How America’s War on Poverty is changing

January 9, 2014

Is ‘The Field’ an outdated and reactionary concept?

January 9, 2014

Obesity, Diabetes, Cancer: welcome to a new generation of ‘development issues’

January 9, 2014
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I failed miserably to stop myself browsing my various feeds over the Christmas break (New Year’s resolution: ‘browse less, produce more’ – destined for failure). One theme that emerged was the rise of the ‘North in the South’ on health – what I call Cinderella Issues. Things like road traffic accidents, the illegal drug trade, smoking or alcohol that do huge (and growing) damage in developing countries, but are relegated to the margins of the development debate. If my New Year reading is anything to go by, that won’t last for long.

ODI kicked off with Future Diets, an excellent report on obesity by Sharada Keats and Steve Wiggins. Its top killer fact was that the number ofODI FuturedietsObesityisgrowinginthedevelopingworld_52c57b6297319_w1500obese/overweight people in developing countries (904 million) has more than tripled since 1980 and has now overtaken the number of malnourished (842 million, according to the FAO).

Other key messages:

• Diets are changing wherever incomes are rising in the developing world, with a marked shift from cereals and tubers to meat, fats and sugar, as well as fruit and vegetables.

• While the forces of globalisation have led to a creeping homogenisation in diets, their continued variation suggests that there is still scope for policies that can influence the food choices that people make.

• There seems to be little will among public and leaders to take the determined action that is needed to influence future diets, but that may change in the face of the serious health implications. Combinations of moderate measures in education, prices and regulation may achieve far more than drastic action of any one type.

Meanwhile, the Economist ran a two page report and editorial on ‘the new drugs war’:

‘Pharmaceutical companies are widely regarded as vampires who exploit the sick and ignore the sufferings of the poor. These criticisms reached a crescendo more than a decade ago at the peak of the HIV plague. When South Africa’s government sought to legalise the import of cheap generic copies of patented AIDS drugs, pharmaceutical companies took it to court. The case earned the nickname “Big Pharma v Nelson Mandela”. It was a low point for the industry, which wisely backed down.

Now arguments over drugs pricing are rising again. Activists are suing to block the patenting in India of a new Hepatitis C drug that has just been approved by American regulators. Other skirmishes are breaking out, in countries from Brazil to Britain. But the main battlefield is the Trans-Pacific Partnership (TPP), a proposed trade deal between countries in Asia and the Americas. The parties have yet to reach agreement, partly because of the drug-pricing question.

Economist IP graphicThe resurgence of conflict over drug pricing is the result not of a sudden emergency, but of broad, long-term changes. Rich countries want to slash health costs. In emerging markets, people are living longer and getting rich-country diseases. This is boosting demand for drugs for cancer, diabetes and other chronic ailments. In emerging markets, governments want to expand access to treatment, but drugs already account for a large share of health-care spending—44% and 43% in India and China respectively, compared with 12% in Britain and America. Meanwhile, a wave of innovation is producing expensive new treatments. In 2012 American regulators approved 39 drugs, the largest number since 1996. Cancer treatment, especially, is entering a new era.’

This all poses a bit of a conundrum for NGOs and aid agencies. While (rightly) focussing on the outrage of 842 million hungry people in a world of plenty, should we also start to discuss public health issues such as obesity, which is no longer confined to the well off? If we shy away from doing so because it would muddy our message, we risk our description of life in the Global South being increasingly at odds with reality.

Similarly, what would happen in our work on health, if in addition to our work on the diseases of underdevelopment (malaria, HIV, polio) we acknowledge the increasing importance of those same old non-communicable diseases that we worry about for ourselves and our parents (cancer, heart disease, and beyond them, Alzheimers)? Would the loss of an exotic ‘other’ reduce public or media interest? And if so, should we care?

The positive aspect of the story is that governments, scientists and others in the North have lots of experience in these issues, and their advice and assistance would probably be a lot more useful to developing countries than banging on about stuff the rich world is currently not very good at (growth, jobs, smallscale agriculture etc).

Oh, and the Center for Global Development seems to be thinking along similar lines – a global anti-smoking drive tops its wishlist for 2014.


  1. This is perhaps an area where the experience of Australia’s longstanding programs in the Pacific region may have something to offer. While poverty in the Pacific islands is not generally at African or Asian levels, and rates of communicable diseases relatively low in Polynesia and Micronesia, non-communicable diseases such as diabetes have long been of concern. Hence some very active programs around health promotion, prevention of smoking etc.

  2. Thanks for a great post on an increasingly important matter. It is rather closely related to that of population ageing in all parts of the globe, which raises some of the same issues, as laid out in the UNFPA/HelpAge International report ‘Ageing in the Twenty-First Century: A Celebration and a Challenge’, and at the conference ‘100 years of social pensions in Sweden–
    Global poverty challenges and experiences of social protection’ in Stockholm last October (see programme and presentations @

    The ageing of the populations also in the Global South is quite a game-changer, which has not been reflected sufficiently by the development community, eg. in the post-2015 documents and debates.

    The aged, especially women, are a fast-growing portion of the poor.
    The face of poverty is getting wrinkled, and this calls for adjusted poverty reduction measures.

  3. The shifting nature of healthcare needs raises questions in many of the countries where MSF works. Obesity, heart disease and cancer are not only different from malaria, sleeping sickness and respiratory infections, they are different in an important way: their requirement for management over time vs treatment/cure. As you can imagine, these non-communicable diseases challenge our humanitarian ways of working, and place even more emphasis on the need for development of healthcare systems rather than short-term emergency approaches.

    You also wonder aloud if talking about obesity would “muddy” aid messages. I think that ship sailed. NGOs already bow to the dictates of fundraising when it comes to the realities we portray of the Global South. Re obesity as an aid issue, it’s pretty simple, isn’t it? Fat children staring into a camera will not open purses.

  4. Well as the present saying goes, these are considered as “first world problems”. Maybe it would be nice if could see a graph or illustration of Obesity and Hunger/Malnutrition statistics across the globe. And ironically, I am not generalizing it, but most people I know who suffered and died from Cancer came from the richer– upper social bracket (here in my country that’s the usual case).

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