LONDON Ten years after committing to fight AIDS, the United Nations is taking on an even bigger bunch of killers -- common chronic diseases -- in what is shaping up to be a bruising battle between big business, Western governments and the world's poor.
Tobacco, food and drinks companies are in the firing line for peddling products linked to cancer, diabetes and heart disease, while politicians in the rich world are accused of failing to set firm targets or provide funds for a decent fight.
"This is a once in a generation opportunity. We could save millions of lives here, and it's shameful and immoral that industry lobbying has put short-term profits in front of a public health disaster," Rebecca Perl of the World Lung Foundation (WLF) told Reuters. WLF has been involved in tetchy preliminary talks for several months.
The fear is that big business has successfully lobbied rich governments to be only half-hearted in battling non-communicable diseases, or NCDs, despite predictions that they could cripple healthcare systems of developing countries.
A bit like climate change, preventing and treating non-communicable diseases requires wealthy nations and multinational firms to take a near-term financial hit to help prevent poor nations being overwhelmed in the future.
In these austere times, fears are already growing that a high-level U.N. meeting in New York on September 19-20 -- only the second to focus on disease after one on AIDS in 2001 -- could be a flop.
The gathering will include scores of delegates from U.N. member states, including around 20 heads of government as well as representatives from public health groups, non-governmental organizations, the private sector and academia.
According to those close to the negotiations, a draft version of the political declaration that will form the cornerstone of the U.N.'s thinking on NCDs contains many platitudes but few tangible commitments.
"There are no strong, time-bound commitments in there," Ann Keeling, chair of the NCD Alliance which groups 2,000 health organizations from around the world, told Reuters. "It's a great disappointment from that point of view."
NOT ROCKET SCIENCE
The scale of the problem is immense. Around 36 million people die every year from NCDs -- around 80 percent of them in poor nations where prevention programs are virtually non-existent and access to diagnosis and treatment is very limited.
As a result, death rates from NCDs are nearly twice as high in poor countries as in the industrialized world.
Preventing these deaths -- or at least a good proportion of them -- isn't rocket science. Proven measures such as reducing smoking rates, improving diets, making simple drugs available and boosting exercise could knock a huge hole in that figure.
"There is a common story that unites cancer, cardiovascular, diabetes and respiratory medicines around tobacco, alcohol, diet and exercise -- and that is where we have the most cost-effective impact," says David Kerr, president of the European Society of Medical Oncology.
The crucial sticking points are targets, taxes and money.
Stopping a billion people from lighting up every day or providing cheap drugs like aspirin and statins to prevent heart attacks and strokes may be cost effective, but the payback won't be quick and it is unlikely to win many votes.
"The time horizon for the return on that investment is very long and beyond many political horizons. So it's difficult to get people to commit to these kinds of resources," says Gordon Tomaselli, president of the American Heart Association.
The NCD Alliance says spending $9 billion a year on tobacco control, food advice and treatment for people with heart risks would avert tens of millions of untimely deaths this decade.
Is that a lot? By comparison, caring for HIV patients in developing countries already costs around $13 billion a year.
In contrast to the AIDS fight that was the UN's focus a decade ago, the price of drugs is less an issue here, since many are available as cheap generics, although there are disputes over the cost of some more pricey products like insulin.
STUBBING OUT TOBACCO
The sharpest focus this time is on makers of fatty foods, sugary drinks and -- above all -- the tobacco industry, which World Health Organization director general Margaret Chan has described as "an industry that has much money and no qualms about using it in the most devious ways imaginable."
With tobacco predicted to kill more than a billion people this century, if current trends persist, the public health lobby says if the U.N. meeting does nothing else, it should at least make a smoke-free world one of its central targets.
Smoking alone causes one in three cases of lung disease, one in four cases of cancer, and one in 10 cases of heart disease, says Perl. "So look what a bang you get for your buck there."
Conflicted governments will find it tough. Japan Tobacco, for example, is 50 percent owned by the Japanese government, and the massive profits of U.S. cigarette makers bolster the U.S. economy.
In China, home to a third of the world's male smokers, the combination of taxes and sales from China National Tobacco -- a wholly state-owned entity -- account for around 9 percent of the government's annual fiscal revenues.
This is all the more reason, according to Paul Lincoln of the UK National Heart Forum and Jaakko Tuomilehto, an epidemiologist at the University of Helsinki, to hike cigarette taxes, curb advertising and insist on graphic health warnings.
"There are no more excuses," said Lincoln. "We have the know-how. The challenge as ever in public health is to overcome the ideological and vested interests."
Tuomilehto is more blunt: "It's a crazy thing to have a product in the shops that kills every second consumer -- it's madness."
(Editing by Sonya Hepinstall)