Part 3. Debates and Reflections
By Alexa Zeitz
Photographs by Elizabeth Wagemann
The conference threw up many questions, as is to be expected at this early phase in the NCD movement. Among these was the role of the private sector and conflicts of interest. While the tobacco industry has been roundly rejected from debates about NCDs because of its vested interest in perpetuating one of the behavioural causes of NCDs, the alcohol, food and drug industries still have conflicted positions. Many corporations from these sectors lobbied effectively to influence the Political Declaration of the UN Summit. Inviting a group discussion on this subject, the conference chair Dr. Smith argued that while alcohol corporations were part of the problem (since the chief means of increasing profit is to sell more alcohol), food corporations could be part of the solution (as they could increase profits by providing healthier, improved foods). Other speakers showed themselves more sceptical, pointing to conflicts of interest in food companies participating in documents that ought to recommend reduced salt and fat intake. A straw poll of the audience showed the participants divided on the question whether food corporations could be considered ‘part of the problem of the solution’.
Another debate centred on the point at which to intervene to address NCDs. A common characterization of the risk factors for NCDs shows a pyramid with social determinants, such as poverty, at the bottom followed by behavioural risk factors, including smoking, harmful use of alcohol, physical inactivity and unhealthy diet, topped by biological risk factors, such as raised lipids or hypertension, ultimately resulting in NCDs. Dr. Smith suggested that the ‘medicalized,’ doctor-focused approach of the West emphasizes intervention at the level of biological risk factors. It would be more effective, he argued, to intervene at the level of behavioural risk factors, using tools such as taxation and regulation to limit smoking, excessive drinking or unhealthy eating. Social determinants, while at the base of the pyramid, could be too difficult to address because of their unpredictable links to NCDs, Dr. Smith claimed. Nicola Watt, giving her personal reflections on the UN NCD Summit, argued that addressing NCDs required a serious debate on the question ‘What kind of society do we want to live in?,’ thereby invoking the continued importance of addressing social determinants in combating NCDs.
The healthy debate on the key themes of the conference continued on Twitter, where participants commented live on the events using the #camglobalhealth hashtag. Peter Singer, who had given the keynote address at the opening event of the Humanitarian Centre’s global health year, joined the discussion from Canada, tweeting:
#FF grt #globalhealth conf at #cambridge on #NCDS & #mentalhealth now. Hashtag #camglobalhealth. Paging @abdallahdaar @pamela_kanellis
For those unfamiliar with twitter speak, Dr. Singer was alerting his more than 2000 followers to the great global health conference on NCDs and Mental Health at Cambridge, inviting his Grand Challenges colleagues Abdallah Daar and Pamella Kanellis to join the discussion. In reaching such a global audience, the Humanitarian Centre’s Post-UN Summit was an important contribution to advancing NCDs and mental health on the global health agenda.
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