13.12 Prevention and control of noncommunicable diseases

The twentieth century saw a transition from acute to chronic illnesses which became the main cause of mortality. Thirty-eight million deaths occur each year due to non-communicable diseases (NCDs), mainly cardiovascular diseases, cancers, respiratory diseases, and diabetes. When the injuries are taken into account NCDs are responsible for 70% of all deaths of which 80% occur in L&MICs. The estimation made by WHO is that over the next 10 year period deaths from NCDs will increase by 17% with the greatest increase in African Region and Eastern Mediterranean Region.

The United Nations General Assembly decided to convene a high-level meeting on NCDs in 2011 in resolution A/RES/64/265 which required the Assembly to hold consultations on the scope, modalities, format and organization of the high-level meeting. Under this WHA64 agenda item the Assembly considered document A64/21, a report by the Secretariat on WHO’s role in the preparation, implementation and follow up to the upcoming High Level Meeting.

WHO and the Russian Federation had jointly organized the First Global Ministerial Conference on Healthy Lifestyles and Noncommunicable Disease Control in April 2011. It aimed to support Member States to develop and strengthen policies and programmes on healthy lifestyle and NCD prevention; based on the 2000 Global Strategy for the Prevention and Control of Noncommunicable Diseases and it’s 2008-2013 Action plan with a focus on multisectoral and innovative approaches in prevention and care. The Ministerial Conference resulted in the adoption of the Moscow Declaration. Capitalizing on the opportunity presented by the Ministerial Conference, WHO had convened a “multi-stakeholder forum” the day before the conference. The intention was to create an opportunity for the different groups to listen and respond to each other to allow WHO to canvass a wider and richer range of views to inform its work on noncommunicable diseases.

PHM Comment

The report by the secretariat neglects mental health as an NCD which is estimated to be one of the leading causes of burden of disease by the year 2030. Currently the scope of NCDs is limited to four diseases (cardiovascular disease, cancer, chronic respiratory disorders and diabetes) but there is a need to widen the scope of coverage of NCDs to include various other diseases especially mental ill-health.

Regrettably the EB discussions on NCDs was focused on the behavioral determinants of NCDs. The name "non-communicable disease" was challenged because of the so called “socially communicable” nature of its risk factors. The focus on life-style and behaviour returns to an older 'victim blaming' approach rather than addressing the core determinants. It is extraordinary that there is no reference to the work of the Commission on Social Determinants and Health (CSDH) in the Annex summarizing previous events leading up to this meeting. Unhealthy behaviors do play an important role in determining NCDs however as the report by CSDH has indicated there are structural determinants like education, income, gender and ethnicity which are underlying causes of NCDs and their contribution to behavioral risk factors needs to be tackled. The CSDH emphasized the importance of looking at the equity dimensions as well as the disease process. Clearly there are important equity dimension to the incidence and prevalence of NCDs and these variations are closely linked to the social and environmental factors; not just individual behaviors. Therefore if the UN General Assembly is to provide an action-oriented outcome document preventive measures for social and environmental factors must be included.

The focus of the NCD initiative has been on the prevention of NCDs rather than treatment. While prevention is important we also urge member states to address the access to affordable treatment for NCDs. Hence it is important the resolution clearly spell out the response of the member states and WHO to initiate law and policy measures to ensure access to affordable diagnosis tools and treatment, in particular the full use of the flexibilities of TRIPS. 

The development of new diagnostic tools and medicines are crucial for early detection, and also for the people living with NCDs. However the usage of these products requires further attention (guidelines, education & regulation) in order to avoid over consumption that will burden the health systems. Therefore rational use of medicines and diagnostic tools must be vigorously promoted.   

We appreciate the role of WHO and the FCTC in tobacco control but it is also important to curb the practices of other industries which contribute to the prevalence of NCDs such as food and agricultural corporations. Therefore it is important the proposed resolution should incorporate a call to develop a code of conduct to regulate their advertisement and promotion of products.

The Secretariat report is very weak on the health systems implications of NCDs.  Actually the challenge of chronic disease management underpins the managemenet of the four specific diseases highlighted in this initiative as well as many other chronic conditions, including psychiatric disorders and emotional problems. Chronic disease management calls for on-going follow up and monitoring and clinical audit based on comprehensive primary health care. The need to strengthen comprehensive PHC as the basis for managing chronic disease is not recognised in this report. 

The drive to give more prominence to NCDs includes some distinguished civil society networks which bring together much professional expertise and commitment.  This drive is also strongly supported by some very large transnational drug companies who have clear interests in terms of marketing and profits in the progress and direction of the NCD Initiative. WHO needs to have a rigorous set of protocols in place to identify and protect against conflict of interest at the institutional level.  At this time WHO has protocols in operation which deal with potential conflicts of interest involving contracted experts but there are no such provisions with respect to insitutional conflict of interest.  

See NCDnet

See NCD Alliance.

See The action plan proposed by Lancet NCD Action Group and the NCD Alliance

See Global Status Report on NCDs (2010)

See the Medicus Mundi International and PHM statement on NCDs read at the 64^th WHA