In 1996, the United Nations together with its global technical body on health - the World Health Organization (WHO) - established a new UN initiative charged with the mitigation and prevention of HIV and AIDS. Strengthened following the UN meeting in 2001, this initiative was called UNAIDS.
When a similar UN High Level Meeting was held on NCDs (non-communicable diseases including diabetes, heart disease, cancers and lung diseases) in 2011, it was decided early on that there would be no UNAIDS-like initiative for this group of diseases. No separate, vertical UN body would be created, and NCDs would remain part of the agenda for the WHO and existing UN bodies.
But why not create a UNNCDs?
Rationale for a WHO-led response
Most people would agree that the WHO, the architect of the Framework Convention on Tobacco Control (the great success of global health this decade), would be the prime candidate for leading the control and prevention of NCDs. These diseases are exactly what the WHO was established to address and taking these issues away from it undermines its credibility, its role and would erode its already limited funding.
Others argue that there’s no one else weighty enough in the global health arena to take on the large task of addressing NCDs, which will include the regulation of multinational food, tobacco and alcohol industries.
Finally, many including myself, would highlight the fact that this is not a single disease caused by one pathogen. This is a group of diseases caused by a wide range of direct and indirect factors, including social determinants of health. So while a vertical approach (thematic or disease-focused) may be appropriate for health threats that can be clearly defined and responses carved out (like HIV), more organizations need to be involved for the successful mitigation of NCDs.
This is an issue that will take the involvement and knowledge of a range of sectors - with strong coordination from health sectors worldwide and the World Health Organization.
Rational for UNNCDs
Already under-funded and over-stretched, many argue that the WHO is not currently adequately resourced to tackle possibly the largest and most complex global health issue of the century. If history were repeated, establishing a new agency may lead to a rallying of support and an acknowledgement of the scale of the problem at hand. This may lead to more ear-marked funding reserved solely for the mitigation and prevention of NCDs – something we sorely need.
What’s more, while being a technical body for health is a strength, having the WHO leading the charge may also create some limitations. One such limitation is that the NCD epidemic may continue to be seen solely as a health issue in which only health professionals, health ministries and health NGOs can be involved.
This is not the case and reflecting the strong non-health determinants of the NCD burden will require the involvement of a range of sectors.
Toward future efforts
I hope the lack of UNNCDs is not a reflection of a lack of political buy-in or successful lobbying, but rather the result of the fact that the global community has become smarter about how to tackle these defining health issues.
I hope we have consciously and purposefully decided not to silo NCDs in a bid to reduce duplication of responses and ensure a broad approach because we have acknowledged the inter-sectoral and inter-disciplinary nature of NCDs’ causes. NCDs are not just a health issue, they’ve been described by Ban Ki-Moon as global political, economic, environmental, social and cultural crisis.
I hope that with the WHO at the helm, ever greater progress will be made toward tackling this global epidemic. It’s a responsibility we must all take up, regardless of who leads the charge.
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This article is also published at Translational Global Health, by Alessandro with PLOS.