6.1 NCDs: Outcomes of the High-level Meeting of the General Assembly on the Prevention and Control of Noncommunicable Diseases and the First Global Ministerial Conference on Healthy Lifestyles and Noncommunicable Disease Control

Secretariat Note

Resolution WHA64.11 requested the Director-General to report to the Sixty-fifth World Health Assembly, through the Board, on the outcomes of the first Global Ministerial Conference on Healthy Lifestyles and Noncommunicable Disease Control and the High-level Meeting of the United Nations General Assembly on the Prevention and Control of Noncommunicable Diseases. The Director-General submits to the Board, for its consideration, reports on the outcomes of these two meetings and observations on their significance for public health policies and implications for the Organization’s programmes.

Document EB130/6 reports to the WHA on the outcomes of the High-level Meeting of the General Assembly on the Prevention and Control of Noncommunicable Diseases and the First Global Ministerial Conference on Healthy Lifestyles and Noncommunicable Disease Control.

The document reviews the actions committed to in the Political Declaration including

• actions required of member states
• actions at the international level
• actions specifically required of WHO

The actions required of WHO include: 

• setting norms and standards: 
  • to develop a global monitoring framework (paragraph 61) and recommendations for a set of voluntary global targets, building on the Secretariat’s ongoing work, through the governing bodies of WHO in 2012 (paragraph 62); 
  • to collaborate with the United Nations Secretary-General in submitting a report to the General Assembly at its sixty-seventh session (in 2012) on options for strengthening and facilitating multisectoral action through effective partnership (paragraph 64); 
• exercising a leading and coordinating role within the United Nations system: 
  • by establishing and institutionalizing strong  collaborative links with United Nations agencies, funds and programmes (paragraphs 13, 43, 45, 46, 51 and 61–64); 
• developing an implementation plan for the outcome of the High-level Meeting:
  • by preparing, in consultation with Member States and organizations in the United Nations system an updated six-year action plan (2013–2018), taking into account the outcomes of the High-level Meeting; 
• expanding technical competence and resources: 
  • by providing support to WHO’s Member States in developing national plans and policies for prevention and control of noncommunicable diseases (paragraphs 43(e), 45 and 51) in the areas of normative functions, technical collaboration, and strengthening and facilitating multistakeholder action. 

The document presents a plan for fulfilling these commitments.  

Watchers' notes of EB discussions of NCDs

Prevention and Control of Noncommunicable Diseases (EB Documents 130/6, 130/7, 130/8)

Member States highlighted the importance of the UN High-Level Meeting on the prevention and control of noncommunicable diseases (HLM) and stated the momentum should not be lost.

USA introduced the draft resolution co-sponsored by Australia, Barbados, Canada, Costa Rica, Kenya, Norway and Switzerland. The resolution attempts to set out a clear process of active participation by Member States through the critical year of 2012 on three areas, reflecting the tasks given to WHO by the UNGA at the HLM (to develop a comprehensive global monitoring framework with targets and indicators; to strengthen multisectoral action through partnerships; and to develop a new Action Plan for 2013-2020).  

The USA, Mexico, South-Africa, Brazil, Thailand, France and Estonia on behalf of the EU emphasized the importance of linking future NCD action with action addressing the SDH and the Rio Declaration.

The need for multisectoral action was highlighted by several countries. Canada looked forward to working with “funds, programs, Member States and WHO”.  Brunei Darrusalam mentioned the need to engage with the food and beverage industries. France however, stressed that health should remain at the heart of a multisectoral approach. The commitment of all stakeholders is essential, but any involvement in this very lucrative sector should be very transparent. Safeguards should be in place to prevent conflict of interest.

Switzerland recognized that the work of the framework and the targets should be protected from conflict of interest, but urged that all stakeholders should be involved in the implementation of the Action Plan.

India on the other hand, recalled that the Political Declaration of the HLM specifically recognizes the fundamental conflict of interest between the tobacco industry and public health [par 38] and urged for similar action to minimize the use of alcohol. They requested WHO to initiate action on a framework convention on alcohol, similar to the one on tobacco. As for the development of the comprehensive monitoring framework and the setting of targets, they urged for the process to be as inclusive as possible, involving CSOs and international organizations.

Access to medicines was taken up in the draft resolution and its importance was stressed by India, Brazil, Mexico, South Africa, Côte d’Ivoire and the US. Mozambique on behalf of the AR, Brazil and Algeria specifically asked for the implementation of TRIPS flexibilities.

Several developing countries stressed the importance of continuous technical support tailored to country needs, data collection and working both on lifestyle changes and strengthening health systems, including training of primary health care workers.

The need for health system strengthening was emphasized by India, Mexico and France, calling for universal health coverage. The need to increase funding was touched upon by Myanmar, India, South Africa and Mozambique on behalf of the AR. Algeria mentioned that additional expenditure on health was being backed up by innovative methods deriving from taxing tobacco.

