Intended for healthcare professionals


World leaders sign up to tackle causes of non-communicable diseases

BMJ 2011; 343 doi: (Published 21 September 2011) Cite this as: BMJ 2011;343:d6034
  1. Rebecca Coombes
  1. 1New York

More than 30 world leaders and 100 senior ministers representing the 192 member states of the United Nations signed a political agreement at the UN General Assembly this week, agreeing to tackle the world’s major non-communicable diseases: diabetes, lung disease, cancer, and cardiovascular disease.

It marks the end of months of negotiations among the member states in which factions have wrangled over the need for greater regulation to reduce some of the key risk factors in these diseases: consumption of alcohol, tobacco, processed foods, and salt. Other sticking points were opening up access to essential drugs, such as those for diabetes and cancer, by relaxing intellectual property agreements.

The final document, agreed on 19 September, falls short of setting any targets or goals for results in all four of the disease areas, which together cause 63% of the world’s deaths, four fifths of which are in low and middle income countries. Weak areas include a failure to urge countries to use pricing policies to curb harmful alcohol consumption.

However, tobacco control emerges as the clear winner of all the action points, with a strongly worded commitment to “accelerate” the adoption of the World Health Organization’s Framework Convention on Tobacco Control. Health ministers from France, Norway, and Australia lined up to publicly lambast the tobacco industry for launching legal action against those countries seeking to restrict their influence.

WHO’s director general, Margaret Chan, told the meeting that non-communicable diseases are “the diseases that break the bank.” A new WHO study of the costs of scaling up a core intervention package to prevent and treat such diseases in low and middle income countries has shown that it will cost $11.4bn (£7.2bn; €8.3bn) a year for all these countries, far less than the World Economic Forum’s estimated bill of nearly $500bn in economic losses every year between now and 2025 if a “business as usual” approach is taken and disease rates continue to soar.

The UN secretary general, Ban Ki-moon, said that these diseases were a threat to development, hitting poor people particularly hard and driving them deeper into poverty.

Reclassifying non-communicable diseases as a “development” issue could be crucial in funding terms—for example, by attracting the resources and expertise of major international development agencies such as Oxfam and Médecins Sans Frontières in tackling these diseases in low income countries.

The NCD (non-communicable disease) Alliance, a network of 2000 non-governmental organisations, said that UN millennium development goals should now include targets on these diseases, including a commitment to reduce the global number of deaths from them by 25% by 2025.

Ann Keeling, chairwoman of the alliance, said, “This meeting has made the world sit up and take notice of the huge global burden that NCDs are placing on all countries. Countries now need to be urgently factoring NCDs into their longer term health planning alongside other pressing health challenges.”

The next step is for WHO to develop a framework for monitoring global progress and to prepare—before the end of 2012—recommendations for a set of global targets to monitor trends and assess countries’ progress. This is likely to include a limit on consumption of salt of 5 mg per person a day—a target that was deleted from an earlier draft of the declaration.


Cite this as: BMJ 2011;343:d6034