FT Health: Governments and industry must do more on NCDs

After the seasonal excesses come the new year resolutions: individuals will be planning to improve their diet and exercise — but governments and industry must also play their part. The cost of inaction is preventable non-communicable diseases (NCDs), which are spreading unnecessary long-term suffering around the world. Civil society, such as campaigns in India against junk food, can help.

But the food, drink and retail sectors need fundamental change, since the evidence for the impact of voluntary measures alone is limited. It is also concerning to learn about corporate lobbying and covert funding of sympathetic academic research. On the plus side, “exiles” from the industry are beginning to call out bad practices and apply their marketing skills in different ways.

Tighter regulation is needed: we already see “sin” taxes on sugar to reduce consumption starting to have an effect. Controls on aggressive marketing could go much further, including tougher standards on food in schools, hospitals and social care, and the use of planning to encourage more walking and outdoor activities. The latest NHS efforts to clamp down on unhealthy food are a welcome start — if they can be properly enforced.

Three questions

José Luis Castro, president of Vital Strategies, which works with governments on public health in lower and middle-income countries to tackle non-communicable diseases.

Is it fair to compare “big food” with “big tobacco”?

The mega-corporations have the size and clout to frame NCDs as lifestyle diseases that are the result of personal choice, but what they are doing is shifting the responsibility to individuals for the products they are pushing which are unhealthy. They have learnt from tobacco in getting people to consume these products and how to block governments from legislating on access. We need taxes to reduce affordability and consumption. Countries like Mexico have had the courage to go ahead, and have found they generate revenue to fund public health.

Can we learn any lessons from Cuba, known for its pioneering approach to health, where there is less junk food?

I was born in Cuba and left as a child. The country has a remarkable record on infectious disease: it has made great progress on reducing infant mortality and is very close to eliminating TB. The family doctor idea is good. But it needs to work on the prevention of NCDs. There is a significant increase in obesity and cancer linked to diet and lifestyle. People don’t have access to junk food but sugar is a big part of people’s diet. They put it in coffee, milk and juice. Like tobacco, they think it’s part of the culture — Cuba has been a sugar producer for a long part of its history.

Why should this year’s UN high-level meeting on NCDs achieve more than the one in 2011?

Unlike the meeting on Aids in 2000, the meeting on NCDs in 2011 did not have a commitment to end the diseases, a financing plan or resources. What gives me cautious optimism this time is that there is much more awareness, many countries have begun to develop plans and civil society has been mobilised around the world. NCDs are killing 40m people a year. We see 10-year-old children becoming obese, developing diabetes and having legs amputated at 27. We have to keep countries accountable.

The year ahead

NHS: Britain's National H ealth Service is 70 on July 5. Here's a timeline of achievements.

Flu: 2018 is the 100th anniversary of the great flu epidemic. Historian John Barry discusses the key lessons. (WBUR podcast, 10m)

Plague: January marks the 500th anniversary of the first attempt by English authorities to control an infectious disease by regulation: Henry VIII's plague control measures. (Lancet)

Science: Policy and research highlights to look out for. (PLoS)

Trends: Political events, court battles, pharma initiatives and biotech developments to watch. (Stat)

Diary: Browse the Global Health Council 2018 events calendar and WHO awareness days.

FT events kick off with "Will there be a cure for Alzheimer's?" on January 18. Deputy editor Roula Khalaf talks to science editor Clive Cookson; Kate Bingham, managing partner of the Dementia Discovery Fund; and David Reynolds, chief scientist of Alzheimer's Research UK. Healthcare and Digital Health summits and more FT Health networking events will follow.

FT reports include Future of Rare Diseases on February 28 and Combating Dementia on March 12. More details here.

Chartwatch

Drug approvals The US Food and Drug Administration approved 46 new medicines in 2017 — the highest for 21 years — while the EU recommended 92. Here are some of the products on the horizon in 2018. (FDA, Reuters, Pharmacy Times)

News round-up

Gaming addiction The World Health Organization has classified addiction to video games as a mental health disorder for the first time. The draft version of its new International Classification of Diseases describes it as persistent behaviour so severe that it takes "precedence over other life interests". The Children's Commissioner for England warned of the effect of social media on school children's wellbeing. (BBC, Children's Commissioner)

HIV setback President Trump's decision to fire all remaining members of his HIV/Aids advisory panel has been attacked by campaigners. The move comes as the opioid epidemic sparks new cases of HIV linked to injections. (Politico)

Typhoid vaccine The WHO has recommended a new vaccine for typhoid, the disease that kills up to 161,000 people a year. Typbar TCV, from India’s Bharat Biotech, can be used on children under two — a significant advance on previous vaccines. (WHO, Global Health Now)

