What causes two out of every three deaths in the world, has been described by the Director-General of the World Health Organisation as “a slow motion disaster” and by the Secretary-General of the UN a “global epidemic”?
The answer is non-communicable diseases (NCDs): cardiovascular diseases, diabetes, cancers and lung diseases.
One year ago, world leaders met in New York and agreed to strengthen national responses to NCDs, as well as commit to coordinated international action. This was a landmark event that established NCDs as a fundamental macroeconomic, developmental and political challenge of the 21st century.
One year on, let’s look at how far the international community has come, and what challenges lie ahead.
Why are NCDs a big deal?
Without action, NCDs will be responsible for three out of every four deaths in the world by 2030 – that’s 52 million lives every year. Cardiovascular diseases alone now kill more people than AIDS, malaria and tuberculosis combined.
In all but the poorest countries, economic development, unplanned urbanisation, population ageing, increasing trade and the activities of transnational corporations fuel the consumption of NCD risk factors: tobacco, unhealthy foods, alcohol, and physical inactivity. No longer simply “diseases of affluence”, four out of five NCD deaths are in the world’s poorest countries.
In these same countries, NCDs deliver a “two-punch blow to development”:
Between now and 2030, developing countries face $14 trillion in NCD-related health-care costs and lost productivity.
For many millions, developing diabetes can mean devastating out-of-pocket health care costs, compounded by losses in family income. For these reasons, NCDs and poverty often feed off one another.
But these outcomes are not a given. Effective, affordable and politically feasible solutions such as tobacco control, salt reduction and life-saving medicines exist.
NCDs and the global development agenda
A number of important processes were initiated by the UN Meeting that could help feed NCDs into the global development agenda:
The Rio 20+ Declaration on Sustainable Development recognised NCDs as a barrier to sustainable development.
The UN Development Programme (UNDP), which works with WHO, requested country-level offices to integrate NCDs into UN Development Assistance Frameworks (UNDAF).
The UN team that drafted recommendations for the post-2015 development agenda acknowledged NCDs as a “priority for social development”.
It’s still uncertain, though, to what extent NCDs will be incorporated into the post-2015 development goals. This is partly because targets for NCDs are still in preparation.
What gets measured gets done
Targets and indicators are essential tools for international health policy and progress, holding countries accountable. So what’s happening here?
In May, countries adopted an ambitious overarching target: a 25% reduction in premature NCD-related deaths by 2025 or “25 by 25”.
Further, WHO is developing a comprehensive global monitoring framework. This will include indicators and voluntary global targets in key areas such as tobacco control, salt intake and the availability of generic essential medicines. However, few of these targets are process orientated – barely any refer to multi-sector interventions.
This much anticipated framework should be finalised in November, before review by the World Health Assembly early next year. So watch this space.
New global structures
As the UN Secretary-General notes, NCDs are “not a problem that health ministers can solve on their own”. Mitigating and, more importantly, preventing NCDs will require cooperative action across multiple sectors including health, food systems, urban planning, trade and finance. It also requires engagement between private and public sectors, without conflicting interests. Coordinating such responses is tricky for any one international agency to manage.
At present, global coordination for NCDs sits within WHO. However, donor countries and private donors have historically constrained WHOs funding for NCDs, limiting its capacity. Advocates are calling for a new high-level platform to coordinate responses across intergovernmental agencies, donors, governments, civil society and the private sector, similar to that for child and maternal health.
Lets take a look at what’s happening here.
WHO is preparing a Global Action Plan for NCDs, for adoption in May next year. This builds on a previous action plan and will guide global implementation. Akin to climate change, coordinating such activity requires considerable leadership from within the UN.
To this end, WHO is finalising a report on options for multi-sector action and partnerships, for presentation to the UN General Assembly by the end of the year. This will inform and determine if a new coordinating platform is established. The success of this platform will depend on achieving buy-in from other organisations important to global health.
Some UN agencies are starting to come on board including UNICEF and UNDP. However, engagement by other crucial players - international financial institutions, UN agencies, rich country donor agencies, transnational health and development NGOs, and large private donors - appear minimal and uncertain.
The need for a common agenda
Some perceive the growing attention to NCDs as a threat to existing program funding to address infectious diseases such as AIDS, malaria and tuberculosis. Although addressing these diseases should remain a priority among the poorest of the poor, a siloed approach is a false dichotomy.
In reality, NCDs often fuel as well as feed off infectious diseases. Diabetes, for example, can increase the risk of tuberculosis threefold, while antiretroviral drugs for treating HIV/AIDs can increase cardiovascular risk.
Where to from here?
One year on, significant progress has been made but many uncertainties remain. Will NCDs take their place within the global development agenda? Will a capable global coordinating platform be established? Will a strong monitoring framework emerge?
It’s in Australia’s national interest to ensure the answer to these questions is yes. After all, this slow motion disaster is playing out on our back door step. We are a world leader in tobacco control, but alcohol and obesity remain considerable policy challenges in this country.
NCDs are common challenges that all countries share. Australia’s leadership can be pivotal in saving the lives of millions.
This article builds on a series of articles published to mark the first anniversary of the 2011 United Nations High-Level Meeting on Non-Communicable Diseases on September 19. The series was coordinated by the non-profit organisation Arogya World in partnership with the Young Professionals Chronic Disease Network.
Thank you to Benn Grover, Nalini Saligram, Kyra-Bae Snell and Sandeep Kishore for their guidance on this article.