Small Steps Can Save Millions of Lives

More people now die from noncommunicable diseases than from causes like malaria and polio. Policy makers need to catch up.

Celebrating World No-Tobacco Day in China.

Photograph: STR/AFP/Getty Images

The following is an adaptation of an annual letter about philanthropy.

For the first time in human history, more people around the world are dying from noncommunicable diseases, such as heart disease and cancer, than communicable ones, such as malaria and polio. This change occurred in higher-income countries at some point in the middle of the last century. In lower-income countries, the shift is just a few years old.

The way we think about mortality, however, has not kept up with this new reality. We tend to accept these deaths as unavoidable. They’re not. Changing this false perception is critically important to saving millions of lives across the globe.

Every year, noncommunicable diseases (NCDs) kill nearly 40 million people. Seventeen million of those deaths occur before the age of 70. In fact, seven in ten of all deaths each year are the result of noncommunicable diseases, which also include strokes, diabetes and chronic respiratory diseases. Add in injuries, and the total represents more than three-quarters of all deaths annually. Many of these are preventable, but the world’s governments -- including the U.S. -- have not made stopping them a priority.

This problem is especially acute in low- and middle-income countries. As shown in the chart below, only 1 percent of global health funding is aimed at preventing noncommunicable diseases in these countries, even though they make up 67 percent of deaths.

One reason for the lack of attention given to NCDs and injuries is that we tend to blame victims’ personal negligence or genetics. It’s true that our behavioral choices often lead to disease and injury and that genetics can predispose us to certain conditions. But that doesn’t mean such outcomes are inevitable. Far from it.

In fact, we know that with modest actions, governments can reduce the likelihood that their citizens will fall victim to nearly every category of disease and injury. This is why Bloomberg Philanthropies concentrates its resources on cities -- because local officials are in the best position to tackle our greatest challenges. It’s also why, as part of my role as the World Health Organization’s Global Ambassador for Noncommunicable Diseases, we have started a new global network of cities, called The Partnership for Healthy Cities, to put in place policies to prevent deaths caused by NCDs and injuries.

Here are some of the areas where relatively small steps can save an enormous number of lives.

Follow the Data  

Nearly two-thirds of all deaths in the world go unreported -- and millions that are reported lack a documented cause of death. How are elected officials and health-care leaders to target their resources on the leading causes of death without good data on what those causes are, or whether their interventions are working?

The truth is, if you can’t measure it, you can’t manage it. That is why we started our Data for Health program, co-funded by the Australian government. Data for Health is working with 19 countries, representing more than a billion people, to close the data gap on births and deaths. It’s our hope that the lessons we learn about collecting data will spread around the world and help governments better understand how to save more lives.

Tobacco Control

The tobacco industry spent decades misleading the public about the dangers of smoking and fighting efforts to reduce it. When we proposed an indoor smoking ban in New York City, the industry went full tilt to defeat it. They lost; the ban proved highly effective and popular; and cities, states and countries around the world have since adopted similar bans. Whether it’s smoking bans, tobacco taxes or regulations on packaging, the industry continues to fight any effort by governments to adopt policies that are proven to reduce the use of their product.

One in ten deaths around the world is caused by smoking. Most occur in developing and middle-income countries where tobacco companies have shifted their marketing, lobbying and legal efforts. With smoking on the decline in the U.S. and much of Europe, the industry is targeting the poor and using its deep pockets to bully governments from enacting life-saving public-health measures.

We’re helping these governments stand up for their people through the Anti-Tobacco Trade Litigation Fund, which we created with the Gates Foundation. The fund supports governments such as Uruguay, which last year fended off a tobacco-industry lawsuit arguing that its graphic package warnings ran afoul of international trade laws. The case was dismissed in 2016 by a World Bank tribunal, handing Uruguay a major victory and establishing a critical precedent.

Elsewhere, Romania passed a comprehensive tobacco control law; Shanghai and Shenzhen put in place comprehensive smoke-free laws; the Philippines and Bangladesh began displaying new graphic tobacco package warnings; and Colombia and Ukraine both raised tobacco taxes. It was not a good year for the tobacco industry.

We have committed almost $1 billion to our tobacco-control program and helped save 30 million lives. When we started in 2007, 11 countries had gone smoke-free. Today, the number stands at more than 50, covering nearly 1.5 billion people.

Obesity Prevention 

A common reaction to public health interventions aimed at combating obesity is that government shouldn’t be involved and that people should be allowed to make their own choices -- and if they become obese and develop a disease as a result, that’s their fault. Leaving aside the fact that taxpayers bear a large burden for these illnesses, I’ve always believed that a critical role of government is to help protect people from harm. That’s why we have laws requiring seat-belt use.

People also have misconceptions about what causes obesity. They tend to think it’s primarily an issue of laziness -- a lack of exercise. But that’s not true. The main culprit is diet. And the single biggest contributor to the problem is soda and other sugar-sweetened beverages, because they contain a lot of calories but consuming them doesn’t reduce appetite.

As awareness of the danger has spread, countries and cities have begun taking action. Two years ago, no municipalities had sugary-beverage taxes. Now, seven cities and counties do, representing more than 8 million residents. Last year, four large U.S. cities -- Chicago, Philadelphia, San Francisco and Oakland -- passed taxes on sugar-sweetened beverages. More cities are likely to follow as the evidence in favor of the tax becomes increasingly irrefutable. A recent study of Mexico’s sugar-sweetened beverage tax found that purchases of taxed beverages have declined by nearly 10 percent.

Road Safety

Vehicle crashes kill 1.3 million people each year and injure up to 50 million more. Crashes are the 10th leading cause of death in the world, and the No. 1 cause of death for people aged 15 to 29. Once again, low- and middle-income countries suffer the most. Even though these countries have only half the world’s cars, they account for 90 percent of all road deaths.

One reason is that roads, walkways and other infrastructure aren’t designed for safety. We are working with governments and transportation experts to change that. Unsafe vehicles are also an important cause of crash deaths. In the U.S. and Europe, basic safety protections such as air bags and electronic stability control are required by law. But in much of the rest of the world they are not, allowing automakers to sell cars that are virtual death traps. More than a century after Henry Ford began mass-producing cars, 80 percent of countries do not regulate vehicle safety.

In low- and middle-income countries, automakers -- including U.S. and European manufacturers -- routinely sell cars and other vehicles without many of the basic protections that are standard here at home. The result: People are being killed in crashes that they would have likely survived in the U.S. or Europe.

This is especially disturbing because it costs so little to make cars safer -- usually just a few hundred dollars.

Our road-safety program is working with consumer groups and governments to change this. We have funded vehicle testing in Latin America, India and Southeast Asia, and the results have been publicly released so that consumers can make informed decisions. We have also begun conversations with manufacturers to convince them to meet U.N. safety standards in every country, but we know that voluntary compliance is not enough. More governments must establish safety standards, and we have begun working with partners in countries to encourage them to take action.

In each of these areas, the return on investment will be enormous, because many of the best solutions require relatively small sums -- often to support grassroots organizing and advocacy campaigns. And even better, many require no money at all -- just for government leaders to change their mindset.

    To contact the editor responsible for this story:
    David Shipley at

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