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Non-communicable diseases kill a person under 70 every two seconds, says WHO | Global health

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Every two seconds someone under 70 dies of a non-communicable disease (NCDs), the majority of them in low- and middle-income countries (LMICs), according to a new report by the World Health Organization.

The WHO study, released today at the UN general assembly in New York, said that LMICs account for 86% of these premature deaths, most of which could be avoided or delayed if people had access to prevention, treatment and care.

The diseases pose one of the greatest health and development challenges of the century but they are “overlooked and underfunded”, according to the report, entitled Invisible Numbers.

Deaths from NCDs graphic

Only a few countries remain on track to meet global development targets to reduce premature deaths from NCDs by a third by 2030, showing that the world is failing to take heed of the true extent of these diseases, which cause about 41m deaths each year, or 74% of all deaths globally.

At least 17 million people die prematurely before the age of 70 every year due to NCDs, including heart disease, cancer, diabetes and respiratory disease.

“The data paint a clear picture. The problem is that the world isn’t looking at it,” said the report, due to be presented at the UN for the first heads of state group focused on the prevention of NCDs, chaired by Nana Akufo-Addo, the president of Ghana.

Even though people “instinctively understand why NCDs matter to individuals and families … this understanding of the individual health consequences has not translated into adequate action, either nationally or globally”, the report said.

“This inaction is partly due to a failure to understand the scale of the toll that NCDs take on health, on equity and on economies.”

Cardiovascular diseases (heart disease and stroke) kill more people than any other disease, accounting for one in three deaths a year or nearly 18m deaths. “Two-thirds of the people with hypertension live in LMICs, but almost half of the people with hypertension are not even aware they have it,” researchers said.

About one in six deaths occur due to cancer, one in 13 due to chronic respiratory diseases and one in 28 are caused by diabetes.

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A common condition

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The human toll of non-communicable diseases (NCDs) is huge and rising. These illnesses end the lives of approximately 41 million of the 56 million people who die every year – and three quarters of them are in the developing world.

NCDs are simply that; unlike, say, a virus, you can’t catch them. Instead, they are caused by a combination of genetic, physiological, environmental and behavioural factors. The main types are cancers, chronic respiratory illnesses, diabetes and cardiovascular disease – heart attacks and stroke. Approximately 80% are preventable, and all are on the rise, spreading inexorably around the world as ageing populations and lifestyles pushed by economic growth and urbanisation make being unhealthy a global phenomenon.

NCDs, once seen as illnesses of the wealthy, now have a grip on the poor. Disease, disability and death are perfectly designed to create and widen inequality – and being poor makes it less likely you will be diagnosed accurately or treated.

Investment in tackling these common and chronic conditions that kill 71% of us is incredibly low, while the cost to families, economies and communities is staggeringly high.

In low-income countries NCDs – typically slow and debilitating illnesses – are seeing a fraction of the money needed being invested or donated. Attention remains focused on the threats from communicable diseases, yet cancer death rates have long sped past the death toll from malaria, TB and HIV/Aids combined.

‘A common condition’ is a new Guardian series reporting on NCDs in the developing world: their prevalence, the solutions, the causes and consequences, telling the stories of people living with these illnesses.

Tracy McVeigh, editor

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Tobacco use, unhealthy diets, harmful use of alcohol and physical inactivity are among the major risk factors leading to NCDs. More than 8m deaths every year are attributed to tobacco use; unhealthy diets account for a similar number.

An NCD data portal containing the latest global data on NCDs, risk factors and policy implementation for 194 countries was released alongside the report.

“NCDs undermine social development and are a handbrake on global development,” said Bente Mikkelsen, director of NCDs at WHO. “World leaders recognised the critical importance of NCDs in the sustainable development goals, aiming to reduce premature death from NCDs by one-third by 2030. But currently, just 14 of 194 countries globally are on track to achieve this goal.”

Mikkelsen added that poorer people, especially women and young people, are often aggressively targeted by industry to use tobacco and alcohol, key risk factors for NCDs. “Millions don’t have access to the prevention, treatment and care that could save lives or give years of life back,” she added.

