Sustainable Development and NCDs

George Alleyne

April 18, 2012

Pan American Health Organization

Presentation

Concept of sustainable development Sustainable Human Development (SHD) What makes it sustainable? The place of health SHD and NCDs NCDs in LAC NCDs in Rio+ 20 Conclusions

Rachel Carson 1907-1964

Only within the moment of time represented by the present century has one species -- man -- acquired significant power to alter the nature

of his world ( The Silent Spring, 1962)

Gro Harlem Brundtland

“Our Common Future”The World Commission on Environment and Development

(1987)

Sustainable development: “ Development that meets the needs of the present without compromising the ability of future generations to meet their own needs”

Sustainable development

Our Common Future

“ The concept of sustainable development does imply limits –not absolute limits, but limitations imposed on environmental resources and by the ability of the biosphere to absorb the effects of human activities”

Rio-UNCED 1992

“The spirit of the conference was captured by the expression "Harmony with Nature", brought into the fore with the first principle of the Rio Declaration: "Human beings are at the centre of concerns for sustainable development. They are entitled to a healthy and productive life in harmony with nature".

The Johannesburg Declaration created “a collective responsibility to advance and strengthen the interdependent and mutually reinforcing pillars of sustainable development—economic development, social development and environmental protection—at local, national, regional and global levels.”

Johannesburg 2002

Of what? Of whom?

Answer to the unanswered questionDevelopment of what?

Development of whom?

“Development has a face, and

that face is the face of man”

Dr. Eric Williams (1973)

PM Trinidad and Tobago

The anthropocentric view

Other graphical representations

Human development

Social

Economic

Environment

Current basic concepts

Sustainable development is NOT only about the environment-preservation of natural resources

The definition characterizes sustainability and NOT development

We must characterize development as Human Development

“Human development is a process of enlarging people’s choices. The most critical ones

are to lead a long and healthy life, to be educated and to enjoy a decent standard of living.”

Mahbub Ul Haq

Development can be seen, it is argued here, as a process of expanding the real freedoms that people enjoy

Capabilities-what are persons able to be and do-their substantial freedoms

The most important things in life. (% responses)

Male Female Total

Good health 42 40 44

Happy family life 36 40 38

Employment 30 27 27

Live in a country without war

14 19 17

Source: Millennium Gallup Poll 1999

Health is an end of Human Development Health is an instrument of Human Development Health is one component of the social strand

( health, education, political freedom etc) NCDs can make human development

unsustainable through negative impact on health as well as on the three strands of the helix

Therefore: the control and prevention of NCDs must figure in any goal for sustainable human development

NCDs on sustainability strands

Social Economic Environment

NCDs

Note also the reverse causality

Impact on social strand

Equity unfair distribution of life chances-inequity disproportionate impact on the poor Social cohesion stigma and discrimination-esp. cancer and

diabetes chronic care –social fraction Gender early male death-widowhood and poverty Education

Impact on economic strand

Effect on macroeconomy eg 37 $trillion dollars over next 2

decades( Bloom) impact on GDP Effect on microeconomy poverty and preventing escape from

poverty trap Fiscal consequences Increased government expenditure in

care, pensions etc; reduced government revenue

Impact on environmental strand

Difficult ? Impossible to show any direct impact of NCDs on the environment.

However, it is possible to show impact of the NCD risk factors on the environment e.g

-Tobacco production and climate change

-Food production and climate change.

(livestock production responsible for 18%

global GHG-more than transportation )

NCDs in the Americas

Total NCD Deaths 2009: 4.5 Million Source PAHO

In most countries of LAC

Almost half of those with diabetes and one third of those with hypertension are undiagnosed

More than half of those with diagnosed diabetes and one fourth of those with diagnosed hypertension are uncontrolled

Almost one third of those with diagnosed diabetes and half of those with diagnosed hypertension do not take appropriate medication

Source: PAHO, population based surveys of NCD and risk factors

Strategies to address NCDs

Population based interventions;Primary prevention

Clinical interventionsSecondary prevention

Hea

lth

y

NC

D

Society/environment

Individual

United Nations A/66/L.1General Assembly

Political Declaration of the High-level Meeting of theGeneral Assembly on the Prevention and Control ofNon-communicable Diseases

September 19-20, 2011

82 Countries35 Heads of StateCivil Society +++Private SectorUN Agencies

The Political Declaration

Commitments: Reduce risk factors Strengthen policies and health systems International cooperation Partnerships Research and development Monitoring and evaluation Follow-up

Earth Summit 2012

Objectives

Themes

“Wish list” for Rio+ 20• Acknowledge NCDs as an “emerging

challenge”• Recognize the outcome of the New

York UN HLM as one component for the objectives of Rio + 20

• Incorporation into the Declaration the essentials of the commitments made in the UNHLM for NCDs

Conclusions

Our concern is sustainable human development Health is an end as well as a means towards

SHD Human development is made sustainable by a

helix of three strands-social, economic, environmental

NCDS impact adversely directly or indirectly on the three strands making HD unsustainable.

Thus the case for NCDs prevention and control figuring in sustainable human development