The WHO has just published Invisible numbers: The true extent of noncommunicable diseases and what to do about them.
I’m not sure where the WHO gets the idea that the statistics on death and disease from cardiovascular and respiratory diseases and cancer are ‘invisible’. There is a wealth of data out there from national and international public health, medical and academic sources, including the Global Burden of Disease annual reports and the WHO’s own International Agency for Research on Cancer.
So, not invisible, but certainly worth highlighting again. And the figures make sober reading. The four major noncommunicable diseases (NCDs) are cardiovascular diseases (heart disease and stroke), cancer, diabetes, and chronic respiratory diseases. Over three-quarters of all deaths worldwide are caused by NCDs. Seventeen million people die from an NCD before the age of 70. The key risk factors are listed as tobacco use, harmful use of alcohol, diet, and lack of physical activity linked to obesity. And as with most global metrics of poor health, 86% of NCD deaths occur in lower- and middle-income countries (LMICs).
The whole thrust of the report is to restate the importance of achieving a 33% reduction in NCDs by 2030 in line with the Sustainable Development Goals. Without naming them, the WHO states that in 2022, “only a handful of countries” are on track to meet this target. Hard to imagine that the situation will improve much in the next eight years given the current state of the world economy and the health fall-out from the growing devastation caused by climate change.
In reality, the WHO can do little except to exhort individual governments to do more – invest in health care provision, restrict advertising on junk food, tobacco and alcohol, encourage people to do more exercise, and push for a collective investment of $140bn US to make a difference. But will it?
Take the idea of more physical exercise. Only the richest countries can afford to host an Olympic Games. Host cities spent millions and put themselves in debt on the legacy promise of shiny new sport facilities for local communities. Measurable impact on increased take-up of daily exercise as a result – zero. New stadiums fall into disrepair, while, for example, local authorities in England have been selling off school playing fields for housing development. At the other extreme, I can’t imagine that young people in the poorest countries walking miles to school or parents taking daily long hikes for fresh water need more exercise.
The impact of poor diet is not just junk food (which is causing a rise in cancers among younger age groups) – but no food. The war in Ukraine has shown how fragile the world’s food supply chain is.
The report majors on aspirations like ‘Leading from the top’; ‘Set the right priorities’; and ‘Choose the right policies and interventions’. Maybe those in charge of WHO tobacco control policies need to ponder on these, because currently they are failing in all respects to offer real leadership in tackling death and disease from smoking.
Let’s go back to the list of WHO key risk factors – tobacco and harmful use of alcohol. What’s the message here? Agreed that moderate use of alcohol is not harmful (but only in respect of NCDs with no reference to the damage caused by drunk driving, domestic violence and public disorder).
What about tobacco? There may be no safe moderate use of combustible tobacco, but the WHO knows full well, the welter of independent evidence shows that whether as tobacco or nicotine, the use of vaping, heated tobacco products, safer oral products such as snus or
nicotine pouches carries none of the attendant NCD risks of smoking.
The WHO clouds the issue when it states that tobacco is the leading cause of preventable NCD deaths. It is smoking, which causes virtually all the 8 million tobacco-related deaths each year. The WHO response is to trumpet the fact that some five billion people are ‘protected’ from smoking as recorded by its MPOWER evaluation tool. It is delusional to imagine that smoking bans, plain packaging and warning labels ‘protects’ anybody. High tax may have some impact in reducing prevalence, but this just hits the poorest people who are likely to turn to readily available illicit supplies. These are just laws on the statute book which in many countries are simply unenforceable.
If the WHO was serious about tackling this most damaging source of NCD, it would be taking proactive steps to encourage countries to introduce risk proportionate legislation to promote uptake of safer products. If countries made products accessible through legislation, then the industry – big or small – could be left to determine which products were appropriate and acceptable for different countries and price them accordingly. And all at no cost to governments, many of whom in LMICs have enough health problems to worry about as the WHO report points out.
However, the WHO ignores all the evidence that could help spark a revolution in public health, instead focusing on an ideological war against nicotine funded by Bloomberg Philanthropies whose CEO makes this pronouncement in the report:
“Bloomberg Philanthropies will continue expanding our efforts to help more cities and countries take actions that will stop preventable deaths, and ensure longer, healthier and happier lives for all.”
For those millions looking to switch from smoking but unable to access or afford safer products, this must read like a sick joke with an emphasis on sick.
