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Waging war on disease

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SHAKE NO MORE: WHO wants countries to reduce average salt intake to less than five grams per day to prevent lifestyle diseases like high blood pressure

It is being called the biggest ever offensive against an umbrella of diseases that was behind 63 per cent of all deaths worldwide in 2008. For the first time, the World Health Assembly that kicks off on May 21 will see over 190 member countries, including India, join hands to put in place targets to be achieved by 2025 to help cut down mortality due to non-communicable diseases (NCDs) like cancer, cardiovascular diseases, diabetes and chronic lung diseases.
The last time nations across the world came together like this was in 2001 and the enemy then was the deadly HIV virus. NCDs have pushed aside infectious diseases to become the top cause of death worldwide. They killed more than 36 million people in 2008.

Experts say the five proposed targets to be floated by the World Health Organisation (WHO) next week will be revolutionary. They include reduction of mortality from cardiovascular disease, cancer, diabetes and chronic respiratory disease in people aged 30-70 years by 25 per cent, a 25 per cent reduction in prevalence of high blood pressure among adults, 30 per cent reduction in prevalence of current tobacco smoking among persons aged 15 years and above, 30 per cent reduction in mean salt intake with the aim of achieving the recommended level of less than five grams per day, and 10 per cent reduction in prevalence of insufficient physical activity.

Ann Keeling, chair of the NCD Alliance and CEO of the International Diabetes Federation says, "We particularly called for the adoption of an overarching goal to reduce preventable deaths from NCDs by 25 per cent by 2025. Eight months on from the UN Summit, there can be no excuse for the world's health ministers not to adopt at least this global goal, and support targets. "

In accordance with the Political Declaration agreed at the UN Summit, the WHO released a discussion paper in December 2011, in which 10 targets were presented. But following inputs from just 21 member states (when the UN has 194), the second paper, released in March, had reduced the targets to just five.

The dropped targets include one to reduce by 10 per cent the adult per capita consumption of alcohol. "If countries are serious about tackling the NCD crisis, they must be bold and commit to 10 targets, not five or fewer, " says Keeling.
In addition to these, the NCD Alliance is advocating another five goals - increased availability of affordable, quality-assured essential medicines, 80 per cent coverage of multidrug therapy for people aged 30-plus with a 10-year risk of heart attack, stroke or diabetes greater than 30 per cent or existing cardiovascular disease. They have also called for removal of industrially produced trans-fats from the food supply, a sustained downward trend in prevalence of obesity in below-5 s and school-aged children to less than 5 per cent of the population by 2025. Measurable targets are essential since, as WHO Director General Dr Margaret Chan says, 'What gets measured, gets done. '

The targets will be crucial for India, which is reeling under a burden of NCDs - 52 lakh people died of NCDs in 2008. The health ministry has allocated Rs 58, 072 crore for NCD control in the 12th five-year plan - a nearly 600 per cent increase from the previous plan. The programme to fight cancer will see the highest allocation - Rs 15, 885 crores - followed by diabetes, stroke, trauma, burn injuries and mental health, in that order.

More than 20 per cent of the Indian population has at least one chronic disease. Union health minister Ghulam Nabi Azad says reversing the NCD epidemic is not only the government's responsibility, but requires engagement from civil society, too. "We hope to achieve early diagnosis and treatment of over twothird of NCDs. With the cumulative increase in losses from premature deaths due to NCDs, India stands to lose $237 billion during the decade 2004-2015. "

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