Health ministers pledge to tackle non-communicable diseases with global actionBMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d2796 (Published 04 May 2011) Cite this as: BMJ 2011;342:d2796
Ninety health ministers and health officials from 167 countries committed themselves to taking “whole of government” and international actions to combat non-communicable disease (NCDs) at a meeting in Moscow last week.
They gathered at the First Global Ministerial Conference on Healthy Lifestyles and Non-communicable Disease Control, which is part of the build up to the United Nations High Level Meeting on NCDs to be held in New York in September. This will be only the second such UN meeting on health; the first, in 2001, gave rise to the Global Fund for AIDS, TB, and Malaria.
NCDs were left out of the Millennium Development Goals, but pressure for global action has been growing steadily. Margaret Chan, director general of WHO, said, “For some countries it is no exaggeration to describe the situation as an impending disaster. I mean a disaster for health, for society, and most of all for national economies.”
At the conference WHO released the Global Status Report on Non-communicable disease, (BMJ 2011;342:d2648 doi:10.1136/bmj.d2648) which shows that 63% of global deaths (36 million) in 2008 were caused by cardiovascular disease, diabetes, chronic respiratory disease, and cancer. Four fifths of the deaths were in low and middle income countries, and 29% of the deaths in low and middle income countries were in those under 60 compared with 13% in high income countries.
Ala Alwan, assistant director general of WHO responsible for NCDs, emphasised strongly at the Moscow meeting that NCDs are a major problem in developing countries and a threat to development. Deaths from NCDs are expected to increase by 15% globally between 2010 and 2020 with the biggest increases in Africa, the Eastern Mediterranean, and South East Asia, where they will increase by 20%.
NCDs, the report shows, are caused by tobacco (6 million deaths annually), physical inactivity (3.2 million deaths), harmful use of alcohol (2.3 million deaths), unhealthy diet, raised blood pressure (7.5 million deaths), and obesity and overweight (2.8 million deaths). Underlying these causes are social determinants like modernisation, globalisation, and urbanisation.
The report identifies highly cost effective “best buys” for responding to NCDs, “actions that should be undertaken immediately to produce accelerated results in terms of lives saved, diseases prevented, and heavy costs avoided.” Seven of the 10 relate to tobacco and alcohol.
The ministers in the Moscow Declaration “note that policies that address the behavioural, social, economic, and environmental factors associated with NCDs should be rapidly and fully implemented” and “emphasise that prevention and control of NCDs requires leadership at all levels, and a wide range of multilevel, multisectorial measures.”
One of the major themes of the conference was the recognition that health ministers and health services alone can make only a small impact on NCDs. “A paradigm shift is imperative in dealing with NCD challenges,” says the declaration. There is a need to “shift from disease centred to people centred approaches and population health measures.”
As part of the need for doing things differently, WHO held a Global Forum on Addressing the Challenge of NCDs the day before the ministerial meeting, and the forum included non-governmental organisations, the private sector, professional organisations, and others. The output from this forum was fed into the ministerial meeting, and at the end of the forum Dr Chan described how WHO needed to change to cope with new challenges—not only NCDs but also mental heath, injuries, and other problems that need action from more than the health sector (BMJ 2011;342:d2766; doi:10.1136/bmj.d2766).
Dr Chan said that the rise of NCDs “also calls for some serious thinking about what the world really means by progress . . . What is the net gain if the benefits of modernization and economic growth are cancelled out by the costs, like medical bills, lost productivity, and premature death, of a preventable disease?”
RS has written two blogs on the Moscow meetings, which can be accessed at http://blogs.bmj.com/bmj/category/richard-smith/
Cite this as: BMJ 2011;342:d2796
Competing interest: RS is the director of the UnitedHealth Chronic Disease Initiative. UnitedHealth Group is a for-profit organisation, but its chronic disease initiative is a philanthropic programme. UnitedHealth paid RS’s expenses for attending the meeting, but he facilitated a meeting of ministers on behalf of WHO.
The declaration can be seen at http://www.who.int/nmh/events/moscow_ncds_2011/conference_documents/moscow_declaration_en.pdf.