Developing Countries Pledge to Combat Diabetes and Obesity; China & Thailand Suggest Global Targets Are Too Ambitious
Botswana’s representative, Dr Edwin Dikolo, at the WHO Executive Board Thursday – fighting COVID has pushed aside the battle against NCDs in Africa and beyond.

In a long and winding discussion Thursday at The World Health Organization’s Executive Board, low- and middle-income countries (LMICs) pledged to redouble their efforts against noncommunicable diseases (NCDs), such as diabetes and obesity, which are having increasing impacts on health and well-being – in addition to infectious diseases that have been at the forefront of health sector efforts for most of the past half century. 

Some 70% of premature deaths worldwide are now due to NCDs.  And two-thirds of deaths annually in low- and middle-income countries are NCD-related, according to the NCD Alliance

Risks of dying young from cancer, diabetes, a heart attack or another chronic diseases are higher in most developing countries, because health systems still don’t offer basic primary prevention measures like cervical cancer screening, diabetes diagnosis or insulin treatment – not to mention more costly and high-tech treatments for conditions like cancer.  

The Thursday session focused on action plans to implement a 2018 political declaration of UN General Assembly on the prevention and control of noncommunicable diseases (NCDs), a cross section of African countries noted that the ongoing COVID-19 pandemic has made it even more difficult for them to combat both diseases and other NCDs.

Among the NCD risk factors, obesity stands as one of the largest – and growing risks. Worldwide obesity has tripled since 2021 and more than 1.9 billion people over the age of 18 are obese today, according to WHO.

Africa – COVID pandemic has sapped resources from NCD prevention and treatment

As with other NCDs, death rates from obesity in parts of Africa, the Middle East and South-East Asia are among the highest in the world – even though there are just as many or more obese adults, per capita, in the United States and other parts of the Americas. That is just one more example of the lack of preventive and other treatment services in LMICs.

Dr Edwin Dikolo from Botswana, speaking on behalf of the African region, noted that resources and manpower that could have been channeled toward tackling the diseases have been repurposed for the COVID-19 pandemic response in member states. 

According to him, there is the need for investments in LMICs to facilitate the emergence and availability of context-specific medical devices and technologies that are more attuned to countries’ health systems capacity and disease responses.

The region also asked for international and regional collaboration, and support for research and measures to promote more transparency in the licensing of Intellectual Property rights. 

“Another demand is improved access to WHO’s pre-qualification list, and support for member states in improving access and affordability of medicines for NCDs,” the statement concluded.

Last October, WHO’s Essential Medicines List (EML) Expert Committee recommended that the Agency establish a pricing committee, as an adjunct team to provide “advice to WHO on policies and actions to make highly priced essential medicines more affordable and accessible” – incorporating pricing issues more directly into the WHO review and recommendations on new “essential medicines.”

But WHO’s senior leadership has been foot dragging on making such a formal recommendation, civil society sources in Geneva have suggested.  

Kenya’s representative, meanwhile, noted that while there are commendable regional efforts to improve access to diabetes care at the primary health care level, and many countries in the region, including Kenya, have integrated diabetes into the universal health coverage packages, diabetes services remain unequitable. 

“Insulin and associated interventions required in the management of diabetes remain unaffordable in many low and middle income countries and out-of-reach for many patients,” the representative from Kenya stated.

Kenya’s representative speaking at the WHO Executive Board in Geneva, Thursday.

Addressing obesity

Mother and son in Usolanga, Tanzania. Childhood fat is traditionally seen as a sign of abundance, but it can lead to adult obesity, and related diseases later in life.

According to the WHO, a major risk factor for diabetes is obesity. Moreover, obesity is believed to account for 80-85% of the risk of developing type 2 diabetes, while obese people are up to 80 times more likely to develop type 2 diabetes than those with a body mass index (BMI) of less than 22.  People with a BMI greater than 25 are considered overweight, according to WHO.  Childhood obseity is another growing problem, increasing risks of chronic disease later in life. 

