Name and Title 

Good morning distinguished guests, esteemed colleagues and friends.  

 My name is José Luis Castro.  

 It is an honor to be here with all of you to discuss the most pressing concerns in global health. Thank you to the World Healthcare Forum for the invitation to participate in this important meeting of the minds.  

We are all aware of the huge toll of non-communicable diseases—called NCDs–worldwide. By this I mean diseases such as cancer, diabetes, cardiovascular and chronic respiratory illness. 

Why do NCDs matter so much? Why when there are other urgent issues impacting human health, several of which were addressed yesterday: issues such as anti-microbial resistance, the effects of climate change, and the ongoing threats of communicable disease. 

To put it practically, the economic and social cost of NCDs greatly exceeds their medical costs. The cost of inaction on NCDs far outweighs the price of their reduction. 

 NCDs not only affect individuals and families, they affect economies and health systems through reduced work productivity, a higher medical burden, and lost savings. These effects compound poverty and inequality worldwide. And despite our efforts, NCDs continue to rise in low- and middle-income countries. They are predicted to rise significantly unless we change our approach. 

Crisis of our Own Creation 

As you know, NCDs are largely a crisis of our own creation. By this I mean that many of the health threats that contribute to NCDs, such as tobacco use, harmful use of alcohol, unhealthy diets, physical inactivity, and increasingly, poor air quality are driven by commercial interests. Interests that do not emphasize  health, and have worked consistently to promote their products at the expense of health.  

A few years ago, the World Bank asserted that we will never be able to “treat our way out” of the challenge of NCDs. The immense costs associated with this strategy simply exceed our resources.  

Based on its economic analysis, the World Bank urged prevention as the method that would deliver the greatest success, provided multiple sectors get involved in the effort.    

As the leader of three organizations involved in NCD reduction—the NCD Alliance, as well as the International Union Against Tuberculosis and Lung Disease, and Vital Strategies—I have seen first-hand the ways that prevention is the most powerful tool at our disposal—not just among public health professionals and their global network—but also among medical societies, healthcare organizations and the private sector.  

I know that by aligning our goals, we can reduce the burden of NCDs worldwide. A burden that claims the lives of more than 43 million people each year. A burden that amounts to more than 70 percent of deaths globally.  

Fortunately, we know what works when it comes to reducing NCDs.  

Tobacco Harms 

Tobacco use, as you know, is the number one cause of preventable death and disease worldwide, claiming six million lives each year. Secondhand smoke causes 600,000 deaths a year, and children are especially vulnerable to asthma and other respiratory problems from exposure to tobacco smoke.  

We even know that there is a correlation between tobacco use and tuberculosis. New research shows that children who live in households where adults smoke have a higher TB infection rate than children living in smoke-free homes.  

Sadly, two-thirds of those affected by tobacco use live in low- and middle-income countries.  

 Tobacco fixes 

With tobacco use, there is a clear path to prevention of NCDs. The Framework Convention on Tobacco Control—the world’s only international health treaty—should be the tool we use for reducing NCDs related to tobacco use. Implementing FCTC policies would greatly reduce illness and death. 

For example, national laws establishing smoke-free zones across all public and many private sector locations, including government and private office buildings, public parks, restaurants and bars along with the schools, hospitals and public transportation systems, should be established in all countries. We know that such laws—along with designated funding for smoke-free enforcement–drive smoking rates lower.  

Two additional measures lessen lives lost and families disrupted by tobacco use: bans on tobacco advertising and promotion and large graphic warning labels on tobacco packaging. 

The world’s largest tobacco companies use their vast wealth to recruit new smokers through appealing marketing—whether that is on television or billboards or via vibrant pack colors and logos. And I don’t need to tell you it is young smokers they are after. Young smokers are often not aware of the harms of long term tobacco use. Getting them hooked represents decades of profit to these big, multi-national companies. 

We must break the cycle of addiction and ill health wrought by the aggressive marketing of cigarettes worldwide. We must protect our children from big tobacco companies’ tactics.  

Graphic warning labels on cigarettes, snuff and other tobacco products are a proven measure to curb tobacco’s harms.  

Taxes on all tobacco products along with raising their prices are proven to bring even more strength to prevention of NCDs. A 10 percent increase in the price of tobacco products, for example, can reduce consumption by five percent.  

I can’t emphasize enough how important the FCTC’s tobacco control guidelines are for the reduction of NCDs.  

ALCOHOL, SSBs AND PFs HARMS 

While the harms of tobacco use are well-established, many people are less aware of the harms of excessive alcohol use, as well as harms associated with sugar-sweetened beverages and highly processed foods. But the health toll is staggering. 