Leanne Riley, one of the report’s authors, said NCDs do not get the attention and funding that is commensurate with their devastating impact. She said people living with NCDs face additional complications at the time of humanitarian crisis, such as during the conflict in Ukraine.

“Russia’s invasion of Ukraine disrupted many health services – including insulin access for people with diabetes. About 9% of Ukrainian adults have raised blood sugar and, as the conflict escalated, millions of people living with diabetes were at risk of not being able to access the daily lifesaving medication they need,” she said.

Riley referred to Rwanda’s success with its HPV vaccine rollout to tackle cervical cancer. In 2011, the country became the first African country to introduce a national HPV vaccination programme.

Nearly 40m deaths could be averted by 2030 if countries adopted the interventions that are known to work, the report said. Only 5% of external aid for health in LMICs goes to prevention and control of NCDs.

“This report confirms what we’ve long suspected – that chronic diseases are now beginning to outstrip infectious diseases as the main driver of mainly preventable ill health and death in lower- and middle-income countries,” said Katie Dain, CEO of the NCD Alliance. “We urgently need a major financial and public health reset by national governments and the global health community before it is too late.”

“The imperative for action is clear and urgent,” Dain said. “NCDs will cost more suffering and lives this decade than any other health issue; will drain the global economy and impede human capital; will both fuel and be fuelled by the growing inequalities in our countries and globally; and will undermine any efforts to ensure the world is better prepared for future pandemics after Covid. Inaction and paralysis is not a viable option.”

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Mobilising Assam’s ‘hargila army’: how 10,000 women saved India’s rarest stork | Global development

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On a cool December afternoon a group of women dressed in brightly coloured mekhela chadors (Assam’s traditional handwoven clothing) sit in a circle on the grass at the Bhokha Beel wetlands, singing and clapping.

Some of the women are wearing papier-mache headdresses shaped like long-necked birds. As they sing, one of them gets to her feet and starts dancing.

They are part of the “hargila army”, a group of rural women in the Indian state of Assam who work to protect one of the world’s rarest storks: the greater adjutant (Leptoptilos dubius) – or hargila (meaning “bone swallower” in Assamese) as the scavenger bird is known locally. They are celebrating the recent UN Environment Programme’s Champions of the Earth award, conferred on the group’s biologist founder, Dr Purnima Devi Barman.

A greater adjutant stork

Barman won the award for her achievement in mobilising more than 10,000 women to help save the stork. “They are the protectors of the birds and of their nesting trees,” says Barman, referring to the band of homemakers turned conservationists.

The greater adjutant, a member of the stork family that can grow up to 1.5 metres (5ft) tall, was once abundant across south Asia. But its distinctive features – a featherless head, dangling gular (throat) pouch, striking pale eyes and long skinny legs – and its foul-smelling droppings and dietary preference for carrion – won it few fans.

The birds were not just reviled, they were seen as a bad omen and carriers of disease. Villagers attacked them with stones, cut down trees where they roosted communally and burned their nests.

Today the greater adjutant is endangered, with fewer than 1,200 adult birds in its last strongholds – the Indian states of Assam and Bihar, and Cambodia. Most of the global population is found in Assam, making Barman and the hargila army’s work critical to its survival.

Barman grew up in a village on the Brahmaputra, a river that flows for 2,500 miles through Tibet, north-east India and Bangladesh. As a child, she learned about Assam’s wildlife from her grandmother, who took her into the paddy fields where she worked and taught her about local birdlife. “She didn’t know how to write but she had a feeling for nature and taught me lots of songs and stories about the birds,” says Barman.

Barman and members of the 10,000-strong hargila army sing and dance to traditional songs.

Her love of the natural world stayed with her. She gained a first degree and a master’s in zoology and was about to embark on a PhD on the greater adjutant when a contact phoned to tell her that a villager in Dadara had cut down a kadam (burflower) nesting tree in his yard.

When she arrived at the site she was appalled to find the ground littered with nests and dead or injured chicks. “It was my mothering instinct. I wanted to do something to protect these innocent creatures,” says Barman, whose twin girls were two at the time.

