UN Renews Pledge to Decrease Noncommunicable Diseases

Troy Brown, RN

October 01, 2018

The United Nations (UN) General Assembly held its third high-level meeting on the prevention and control of noncommunicable diseases (NCDs) on September 27. The group passed a political declaration entitled, "Time To Deliver: Accelerating Our Response to Address NCDs for the Health and Well-Being of Present and Future Generations," in which member nations reaffirmed their commitment to reduce mortality from NCDs by one third by 2030, known as Sustainable Development Goal target 3.4 (SDG 3.4).

The first and second UN high-level meetings on the prevention and control of NCDs occurred in 2011 and 2015, respectively.

Over and over, speakers during the opening segment and plenary sessions spoke about the health and economic consequences of NCDs and the fact that those in the poorest countries are disproportionately affected. Many emphasized the need for addressing climate change, nutrition, alcohol and drug use, mental health issues including suicide, and tobacco use.

"While this is not the first time NCDs have been discussed in these halls, this year's high-level meeting takes place at a particularly critical juncture. With an increasingly globalized world, longer life expectancy, a rapidly changing climate, and increasing levels of urbanization, we are witnessing shifts — demographic and otherwise — that see the burden of NCDs rising in all our nations," said Amina J. Mohammed, deputy secretary-general, United Nations, who delivered remarks at the meeting on behalf of UN Secretary General Antonio Guterres.

"The current state of affairs is alarming; 1.5 million people between the ages of 30 and 70 will die this year as a result of [NCDs], and most of these people — about 80% of them — live in developing countries; men and women who should be living vibrant and productive lives are dying prematurely," Mariá Fernanda Espinosa Garcés, president of the General Assembly, said during the opening segment of the meeting.

Economic Burden Is High

NCDs including mental health disorders have profound effects on societies, with ramifications that extend far beyond health, Mohammed said.

"These diseases rob people of the ability to earn a living and fuel a cycle of poverty that continues to impoverish families and communities. The costs of NCDs are enormous, not only to the people affected, but also to national budgets, health systems, and the global economy," she explained.

"Not only is it more likely that the poorest are the ones suffering from [NCDs], but rather the effects of cancer, diabetes, and mental health conditions and cardiovascular diseases affect their capacity to carry out social and economic activities and contribute to the development of their communities. In fact, [NCDs] lead to annual losses of up to 6% of [gross domestic product] in our countries. To put it succinctly, [NCDs] have become our greatest challenge to health and also lead to serious economic and fiscal problems," Garcés said.

Garcéstalked about the need for working at all levels to change "deeply entrenched" practices in many countries to prevent NCDs.

"WHO has developed a tool we call the Best Buys — a set of 16 practical interventions that are cost-effective and feasible for all countries, including low- and middle-income countries," Tedros Adhanom Ghebreyesus, PhD, director-general, World Health Organization (WHO), said at the meeting.

The Best Buys could have an enormous economic impact. "Implementing all 16 Best Buys globally will generate US $350 billion in economic growth in the poorest countries between now and 2030," he added.

Climate Change, Mental Health Need More Attention

Mohammed emphasized that addressing climate change is a vital step in the prevention of NCDs, as the risk rises along with increasing air pollution. She said that according to WHO, air pollution is responsible for a quarter of adult deaths from both heart disease and stroke, and 30% of deaths from lung cancer.

The group must also increase its focus on mental health, "which has been a neglected element of this agenda for far too long," Mohammed said, explaining that one in four will experience a mental health episode at some point during their life and 800,000 will die from suicide this year alone. Although this is a global phenomenon, developing countries bear the brunt of mental health issues and suicide. Alcohol and drug use must also be addressed, she added.

Political Will Needed

"WHO's Best Buys include increasing tobacco taxes; restricting alcohol advertising; reformulating food products with less salt, sugar, and fat; vaccinating girls against cervical cancer; treating hypertension and diabetes; and more. The Best Buys were endorsed by all of your countries at the World Health Assembly last year. If implemented globally, they will save 10 million lives by 2025 and prevent 17 million strokes and heart attacks by 2030," Tedros explained.

Some of these steps may be unpopular, such as increasing tobacco taxes, limiting alcohol advertising, taxing sugary beverages, and reformulating food products. Countries need to have the "political will" to implement these steps and finance other preventive strategies, several speakers noted.

