This is an exciting time for global health. A possible change in priorities could signal the beginning of unprecedented and much-needed action to promote health and address risks that have remained outside mainstream domestic and international public policy planning.
Non-communicable diseases (NCDs) represent a new frontier in the fight to improve health and development worldwide. The four types of NCDs – cardiovascular diseases, cancers, chronic respiratory diseases and diabetes – make the largest contribution to mortality in the majority of developing countries and economies in transition. In 2008, over 28 million people in developing countries died from NCDs. Some 8 million of these were under the age of 60.
In addition to their serious impact on health, NCDs have an adverse influence on socioeconomic development, leading to increased burdens on households, including impoverishment from long-term healthcare costs and loss of productivity. The cumulative lost output in developing nations associated with NCDs is estimated to be $7tn between 2011 and 2025.
Fortunately, these diseases are largely preventable. Much of the premature mortality they cause can be avoided by implementing evidence-based, lowcost measures that promote access to healthcare and tackle the four modifiable risk factors shared by NCDs: tobacco use, unhealthy diet, physical inactivity and the harmful use of alcohol.
Last year, the UN General Assembly convened a high-level meeting (UNHLM) on NCDs, which produced a commitment by world leaders on taming the world's biggest killers. Not only did the meeting mobilise unprecedented political support, it also built effectively on work done to date. In 2000, the World Health Assembly – the decision-making body of the World Health Organisation (WHO) – endorsed a three-pronged strategy for the prevention and control of NCDs: monitoring the NCD burden, its risk factors and determinants; addressing the shared risk factors; and improving access to basic healthcare. Since then, the WHO has worked with states on developing tools to implement the strategy, including the 2003 Framework Convention on Tobacco Control; the 2004 Global Strategy on Diet, Physical Activity and Health; and the 2010 Global Strategy to Reduce the Harmful Use of Alcohol. In 2008, the Assembly also endorsed a five-year action plan to provide a global roadmap and guidance for establishing national programmes, with a particular focus on developing countries.
Last year's meeting recognised NCDs as a major challenge for development in the 21st century and outlined priority actions to be taken at the national level, such as institutionalising NCDs in health-planning processes and countrydevelopment plans through approaches within and outside of the health sector. It also garnered consensus on the need to foster partnerships, global monitoring, and multi-sectoral action, and to support relevant international organisations in providing technical assistance and capacity-building to developing countries. These developments come at a time when the benefit of insights from past experience and current trends in global health can inform the global response to NCDs. A "whole-government approach" to health issues and the notion of "health in all policies"; emphasis on universal health coverage as an end and the resurrection of primary healthcare as a means to this end; lessons from scaling up HIV care; and burgeoning technology, in particular "mHealth" – health and medical practices supported by mobile devices – all are relevant to shaping this response. Discussions on NCDs now accord attention to accountability, with greater emphasis on learning from the Millennium Development Goals experience and on aid effectiveness norms – increasingly recognised as tools to build country capacity.
The range of normative instruments, diversity of stakeholder networks and insights from past health initiatives provide fertile ground from which to mount an effective response to NCDs. But in order to have impact, governments must translate the commitments expressed during the UNHLM into concrete action. So too must other stakeholders. Civil society and non-governmental organisations played an important role in the lead-up to the meeting and are now preparing for a more effective role in delivering the challenging agenda contained in its outcome document. The private sector, including the food and non-alcoholic beverage and the pharmaceutical industries, has also been given clear responsibilities. Higher levels of joint work and co-ordination should replace competition and fragmented initiatives.
Whilst opportunities abound, the threat of inaction also looms. With a global economic crisis underway and competing priorities, including a pressing environmental sustainability agenda, international attention can waver, especially if various NCD factions stand divided. It is critical that governments and other stakeholders begin delivering now and remain committed to the vision expressed at the UN last September.
Dr Ala Alwan is Assistant Director- General for Noncommunicable Diseases and Mental Health at the World Health Organisation. Dr Sania Nishtar is Founder and President of Heartfile, a leading NGO based in Pakistan that focusses on health policies and systems
