I’ve always believed that a critical role of government is to help protect people from harm. That’s why we have laws requiring seat belt use.
People also have misconceptions about what causes obesity. They tend to think it’s primarily an issue of laziness — a lack of exercise. But that’s not true. The main culprit is diet. And the single biggest contributor to the problem is soda and other sugar-sweetened beverages, because they contain a lot of calories, but consuming them doesn’t reduce appetite.
As awareness of the danger has spread, countries and cities have begun taking action. Two years ago, no municipalities had sugary-beverage taxes. Now, seven cities and counties do, representing more than eight million residents. More cities are likely to follow as the evidence in favour of the tax becomes increasingly irrefutable. A recent study of Mexico’s sugar-sweetened beverage tax found that purchases of taxed beverages have declined by nearly 10 per cent.
n Road Safety:
Vehicle crashes kill 1.3 million people and injure up to 50 million more each year. Crashes are the 10th leading cause of death in the world, and the No 1 cause of death for people aged between 15 and 29. Once again, low and middle-income countries suffer the most: Even though they have only half the world’s cars, they account for 90 per cent of all road deaths.
One reason is that roads, walkways and other infrastructure aren’t designed for safety. We are working with governments and transportation experts to change that. Unsafe vehicles are also an important cause of crash deaths. In the US and Europe, basic safety protections such as air bags and electronic stability control are required by law. But in much of the rest of the world they are not, allowing automakers to sell cars that are virtual death traps. More than a century after Henry Ford began mass-producing cars, 80 per cent of countries do not regulate vehicle safety.
In low and middle-income countries, automakers — including US and European manufacturers — routinely sell cars and other vehicles without many of the basic protections that are standard at their home countries. The result: People are being killed in crashes that they would have likely survived in the US or Europe.
This is especially disturbing because it costs so little — usually just a few hundred dollars — to make cars safer.
Our road-safety programme is working with consumer groups and governments to change this. We have funded vehicle testing in Latin America, India and Southeast Asia, and the results have been publicly released so that consumers can make informed decisions. We have also begun conversations with manufacturers to convince them to meet United Nations safety standards in every country, but we know that voluntary compliance is not enough. More governments must establish safety standards, and we have begun working with partners in countries to encourage them to take action.
In each of these areas, the return on investment will be enormous, because many of the best solutions require relatively small sums — often to support grass roots organising and advocacy campaigns. And even better, many require no money at all — just for government leaders to change their mindset.
— Washington Post
Michael R Bloomberg, the former mayor of New York City, is the founder and majority owner of Bloomberg LP. He is the UN secretary-general’s special envoy for cities and climate change.
