Iain Scott | May 10th 2012 | @Healthcare
Kofi Annan, the former United Nations secretary-general, has been busy lately, attempting the enormous task of brokering a peace plan in Syria. But at a forum in Copenhagen earlier this month he sounded positively warlike.
The adversary Mr Annan described at the forum is diabetes, a disease whose growth has been so rapid that it is now often referred to as an epidemic—and not just in rich countries. If its growth continues at current rate, diabetes could reverse the social and economic gains made by many emerging economies over the past decade, decimating workforces and pushing people into poverty.
Our best weapon in the fight against diabetes, Mr Annan said, is a "relentless" focus on prevention—making sure people do not develop the disease in the first place. But while prevention may be better than cure, it is not so easy to get it to work.
Wide-scale preventive strategies against diabetes range from mass media marketing tools urging us to eat better and exercise, to much more complex interventions such as ensuring that visits to the doctor also include a consultation with a dietician and counsellor. In most cases they represent a long-term investment—and a substantial one. As Michele Cecchini, a health policy analyst at the OECD, told the Copenhagen forum, the approach that works best is a comprehensive one combining both population and individual; approaches. In some cases, he pointed out, the cost of implementation can surpass the cost of treatment. "Expectations of prevention need to be realistic," he said—they don't always work, and they can be costly.
The latest preventive strategy undertaken by the Danish government, under whose auspices the forum was conducted, is to raise taxes on the main sources of saturated fat—meat, dairy products, animal fats, edible oils, margarine and so on—which contribute to obesity, diabetes and cardiovascular diseases. The new taxes are expected to contribute more than £150m to Danish coffers each year, making up for a decline in income tax revenue.
This approach has pros and cons. Data for tobacco and alcohol show that there is evidence for correlation between the price of goods and their consumption. But what happens when revenues from taxation begin to decline as citizens' diets improve and they consume fewer and fewer fatty foods? In any case, the Danish example (and similar experiments in Hungary, Austria and a few countries) is unlikely to be workable in the rest of the world, where citizens are less comfortable with high taxes.
Policymakers elsewhere have different problems when it comes to implementing preventive strategies. A vicious face-off has escalated from the Australian government's attempt to force tobacco companies to make all their packaging a uniform, dull khaki, emblazoned with warnings and graphic images and with the brand name writ small in a plain, universal typeface. In most of the developed world, packaging has been tobacco companies' last avenue for distinguishing their brands from competitors, and they have reacted furiously. Ukraine, a tobacco producer, sued Australia for violation of trade laws. Canada, Brazil and the EU have also signed up to the legal complaints.
That cigarettes cause cancer, or that overconsumption of fatty food is a frequent cause of obesity and diabetes, is not disputed. But clearly governments should avoid embroiling themselves in the sort of situation in which Australia finds itself. If things turn out badly for the Australian government, others will certainly be put off from attempting to curb the influence of the tobacco industry. What they ought to be looking for—again, as urged by Mr Annan—is the creation of effective partnerships between stakeholders to address citizens' health but share costs and risks.
It is increasingly clear that the best argument for implementing a health policy is an economic one. It is also increasingly clear that many of the best strategies for keeping people healthy are by no means the preserve of health ministries at all—access to education and employment, for example, is as important to a citizen's health as a good local doctor. Finding ways to think and act across sectors will be essential if diseases such as diabetes are to be tamed.