UN High Level Meeting on NCDs: the discussions must go on
The current standstill in the negotiations of the United Nations High
-Level Meeting (HLM) on Non-Communicable Diseases (NCDs)  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 .
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 .
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
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
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 . 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 . 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 .
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 , 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 . 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
 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  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.
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
3. Global Status Report on Noncommunicable Diseases 2010. WHO 2011.
http://www.who.int/chp/ncd_global_status_report/en/index.html (accessed 30
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
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;
11. Grant W. The Political Economy of Food Governance. International
Studies Review. Volume 13, Issue 2, pages 304-309, June 2011
Competing interests: Member of the Young Professional Chronic Disease Working Group