Conference organised by The Lancet & the London School of Hygiene & Tropical Medicine, 11 February 2013
The Lancet (the world’s leading medical journal), together with a number of international organisations (e.g.WHO, UNDP, World Bank), national governments and civil society, examined UN progress on the global development agenda. The discussions explored solutions for better accountability for global action on non-communicable disease (NCDs). EPHA, which closely followed the discussion, developed a number of key messages relevant to the public health community.
The Lancet Non-Communicable Diseases Series 2013 (Published February 12, 2013) is available in pdf format on The Lancet website here.
The chief aim of the event was to encourage a much wider participation in support of the commitments agreed at the UN High Level Meeting on non-communicable diseases(NCDs).
In his statement, UK’s Prime Minister David Cameron welcomed the conference, and he pointed out that “NCDs affect the poorest people the most”.
Helen Clark, United Nations Development Programme Administrator and former Prime Minister of New Zealand stressed that NCDs have to be put at the very heart of the global development agenda since they are major challenges for development. Earlier advocacy focused on universal health coverage so that everybody in need hasaccess to healthcare. However, addressing NCDs is not possible without tackling social determinants of health.
Joint letter signed by Helen Clark (United Nations Development Programme, UNDP) and by Margaret Chan (WHO) of 26 March 2012
Dr Nick Banatvala (World Health Organization) made it clear that NCDs prevention and control are a priority for the WHO. The task of WHO is shaped by the UN high level meeting on NCD prevention and control. The declaration adopted during that meeting set up 9 voluntary global NCD targets for 2025.
Several countries are suffering from the multiple burden of communicable and non-communicable diseases in Africa, pointed out Dr Patricio Marquez (World Bank). In order to improve the situation a healthy, skilled workforce is essential. Universal health coverage, increasing the domestic social spending and focusing on social determinants associated with the risk factors of Cds/NCDs are also important factors.
Deborah Carvalho from Brazil and Dr Dong Zhao from China presented effective measures taken by their countries and pointed out that other states should build consensus and adopt effective policies and measures of prevention and treatment.
By presenting the core elements and achievements of the Framework Convention on Tobacco Control, the only global and legally binding health treaty on tobacco,, Paula Johns (Tobacco Control Alliance, Brazil) highlighted that in spite of the preferred action by the tobacco industry (i.e. a focus on individual behaviour, physical activity, voluntary agreements, self regulation, and public-private programmes) the measures having real effect are tax policies, advertising and promotion restrictions, and labelling policies (traffic light and others).
In western economies food and nutrition dominate among risk factors for chronic diseases pointed out Dr Tim Lobstein (International Association for the Study of Obesity)
Overview of The Lancet NCD 4 series – highlights by the authors
Professor Robert Beaglehole, The University of Auckland, New Zealand and The Lancet NCD 4 series coordinator
Embedding NCDs into the Post-2015 agenda is crucial since NCDs have effects on social, environmental and economic development. To achievement of the agreed 25 by 25 NCD goal (25% reduction in avoidable NCD mortality by 2025) is not possible unless we speak about NCDs’ negative impacts on health. Sir George Alleyne, Director Emeritus, Pan American Health Organization
Strong leadership is needed to meet commitments to the UN political declaration on NCDs. A national response to the political declaration involves three steps: planning, implementation and accountability. Dr Dong Zhao, Deputy Director, Beijing Institute of Heart
Access to NCD medicines and vaccines is unacceptably low worldwide and access to medicines for NCDs should be supported by action, resources and systematic monitoring. Dr Veronika Wirtz, Associate Professor, Center for Global Health and Development,
Without legislation on tobacco, food and alcohol we cannot prevent harmful effects. The usual arguments are that “food is essential, food is not problem, but that diet is a problem since in a ceratin quantity everything causes problems” are true arguments for food but not for food/drink products. The formulation of these products makes it very unlikely that low quantities of them will be consumed. Professor Carlos Monteiro, University of Sao Paulo, Brazil
The lessons learnt from the HIV response can guide the introduction and stepwise expansion of the actions to address NCDs and multi-morbidity. Professor Rifat Atun, Professor of International Health Management, UK
The focus should be on the five key drivers of NCDs. We have learnt from the past that it is more efficient to focus on small groups of identified targets. UNDP can offer important support to built capacities and to use a multisectoral approach in putting actions into practice. The identified five main causes of NCDs are tobacco, alcohol, ultra-processed high fat, salt and sugar food.
A multisectoral approach is essential. WHO can play an important role in building capacity, providing technical assistance, and raising awareness, but it cannot resolve the challenge of NCDs alone. The means and possible solutions often lay outside the health sector either at national and global level so co-operation between health and other sectors is crucial.
Communicable and Non Communicable diseases are interconnected and influence each other. We have to focus on social determinants associated with the risk factors in close co-operation with those outside the health sector such as transport, food systems and the environment.
The Lancet NCD 4 series is a proposal on an independent global accountability mechanism for NCDs. The scientific health community shall build up independent accountability. There is a need to establish an appropriate model which contains monitoring, review and if necessary, remedial action with clear targets and indicators. A small set of indicators is key to achieving change.
Countries would have never reduced smoking prevalence through voluntary agreements with the tobacco industry and self regulation Harmful behaviours like the abuse of tobacco, alcohol or food need legislative action – self-regulation does not work. Legally binding measures allow for a strong follow-up. The implementation reports provide evidences for further actions.
NCD monitoring should include the monitoring of the food environment and the factors that shape them: the food supply chain, agricultural policies, trade, and investment
LANCET NCD4 SUMMARY:
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