There were many CSO statements, from Alzheimer’s Disease International, Consumers International, International Special Dietary Food Industries, World Dental Federation, Union of International Cancer Control, Thalassemia Association, World Health Professional Association, Patient Protection NGO, International Federation of Medical Students’ Associations and off course,

Medicus Mundi International on behalf of the People’s Health Movement (click here for our statement). Some very positive amendments were made to the resolution (click here for the final resolutions with the amendments in track changes).

Timor-Leste and France added language on civil-society engagement and the need for transparency and safeguards for conflict of interest when engaging in partnerships. Interestingly, the original draft contained the following sentence regarding access to essential medicines: to facilitate engagement by governments and the private sector.

TimorLeste requested to add “as appropriate civil society and” before the “the private sector”. Several countries supported, but Canada explicitly rejected the amendment as they believe the word “civil society” is not clear. They asked whether the Secretariat could provide a definition of the term to clarify whether it does or does not include the private sector. The Secretariat did not respond.  

Also noteworthy is the amendment by Timor-Leste of language that was adopted from the Political Declaration of the HLM. In the declaration WHO is asked to develop “options for strengthening and facilitating multisectoral action through effective partnerships”. Timor-Leste amended this to “through effective and transparent partnerships, while safeguarding public health from any potential conflict of interest”.

The point raised by Switzerland that language coming from the Political Declaration should not be amended was neglected and Timor-Leste’s request was supported by several other countries.

The resolution on “Strengthening noncommunicable disease policies to promote active ageing” was also adopted after some amendments. The EU introduced language on health promotions, social services etc; India introduced access to medicines and Mexico stressed a life-course approach. To see the amendments in track changes in the final resolution, click here.  

Background

See WHO Watch topic page on NCDs for background references.

The key documents are: 

• Document A53/14: a Global strategy for the prevention and control of NCDs (May 2000)  
• Resolution WHA53/17 on Prevention and control of NCDs (May 2000) 
• Finalisation of the Global strategy on diet, physical activity and health in May 2004
• Document A61/8: Implementation of global strategy (May 2008)
• Resolution WHA61.14: Prevention and control of NCDs: implementation of global strategy (May 2008)
• First global status report (2010) on implementation of global strategy (2011)
• Moscow Declaration (April 2011)
• UNGA Special Session on NCDs (Sept 2011) Political Declaration

Comment

There is no debate regarding the need to recognise the epidemics of NCDs as a real and present crisis which continues to grow in magnitude. In some countries the epidemic is little short of a tsunami.  The implications stretch from premature death and years of disabilty to massive pressures on health expenditures to impacts on productivity and economic development. 

Much has been achieved since the Global strategy was adopted in 2000 and there are many valuable ideas in the material produced more recently.  

However, there are some issues which are at risk of being neglected or underplayed and we highlight these in this comment.

The PHM MMI intervention on the floor of the WHA64 in May 2011 highlighted the following issues as important and at risk of being neglected: 

• omission of mental health from the 'package';
• the focus on life style in the Moscow meeting and the absence of any reference to the Commission on SDH in Document A64/21 prepared by the Secretariat for WHA64, including in particular its treatment of equity factors and structural determinants (including food supply);
• need to address affordable treatment including access to medicines;
• the need to attend to the rational use of medicines and diagnostic tools and to manage the pressures for over use as well as the barriers to access; 
• the role of health systems as a key platform for addressing NCDs and in particular the PHC sector and the comprehensive primary health care approach; this is in contrast to the disease specific approach which has fragmented health systems and weakened their ability to deal with health needs comprehensively;  
• the ambiguous role of large transnational pharmaceutical companies in support of the NCD Initiative and the importance of WHO having proper policies and protocols to identify and manage institutional conflict of interest.

This agenda item deals with a list of actions to which WHO is committed (and should deal with other relevant actions to which it has committed in other previous resolutions). However, whether there is money to support effective and sustained action will depend on the new arrangements for 'collective financing' or 'open pledging'. Given the brutality of the negotiations around the Political Declaration it seems likely that any decisions taken at this WHA will be reviewed and reworked in the context of the ongoing 'dialogue with donors'.  

There is some policy leverage to direct further attention to these issues available in the Political Declaration.  However, it is a very long document with something for almost everyone (although it is truly astonishing that there is no mention of food supply in the Declaration) and the challenge will be to identify a small number of strategic issues to be advanced through this EB and the subsequent WHA, for example, advocating for collaboration between WHO and UNCTAD on options for regulating international trade in ways which would help to promote healthier food supply.

It may be that a different agenda for action needs to be promoted focusing more explicitly on: opposing trade agreements which reduce governmental policy space; promoting wider use of TRIPS flexibilities to access pharmaceuticals for NCDs; focusing on health systems strengthening and in particular comprehensive PHC; addressing the social determinants of health; and regulating the transnationals. 

However, the NCDs initiative has considerable momentum and there may be scope for progressive outcomes to be achieved under its aegis.