When it was launched by the World Health Assembly in 2008, the six-year action plan for a global strategy to prevent and control non-communicable diseases brought attention to the heavy burden they impose on all countries. This is a development issue of such importance that the United Nations General Assembly is scheduled to hold a high-level meeting on it in 2011. Cardiovascular diseases, cancer, diabetes, and chronic respiratory conditions kill a large number of people every year and cost economies dear. They are often both the cause and result of poverty. A higher number of premature deaths (below the age of 60) from preventable non-communicable diseases occurs in the lower-middle income and low-income countries. The persistence of this trend, in spite of the World Health Organisation setting targets to reduce mortality, should occasion a review of public health policy by high-burden countries. The problem of chronic diseases has been aggravated by the global economic downturn during the past couple of years. Higher food prices have affected nutrition levels, and some of the gains made over the years in improving health equity have been eroded. Political leaders must recognise this and make far-sighted investments for prevention and control.

All countries waging a campaign against chronic diseases must show greater political commitment. Unlike communicable diseases such as HIV/AIDS, which enjoy high visibility and policy support, diabetes, hypertension, and other non-communicable diseases are often explained away as effects of personal choices. This approach is clearly wrong and it reduces the importance of policy impacts on health. For regulation and taxation of tobacco and alcohol, labelling of food, and urban development norms, to name a few areas, all influence population-level health. Unfortunately, governments adopt short-sighted policies to maximise revenue from sale of alcohol, the harmful use of which is linked to disease. Their hesitation to highlight the dangers of tobacco through stark pictorial warnings on packaging is deplorable. Further, urbanisation in fast-growing countries has had negative effects for health. Although WHO advocates safe, active commuting, walking and opportunities for recreation, urban development policies continue to give priority to motorisation and road building. India suffers from the same malaise. It is time to make a decisive shift. The causes of disease are clear and they must be addressed with urgency. A political consensus to deal with the ‘big four' — tobacco use, unhealthy diet, harmful alcohol consumption, and physical inactivity — through policy is the vital first step.

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