A WHO target set in 2016 called for halting the global increase in obesity in children, adolescents and adults altogether by 2025 .

But countries are far off course in reaching that goal.  As things stand now, one in five adults worldwide will be obese by 2025, with LMICs experiencing the greatest obesity surges, according to the World Obesity Federation.

As a result, WHO has now proposed shifting the target of halting the rise in obesity to 2030.

At the same time, it has etched out more modest “intermediate” targets that countries could aspire to reach.  Those include reducing intakes of free sugars to less than 10% of total energy intake and reducing physical inactivity by 15% by 2030.  Other “process targets” would include increasing primary health care coverage of obesity prevention, diagnosis and treatment, increased regulation of corporate food marketing of unhealthy foods and drinks to children, and national physical education campaigns.

WHO’s interim proposed targets for obesity reduction – very far from the ambitious 2016 goals of halting the rise in obesity altogether by 2025.

At Thursday’s session,  the United Kingdom said it would support the WHO-proposed intermediate targets.   The UK government delegate, however, stressed that countries need to do more on their own as well as bolstering  global collaborations addressing obesity.

“Action to date has been insufficient, and we would therefore like to call on member states for further joint action to address the global burden of obesity and achieve better health worldwide,” the UK  representative said. Sharing the UK experience at today’s session, the representative described how the UK has put in place a policy package that includes front-of-package labeling, taxes on sugary drinks and salt, sugar and calorie reformulation programs. 

“This year we are going further and we’ll be introducing new regulations on advertising, promotions and calorie labeling in the out-of-home sector,” the representative said.  

The UK also is leading WHO/European Region Sugar and Calorie Reduction Network that will be launched next April. 

“The network will provide a forum for countries to share lessons learned, identify and address barriers to sugar and calorie reduction and assist industries in their efforts to make food and drink healthier. We will also be working on addressing the data gaps and increasing transparency and accountability,” the UK stated.

Concerns from China and Thailand that targets are too ambitious 

Diets rich in fresh fruits and vegetables combat obesity – but these are being overtaken by fast and processed foods in developing as well as developed countries. Portrayed here a market in Tamil Nadu, India

Delegations from China and Thailand however expressed concerns that the interim targets for obesity reduction and related programmes remain too high and too difficult to achieve. 

China recommended that the WHO Secretariat should organize in-depth discussions on this issue, building on the development trend in recent years and the indicators “so as to scientifically predict and set the coverage targets to ensure that they are achievable.” 

Addressing the concerns, Dr Francesco Branca, Director of WHO’s Department of Nutrition and Food Safety, said the WHO will support the adoption of healthier dietary and food policies, through development of policy guidelines for: marketing food to children, fiscal policies, and school food offerings, as well as guidelines on the management of obesity in children and adolescents accompanied by practical How to Guides. 

“We’re also developing a service delivery framework for prevention and management. And looking at diagnostic criteria additional to the body mass index. WHO [also] plans to establish benchmarks for the reduction of sugars based on the experience of member states. Nutrition professionals are those trained to pursue a professional career in nutrition [and] are described in most countries as dietician or nutritionist,” Branca said.

Bente Mikkelsen, Director of WHO’s Department for NCDs told China and Thailand that the WHO took national health systems’ contexts and capacities into consideration when developing its policies and in setting the global targets.

“We have developed the targets based on the data from the member states and with the methodology that is developed in the technical paper. The targets seem ambitious but are achievable,” Mikkelsen added.

She added that the NCDs global action plan on tobacco, alcohol health, healthy diet and physical activity also contain similar targets that will “remain and will complement the targets on coverage and treatment”.

Image Credits: Jen Wen Luoh, Paul Adepoju , Political declaration of the third high-level meeting of the General Assembly on the prevention and control of noncommunicable diseases, @veerajayanth03.

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