UN meeting for non-communicable diseasesBMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d5762 (Published 13 September 2011) Cite this as: BMJ 2011;343:d5762
- Tracey Pérez Koehlmoos, programme head
- 1Health and Family Planning Systems Programme, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka 1000, Bangladesh
On 19-20 September 2011, the United Nations will host a general assembly high level meeting on the control and prevention of non-communicable disease (NCD). Although the meeting will be held in New York, the eyes of developing country leaders, decision makers, civil society groups, industry, non-governmental organisations, and researchers will be focused on the event and its outcomes. Previous UN summits have provided the catalyst for change. The summit on HIV/AIDS in 2001 resulted in substantial funding and political commitments.1
The UN meeting is a crucial moment. This is especially true because it developed in the shadow of global efforts to achieve the millennium development goals, which do not include NCD. NCD is by far the largest killer on the planet and has continued to advance in low and middle income countries, so that the cause of 63% of all global deaths receives less than 3% of international development assistance for health.2 About 80% of deaths caused by NCD occur in developing countries and generally in a younger population than in high income countries.3 4 Over the next 10 years, the World Health Organization predicts that deaths from NCD will increase by 17% globally, with the greatest increases in the African (27%) and the Eastern Mediterranean (25%) regions. In terms of the highest absolute number of deaths, the Western Pacific and South East Asian regions are projected to lead the field.1 Because of the scope of the problem, predicted economic impact, and general lack of preparedness to tackle it in many countries, health ministers from low and middle income countries have been the major catalyst for the meeting.
As we head into the final days before the meeting, there is much wrangling over the outcomes document, particularly over targets and resources, and some fear that if world leaders do not turn up with open minds and potentially open chequebooks that NCD might drop off the agenda for 10 years, especially with such tough economic times in so many high income countries. However, it seems unlikely that NCD will disappear from the global health agenda now. Whatever happens at the UN meeting, it has led to the creation of the NCD Alliance and has begun to increase public consciousness about these diseases.
Some claim that NCD may be one of the greatest hindrances to development and alleviation of poverty.3 5 In that light the UN should learn from the models of AIDS and tobacco control. Perhaps the central message that must emerge from the UN meeting is that a “whole of government and whole of society” approach is needed to tackle NCD.6 Only limited progress can be made if action is expected only from within the health system. This is an important message for low and middle income countries. We need to prepare national plans and create partnerships with all stakeholders and emphasise the importance of public health measures beyond the service provision level; we also need to look beyond health policy and include urban planning, agriculture, taxes, indoor air pollution, trade, finance, public transportation, civil society, education, and more. Recommendations for food and agriculture sectors to work on NCD are emerging along with the UN meeting.7
WHO needs to act as the conductor of the UN family and bring together the Food and Agriculture Organization (vital if agriculture is to be transformed to tackle undernutrition and overnutrition better); UN Habitat (to build urban design into its work with a focus on restoring mobility, and safe walking and cycling into everyday lives); Unicef (to use its powerful Convention on the Rights of the Child to tackle many aspects of NCD and move beyond a sole focus on health matters that affect survival in under 5 year olds); the World Bank and International Monetary Fund to ensure that fiscal policy and development finance support NCD goals, and more. The model for this leadership comes to us from tobacco prevention through the Ad Hoc Committee of the UN Economic and Social Council.
Although our governments might need technical help for some of the needed steps, they can also identify focal points for NCDs at the national level, along the model of national tobacco control programmes. Considering the burden of disease for NCDs, a heart disease focal point or a diabetes focal point should not be considered out of the question. Physical activity is another area that may require a focal point to build it into health prevention among adults and into health education for children, as well as planning for safe places to engage in sport or even pavements for safe walking.
Outside of the UN meeting there must be a global commitment, a global partnership, and a global plan, preferably with targets and some resources such as the Stop NCDs Partnership.8 The encouragement of global support for research and networks must continue to build so that we can figure out what works and how to apply it across settings. The United Health-National Heart, Lung and Blood Institute Centers of Excellence network is a comparably small but important example of how research can be funded and capacity can be built across developing countries, but these 11 centres alone cannot reach every country and population that is in need.
In addition to leadership at the UN and national levels, technical support from WHO, the World Bank, and other UN bodies will be needed, along with the provision of more resources for NCDs; not just financial resources, but also investment in knowledge generation, synthesis, and translation. Experts need to be available to help countries with implementing situation assessments of burden, policy, and programmes that may already exist; planning; developing multisectoral approaches and interventions; and training field workers even for deceptively simple tasks like conducting a WHO-STEPS survey.
The strengthening of health systems, although necessary, will not be a sufficient solution for this pressing development problem. Long term commitment within countries is needed now to create change, and countries should demand technical support and financing from global development partners along with strong leadership from the UN.
Cite this as: BMJ 2011;343:d5762
Competing interests: The author has completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declares: no support from any organisation for the submitted work; TPK is engaged in research on NCDs, part of which is funded by the UnitedHealth Group and the NHLBI; she also receives research funding from WHO; no other relationships or activities that could appear to have influenced the submitted work.
Provenance and peer review: Commissioned; not externally peer reviewed.