Sustainable Development
and NCDs
George Alleyne
April 18, 2012
Pan American Health Organization
Presentation
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Concept of sustainable development
Sustainable Human Development (SHD)
What makes it sustainable?
The place of health
SHD and NCDs
NCDs in LAC
NCDs in Rio+ 20
Conclusions
Rachel Carson 1907-1964
Only within the moment of time represented by the present century
has one species -- man -- acquired significant power to alter the nature
of his world ( The Silent Spring, 1962)
Gro Harlem Brundtland
“Our Common Future”
The World Commission on Environment and Development
(1987)
Sustainable development: “ Development that meets the
needs of the present without compromising the ability of
future generations to meet their own needs”
Sustainable development
Our Common Future
“ The concept of sustainable
development does imply limits –not
absolute limits, but limitations imposed
on environmental resources and by the
ability of the biosphere to absorb the
effects of human activities”
Rio-UNCED 1992
“The spirit of the conference was
captured by the expression "Harmony
with Nature", brought into the fore with
the first principle of the Rio
Declaration: "Human beings are at the
centre of concerns for sustainable
development. They are entitled to a
healthy and productive life in harmony
with nature".
Johannesburg 2002
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The Johannesburg Declaration created
“a collective responsibility to advance
and strengthen the interdependent and
mutually
reinforcing
pillars
of
sustainable
development—economic
development, social development and
environmental protection—at local,
national, regional and global levels.”
Of what? Of whom?
Answer to the unanswered
Thequestion
anthropocentric
Development of what?
Development of whom?
view
“Development has a face, and
that face is the face of man”
Dr. Eric Williams (1973)
PM Trinidad and Tobago
Other graphical representations
Human
development
Social
Economic
Environment
Current basic concepts
Sustainable development is NOT
only about the environmentpreservation of natural resources
 The definition characterizes
sustainability and NOT development
 We must characterize development
as Human Development
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Mahbub Ul Haq
“Human development is a process of enlarging
people’s choices. The most critical ones
are to lead a long and healthy life, to be educated
and to enjoy a decent standard of living.”
Development can be seen, it is argued here, as a process
of expanding the real freedoms that people enjoy
Capabilities-what are persons able to be and do-their
substantial freedoms
The most important things in
life. (% responses)
Male
Female Total
Good health
42
40
44
Happy family life
36
40
38
Employment
30
27
27
Live in a country 14
without war
19
17
Source: Millennium Gallup Poll 1999
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Health is an end of Human Development
Health is an instrument of Human Development
Health is one component of the social strand
( health, education, political freedom etc)
NCDs can make human development
unsustainable through negative impact on
health as well as on the three strands of the
helix
Therefore: the control and prevention of NCDs
must figure in any goal for sustainable human
development
NCDs on sustainability strands
NCDs
Social
Economic
Environment
Note also the reverse causality
Impact on social strand
Equity
unfair distribution of life chances-inequity
disproportionate impact on the poor
 Social cohesion
stigma and discrimination-esp. cancer and
diabetes
chronic care –social fraction
 Gender
early male death-widowhood and poverty
 Education
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Impact on economic strand
Effect on macroeconomy
eg 37 $trillion dollars over next 2
decades( Bloom) impact on GDP
 Effect on microeconomy
poverty and preventing escape from
poverty trap
 Fiscal consequences
Increased government expenditure in
care, pensions etc; reduced
government revenue
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Impact on environmental strand
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Difficult ? Impossible to show any direct
impact of NCDs on the environment.
However, it is possible to show impact of the
NCD risk factors on the environment e.g
-Tobacco production and climate change
-Food production and climate change.
(livestock production responsible for 18%
global GHG-more than transportation )
NCDs in the Americas
Total NCD Deaths 2009: 4.5 Million
Source PAHO
In most countries of LAC
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Almost half of those with diabetes and one third
of those with hypertension are undiagnosed
More than half of those with diagnosed diabetes
and one fourth of those with diagnosed
hypertension are uncontrolled
Almost one third of those with diagnosed
diabetes and half of those with diagnosed
hypertension do not take appropriate
medication
Source: PAHO, population based surveys of NCD and risk factors
Strategies to address NCDs
Population based
interventions;
Primary prevention
Clinical interventions
Secondary prevention
Individual
NCD
Healthy
Society/environment
United Nations A/66/L.1
General Assembly
Political Declaration of the
High-level Meeting of the
General Assembly on the
Prevention and Control of
Non-communicable Diseases
82 Countries
35 Heads of State
Civil Society +++
Private Sector
UN Agencies
September 19-20, 2011
The Political Declaration
Commitments:
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Reduce risk factors
Strengthen policies and health systems
International cooperation
Partnerships
Research and development
Monitoring and evaluation
Follow-up
Earth Summit 2012
Objectives
Themes
“Wish list” for Rio+ 20
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Acknowledge NCDs as an “emerging
challenge”
Recognize the outcome of the New
York UN HLM as one component for the
objectives of Rio + 20
Incorporation into the Declaration the
essentials of the commitments made in
the UNHLM for NCDs
Conclusions
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Our concern is sustainable human development
Health is an end as well as a means towards
SHD
Human development is made sustainable by a
helix of three strands-social, economic,
environmental
NCDS impact adversely directly or indirectly on
the three strands making HD unsustainable.
Thus the case for NCDs prevention and control
figuring in sustainable human development