7th Annual Nossal Institute Forum
Tuesday 30th August 2011
Oration: Sir George Alleyne, UN Special Envoy for HIV/AIDS in the Caribbean.
Time: 6:30 pm
Venue: Asia-Link Carrillo Gantner Theatre,Swanston St, Carlton
Wednesday 31st August 2011
Forum: “Non communicable diseases and development in the Asia-Pacific region: Building a new way of working in a rapidly changing world”.
Time: 8:30 am – 5:00 pm
Venue: Bio21 Institute Lecture Theatre
Flemington Road, Parkville
To view the Forum Program please click here
Report on the Nossal Forum, August 31 2011
Non-Communicable Diseases and Development in the Asia-Pacific Region: Building a new way of working in a rapidly changing world
The 7th Annual Nossal Forum brought together a multi-disciplinary group to focus on Non-Communicable Diseases (NCDs) in the lead-up to a United Nations High Level Meeting on this subject in New York on 19-20 September. Health professionals, academics, international development organisations, health agencies, politicians, bureaucrats, lawyers, economists and political scientists were represented in discussions of the rising epidemic of NCDs. In line with the focus of the UN High Level Meeting, participants concentrated on the four major conditions of cancer, diabetes, cardiovascular disease and chronic respiratory disease, whilst recognising that other conditions such as injuries and mental health also fit within the definition of NCDs. There was a particular focus on the Asia-Pacific due to Australia’s proximity to this region, its very high rates of NCDs, and the rapid economic and social shifts these nations are undergoing.
Participants at the Forum were made aware of the magnitude of the problem of NCDs, and their propensity to affect poorer and more vulnerable populations. Rates of NCDs have been rapidly growing; they now account for over 60% of deaths worldwide and are predicted to cause 75% of global deaths by 2030 –mostly as a result of rising prevalence in the developing world. A number of speakers highlighted the variety of social (urbanisation, ageing populations, globalisation and commercial interests such as the tobacco, alcohol, food and beverage, and energy industries), behavioural (high smoking rates, high salt/sugar/fat intake, and physical inactivity) and biological factors driving these changes.
There is strong evidence linking poverty, a lack of education and other social determinants to the impact of NCDs; diseases which in turn can reinforce poverty through a decreased ability to work productively and increased expenditure on health care. Additionally, as NCDs cause great morbidity and mortality amongst the working population – with one-quarter of all NCD deaths and significant chronic morbidity occurring in those under 60 – they reduce a nation’s productivity and can place economic development at risk. Finally, it is also known that many of the social and economic changes currently taking place in the Asia-Pacific region are increasing the rates of NCD risk factors, such as an unhealthy diet and sedentary lifestyle. Connecting the above information, speakers presented a compelling case that NCDs pose a threat to development, and risk eroding hard-earned gains in health and other development measures over the last decades. The economic realities of, and future threats posed by NCDs were demonstrated in an excellent presentation by Patricio Marquez, who summarised his recent work in China with the World Bank assessing the present rates and impact of NCDs and developing possible policy interventions. An excellent reflection on the problems in smaller countries nearer Australia was provided by Louisa Ryan who illustrated some of the issues in relation to Samoa and New Zealand.
Due to NCDs’ greater prevalence in poorer countries and especially in poorer groups within these countries, both development agencies and foreign aid will certainly play a large role in tackling this problem. Donors such as Australia, which provides half of the aid to the Pacific region, have a responsibility to carefully consider how their aid is to be used. As explained by AusAID Director-General Peter Baxter, Australia is an example of a country that has recently reviewed its aid program, and is now placing a much greater focus on aid effectiveness, whilst also recognising the threat to development posed by NCDs. Economist Stephen Howes, a contributor to the review of Australia’s aid program, discussed the crowded and fragmented nature of many aid environments, and the need for aid delivery along aligned, and where possible existing, means. Both speakers emphasised that NCDs provide an opportunity to incorporate all of these emerging priorities and concerns around how we undertake aid. In terms of effectiveness, prevention activities around NCDs offer some of the most cost-effective ways to improve health. In terms of fragmentation, the unique combination of contributing factors to NCDs – social, political, economic, behavioural and biological – can facilitate and indeed necessitate increased collaboration between different organisations, who may work on different aspects of a shared goal.
A common theme throughout the day was that the socio-economic determinants of health, and in particular NCDs, involve a number of factors that lie outside the traditional health sphere – such as trade, law, economics, political science, and many others. Indeed, Greens Senator Richard di Natale declared that it was this realisation that directed his journey from clinical practice into public health and on to politics. Due to this wide array of contributing factors, any meaningful response to address NCDs requires a multi-sector approach. Descriptions by Deborah Gleeson of the importance of trade, and by Paula O’Brien of the possible roles of laws and regulation in providing solutions to NCDs, were excellent accompaniments to Federal Health Minister Nicola Roxon’s discussion of Global Tobacco Control. Minister Roxon presented a pertinent and insightful case study of the legal, political and social obstacles that can be encountered when trying to bring about a public health measure, especially one involving such strong commercial interests from large corporations.
Nossal Orator Sir George Alleyne proposed that a new paradigm is necessary to tackle NCDs, given the great threat they pose, their uniquely diverse combination of contributing factors and the failure of existing responses to restrain the rising epidemic. He believes that key elements of any new approach would include promotion of the magnitude and consequences of NCDs, constant dispelling of myths that such diseases are inevitable or that we are unable to prevent them, a review of primary health care and the way that health services are delivered, and utilisation of new political and technological approaches. In particular, Sir George emphasised the importance of political and community ‘champions’ representing NCDs and the potential role of social media.
As outlined in the Forum’s title, a strong focus of the day was ‘building a new way of working’ – investigating how different groups can move forward in tackling NCDs in a collaborative and co-operative fashion. From the day’s presentations and discussions, a number of principles could be gathered. First, promotion of the importance of NCDs is essential, alongside other priorities such as HIV, TB, malaria, maternal health and mental health in health diplomacy. Secondly, National Governments, NGOs and donor countries must recognise NCDs as a key aspect of their development agenda. Finally, a multi-sector approach involving a number of professions is required in order to develop an effective and sufficiently broad response to NCDs.