UN Summit on Noncommunicable Diseases Hits Snag

Jacquelyn K. Beals, PhD

August 11, 2011

August 11, 2011 — The first United Nations (UN) High-Level Summit Meeting on Non-Communicable Diseases (NCDs) will be held September 19 and 20 in New York City, with the participation of heads of state and heads of government from around the world.

However, negotiations over an outcomes document for discussion at the Summit have hit a wall, with the United States and the European Union opposing many of the target-oriented resolutions on the grounds that they would be responsible for the bulk of the action items.

The NCD Crisis

A General Assembly resolution calling for this high-level meeting on NCDs was adopted May 14, 2010. The resolution called for action to the curtail premature deaths from NCDs, the leading cause of deaths worldwide. The diseases to be focused on — cardiovascular diseases (heart disease and stroke), chronic respiratory diseases, cancers, and diabetes — are responsible for close to 35 million deaths each year.

In anticipation of the Summit, a Health Policy article on the NCD crisis was recently published (Lancet. 2011;377:1438-1447). The authors, who represent the Lancet NCD Action Group and the NCD Alliance, point to the growing global burden of NCDs and the need for interventions to reduce NCD death rates.

According to the article, NCDs currently account for two thirds of all deaths that occur each year. Four fifths of NCD deaths occur in countries with low- or medium-income levels; their age-specific NCD death rates are almost double those of high-income countries. Throughout the world, NCD deaths are increasing because of aging populations and "globalization of risks," including the use of tobacco.

Many deaths from NCDs, especially in developing countries, could be prevented by decreasing excessive alcohol use, unhealthy diets, the use of tobacco, and inadequate physical activity. Early detection could also reduce deaths from breast and cervical cancers, hypertension, and diabetes.

Summit Stalls

In preparation for the Summit, the NCD Alliance has issued its own "proposed outcomes document" to advocate for outputs and language it would like included in the final UN draft. However, information posted August 7 on the NCD Alliance Web site noted that the negotiations process stalled on August 5, with negotiations "postponed until Thursday 1 September because member states were unable to reach consensus."

"We do not expect the draft as it stands to be made public," continued the NCD Alliance statement. Currently, attempts to access the NCD Alliance proposed outcomes document — previously available online — or the "pocket version" of the proposed outcomes document elicit the message: "The requested page could not be found."

"According to what we have heard, the G77 nations [a coalition of developing nations within the UN that was founded by 77 nations but has expanded 131] have been most positive in their approach to negotiations on the draft political declaration to be unveiled at the Summit," said Brian Ward, policy advisor for the European Respiratory Society, in an email to Medscape Medical News.

Reluctance to Commit

However, "the United States and the European Union...have been rather more reluctant to commit to concrete action-orientated outcomes," continued Mr. Ward. "Despite the fact that the NCD burden is highest in Europe and the United States, these regions have also been very reluctant to commit any financial support to this UN process aimed at tackling the NCD epidemic."

One source of the current lack of consensus is the desire on the part of G77 and other nations to designate global targets in the outcomes document, with time-bound commitments (see July 27 and July 21 NCD Summit action alerts).

By July 21, the United States had proposed that countries establish national plans and policies regarding NCDs by 2013, and Norway had proposed a time-bound target for salt reduction. However, the broader pattern is for the United States and the European Union to oppose time-bound targets, whereas the G77 nations favor them.

Financing the Root of Opposition to Outcomes Document

In each area of the current conflict, the same pattern is apparent — the European Union, the United States, and at times Japan have opposed the "action-oriented outcomes" endorsed by the NCD Alliance and the G77 nations. Because developed nations would foot much of the bill for combating NCDs, they are reluctant to commit to time-bound targets in an uncertain economy.

The NCD Alliance has pointed to 3 major areas of conflict in the negotiations: global targets, partnership, and follow-up. An NCD Alliance spokesman compared the NCD initiative to previous UN initiatives against AIDS, in which global targets provided measurable goals, held countries accountable, and recognized countries meeting the goals.

The NCD Alliance is encouraging the establishment of a global NCD partnership by 2012 to follow-up on commitments made at the Summit. The partnership would include member states, appropriate UN agencies, international financial institutions, civil and private sector organizations, foundations, and academic and research institutions.

Follow-up, as proposed by the NCD Alliance, would include a "high-level and comprehensive review in 2014," and a high-level meeting in 2014 called by the UN General Assembly to report progress on all the issues in the outcomes document, and on the monitoring and evaluation framework with respect to the global, regional, and national targets.

First Step to a Global Solution

Brian Carey, from the European Association for the Study of Diabetes (EASD), in an email to Medscape Medical News, noted that: "This matter, from the diabetes viewpoint, is being addressed by the International Diabetes Federation (IDF)." The president of IDF, Jean-Claude Mbanya, MD, PhD, who is professor of medicine and endocrinology at the University of Yaoundé, and chief of the endocrinology and metabolic diseases unit at the Hospital Central in Yaoundé, Cameroon, will address the delegates at the EASD Annual Meeting on September 13, less than a week before the UN Summit.

An editorial by Dr. Mbanya published in the July 27 issue of Diabetes Research and Clinical Practice, entitled "Less than 100 days to UN Summit," cited the now-unavailable proposed outcomes document, referring to the "4 headlines and 10 priority actions" of the pocket version of that document.

His article listed anticipated major outcomes of the Summit as leadership and international cooperation; cost-effective NCD prevention; early diagnosis, treatment, and care of NCDs; and monitoring, reporting, and accountability.

"We must remember that the Summit is the first step to a global solution," said Dr. Mbanya. "It took just one generation to get to this crisis point for NCDs but it is going to take significantly longer to get past it.... We have the evidence, cost-effective solutions and with the Summit we have the political opportunity. Let us go forward and secure our common future."

New Position Statement Voices "Grave Concern"

On August 10, the NCD Alliance issued a position statement delineating many of the above issues, and expressing grave concern that "international progress on NCDs is at serious risk with recent efforts to postpone negotiations, while blocking accountability measures and time-based targets in the UN political declaration on NCDs ahead of the September high-level meeting."

The NCD Alliance plans to release a media announcement next week regarding the urgent need for consensus on "time-bound commitments to action," and "stepping up the pressure on governments to ensure the meeting really is the turning point for NCDs." Developments between now and September 19 may well determine whether global efforts to combat NCDs will be implemented any time soon.

Individuals who communicated with Medscape Medical News were spokespeople for the organizations they represented and disclosed no relevant financial relationships.


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