My second day experiencing the 69th World Health Assembly began with a brave admission from UNICEF’s Chief of Health, Stefan Peterson: “I used to be called a sausage with freckles.” Within this sad, yet humorous line, Peterson relayed a powerful message that carried on throughout the rest of the day: health is not solely a product of healthcare, but is also intrinsically affected by social, political, and psychological environments. As an overweight child teased for his body type, Peterson was taught at a young age that poor health status is the fault of an individual’s choices. Herein lies the issue of today’s world: noncommunicable diseases (NCDs) are on the rise without an end in sight, for we live in a world where society teaches children to blame themselves. With these social pressures presented throughout childhood, adults hold onto that self blame, often failing to uncover the external environmental plagues which, though out of our control, deteriorate health condition. Therefore, part of the reason why NCDs may, in fact, remain such a tremendous — and rapidly growing — issue within the modern world may be due to the common misconception that individual health is an isolated, internal system. It is this very misconception which has led us to create the self-blaming cultural standard we observe across all age groups.
In fighting this misconception, it appears that we have to tackle the root of the cause: the so-called “enemy” of NCDs. Naming the enemy, however, is a far more complicated task than it may seem at first glance, with causes for disease extending across an endless diversity of physiological, cultural, social, genetic, epigenetic, environmental, and political factors. NCDs pose no single, easily identified “enemy” for advocates to rally against in unison, as was the case for advocates against conditions such as HIV/AIDS, malaria, and TB. Herein lies the potential reason why no strong youth advocate movement against NCDs has yet formed. As a college student, I have observed and participated in numerous peaceful protests to demand change at both the local and state level; this participation feels mandatory to a certain extent, as part of my role as a civilian is to work to positively impact the community surrounding me. All of these protests I have observed, however, have brought about a unified sense of emotion as we are all directed to target a specific and immediate “enemy” (e.g., a virus in the case of HIV/AIDS, a parasite in the case of malaria, and a bacterium in the case of TB). Herein, I realize two potential issues in the case of NCDs: (1) the lack of an identifiable enemy in the battle against NCDs and (2) the lack of apparent immediacy. Although youth can be taught to avoid cigarettes, wear sunscreen, and eat a balanced diet to maintain health, there is no singular cause for NCDs that we can effectively rally behind; we encounter hundreds of risk-factors each and every day. Who is to blame for our cases of cancer, diabetes, autoimmune disease, etc.? Without an answer, we reach the defeatist conclusion of blaming ourselves. Additionally, youth do not feel the need to rise as protesting advocates — as NCD healthcare leaders wish for — because there is not a sense of immediacy in their young eyes. Under the false conception that NCDs are slow-developing and acquired in middle-age, youth do not feel the need to press for change today. They remain blind to the rapidly developing epidemic. Herein, lies the issue. NCDs thus far have been largely publicized as conditions of older adults, which gives children and adolescents a false sense of security. Without urgency, the youth community lacks motivation to rise up.
With this idea in mind, Dr. Karen DeSalvo, the US Department of Health and Human Service’s Acting Assistant Secretary for Health, presented a strong point: we need to shift into an age of person-focused medicine with both the individual and the local community at the center of care. This appears to be the first significant step towards de-stigmatizing NCDs and raising awareness that health is based on more than healthcare. As DeSalvo mentioned and Sir George Alleyne reiterated, we now understand that zip code is a more accurate measure of lifespan that genetic code. Ultimately, this distinction results from global politics more than any other factor, according to Dr. Douglas Webb of the United Nations Development Group, who our class spoke with today.
While NCD patients often look at themselves not as victims but as individuals who have brought disease upon themselves, Webb offers an alternative argument. Clearly, health behaviors serve as significant predictors of lifespan health; however, these behaviors are not under our control as much as many would think. In speaking about his commitment to preserving the human right to health across the lifespan, Webb discussed the mechanisms by which big business and public health often present competition with one another, therein creating a winner and a loser in the situation. In presenting this discussion, Webb prompted us, as students, to find the “winners” and “losers” in each agenda item discussed at the assembly. In this game, he says that there are no “nice guys” in business, as everything has a bottom line. It is this very bottom line which prompts big tobacco companies, for example, to offer bribes (such as mosquito nets) to low-income countries in exchange for continued promise of business. In this example, we observe a socio-political web which traps countries into allegiance with an agent they may wish to disassociate from. For example, although a leader may wish to escape the tobacco industry to increase national life expectancy, is it ethical for him/her to refuse mosquito nets in order to do so? In that single decision, is he/she responsible for all future deaths that could have been prevented by implementation of nets or, alternatively, the break from tobacco? Ultimately, this becomes an unanswerable ethical question regarding which lives should be valued more — those that could be saved by the mosquito nets or those which could be saved by reduction in tobacco sales.
Seemingly unanswerable questions such as these have been repeatedly presented over the past two days of World Health Assembly events. With two full days behind me, I have observed hours of discussions on everything from WHO reform to the economics of noncommunicable disease prevention to the vertical integration of healthcare to the significance of a life course approach. With each discussion, I was extremely thankful to observe experts in everything from economics to health policy to health research to medicine discussing solutions. Although this interdisciplinary approach often brings about conflict in discussion — as scientists and economists attempt to reconcile the fact that countries’ economies benefit from health-harming-produce — it is this necessary conflict which brings about positive change.
Cristina Gago is currently working towards a B.S. in Human Biology and an MPH in Global Health Leadership at the University of Southern California.
The USC Institute for Global Health organizes an annual trip to the World Health Assembly in Geneva, Switzerland, as part of the course “Global Health Governance & Diplomacy in Practice in Geneva at the World Health Assembly.” This year, a group of 12 students are embedded as delegates to NCD Alliance members at the 69th World Health Assembly May 23-28.