The numbers of children who go hungry every day are well known. Less well known—and perhaps even more alarming—are the numbers of those who suffer from obesity. According to the WHO’s “Global Strategy on Diet, Physical Activity and Health–Childhood Overweight and Obesity,” 42 million children under the age of five are obese or overweight, most of them in developing countries. Obese children suffer from breathing difficulties, are at increased risk of fractures, and display early signs of cardiovascular disease. They also experience hypertension and insulin resistance, and suffer from adverse psychological effects. Childhood obesity is also associated with obesity later in life, disability in adulthood, and premature death.
Alcoholism and smoking are two other risk factors for NCDs, and they, too, affect children. The American Journal of Psychiatry study, “Age at First Alcohol Use: A risk Factor for the Development of Alcohol Disorders,” found that in Canada, people who began drinking alcohol before they turned 15 were five times more likely to abuse it than those who started at age 19 or older. Similarly, the Campaign for Tobacco Free Kids’ “Smoking and Kids” study found that in the United States, an overwhelming majority of adult smokers take up the habit before the age of 18, and that about one third of them will eventually die from smoking. Overall, in 2008, NCDs (primarily cardiovascular diseases, cancers, chronic respiratory diseases and diabetes) killed three times more people under the age of 60 than HIV/AIDS at any age.
Given the global toll of NCDs, it is vital that that major risk factors be substantially reduced. Yet even as the global burden of disease shifts away from infectious diseases, NCD’s have been entirely ignored in the Millennium Development Goals. In fact, it was not until September 2011 that the United Nations General Assembly put NCDs on the agenda, demanding that the WHO set up specific targets and indicators.
Even with new high-level recognition of NCDs, the declaration adopted by the General Assembly last September failed to frame prevention and control of NCDs as a matter of human rights. Nor did it include deadlines or link commitments to legislative reform.
This oversight is at odds with the United Nations’ acknowledgement, from as far back as 1948, that governments have a primary role in addressing the determinants of health. In fact, Article 25 of the Universal Declaration of Human Rights enshrines each individual’s “right to a standard of living adequate for the health and well-being of himself and of his family, including food…” And Article 24 of the Convention on the Rights of the Child, which has been adopted by 193 countries, states it as a requirement of governments to fight disease and malnutrition by providing children with adequate nutritious food and clean drinking water.
Human rights are fast becoming the backbone of the international development agenda—a common goal, a working practice, and a lingua franca for sharing and coordinating visions and agendas. The language of human rights is increasingly spoken by governments, development agencies, foundations, and tens of thousands of civil society organizations. Time and again, we have seen the value of human rights. Ignore human rights and the rule of law, and there can be no just, long-term development. That is why the International Development Law Organization’s health law program seeks to embed human rights in all aspects of global policymaking. In our view, the lack of a human rights dimension in the NCD debate, as defined last September, constitutes a failure of vision, all the more so because a template for action already exists in HIV/AIDS programs.
The world’s long experience in tackling HIV/AIDS has highlighted the importance of a human rights-based approach to disease, both in substance and in process. From the moment it was created in 1996, the UN’s HIV/AIDS program, UNAIDS, adopted human rights and gender as cross-cutting themes. For a decade now the relevant monitoring framework has examined legislative and other measures to protect and promote HIV-related human rights in great detail. Civil society is consulted. Country reports are posted publicly on the UNAIDS website. In addition to encouraging good laws and policies, these measures promote accountability, participation and transparency.
It is imperative that the WHO’s monitoring framework for NCDs include indicators for government policies and legislation to prevent disease, such as marketing restrictions on foods and beverages high in salt, fats and sugar (especially in advertisements which target children), as well as food taxes and subsidies to promote healthy diets. It is far cheaper and more effective to use policies, laws and regulations to reduce risk factors for NCDs in children and adolescents than it is to treat diseases once they have taken hold.
None of this is to say that the task of taking on NCDs is an easy one. Tobacco, alcohol and processed food companies know that drinking, eating, and smoking habits which begin in childhood can last a lifetime. Global business empires are built on marketing unhealthy products to children and adolescents as both current and future consumers. Industry resistance to government regulation is substantial and far-reaching, so all governments will need superior legal capacity to fend off legal challenges in national courts and international forums.
Global solidarity should help. The evidence and arguments used in one setting can inform the response to similar challenges in other countries. A Crown Department of Health Report, “Changes in Food and Drink Advertising and Promotion to Children,” outlines the measures the United Kingdom has taken over the past five years to limit television advertising aimed at children which promote snacks and drinks high in sugar. Initiatives such as this one should be documented, evaluated and widely shared. Developing countries must also nurture future leaders in the field of public health law and rights, and take action to identify and address the social determinants of NCDs.
The broader and stronger the civil society demand for action against NCDs in children, the more likely the political will. For this demand to be heard, the right to protest, speak out and mobilize must be protected. In other words, respect for all rights underpins the right to a health. In tackling the challenge of NCDs, as in all other areas of public policy, human rights are universal and inalienable, indivisible, interdependent and interrelated.