"This is a task that is incumbent upon all of us; therefore, we thought it necessary to include in our recommendations the participation of other key stakeholders in this struggle against this pandemic, including civil society and the private sector," Tabaré Vázquez, MD, president of the Eastern Republic of Uruguay and co-chair of the WHO Independent High-Level Commission on NCDs, said at the meeting.

"We did not agree to the inclusion of the tobacco industry, which as you know, is the only industry that kills its own consumers," Vázquez added. An earlier meeting addressed the success of the WHO Framework Convention on Tobacco Control.

"What we need now is political will and allocation of resources for financing our response so that we can achieve the ambitious objectives that we have established for ourselves. Ambitious goals require far-reaching measures. So far our progress has always been lagging behind our expectations...If we are to achieve this goal in the next 12 years, we need immediate, urgent, and swift action. The commitments and the promises set out in the political declaration can only come to fruition when they are complied with and implemented and when their impact actually filters down to people in their homes and their economies," the UN's Garcés explained.

"We Can Change Course, and We Can Do It Today"

With regard to meeting SDG 3.4, "We're dangerously off-course. At the current pace, less than half of the world's countries will meet that target. We can change course, and we can do it today; we can do it now," Tedros said.

"Since our UN high-level meeting in 2011, progress has been inadequate and too slow. In fact, according to a recent study, NCD Countdown 2030, published in The Lancet [2018;392:1072-1088]...it seems that more than half of all countries are not on track to meet the SDG 3.4 NCD mortality target, and [mortality] has stagnated or actually increased since 2010 in 15 countries for women and 24 countries for men," Princess Dina Mired of Jordan, president-elect of the Union for International Cancer Control, said at the meeting.

Mired said that, since 2011, "we in civil society and WHO have done everything in our power to support countries in their fight against NCDs." She listed numerous steps that have been taken, including developing global targets of reducing premature mortality, framing the need for prevention of NCDs in political and economic terms, and supporting and developing evidence-based tools and guidance documents.

But it has not been enough, she said.

"We deleted the box of 'We don't know what to do'; we challenged the 'no money' argument; and we nullified the notion of the impossible, the challenging, and the complex. And yet, 15 million people are still dying prematurely every year right before our very eyes," Mired said.

"How does one explain the obvious and the urgent over and over again to spur serious meaningful action? What else should we do to get the political and economic attention needed to start implementation on the ground?" she asked.

During the plenary sessions, dozens of high-level speakers from member states made brief statements about steps their nations are taking to combat NCDs, including initiatives aimed at promoting healthy nutrition and exercise and discouraging excessive alcohol consumption.

Scaling Up Prevention and Control of NCDs

Two multistakeholder panels addressed steps that can be taken at the national and subnational levels to help prevent and control NCDs, including ensuring that national universal health coverage packages cover NCD and mental health services, embedding NCD prevention and control solidly in primary healthcare, and encouraging governments to work with the private sector.

"A lot has already been done — no question about that — but this fight is far from being over," Adalberto Campos Fernandes, MD, PhD, minister of health of Portugal, said at the meeting, adding he has no doubt that reducing NCDs can be accomplished.

Nevertheless, it is "an extremely big challenge," he said. "It is not hard to understand that the business of sickness is much more profitable than the business of health. Unfortunately, often economic interests oppose health objectives."

The challenges associated with taxing products such as tobacco, alcohol, and sugar-sweetened beverages were discussed by countries who have implemented such steps, and the potential for new technologies to help with management of NCDs was also discussed.

Fernandes pointed to the need for changing the way we think about NCDs and said that the time for thinking the responsibility for healthcare is the government's alone is over. "Everyone has a role to play; everyone must take a seat at the table."

Fernandes concluded by noting that NCDs — once viewed as diseases of adulthood — are increasingly affecting children as well. "Let the future of our children be the motivation that will lead us to run the extra mile. Let the future of our children be the value higher than any other. It is time to act. It is time to deliver. It is our duty, our mission, our health."

The WHO also renewed its appointment of Michael R. Bloomberg as its global ambassador for NCDs and injuries. First appointed in 2016, he will continue to work in support of global, national, and local efforts to protect individuals from NCDs and injuries.

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