24 Feb 2010

Noncommunicable Disease Network Global Forum

Your Royal Highness The Duchess of Brabant,

Honourable Ministers,

Director-General of the World Health Organization,


Distinguished Delegates,

Ladies and Gentlemen,

I would like to thank the Director-General of the World Health Organization for inviting me to deliver the opening key speech today, as WHO turns its attention to non-communicable diseases in low- and middle-income countries.

As a former Goodwill Ambassador for the World Food Programme, I have personally observed that there are new dimensions to the malnutrition problem. Although the proportion of malnourished children under five years of age declined from 27 per cent in 1990 to 20 per cent in 2005 according to the WHO Child Growth Standards, many poorer countries are now beginning to suffer from a double burden of undernutrition and obesity. Underweight children and overweight mothers are now often found in the same households in developing countries.

We are learning how countries in the Middle-East and North Africa have the highest maternal overweight rates, followed by those in Latin America and the Caribbean. We are seeing how several African countries have more than 20 per cent maternal overweight rates. We are discovering how even low-income countries are seeing shocking increases in obesity, especially in urban areas and often starting in childhood. We are also finding out that more than 2 million people died in developing countries in 2004 from non-communicable diseases attributed to overweight and obesity.

This is a seeming paradox: Malnutrition and obesity may seem mutually exclusive, but, in fact, the two are linked by their common origins in poor diet.

Processed foods, full of fat and sugar and low in essential nutrients, have become the cheapest way to fill a hungry stomach in developing countries. We have all grown accustomed to the televised news reports on malnutrition and noticed that the babies and children, with their vacant eyes and swollen bellies, are often attended by overweight mothers.

The cheap, low-grade and processed foods that make adults fat, starve children of absolutely essential nutrients. Children who are malnourished and underweight during the first two years of life are damaged for the rest of their lives. Evidence clearly shows that they will have increased predispositions to obesity, diabetes and cardiovascular diseases later in life.

Thus, obesity is not just a "rich" country problem. It is already as widespread in lower-income countries such as Benin, Fiji, India, Egypt, Guatemala, Mauritania and South Africa, as in high-income countries such as the Gulf States and the United States.

And when something so fundamental to life as healthy food is priced beyond the reach of the poor in developing countries, we know that something needs to be addressed urgently.

In our region, tackling obesity is becoming a priority. I have specifically focused on childhood obesity and noncommunicable diseases during the Third Arab Child Health Conference, which was organized in Dubai in March 2008. Globally, around 43 million children under five years old are overweight. What may shock you is to learn that more than 80 per cent of the world's overweight children live in developing countries. Based on the recommendations resulting from the Conference, my office has been working closely with the WHO Noncommunicable Diseases Cluster and the WHO Regional Office for the Eastern Mediterranean to expedite the development of a regional plan on healthy diet, physical activity and health.

The good news is that overweight and obesity in children is largely preventable by improving diets and increasing physical activity. We, together, must ensure that children have access to a variety of healthy foods, including fruits and vegetables. We must cut the amount of fatty, sugary foods in their diets. And we must provide children with opportunities to engage in aerobic exercises like biking, running and swimming for at least 60 minutes each day.

And this brings me to my next point.

Ladies and gentlemen,

Two other epidemics have started to plague developing countries.

The first one is the growing problem of physical inactivity in developing countries. In rapidly growing large cities of the developing world, urban sprawl has reduced physical activity levels by discouraging walking or bicycling. We have seen shifts away from physical activity for pleasure and work. As a result, more than half of adults in developing countries are now physically inactive. WHO estimates that almost 2.6 million people die every year in developing countries from non-communicable diseases associated with physical inactivity.

Socio-cultural factors and stereotypes still prevent women from pursuing physical exercise in many parts of the world. And physical inactivity is linked to higher rates of breast cancer, high blood pressure and other non-communicable diseases we are seeing among women in the Middle East.

