From 10-11 July 2014, the UN General Assembly convened a High-Level Meeting on the theme “A Comprehensive Review and Assessment of the Progress Achieved in the Prevention and Control of Non-Communicable Diseases (NCDs)” at UNHQ in New York, which also sought to make recommendations to guide the NCD response in the context of the post-2015 development agenda.
In September 2011, Heads of State and Government adopted the Political Declaration on NCDs at the United Nations General Assembly and committed themselves to develop national plans to prevent and control NCDs. This follow-up meeting was held to take stock on progress made in implementing those national plans, to share best practices and lessons learned, to identify opportunities for scaling up multi-stakeholder and multisectoral responses, and to make recommendations to guide the NCD response in the context of the post-2015 development agenda.
The impetus for the meeting came from UN General Assembly Resolutions 66/2 and 68/271 which were adopted in January 2012 and May 2014, respectively. The two-day meeting included plenary sessions with participation from political leaders and ministers of health, and two roundtable discussions which brought together Member States, observers, and representatives of UN entities, civil society, academic institutions and the private sector to explore how to strengthen national and regional capacity, and fostering partnerships and cooperation in addressing NCDs.
Over 14 million people die each year from NCDs between the ages of 30 and 70, 85% of which are in developing countries.  It is estimated that up to two thirds of these premature deaths from NCDs are linked to exposure to risk factors – namely, tobacco use, unhealthy diet and physical inactivity, and the harmful use of alcohol – with the remaining third of all such deaths linked to weak health systems that do not respond effectively and equitably to the health-care needs of people with NCDs – principally cardiovascular diseases, cancers, chronic respiratory diseases and diabetes.
In his background note for this High-Level Meeting (HLM), John Ashe, President of the General Assembly, stressed that most of the world’s annual premature deaths from NCDs are preventable by “influencing public policies in sectors outside health, rather than by making changes in health policy alone.” At a macro level, NCDs drag on economic growth, as morbidity and mortality due to NCDs sap productivity among working age populations. The economic impacts associated with NCDs are expected to be disproportionately worse among low- and middle-income countries, where NCDs are expected to affect people at younger ages. Managing NCDs can be expensive and strain already overburdened health systems, driving up costs and diverting scarce health resources away from other health issues. At a micro (household) level, NCDs can also have strong negative impacts, including pushing households into poverty, particularly those without adequate social protection measures, such as health and disability insurance. Some governments have recognized that gains against the NCD epidemic can be achieved through interventions that involve all government departments or a “whole-of-government approach.”
The opening session of the HLM heard from governments who have experienced success in strengthening local, provincial, national and regional capacities to address both the medical and social determinants of NCDs, and those governments that have faced challenges in increasing and sustaining human, financial and technical resources to address the same issues.
In his remarks delivered by his Chef du Cabinet, Susana Malcorra, UN Secretary-General Ban Ki-moon recalled that three years ago, the UN High-level Meeting on NCDs helped convert political inaction into political leadership. He noted that the Meeting led to global accountability, with the first set of global targets and a goal to reduce the number of premature deaths from NCDs by 25% by 2025. He regarded the meeting as having put “the NCDs firmly on the global health and development agenda.”
Reflecting on progress made since 2011, the Secretary-General cited the creation of the UN Interagency Task Force on NCDs, which is providing much needed support to developing countries, as well as the creation of the WHO Global Coordination Mechanism on NCDs, which will facilitate engagement among Member States and non-State actors, including by establishing Working Groups to recommend ways and means of encouraging Member States and non-State actors to explore the provision of resources through domestic, bilateral, regional and multilateral channels. The number of countries with an operational policy to address NCDs with a dedicated budget has increased from 32% in 2010 to 50% in 2014. The Secretary-General emphasized that developing countries are disproportionately affected by NCDs as many are facing the “double burden” of high rates of communicable diseases alongside climbing rates of NCDs. Framing this as a social justice issue, he called on Member States to urgently address the resource gap for NCDs at global and national levels.