Barman began teaching the villagers about the birds’ importance as “nature’s cleaning crew”, and why nesting trees should not be cut down. In response, she was taunted and asked to clean the foul-smelling mess herself. The hostility she faced made her realise that to save the bird, she first needed to change the community’s attitude to it.

Purnima Devi Barman with a lifesize cutout of a greater adjutant stork
Badge worn by hargila army members
A sign in Dadara village shows the partnership of the hargila army with the state forest department and the district administration and police

She delayed her PhD and set to work: she organised public meetings where she honoured the owners of trees, mostly men, instilling in them a sense of pride in their role as guardians. The tactic paid off. “Not a single nesting tree has been cut down since 2010,” she says.

But it was the women who Barman believed held the key to sustainable and community-led conservation. The problem was they were confined to their homes and household chores. So Barman found creative ways to bring them out where she could talk to them. She began organising cooking competitions of traditional sweets and snacks, where she befriended the women and talked about the birds.

A primary school student with a greater adjutant poster

She tapped into the women’s nurturing side by organising “baby showers” during the storks’ breeding season, inspired by a Hindu ritual for expectant human mothers, and “happy hatching” ceremonies to commemorate the arrival of the chicks. Slowly but surely, the women began to accept the birds as part of their world.

By 2014, the conservation movement had gathered momentum and the hargila army was born. “Conservation is all about uniting people and building ownership,” says Barman. “I’ve always believed that, if given a chance, women can make a big difference in conservation.”

Today, the once-maligned bird is now a cultural symbol, appearing on everything from towels to road-safety campaigns.

In the villages of Dadara, Pacharia and Singimari (all in Kamrup district), greater adjutants’ nests have increased from 28 in 2010 to more than 250 according to Barman’s last count, making the area the world’s largest breeding colony. “We now have more than 1,000 hargila birds in Assam,” says Barman, referring to recent but unpublished data collected by her team.

The conservation efforts have also transformed the lives of the women, who now go into other villages to raise awareness of the birds. “Joining the hargila army gave me a chance to show everyone that I could do something meaningful with my life,” says Daivaki Saikia, a young widow from Dadara’s marginalised fishing community, who has been a member for five years.

The UN award was for Barman’s “entrepreneurial vision” in using conservation to improve women’s economic status. Assam has a rich tradition of weaving, so Barman secured funding for 30 looms and provided training in weaving the hargila motif into fabrics, providing women with an independent income. Eighty women were also given sewing machines to make bags, cushion covers and other items from the handwoven fabrics.

Mamoni Malakar, a Hargila Army member paints a henna tattoo of the hargila on Purnima Devi Barman’s palm.

In 2021, Barman established the Hargila Learning and Conservation Centre in a government school in Pacharia village, where hargila army members use songs, art and games to encourage children to protect the birds.

Juggling her job as a biologist at Aaranyak, a wildlife non-profit organisation based in the city of Guwahati, Barman continues to help preserve the hargila. In February the hargila army begins its work in the districts of Morigaon and Nagaon, with further expansion planned for Assam.

She also hopes to set up a nursery for kadam trees that can be distributed to those who want to plant them in their gardens (45,000 saplings have already been handed out). “This will help improve the back-yard biodiversity,” says Barman.

Barman’s unwavering dedication has been recognised in India and internationally. Last year she was named World Female Ranger and in 2017, she received the prestigious Whitley award, known as the “Green Oscars”, as well as India’s highest civilian honour for women – the Nari Shakti Puraskar.

Hargila army member Sarawasti Das is weaving a mekhela chador set with the hargila motif

But Barman refuses to rest on her laurels. No opportunity to advocate for the bird is missed. “My intention is to involve everyone,” she says. “If people are concerned about the conservation of the hargila and its habitat, it will help other species as well.”

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Video | The 10 deadliest earthquakes of the 21st century | International

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The death toll from the Syria and Turkey earthquake rose Wednesday to more than 11,000, making it the deadliest quake worldwide in more than a decade and one of the 10 most lethal earthquakes of the 21st century.

