United Nations Summit on NCDs

World comes together to tackle noncommunicable diseases

In an all-out attack on noncommunicable diseases (NCDs) – the biggest cause of death worldwide – the United Nations General Assembly has held a high-level meeting to tackle the issue – only the second time in the history of the United Nations that a health issue has been discussed at this level. Eleven years ago the General Assembly endorsed the Global Strategy for the Prevention and Control of Noncommunicable Diseases and in September this year world leaders gathered again to outline a plan of attack for the Prevention and Control of NCDs. Middle East Health reports.

Noncommunicable diseases – mainly cardiovascular diseases, cancers, chronic respiratory diseases and diabetes – are the biggest cause of death worldwide. More than 36 million die annually from NCDs (63% of global deaths), including 9 million people who die too young before the age of 60. More than 90% of these premature deaths from NCDs occur in developing countries, and could be largely prevented by interventions that tackle four risk factors for NCDs: tobacco use, unhealthy diets, physical inactivity, and harmful use of alcohol.

In a landmark meeting, the General Assembly met with the participation of Heads of State and Government to tackle an emerging health issue with major socioeconomic impact. The two-day high-level General Assembly meeting, held 19-20 September 2011 in New York, was attended by more than 30 heads of State and Government and at least 100 other senior ministers and experts.


Delegates adopted a declaration calling for a multi-pronged campaign by governments, industry and civil society to set up by 2013 the plans needed to curb the risk factors behind the four groups of NCDs.

Steps range from price and tax measures to reduce tobacco consumption to curbing the extensive marketing to children, particularly on television, of foods and beverages that are high in saturated fats, trans-fatty acids, sugars, or salt. Other measures seek to cut the harmful consumption of alcohol, promote overall healthy diets and increase physical activity.

“This will be a massive effort, but I am convinced we can succeed,” UN Secretary-General Ban Ki-moon told the opening session of the summit. He noted that over a quarter of all people who die from NCDs succumb in the prime of their lives, the vast majority of them in developing countries.

“Our collaboration is more than a public health necessity. Noncommunicable diseases are a threat to development. NCDs hit the poor and vulnerable particularly hard, and drive them deeper into poverty,” he said, with millions of families pushed into poverty each year when a member becomes too weak to work or when the costs of medicines and treatments overwhelm the family budget.

“The prognosis is grim. According to the World Health Organisation (WHO), deaths from NCDs will increase by 17% in the next decade. In Africa, that number will jump by 24%.”

He called on governments, individuals, civic groups and businesses to all play their part. “There is a well-documented and shameful history of certain players in industry who ignored the science, sometimes even their own research, and put public health at risk to protect their own profits,” he said.

“There are many, many more industry giants which acted responsibly. That is all the more reason we must hold everyone accountable, so that the disgraceful actions of a few do not sully the reputation of the many which are doing such important work to foster our progress,” he added, calling on corporations that profit from selling processed foods to children, including manufacturers, media, marketing and advertising companies, to act with the utmost integrity.


Two developments have led to the summit at this juncture. The first development is the growing international awareness that premature deaths from NCDs reduces productivity, curtails economic growth, and poses a significant social challenge in most countries. The second development is the now unequivocal evidence that “best buy” interventions to reduce the toll of premature deaths due to NCDs are workable solutions and that they are excellent economic investments – including in the poorest countries.

Implementing cost-effective interventions that reduce risk factors for NCDs will contribute up to two-thirds of the reduction in premature mortality. In addition, health systems that respond more effectively and equitably to the healthcare needs of people with NCDs can reduce premature mortality by another one-third up to one-half.

It is estimated that the cost of inaction due to current losses in the national product of developing countries resulting from NCDs and shrinking workforce that curtails economic growth runs into hundreds of billions of dollars, according to the United Nations.

General Assembly President Nassir Abdulaziz Al-Nasser stressed the need for international cooperation to tackle the problem.

“The global community must work together to monitor, reduce exposure to risks, and strengthen health care for people with noncommunicable diseases,” he said.

“The impact of this loss, this tragedy, goes beyond individuals, beyond families. NCDs are altering demographics. They are stunting development. And they are impacting economic growth.”

2008-2013 Action plan for the global strategy for the prevention and control of noncommunicable diseases http://www.who.int/nmh/publications/9789241597418/en/index.html

World leaders urged to stand up against food industry pressure

Ahead of the Summit Special Rapporteur on the Right to Food, Olivier De Schutter, called on world leaders not to bow to industry pressure. He called for the taxing of unhealthy food, regulating harmful marketing practices and standing up to the food industry.

“Voluntary guidelines are not enough,” he said. “It is crucial for world leaders to counter food industry efforts to sell unbalanced processed products and ready-to-serve meals too rich in transfats and saturated fats, salt and sugars. Food advertising is proven to have a strong impact on children, and must be strictly regulated in order to avoid the development of bad eating habits early in life.”