Many delegates echoed the Secretary-General’s call to address the resource gap for NCDs, which pose a challenge for developing countries in particular. Fenton Ferguson, Minister of Health, Jamaica, pointed out that the evidence suggests that NCDs are the number one cause of death in the world, yet they receive 1.2% of the US$31 billion in development assistance allocated for health. This, he noted, was evidence that clear communication to dispel myths about NCDs (that NCDs only affect developed countries and only the wealthy in societies; that the control of NCDs is expensive and ineffective, etc) is needed.
In spite of funding challenges, many representatives came to the table with policy success stories from their respective countries which have been enacted since the 2011 HLM.
Mercedes Juan Lopez, representative of Mexico, explained that the main public health issue facing her country is that of obesity and diabetes, of which Mexico has one of the highest rates in the world (70% of adults and 30% of children are either overweight or obese). The government has recently implemented a cross-cutting strategy for the prevention and control of obesity and diabetes that engages the public health (including the prohibition of the sale of unhealthy foods in schools and the development of a mass media campaign to educate the public on the importance of a healthy diet and an active lifestyle); medical care (including the creation of a specialized diabetes care center that is being scaled up at the national level); and regulatory sectors (including mandatory nutrition labeling on all food products and a nutritional seal granted to products that meet nutritional standards, marketing that targets children has been outlawed; and a tax has been levied on products at the level of 8% for every 100g of sugar a product contains).
Juan Luis Manzur, representative of Argentina also spoke of success in targeting diet-related risk factors for NCDs through industry regulation and the taxation of products. In 2014, Argentina became a “trans-fat free country” by modifying the national food code to ban the production and marketing of products that contain trans-fats. He stressed that success in this area was achieved through a participatory process with the food industry and agreed-upon deadlines so that producers would have time to make replacements. Additionally, a 200% increase in taxes on tobacco products over the last decade has brought about a decline in tobacco use in the general population from 40% in 2003 to 22.5% in 2012.
On the topic of whole-of-government responses and integrated national policies on NCDs, Tonio Borg, Commissioner for Health and Consumer Policy, European Union, noted that in all EU treaties there is a specific reference to the duties of Member States to take a multisectoral approach to policy planning – meaning that public health implications must be considered when each branch of government makes a decision. However, he noted, whether health is taken into account in practice is a different story. He called for renewed efforts to engage, for example, city planning, trade and regulatory departments in policy-making efforts around targeting the risk factors for NCDs.
Delegate presentations touched on many of the different commitments made in the 2011 NCD meeting. A pervasive theme that emerged from the discussion was the notion that addressing NCDs can lead to enormous gains in health and social and economic growth around the world – thus NCDs must play a major role in the context of the post-2015 development agenda.
Following the plenary, the Assembly held two roundtable discussions.
The first roundtable sought to answer questions regarding “strengthening national and regional capacities, including health systems, and effective multisectoral and whole-of-government responses for the prevention and control, including monitoring, of non-communicable diseases.” It was chaired by the Fenton Ferguson, Minister of Health, Jamaica, and featured presentations by the following panellists: Tonio Borg, Commissioner for Health and Consumer Policy, European Union; Anna Lartey, Director, Nutrition Division, Food and Agriculture Organization (FAO); Vash Mungal-Singh, CEO, Heart and Stroke Foundation, South Africa; and Sandeep Kishore, Chair, Young Professionals Chronic Disease Network; Physician, Yale School of Medicine.
Mr. Borg noted that within the EU there is a sense of State responsibility to address health systems issues and that the role of the EU is to support States to finance research and to bring civil society to the decision-making table. Mr. Borg highlighted the EU’s “Active and Healthy Aging Project” as an example of a multisectoral response to NCDs, which has brought together more than 300 partners in academia, public health, industry, and government for health research and innovation. Mr. Borg sees the EU’s role as being able to add value to Member State actions by supporting countries in adapting programmes that have worked in other Member State settings, and in scaling up their programmes.
