Date: 6/15/2008
TUMSPR News: The interview with Professor Beaglehole, the former WHO director of non-communicable diseases and Dr. Akiko Maeda, from the World Bank ensued a two-day National Conference on Policy-Making for Non-Communicable and Chronic Diseases, at Tehran University of Medical Sciences (TUMS), 8 – 9 June, 2008.
This is the second part of the interview by the representative of the Public Relations Office of TUMS, Dr. Hashemi, with Professor Robert Beaglehole, the former World Health Organization’s (WHO) director for non-communicable diseases and Dr. Akiko Maeda, from the World Bank for the Middle –East and North Africa. The interview ensued a two-day National Conference on Policy-Making for Non-Communicable and Chronic Diseases, at Tehran University of Medical Sciences (TUMS), 8 – 9 June, 2008.
H. Identifying the causes of burden of disease and trying to make policies for them has been in focus. What would be good examples for these? For example diets. Which diets do you prefer most?
B. Well, I think that we have a lot of experience from higher-income countries about chronic diseases and that experience is very positive. In the sense that although the death rates increased from, say 1920s through to the late 1960s, depending on the countries, they both declined since then, particularly for heart disease and stroke. In New Zealand for example, death rates from heart disease and stroke have come down by 60%.
H. Very remarkable!
B. Yes, 60% in about 30 years, which has made huge difference for people from my generation, because that means we are living much longer now. We’ve got the benefits of the knowledge and the epidemiological [research]; the public health research has been translated informally just for the diffusion of knowledge and then more formally for the government programs, and it’s had a huge impact and people are living longer. They tend on the whole to be living longer in good health, [although] that’s not universal.
So, there are lots of lessons to be learned, in general, and then very specifically from tobacco control, which has been the major preventable risk factor which has been under investigation for so long.
So, Iran obviously has to adapt all this experience to local conditions. But there is a lot of knowledge and it’s quite positive. I think you should, [and] many countries including New Zealand are still struggling with the equity issue, making sure that the information we have, the policies that we implement, benefit in particular the most disadvantaged. That’s though the challenge and may be a challenge for Iran [too].
H. I appreciate sir. One of the gentlemen was talking about the aging population of Switzerland and said that they’re moving toward 100 and more. Then, what lies ahead for countries that have passed this era [of non- communicable diseases]?
M. As you know, Japan has the longest life expectancy in the world, and Japanese women the longest, especially. The challenge of aging populations has major implications and not just on the health but also the whole economy.
We are all struggling to figure out what to do. But from the overall health perspective, the policy of the Japanese government now is to make sure that everyone lives not just long but really to, what we call it, go from morbidity compression, meaning that, we want people to live as healthfully as possible, not necessarily long but just as healthy and really to ensure that. Therefore some of the polices we have for these challenges are, for example, a green college in one of municipalities for retired people to go and in a college setting to re-invigorate their interest and have their participation as volunteers and others to try to re-appreciate the contribution of the elderly and not consider them as finished and spent forces and put aside as retired, but rather keep them vigorous and healthy and mentally active as well, and also keep them busy contributing to the society.
That’s in our challenge. I'm not saying its working well [but] the government is trying to do and eventually they're trying to reduce the pension cost as well, so that number of years in which you have elderly receiving support from our dwindling young work force will be reduced.
This is an extremely serious issue in countries like Japan. Therefore, we want to really make sure that we have healthy [old people] that do not go for treatment.
B. That's a very positive challenge for countries and, of course, the problem of aging is also being felt in low and middle-income countries just because of the sheer magnitude of the population. Therefore, countries like Iran will have to finish infectious diseases agenda, chronic diseases and then the same issues around aging populations.
H. Would you like to add anything as your final words?
B. Well, I think that, there’s a lot of many positive examples of work being done in Iran that does seem to me that there’s a need to bring it all together, to integrate it and to focus on, but I think, there’s a lot of willingness to do this and I am absolutely confident with your fundamentally good health system and the strong public and primary health care, particularly in rural areas.
There’s an opportunity for Iran to advance this agenda and for other countries to learn a lot from your experience and I think that’s been very exciting period.
M. I’d like to add and emphasize what Dr. Beaglehole said. Perhaps as a health economist, I’d like to add one more aspect, which is that; I think it’s very important to make sure whatever proposals and programs that you look at but also involve the ministers of economy and finance, becomes, there will be not only the budget impact, because you have to prove that the investments, the public investments will bear high returns from the public perspective, but you have also to make sure that it doesn’t have a negative spill over on the labor productivity for the overall economy.
I think that having the ability to articulate and make the case on economic grounds, and not just on the costs, relying on economic productivity grounds will be extremely important moving forward, and it’ll become more important as Iran evolves into a higher-income economy. So, I hope that this is an aspect to pay more attention and develop the capacity and health economists help as well within the overall public health perspective
H. I really appreciate the time you allocated for the interview.
M. Thanks.
B. My pleasure.
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