Dealing with noncommunicable diseases
Noncommunicable Diseases (NCDs) pose a serious threat not only to global public health but also to the global economy and sustainable human development (1). A total of 56 million deaths occurred worldwide during 2012. Of these, 38 million were due to NCDs, principally cardiovascular diseases, cancer and chronic respiratory diseases and diabetes (1). Nearly three quarters of these NCD deaths were in low- and middle-income countries, which have limited capacity to address them. Nearly half (42% ) of deaths due to NCDs occur under the age of 70 years (2).
No country can control the NCD epidemic focusing only on treatment. Health care costs due to NCDs will continue to rise with continuing exposure of the population to behavioural risk factors and as populations age. To deal with NCDs effectively, a comprehensive public health approach is required which combines governance, prevention , health care and monitoring. There are cost effective population-wide prevention interventions and individual-based health care interventions. Population-wide interventions need to address tobacco use, unhealthy diet, physical inactivity, harmful use of alcohol and air pollution and their underlying social determinants. Individual-based interventions need to focus on early detection and treatment in the context of universal health coverage. Some of these interventions are affordable for all countries.
NCDs were placed in the global health and political arena with the adoption of the United Nations political declaration on NCDs in September 2011. The World Health Assembly adopted the “WHO Global Action Plan for Prevention and Control of Noncommunicable Diseases 2013 – 2020” including a global monitoring framework and a set of nine voluntary global targets in 2013. The overarching target is to attain a 25 % relative reduction in premature mortality from major NCDs by 2025. The global action plan provides an array of policy options to implement population-wide prevention and individual interventions. At the global level, a global coordination mechanism for the prevention and control of NCDs, and a United Nations Inter-Agency Task Force on the Prevention and Control of NCDs have also been established strengthening the global architecture to deal with the challenges of prevention and control of NCDs.
A high-level meeting took place at the United Nations on 10 and 11 July 2014 to review the progress achieved in the prevention and control of NCDs since the political declaration of September 2011. The outcome document of this review highlights the fact that progress in prevention and control of NCDs at the country level has been insufficient and uneven. At this review, countries have reaffirmed their committments to Integrate NCDs into health planning and national development plans, set national targets and develop national multisectoral plans by 2015 and to implement policies and interventions to reduce NCD risk factors and reorient health systems to address NCDs through primary health care and universal health coverage by 2016 (3). Countries are required to report on the progress in attaining the global targets using the Global Monitoring Framework, starting in 2015. United Nations will convene a third high-level meeting on NCDs in 2018 to take stock of progress in countries.
There is committment and there is no shortage of affordable interventions. Progress is hampered by lack of resources and limitation in the capacity of countries to address the complex challenges of prevention and control of NCDs. More resources need to be generated through domestic and external sources as well as through innovative financing. Country capacity for prevention and control of NCDs need to be strengthened including that of Ministries of Health to provide overall leadership; sectors outside health such as finance, transport, agriculture and social services to address social and environmental determinants of risk factors of NCDs; public health institutions for surveillance and monitoring; health workforce to deliver services effectively particularly in primary care and academia for implementation research.
Whereas the member states have the primary responsibility, in meeting the committments made by countries, other stakeholders have a critical part to play in supporting national efforts. These include International Agencies, bilateral and multilateral donors, philanthropic foundations, development agencies, civil society and the commercial sector. The specific roles of different stakholders are clearly idenitifed in the Global Action Plan for Prevention and Control of Noncommunicable Diseases. Accountability of all stakeholders in supporting national efforts will be critical in reversing the rising trend of noncommunicable diseases in all countries.
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1. Global action plan for the prevention and control of noncommunicable disease 2013-2020 (WHA 66.10). Geneva: World Health Organization; 2013.
2. United Nations General Assembly Resolution 66/2. Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases.
3. United Nations General Assembly Resolution A/68/L.53 Outcome document of the high-level meeting of the General Assembly on the comprehensive review and assessment of the progress achieved in the prevention and control of non-communicable diseases