Monday, February 13, 2012

[EQ] Ethical tensions in dealing with noncommunicable diseases globally

Ethical tensions in dealing with noncommunicable diseases globally

Sridhar Venkatapuram a Martin McKee a & David Stuckler b

a London School of Hygiene and Tropical Medicine, London, England.

b Department of Sociology, University of Cambridge, England.

Bulletin of the World Health Organization
Online First -Published online: 3 February 2012

Available online at:

“…..Noncommunicable diseases pose an increasingly high burden of disease that threatens economic and social development, yet cost-effective health interventions exist. World leaders recognized the compelling case for action with the declaration at the United Nations high-level meeting on noncommunicable diseases in September 2011.1,2

Since that meeting, the World Health Organization (WHO) has been developing a Global Monitoring Framework and the United Nations Secretary-General is preparing to report to the 67th session of the General Assembly in September 2012 on ways to tackle noncommunicable diseases across different sectors.

This paper aims to inform these debates by reviewing the declarations that resulted from WHO regional meetings held in preparation for last September’s high-level meeting (Table 1). We identified four “ethical tensions” that must be resolved. These tensions are not exhaustive or mutually exclusive but provide a framework for debate.

Human rights approaches
‘…Effective action on noncommunicable diseases involves addressing multiple human rights, such as the right to information to make informed choices about diet and activity (e.g. food labels that people can understand), the right to bodily integrity (e.g. freedom from exposure to second-hand smoke); and the right to health (including access to essential medicines). These human rights may conflict with corporate rights, such as the right of pharmaceutical companies to exploit patents or express freedom of speech (through marketing)….”

Social determinants

“….Political leaders face difficult decisions about where to invest resources along the causal chain of disease. They must care for those already ill but also tackle the underlying causes of the diseases….”


“…Governments must balance the needs of their own citizens with their obligations to provide aid to other countries. There is a glaring global inequality in the burden of noncommunicable diseases and in the domestic resources available to address them….”

Which diseases?

“….All governments must set priorities for action, such as whether to focus on interventions for those people in most need, those who would benefit most or on actions that would benefit the most people. The high-level meeting initially prioritized four diseases (cardiovascular disease, cancer, chronic lung diseases and diabetes) with high mortality burdens and four risk factors (tobacco use, poor diet, harmful use of alcohol and physical inactivity)…..”



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