1. Urbanisation, globalisation and business:the story of NCDs Thomas Abraham

2. What we will explore today.. Why the world is getting wealthier, but not necessarily healthier… We have seen great advances in medicine so people no longer die of infectious diseases at a young age Instead we are living longer, but also being sicker Heart diseases, cancers and other chronic conditions are major global health issues

3. What are non-communicable diseases? Diseases or conditions that are not transmissible, or caused by injury Cardiovascular disease, cancer, diabetes, chronic respiratory diseases ( asthma, other pulmonary diseases) Also referred to as chronic diseases

6. WHO Director General Margaret Chan: “The worldwide increase of non-communicable diseases is a slow-motion disaster, as most of these diseases develop over time”

7. What are the chronic diseases? Cardiovascular disease: coronary heart disease and stroke Coronary heart disease, or ischaemic heart disease: leading cause of death globally; caused by atherosclerosis, or hardening of the blood vessels of the heart Stroke: Where the blood supply to the brain is affected by diseases of the blood vessels ( cerebrovascular disease)

8. Cancer: A range of diseases in which abnormal cells proliferate and spread out of control Chronic respiratory illnesses: asthma, other pulmonary diseases that can obstruct breathing. Smoking, pollution are risk factors Diabetes: When the body does not produce enough insulin, and/or an inability of the body’s cells to respond to insulin

9. Causes of chronic diseases (Source WHO)

10. Globalisation, business and disease Many of the risk factors for non-communicable diseases arise from the activities of large global corporations Tobacco, fast food chains, food industry,alcohol Public health would say- regulate. Businesses say “consumers should have a choice”

11. Obesity Raised BMI a risk factor for diseases such as type 2 diabetes, cardiovascular diseases, and several cancer BMI- body mass index (weight/height squared) 18.5-25 is considered normal

12. The way we eat and the way we live Changes in the global food system major drivers of obesity epidemic Increase in cheap, high energy food Global distribution systems Persuasive marketing Our living environment Have all combine to create an epidemic of obesity

13. At the same time The amount of energy we need to expend for our daily lives has decreased: Demand for physical activity has decreased in our life styles Our built environment : transportation systems, elevators, escalators etc all are geared towards reducing our energy use. We live in an “obesogenic environment”

18. What can be done Individual action: ie going to the gym, eating healthier, is not not enough Policy changes are required, because this is a larger environmental issue “Obesity is the signal that something is terribly wrong in the policy environment. Widespread obesity in a population is not a marker of failure of individual willpower, but of failure in policies at the highest level.” Margaret Chan, WHO

19. What policy makers want to see Regulation of advertising and marketing by food companies to children Ban fast food in schools Regulation/reduction of high calorie, low nutritional value foods Global food processing industry is a giant worth over US $1 trillion.

21. Poor countries face a “double burden” of disease: both infectious diseases as well as a growing burden of non-communicable diseases.

22. Big Tobacco “The only legally sold product that kills upto half its users.”

28. Big 5 tobacco companies China National Tobacco company (33.7% of global share) $26.8 bill. rev Philip Morris International (17.6%) US$ 81.8 bill. rev British American Tobacco ( 15.1%) US$ 43 bill. rev Japan Tobacco International (6.4%) US$ 37.4 bill Imperial Tobacco (3.6%) US$ 21.5 billion rev.

29. Big tobacco has fought regulation http://www.jeffreywigand.com/7ceos.php

30. Framework convention on tobacco control Entered into force in 2005, negotiated despite obstruction form tobacco industry Requires countries to take steps incuding

34. http://www.bat.com/

35. http://www.who.int/cardiovascular_diseases /resources/atlas/en/ http://www.who.int/cardiovascular_diseases /resources/atlas/en/