In this video, EL PAÍS reviews, in chronological order, the quakes that have caused the largest loss of life since 2001. The list includes the 2010 earthquake in Haiti, which killed 250,000 people and left 1.5 million homeless, as well as the 2004 quake that hit the Indonesian province of Aceh, triggering a tsunami that killed nearly 230,000.

Other major natural disasters include the 2003 earthquake in Iran, the 2015 earthquake in Nepal and the 2011 earthquake and tsunami that hit northern Japan, killing 15,690 people. The video shows the devastating impact of these natural disasters. Earthquakes take an especially hard toll on countries that are ill-prepared to face an emergency of such scale. Japan and Chile, for example, have been hit by stronger quakes, but recorded fewer fatalities thanks to anti-seismic building norms.

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Uganda condemned for ‘shameful’ decision to close UN human rights office | Global development

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Rights activists and campaigners have condemned the Ugandan government’s decision to shut down the country’s UN human rights office, describing it as “shameful”.

In a letter to the Office of the UN high commissioner for human rights (OHCHR) in Uganda dated 3 February, the foreign affairs ministry said it will not renew the host country agreement it signed with the OHCHR, which established its initial mandate in the country in 2005. The current mandate, signed on 9 February 2020, expires in August.

“The government of Uganda will now continue its cooperation with the OHCHR Headquarters either directly or through its Permanent Mission in Geneva,” reads the letter.

The development comes less than three months after the UN’s committee against torture adopted the concluding observations on Uganda, which raised concerns that torture and ill-treatment continued to be frequently practised, and called for investigation and prosecution of security officials accused of excessive use of force, violence and arbitrary detention.

“The closure of the @UNHumanRightsUG office proves that [the] government has lost all sense of shame. It no longer wants any close international scrutiny of its human rights record,” tweeted Adrian Jjuuko, executive director of the Human Rights Awareness and Promotion Forum.

“If the protectors are sent away, what then happens to those they were protecting? We are headed for tough times,” he added.

Adrian Jjuuko, (speaking, centre left) executive director of the Human Rights Awareness and Promotion Forum, has condemned the OHCHR closure.
Adrian Jjuuko, (speaking, centre left) executive director of the Human Rights Awareness and Promotion Forum, has condemned the OHCHR closure. Photograph: Alice McCool

Bobi Wine, the reggae singer turned Ugandan opposition leader, whose supporters remain in unauthorised places of detention or “safe houses”, said it was no surprise that Uganda’s president, Yoweri Museveni, who has been in power since 1986, has closed the OHCHR. He tweeted: “In the face of growing international condemnation and isolation, tyrant Museveni has responded by shutting down NGOs, Facebook, DGF [Democratic Governance Facility] & declaring several internationals Persona Non-Grata or deporting them! Now he shuts down @UNHumanRightsUG.”

Wine added: “You’ll recall in the aftermath of the 2021 election and the hundreds killed or abducted by the Museveni regime, we petitioned the UN Human Rights Office & the military brutalised journalists right there. This UN Office condemned these actions. Not surprising it’s being closed.”

Human right activists and advocacy groups have called the decision a “mockery” and accused the government of running from international scrutiny on abuse and protection of human rights.

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“This is unbelievable, and the reasons given by the government are a mockery of the real state of human rights in the country,” said Jjuuko. “To claim that Uganda no longer needs the office [OHCHR] because of its strong stand for human rights is ironic to say the least.

“A strong stand for human rights would imply opening up to the UN and other actors.”

David Livingstone Sewanyana, founder of the Foundation for Human Rights Initiative in the capital, Kampala, told the Guardian, “The decision not to renew the mandate deprives Uganda of a critical player in the field of human rights promotion and protection.”

At least 38 local and international staff at the head office in Kampala and two field offices in Gulu and Moroto stand to lose their jobs.

Jjuuko said: “Following closely on the closure of the DGF, this is a scary move which indicates that the government is no longer willing to have its human rights record scrutinised by international actors.

“This leaves local organisations at much more risk of being further silenced and their work curtailed without the government fearing close international security. It is a sad day indeed for the human rights movement in Uganda.”



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