Dr. Lartey stressed the primary role that unhealthy diet plays as a risk factor that is driving up the incidence of NCDs globally, and highlighted the need to examine current food systems to make them healthy and sustainable. She indicated that capacity must be built in the areas of funding for research in low-income countries, knowledge sharing, and the development of monitoring and evaluation mechanisms for NCDs if progress is to be made in reducing the incidence of diet-related NCDs.
Dr. Mungal-Singh presented two examples of NCD prevention programmes in South Africa that have been successful in their multisectoral engagement strategies. The first, the “Salt Reduction Initiative,” is a public education programme aimed at reducing discretionary salt use among the population, which has made South Africa the first country with legislation on salt intake levels. The programme’s success, he said, was owed to creativity in the face of gaps in funding. The programme engaged with pharmaceutical professionals, using their networks to reach healthcare professional target groups because their research indicated that health care professionals (doctors in particular) are most trusted when disseminating the health message. The second, was the establishment of the South African NCD Alliance. Dr. Mungal-Singh noted that the NCD Alliance’s greatest asset was its ability to engage with patient groups. This, he said, is very important because the Alliance is able to achieve gains by mobilizing patients and their families on the ground to spread their message.
Dr. Kishore presented at the roundtable in the capacity of a civil society representative. He spoke on behalf of over 2,000 young professionals committed to NCD treatment as a social justice issue, who together, he explained, represent the social movement to tackle NCDs. Dr. Kishore requested that the representatives present at the roundtable commit to solidarity on issues of trade and health. He further requested that concrete personnel units on NCDs be established at the country level to coordinate global efforts, as well as a NCD core fund at the country level to position 10 young leaders to staff a “fellowship for the future.”
The second roundtable discussion, held on 11 July, explored “Fostering and strengthening national, regional, and international partnerships and cooperation in support of efforts to address NCDs.” It was chaired by Howard Koh, Assistant Secretary for Health, US Department of Health and Human Services, and featured presentations from the following panellists: Lochan Naidoo, President of the International Narcotic Control Board (INCB), United Nations Office on Drugs and Crime (UNODC); Sania Nishtar, Founder, Heartfile, Pakistan; and Mario Ottiglio, Director, Public Affairs and Global Health Policy, International Federation of Pharmaceutical Manufacturers and Associations (IFPMA).
Dr. Naidoo’s presentation served as a reminder of the negative impact that addictive disorders and other mental health issues have on human capital and potential, and he noted that the INCB plans to work with governments to improve national supervisory systems to ensure the continuing and improved availability of medicines containing psychotropics and narcotics to treat NCDs.
Dr. Nishtar highlighted the various spaces where new partnerships at the national, regional, and international levels could be formed to address the burden of NCDs. She suggested there are opportunities in the space of official international development where international agencies are already engaging with low- and middle-income countries, and that NCD efforts must try to use similar communication strategies as the MDGs to mobilize resources. HIV/AIDS programmes, she noted, could also provide a point of entry for NCD programming with little financial investment – providing that population-based instruments are up and running and that many countries add NCD survey collection to their efforts.
Mr. Ottiglio gave an overview of pharmaceutical industry involvement in NCD partnerships that have been developed since 2011. He emphasized that that an increased focus on NCDs should not come at the expense of efforts to address communicable diseases, but rather becomes a win-win for all stakeholders. He cited industry efforts to overcome supply-chain problems in the dissemination of certain vaccines as well as efforts to improve NCD diagnostic training to physicians in rural areas as examples of programmes that would result in synergistic benefits to those suffering from communicable and non-communicable diseases.
During the closing session, participants concluded that governments have rightly taken ownership and responsibility for the NCD response and progress has been made at the national level. However, many participants stressed, NCDs still pose a major challenge to sustainable human development in the 21st century and therefore must be central to the post-2015 development agenda.
For the webcast of the opening session of the HLM, click here.
For the President of the General Assembly’s opening remarks, click here.
For the WHO Director General’s opening remarks, click here.
For the webcast of the 10 July afternoon session, click here.
For the webcast of Roundtable 1, click here.
For the webcast of Roundtable 1, click here.