Huge disruption has been caused by the evidence that non-combustible vaping and heated tobacco products and Swedish-style snus can have a game-changing impact on reducing death and disease from smoking. The advent of these products has disrupted industry thinking while governments have been trying to play catch-up with often knee-jerk and harmful revisions to tobacco control policies. But the disruption has been most keenly felt within the global public health community.
As part of my preparation work for the next Global State of Tobacco Harm Reduction report, which is due out in November, I was reading Professor Virginia Berridge’s book Demons: Our Changing Attitudes to Alcohol, Tobacco and Drugs, published in 2013. I was surprised to read that back in the 1970s, the anti-smoking warriors objected to medical help for people who wanted to stop smoking.
In a previous blog, I described a particularly absurd situation regarding tobacco control paranoia about the industry. An anti-smoking NGO operating in Southeast Asia announced an anti-smoking poster competition for young people. Buried in the terms and conditions of entry was the stipulation that entrants could not have any connection with the industry to the ‘fourth level of consanguinity’. In other words, teenagers were barred if their great-great grandfathers had any industry connections.
Globally most smokers know or at least have a strong inkling their habit is bad idea. They may have lost family and friends to cancer or some form of lung disease. They themselves may now be easily out of breath where once they were active sportspeople. They tell researchers they want to quit. But millions don’t. Why?
Traditionally, tobacco regulation has majored on controlling access to cigarettes through taxation, advertising bans and packet warnings, bans on public smoking and youth access and all the panoply of regulation to reduce the death and disease toll from the most dangerous way of consuming nicotine.
We are now used to hearing experts of all disciplines, from virologists to behavioural psychologists, interviewed in the media about COVID-19. There is general agreement on personal safety measures like social distancing and hand-washing. But even at this basic level, questions arise. As it becomes clear that the virus can be carried in airborne droplets, should the recommended distance in the UK remain at 2 metres rather than I metre plus or even 3 metres?
This blog is inspired listening to Mark Carney, former Director of the Bank of England give the BBC 2020 Reith Lecture named after John Reith, the first Director-General of the BBC.
Carney’s theme was how moral values have morphed into market values, a way of economic and financial thinking which ultimately led to the financial crash of 2008. Years of uninterrupted economic growth led bankers to believe they were masters of the universe, that markets were always right. Unlike say teachers and farmers who can directly see the impact of their work through the development of children and the growth of crops respectively, those in the financial world became entirely disconnected from the communities, small businesses, and families they ultimately served. They became fixated on the numbers appearing on their screens, it was all about ‘we win, you lose’ in the financial game. Such tunnel vision corroded any notion of trading ethics.
COVID has accelerated the speed of fake news around the world much to the delight of the dangerous and delusional. In such times, the lay person could be forgiven for thinking that when the media cite ‘peer-reviewed’ papers, the publishing journals in which they appear would be an oasis of unbiased evidence and probity. The expectation is that the editors would have sufficient gravitas to weed out those papers which should never see the light of day. If only.
Richard Smith is the former editor of the British Medical Journal. On leaving his post, he wrote a refreshingly honest book entitled, The trouble with medical journals. Commenting on the quality of much research that manages to get into print, often after multiple rejections. he quoted Drummond Rennie, deputy editor of the Journal of the American Medical Association who observed,
As we have seen with the Trump playbook, seeding the media with conspiracy theories is the last gasp of the desperate and deluded. This is a favoured tactic of all anti-tobacco harm reduction organisations: anybody supporting THR must, by definition, be in the pocket of Big Tobacco and/or be a part of a ‘front organisation’.
A front organisation is a body set up by and controlled by another organisation. Front organisations can act for the parent group without the actions being attributed to the parent group, thereby allowing them to hide from public view. The intelligence services and groups like Scientology have a long track record of setting up front organisations – these organisations appear to be independent and make no mention of the parent body, yet they are entirely controlled by the parent, often with members or former members of the funding/parent body on the board. By implication, front organisations are dark and sinister bodies, whose activities can sometimes sail close to the borders of legality.
Fans of the rock band Queen will instantly recognise this blog title as the title of their 1974 album. Fear not though; what follows is not an attempt to link rock ‘n’ roll with the development of tobacco harm reduction. Instead it is a rather neat (or clumsy, depending on your view) way of exposing yet another increasingly tiresome example of how international scientific and medical organisations put the lives of millions of smokers at risk, by continuing to peddle fabrications about the ‘dangers’ of safer nicotine products.