The $850k drug Spark has priced its Luxturna gene therapy at $850,000, making it the world's most expensive drug. The introduction of such one-off treatments has prompted a wider debate over appropriate pricing and payment methods. The FT uncovered large New Year price increases from Pfizer and other drugmakers. You can watch our video on it here. (FT)

NHS in trouble . . . The NHS had a tough start to its 70th anniversary year, cancelling routine operations until the end of the month to cope with a surge of hospital admissions over the winter. Cutbacks in social care from local authorities have led to overflowing hospital wards as patients cannot be safely discharged. (The Lancet, FT)

. . . and care homes in crisis The debate over the “financialisation” of the UK care home sector intensified as problems at Four Seasons Health Care deepened. Three of the four largest operators are run by private equity but loading up a narrow margin business with a high fixed-cost debt is hopelessly flawed, said the FT's Lombard column. Financial problems are hitting the US too. (FT, NYT)

Supermarkets and superbugs Marks and Spencer is the first supermarket in the UK to publish data on antibiotics in its supply chain. Concern has been rising that their overuse in animal farming could lead to antibiotic resistance in humans. (Guardian)

Cherokee fight back The US Cherokee Nation — hit hard by opioid addiction — is using its tribal court to fight the big pharmacy chains and drug distributors, claiming they have flouted drug-monitoring laws and allowed prescription opioids to flood into their territory at some of the highest rates in the country. (NYT)

Smoke signals WHO chief Tedros Adnaom Ghebreyesus urged governments to step up the fight against tobacco and do more to fight illicit trade. Scientists have questioned research behind iQOS, the ecigarette from Philip Morris awaiting approval from the FDA. It could become the first tobacco product allowed to be advertised as less harmful than cigarettes. (Project Syndicate, Reuters, Economist)

Phage therapy On the 100th anniversary of their discovery, interest is reviving in phages, the viruses described as “the most ubiquitous bacteria fighters on the planet” and their potential for combating antibiotic-resistance. (Outbreak News, Time)

Organ donors The EU reported a 17 per cent increase in organ transplants between 2008 and 2015. Poorer rates were noted in countries hit by the economic crisis, as well as in Germany, where transplants fell 20 per cent, possibly because of a 2011 scandal on manipulation of waiting lists. (European Commission)

The secret life of antidepressants A third of antidepressants are taken for something else. Doctors are prescribing the drugs “off-label” for problems such as migraines, hot flashes, attention deficit hyperactivity disorder and digestive illnesses. (Mosaic)

Best from the Journals

Health diplomacy The WHO framework on tobacco control — the organisation's first global treaty — has profound implications for the future of international health co-operation. (BMJ)

Chinese ambitions China's “Belt and Road” trade initiative could become a new “Silk Road to health”. The country's greater engagement could strengthen development in poorer countries, help disseminate medical knowledge and more productively integrate eastern medicine with western. The country is also ramping up its role in the global drug industry. (The Lancet, NYT)

Surgery in Africa The risk of death from surgery in Africa is double the global average because of scarce resources. One in five surgery patients develop a complication and 2 per cent die. It is estimated that 5bn people worldwide are unable to access safe surgical treatment, and 94 per cent of these live in low- and middle-income countries. (The Lancet)

Migrant health The number of migrants looks set to increase but funding for research into their health problems is scarce. Diseases such as tuberculosis are prevalent: about three quarters of cases in the UK occur in migrants, usually about four years after they enter the country. (BMJ)

Health and wealth A study of outcomes for older people in the US and England found higher risks of death and disability among the poor in both countries, despite very different health systems. There is no marked improvement at 65 when state aid kicks in, suggesting problems may stem from long-term issues such as unstable housing and susceptibility to drug and alcohol addiction. (JAMA)

Antibiotic priorities The Lancet analyses the new WHO priority list — “the first international, global effort to prioritise research and development of new antibiotics according to bacterial drug resistance”.

Alcohol and social class Frequent drinking increases the risk of death from cardiovascular disease, especially among the poor. The effects of binge drinking however are similar for rich and poor alike. (PLoS)

Podcast of the week

The fight against Alzheimer's British neuroscientist Joseph Jebelli on how the disease affects the brain and the long search for a treatment. (NPR, 29m)

Seasonal appeal

Alzheimer's UK is the FT's chosen charity for our seasonal appeal. Read more and donate.

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Final thought

Alcohol abuse ♫ "It was Christmas Eve, babe, in the drunk tank . . .” ♫ Facilities for sleeping off the effects of booze could soon become the norm in UK cities to keep “selfish revellers” out of stretched emergency departments. A worthwhile proposal? Or a move that just encourages careless drinking?