De Schutter noted that the globalization of food supply chains means an increased supply of junk food such as energy-rich, nutrient-poor products processed with transfats to ensure a long shelf life – which are particularly attractive to poor consumers because they are cheap – with “dramatic” consequences for public health, affecting disproportionately those with the lowest incomes.

According to the WHO, at least 2.8 million adults die each year as a result of being overweight or obese, with 44% of diabetes, 23% of ischaemic heart disease and from 7 to 41% of certain cancers attributable to these factors.

De Schutter noted that unhealthy diets are one of the reasons why public health expenditures increased by 50% over the past 10 years in member countries of the Organization for Economic Co-operation and Development (OECD).

He warned against a failure to act decisively. “[This is] a once-in-ageneration opportunity to crack down on the marketing practices and public policy gaps which contribute to unhealthy diets and consign people to debilitating diseases,” he said.

He cited the need to tackle farm policies that make some foods more available than others, for example by providing subsidies that encourage production of grains rich in carbohydrates but relatively poor in micronutrients at the expense of fruits and vegetables.

“If we are serious about tackling the rise of cancer and heart disease, we need to make ambitious, binding commitments to tackle one of the root causes – the food that we eat,” he said. “It is unacceptable that when lives are at stake, we go no further than soft, promotional measures that ultimately rely on consumer choice, without addressing the supply side of the food chain.”

Wake-up call to governments

Dr Margaret Chan, Director-General of the World Health Organisation, addressed the United Nations General Assembly at the High-level meeting on noncommunicable diseases, in New York, in September. This is an excerpt from her speech.

I am strong in my conviction that this meeting must serve as a wake-up call.

But not for the medical and public health professions. We are already wide awake, and with deep concerns. We know the statistics and the ominous trends that now encircle the globe. We know what lies ahead.

Right now, medical and health professionals see the patients, dispense chronic care, manage the complications and disabilities, write the medical bills, and agonize over the huge costs to families and societies. We plead for lifestyle changes and strict tobacco regulation.

But health ministries, acting alone, cannot re-engineer societies in ways that protect entire populations from the wellknown and easily modified risks that lead to these diseases. And this is what needs to happen. This meeting must be a wake-up call for governments at their highest level.

This must be a watershed event, with a clear before and after. With ignorance, complacency, and inertia replaced by awareness, shock, and the right actions, right away.

Why must this responsibility fall on heads of state? Because the problem is too big and too broadly based to be addressed by any single government ministry.

Because the rise of these diseases is being driven by powerful, universal forces, like rapid urbanization and the globalization of unhealthy lifestyles. Because the response to these trends must come with equal power, with top-level power that can command the right protective policies across all sectors of government.

The worldwide increase of noncommunicable diseases is a slow-motion disaster, as most of these diseases develop over time. But unhealthy lifestyles that fuel these diseases are spreading with a stunning speed and sweep.

I can understand why some developing countries are being taken by surprise by the onslaught of these diseases. Their initial burden was greatest in affluent societies with strong R&D capacities to develop ever-better treatments.

When drugs are available to reduce blood pressure, lower cholesterol, and improve glucose metabolism, the situation looks somehow under control. This appearance is misleading and blunts the urgent call for policy change.

The root causes of these diseases are not being addressed, and widespread obesity is the tell-tale signal. Worldwide, obesity rates have almost doubled since 1980.

This is a world in which more than 40 million pre-school children are obese or overweight. This is a world where more than 50% of the adult population in some countries is obese or overweight.

Obesity is the signal that something is terribly wrong in the policy environment. Widespread obesity in a population is not a marker of failure of individual willpower, but of failure in policies at the highest level.

Processed foods, very high in salt, trans fats, and sugar, have become the new staple food in nearly every corner of the world. They are readily available and heavily marketed. For a growing number of people, they are the cheapest way to fill a hungry stomach.

The world certainly needs to feed its population of nearly 7 billion people. But it does not need to feed them junk food.

Just as you cannot hide obesity, you cannot hide the huge costs of these diseases to economies and societies.

These are the diseases that break the bank. Left unchecked, these diseases have the capacity to devour the benefits of economic gain. In some countries, for example, care for diabetes alone consumes as much as 15% of the national healthcare budget.

A recent World Economic Forum and Harvard University study estimates that, over the next 20 years, noncommunicable diseases will cost the global economy more than US$30 trillion, representing 48% of global GDP in 2010.

In large parts of the developing world, these chronic conditions are detected late, when patients need extensive and expensive hospital care for severe complications or acute events. Most care for these diseases is covered through outof- pocket payments, leading to catastrophic medical expenditures.

For all these reasons, noncommunicable diseases deliver a two-punch blow to development. They cause billions of dollars in losses of national income, and they push millions of people below the poverty line, each and every year.

These diseases break the bank, but they are largely preventable through cost-effective measures. Some have an especially big pay-back.

In the absence of urgent action, the rising financial and economic costs of these diseases will reach levels that are beyond the coping capacity of even the wealthiest countries in the world.

Excellencies, you have the power to stop and reverse the noncommunicable disease disaster. You have the power to protect your people and keep your development efforts on track.

 Date of upload: 15th Nov 2011


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