How non-communicable diseases became the biggest threat to our health
Heart and circulatory diseases and cancer are now the most common causes of death. An expert from the World Health Organisation tells Sarah Brealey what this means for our health.
Today’s most serious epidemics aren’t cholera, flu or Ebola, but illnesses you can’t catch, including heart and circulatory disease, cancer, and chronic respiratory diseases.
These non-communicable diseases are increasingly prevalent, accounting for an estimated 86 per cent of deaths in the UK and around two-thirds of deaths worldwide. So I’m keen to ask Dr Gauden Galea, the World Health Organisation (WHO) Europe Director of Non-communicable Diseases, about the problems and possible solutions.
Dr Galea lists the major causes as smoking, drinking and obesity - the first being the biggest issue in western Europe, while drinking dominates in eastern Europe. In the UK, the biggest risk factors are poor diet, smoking, obesity and high blood pressure
The consequences of obesity
Being overweight or obese is becoming the norm in Europe – in all but five of 53 countries, at least half the adult population is overweight or obese. The WHO has a programme studying childhood obesity across Europe, which is yielding worrying findings among children aged six to nine.
“Even with young primary-school children we find levels of overweight and obese children which can reach 40 or 50 per cent,” says Dr Galea. “While adults are already overweight or obese, the next generation is looking equally so or worse.
“The best we can hope is that we see this slow down or stop rising. But in Europe, the rise in childhood obesity means that this is unlikely to happen.”
The consequences are likely to be a rise in deaths from heart and circulatory disease; obesity has been proven to increase risk. It is also linked to type 2 diabetes, a further risk factor for heart and circulatory disease.
The WHO has been organising policy conferences, producing guidance and urging European governments to take action. It is currently drawing up a five-year strategy on non-communicable diseases. Dr Galea and his colleagues also meet with politicians and policymakers in individual countries, giving them information and advice on promising strategies.
Globally, the WHO Commission on Ending Childhood Obesity has just produced a major report outlining the best strategies to decrease childhood obesity. One of the commission members is British athlete Paula Radcliffe, who has shared insight on physical activity.
Research funded by the BHF has helped contribute to our understanding of risk factors. For example, we’ve funded several large studies showing how weight and body shape affect disease risk.
The BHF Centre on Population Approaches for Non-Communicable Disease Prevention specialises in research to prevent diseases such as coronary heart disease.
Protecting people from unhealthy products
Most governments, says Dr Galea, will tell their populations about the risks of alcohol, smoking or unhealthy diet, but restricting the availability of unhealthy products is not yet the norm.
“Food labelling with nutrient information is common, but food labelling with traffic light systems where you’re signposting the healthiness or otherwise of a product is much less common in Europe,” says Dr Galea. “Price policies are much rarer and are the exception rather than the rule. There is a lot of work to be done.”
You might think this sounds like the ‘nanny state’ and that people should make their own choices. But are these free choices?
“It’s a personal choice at some level, but there is a huge amount of evidence that the environment we live in reflects directly on the behaviours we choose,” says Dr Galea. “We need to make healthy choices the easy choices.”
If you want to make money in the food industry you package a combination of sugar, salt and fat
In his view, controlling unhealthy products by regulating their price, availability or advertising is about “making it easier for people to be protected from the influence of marketing and giving them the information to weigh against it.”
Some people may see such government measures as the ‘nanny state’ in action, but Dr Galea doesn’t think so. “The evidence is clear that action on marketing and price and availability is most effective,” he says. “It is also often resisted by industry.”
Dr Galea is sceptical about the instruction to ‘drink responsibly’, often seen in alcohol advertising. “This is subtly shifting the blame, by suggesting that the harm that comes from alcohol is the fault of the consumer and not the product or the industry,” he says.
Nor does he mince his words about the food industry. “If you want to make money in the food industry you package a combination of sugar, salt and fat,” he says. “The sugar gives you the buzz, the salt gives added zestiness, the fat gives you the mouth feel (and I am using industry terms here). You take cheap raw materials, you package them nicely, you put them in shops – often in the eyeline of children – and you create people who are almost addicted to these foods.
“Those kinds of product formulations and their marketing are among the reasons for the rise in obesity in children. It is not just a case of saying that the children are greedy or that the parents should be more responsible. These are changes we are seeing on a population level, influenced by the work of the food industry.”
He believes governments should be transparent in their dealings with industry, particularly the tobacco, alcohol, food, drink and pharmaceutical industries, and that non-governmental organisations, like the BHF, have a role in encouraging this.
“When we have a climate in Europe that sees economic growth and recovery as being the overriding priority, it becomes difficult for public health concerns to have the same sort of impact that industry can,” says Dr Galea.
“But one of the roles we share with the BHF is in looking critically at the role of industry as a cause of problems, as well as solutions. We must be vigilant, use the evidence, and not be afraid to intervene.”
Working to tackle cardiovascular disease
For the most part, Dr Galea says, the WHO tries to “take an integrated approach” to diseases like heart and circulatory disease, cancer and diabetes. As they share many of the same risk factors, it makes sense “to work in as broad a way as possible. Otherwise you can easily fragment your resources into many little operations that become ineffective.”
But there is an exception. Over the past year, the WHO has been looking at how cardiovascular risk is assessed and managed in its European region, at primary-care level, by GPs and practice nurses.
This is because heart and circulatory disease is the biggest contributor to the life-expectancy gap between east and west; people born in eastern Europe are almost five times more likely to die young due to a heart attack or stroke than those born in western Europe.
As part of this, the WHO has been working with countries in central Asia to promote the kind of assessments and interventions that are already standard practice in western Europe, including in the UK.
The UK and other western European countries are currently leading the way in good practice
In November 2015, experts, policymakers, patient associations and other organisations, including the BHF, met for the WHO/Europe International Conference on Cardiovascular Diseases.
The conference – where our Chief Executive, Simon Gillespie, spoke on behalf of the European Heart Network – looked at how to improve the assessment and management of cardiovascular risk, and outcomes and aftercare for people who’ve had a heart attack or stroke.
The UK and other western European countries are currently leading the way in good practice, says Dr Galea, through things like cardiovascular risk assessments (NHS Health Checks), statins and blood pressure management for people considered at risk, and two-hour targets for emergency heart attack treatment.
“If you look at EU member states, the UK among them, you can see a slow but steady decline in mortality from cardiovascular disease, which is a heartening picture,” he says.
So if you’re offered statins or advice on reducing your high blood pressure, consider that measures like these (alongside lifestyle changes like reducing smoking and drinking) are helping us live longer. As Dr Galea says: “It certainly could be an example for other countries.”
The BHF on the world stage
The BHF supports the WHO, particularly through our Centre on Population Approaches for Non-Communicable Disease Prevention in Oxford, which is one of the WHO’s Collaborating Centres.
This means it provides advice and insight for the WHO, for example by giving statistical analysis, producing guidelines and developing new ways to assess the impact of prevention programmes.
The BHF also plays an active role in the European Heart Network (EHN) – a group of members from 24 countries, working to combat cardiovascular disease in Europe. Our Chief Executive, Simon Gillespie, is the EHN President.
CV Dr Gauden Galea
- The WHO Europe Director of the Division of Noncommunicable Diseases and Promoting Health through the Life-course
- Public health doctor
- Worked for the WHO since 1998
- Special interests in health promotion, the social determinants of noncommunicable diseases, and the links between these diseases and the global development agenda