Harmful alcohol use is responsible for 3.3 million deaths each year. And sugar-sweetened beverages and highly processed foods are literally making our world sick by dramatically increasing rates of obesity, type 2 diabetes, heart disease and cancer. While the United States leads the annual death toll worldwide from sugar-sweetened beverages, low- and middle-income countries are harder hit overall. Among young adults, 25 percent of all deaths are alcohol-related. 

It should come as no surprise that, like the tobacco industry, the alcohol, sugar-sweetened beverage and processed food industries practice aggressive marketing and promotion. This is particularly so among children and young adults.  

In many countries, alcoholic beverages with fruity- or candy-like tastes are designed to hook young consumers.  

Sugar-sweetened beverage companies approach schools to provide their product for free or price their products low enough to entice low- and middle-income families to become frequent consumers.  

 ALCOHOL, SSB FIXES 

We must work toward supporting health encouraging fresh foods and working across health sectors to ensure access to them. The medical community can play a strong role in prevention.  

Many of the FCTC guidelines for tobacco policy also serve as a strong model for reducing harms from excessive alcohol use, and the effects of overconsumption of sugar-sweetened beverages and highly processed foods.  

For example, taxes on alcohol and sugar-sweetened beverages would reduce consumption and encourage healthy alternatives. This would help drive the NCD rate down. 

Many countries and large cities around the world are moving toward taxes on sugar-sweetened beverages. In the United States, the Mayor of Philadelphia successfully brought a “soda tax” into effect earlier this year. And more and more cities see the benefit of taxes on sugary drinks. 

PHYSICAL INACTIVITY 

Like encouraging fresh, healthy foods, we must strive to raise awareness about the benefits of physical activity. Physical inactivity causes over 3 million deaths per year. In many parts of the world people would like to be active but there are environmental factors that discourage it. Especially in urban areas there can be violence, excessive traffic, poor air quality and a lack of parks, sidewalks and sports facilities.

Passive modes of transport are also associated with declining physical activity levels. Changes in infrastructure that support healthy behavior will be key to reducing NCDs related to physical inactivity.  

AIR QUALITY HARMS 

Air pollution is becoming an urgent threat to health. In September, the World Health Organization issued a new report revealing that the vast majority of people in the world—92 percent—live in unsafe air. And people living in low- and middle-income countries experience a higher burden of this pollution—particularly in the Western Pacific and Southeast Asia.  

Immediate action is necessary by national and international policymakers to reduce emissions in the transport, energy waste management, and agriculture sectors.  

HOW TO COLLABORATE ACROSS SECTORS 

I’ve described here some of the ways that we know we can reduce NCDs. But there is more to this effort. We can also deepen our public health impact by expanding our current ways of working. In other words, we can be more creative and collaborative in advancing improved public health. 

One of the ways that people here at the conference can reduce NCDs is by working together. Public health departments and civil society organizations must extend themselves beyond their traditional partnerships. Medical societies and healthcare organizations, for example, can be allies in advocating for changes in legislation, international health agendas, national and local health policies, and resource allocation. 

On another front, the health advocacy and legislative change process that traditionally included ministers of health can expand to include ministers of finance, or trade. We’ve seen this model work in the Philippines where they established a “sin tax” on tobacco and alcohol products that would never have happened without the involvement of the Ministry of Finance, along with the health ministry. Both ministries helped reform the tax code so that revenues could support increased access to healthcare among Philippine citizens, a public service that had been lacking.  

 NCDs severely under-resourced 

 The reality is that NCD prevention does make an enormous difference in human health and economic stability where it is put in to practice. But as you can see it is not funded to the extent that it can and should be. We must meet countries where they are with development aid for NCD prevention. The world’s 30 poorest countries, for example, simply don’t have the resources to prioritize NCDs. They will suffer needlessly if we do not give them special consideration until they have the means to give priority to NCDs.  

 How to fund NCD Prevention 

Today we have a model and a mandate for how to improve our funding of NCD work. The Addis Accord agreement brought 150 world leaders to the table in 2015 to decide on the way forward for sustainable development for all countries, including improving health and reducing NCDs.  

The agreement spelled out a four-prong approach involving development aid where it is needed, taxation—some of which I’ve spoken about here, of tobacco products, alcohol and sugary beverages—national and international finance reforms, and partnership with the private sector.  

Reducing NCDs benefits people and nations beyond improved health. The World Health Organization’s 2030 Agenda for Sustainable Development is a model for how our health goals are linked to other important outcomes for our future well-being. Research shows that improved health is linked to greater economic stability and a higher Gross Domestic Product. Improved health fundamentally reduces poverty. Poverty reduction promotes greater equality.  

In Africa, as I’m sure you know, they say: “If you want to go quickly, go alone; if you want to go far, go together.”  

The time has come for us to not only go far, but also to go as quickly as we can. The health and well-being of the world urgently depend upon it.  

As the leaders of the sectors that will make the greatest impact in global health we must act now, we must act swiftly, and most importantly, we must act together.