In one positive development, promoting physical activity for women and girls is now firmly on the United Nations agenda. Already as early as 1995, the Beijing Platform for Action called for accessible recreational and sport facilities in the educational system, the workplace and in communities. In 2000, the Plan of Implementation of the World Summit on Sustainable Development called for the development of programmes to promote physical activity. In 2004, the Global Strategy on Diet, Physical Activity and Health urged countries to adapt the recommendations of the strategy to their national context. In 2005, the United Nations International Year for Sport and Physical Education highlighted that physical activity is critical for women and girls and promotes important international development goals in the areas of health, education and employment. But much more needs to be done.

The growing collaboration between the UN and the International Olympic Committee is an example of the kind of concerted effort we need from NGOs, governments, schools and private sector institutions to encourage healthy lifestyles. As you may know, the IOC was recently granted official UN Observer status in recognition of its work with the UN to use sport for the benefit of humanity.

In a direct response to concerns about youth inactivity, the IOC will launch the first Youth Olympic Games in Singapore this August. This initiative by IOC President Jacques Rogge will combine athletic competition, cultural activities and education programmes to encourage physical activity, cross-cultural understanding and sportsmanship.

The IOC has also embraced the WHO's campaign to discourage tobacco use — the second epidemic that is endangering the health of millions of people in the developing world.

The global tobacco industry has started to exploit the developing world by using the same marketing and lobbying tactics perfected - and often outlawed - in the developed world. The industry now targets women and teens to sell tobacco while pressuring governments to block marketing restrictions and tax increases - the same tactics it has used for decades to boost sales in developed countries. As a result, deaths from non-communicable diseases associated with tobacco use amounted to more than 3.6 million in developing countries in 2004.

Development agencies cannot control tobacco use in developing countries -- it is up to their governments. When something so fundamental to life as protecting people from tobacco smoke is neglected in many developing countries, we need to encourage and influence them to include tobacco control in their priorities.

Ladies and gentlemen,

Our generation is witnessing how the health and the disease profiles have changed in developing countries. Heart diseases, cancers and diabetes, long considered the companions of affluent societies, are now the leading causes of death in all regions of the world, except Sub-Saharan Africa.

This is a shocking development, with huge implications for human suffering, health systems, health budgets, and the drive to reduce poverty in developing countries.

As is so often the case in public health, prevention is not only possible. It is by far the better option. There is now clear evidence that we are dealing with a preventable epidemic and that there are workable solutions to the non-communicable disease problem in developing countries. We also know that addressing non-communicable diseases is an excellent economic investment.

I was delighted to see that the ECOSOC Annual Ministerial Review has given a high profile to the need to include non-communicable disease IN global discussions on development. A number of recommendations for the highest consideration by ECOSOC Member States were prepared during a Regional Ministerial Meeting held in May 2009 in Doha. These recommendations are currently being discussed at the UN General Assembly in New York, where there is a growing awareness that many MDGs will not be reached unless non-communicable diseases are tackled, and that the continued omission of non-communicable diseases in global discussions on development may derail other international efforts in health and poverty reduction.

Today's meeting tries to break this cycle. We are building on the recommendations of the World Health Assembly and the ECOSOC Ministerial Declaration to seek your support to unite around the Action Plan for the Global Strategy for the Prevention and Control of Non-communicable Diseases.

Collaborative efforts are vital because the Action Plan is an agreed set of goals that can be achieved if all actors work together and do their part. Developing countries have pledged to establish national policies and plans to prevent and control non-communicable diseases. International partners are pledging today to support them, through aid and expertise.

I also call on the UN General Assembly to carry this momentum forward to an even broader discussion on the prevention and control of non-communicable diseases in developing countries at a Special Session of the United Nations General Assembly.

The landscape of public health is rapidly changing and the challenges are unprecedented. But if we act together to prevent the spread of non-communicable diseases, we will address the greatest emerging threat to health today.

Thank you.