The current standstill in the negotiations of the United Nations High -Level Meeting (HLM) on Non-Communicable Diseases (NCDs) [1] member states has shocked the international community. Judging from articles written in The New York Times, the Financial Times, the Huffington Post and even Le Monde, morale is at its lowest for a conference which promised to be a historical landmark in global health [2].

NCDs, such as obesity, type 2 diabetes and certain cancers, have been at the center of global health discussion for quite some time now. This group of diseases, once traditionally considered restricted to developed nations, is now becoming a real issue for the developing world where nearly 80% of NCD deaths occur [2, 3]. If no plans are made to combat NCDs it is feared they will kill more people in Africa than Communicable Diseases such as HIV and malaria which have been traditionally associated with the continent [2].

The Moscow Conference which took place in April marked a first step in the international community's recognition of the threat of NCDs. One of the reasons behind the enthusiasm is the fact that these diseases are generally avoidable by removal of risk factors. 80% of type 2 diabetes and heart problems as well as 40% of cancers would thus be avoided with increased physical activity, an improved diet and no exposure to tobacco [4].

Following the Conference, a United-Nations High Level meeting was scheduled with the idea of establishing a global action plan to put a halt to the NCD pandemic. Unfortunately, discussions have been recently put on halt as a conflict has emerged between the G77 and a group formed by the USA, Canada and the European Union. The main areas of discourse concern the financial aspect of the plan as well as the difficulty of quantifying the objectives and feedback on set targets. And these countries do have a point.

With the financial crisis affecting all nations, the idea of having to provide more financial aid to foot a global effort to reduce NDCs is one that may seem hard to imagine for many governments that already have to cut costs elsewhere. But as Andrew Jack from the Financial Times suggests the extra resources could be generated by taxing the risk factors themselves [5]. Creating a global equal tax for tobacco products could for example contribute to the budget for the global fight against NCDs all the while (financially) deterring individuals from using one of the main risk factors for certain cancers. Nalini Saligram and Sandeep Kishore explain the financial issue from a different perspective [6]. In their view the current budget is not enough to support a global initiative and although more financial contribution will be needed at first they will eventually result in savings in the long term as the cost of preventing becomes less than the cost of treating [7].

The objectives set out by the UN HLM to combat the pandemic of NCDs need to be achievable. As Margaret Chan, director general of the WHO, stated in her review of the Zero Draft [8], these need to be quantifiable and therefore clear measurable targets should be set. Just as the member states agreed only recently to treat 15 million people with HIV by 2015, so they should agree on a practical target for NCDs such as reducing preventable deaths from NCDs by 25% by 2025, suggests Ann Keeling, chair of the NCD Alliance [9]. Measurable targets will enable realization of the scale of the task and help generate more interest in methods of combating the problem; furthermore these can always be readjusted when a review of the progress is done.

One final point to add to Deborah Cohen's Feature Article in the BMJ [10] is the regulation of salt and sugars (as well as saturated fats etc.) in ready-made foods. They represent a risk factor group which contributes to the risk of contracting NCDs [11] and as thus their use should be governed by international regulations, suggests Jorge Alday, director of the World Lung Foundation.

We now have to wait for the discussions to continue and await with eagerness the results of the UN HLM. In the meantime it is up to us health professionals and medical students to continue to challenge the international community with debates and discussions. As future policy makers and implementers, recent medical graduates and medical students in particular should aim to take part in this debate through initiatives such as the Young Professional Chronic Disease Working Group, an online discussion group. In any situation, the discussions need to press on and differences be put aside so as to put a halt to a pandemic responsible for nearly 100,000 deaths a day.

References

1. http://www.who.int/nmh/events/un_ncd_summit2011/fr/index.html

2. Global Status Report on Noncommunicable Diseases 2010. WHO 2011. Available at: http:// www.who.int/chp/ncd_global_status_report/en/index.html (accessed 30 May 2011)

3. Global Status Report on Noncommunicable Diseases 2010. WHO 2011. Available at: http://www.who.int/chp/ncd_global_status_report/en/index.html (accessed 30 May 2011)

4. Chronic Disease Report. World Health Organisation. 2005. Available at: www.who.int/chp/chronic_disease_report/media/CANADA.pdf. Accessed on 26 August 2011

5. Jack A. Efforts to tackle diseases under threat. Financial Times. 18 August 2011. London

6. Saligram N, Kishore SP. We Need Measurable Outcomes From The UN High-Level Meeting on NCDs. Huffington Post. 17 August 2011.

7. Rijken PM, Bekkem N. Chronic Disease Management Matrix 2010. Results of a survey in ten European countries. On behalf of the European Forum for Primary Care. NIVEL, Dutch Institute for Health Services Research, 2011.

8. Draft outcome document of the High-level Meeting on the prevention and control of non-communicable diseases". United Nations; published 23 June 2011. Available at: http://www.un.org/en/ga/president/65/issues/ncdiseases.shtml (accessed on 28 June 2011).

9. Kelland K. Europe and US accused of stalling UN disease talks. Reuters. 17 August 2011.

10. Cohen D. Will industry influence derail UN summit? BMJ 2011; 343:d5328

11. Grant W. The Political Economy of Food Governance. International Studies Review. Volume 13, Issue 2, pages 304-309, June 2011