TWN Info Service on Health Issues (May11/06)
26 May 2011
Third World Network

WHO: Spotlight on non-communicable diseases prevention and control
Published in SUNS #7157 dated 25 May 2011

Geneva, 24 May (K. M. Gopakumar and Chiara Bodini*) -- Many developing countries stress the importance of access to medicines and of addressing the social determinants of health in order to prevent and control non-communicable diseases.

This took place at the 64th World Health Assembly (WHA) meeting in Geneva on 16-24 May, during a discussion on the prevention and control of non-communicable diseases (NCDs) that considered the WHO Secretariat report on the matter and a draft resolution sponsored by 61 Member States including EU member countries.

The Secretariat's report (document A64/21) deals with WHO's role in the preparation, implementation and follow-up to the high-level meeting of the United Nations General Assembly on the prevention and control of NCDs to be held in September 2011.

The topic of NCDs has special prominence at this year's WHA because of the high-level meeting (HLM) where Heads of State and Government are expected to participate.

This flows from the UN General Assembly Resolution 64/265 adopted in May 2010 which in its preamble reaffirms "the need for international cooperation in the area of public health through the exchange of best practices aimed at building capacity at the public health system, providing financial assistance, the production of and increased access to affordable, safe, effective and high quality medicines, the training, recruitment and retention of pubic health personnel, the development of infrastructure and the transfer of technology".

Many Member States, in their interventions during the 21 May WHA discussion, underscored the strong link between NCDs and development, and stressed the need to address the social determinants of health (SDH) as well as to take measures to improve access to affordable medicines, to effectively combat NCDs. Interventions also called for more funding and political commitment, better private sector regulation and policy-making free of conflict of interests. Several Member States also supported the inclusion of mental health in the context of NCDs.

A resolution was finally adopted by the WHA focusing on the role of WHO in the preparation of the September HLM. This was agreed to by an informal working group that met on the margins of the WHA to reshape the content of the draft resolution submitted by some countries in January to the WHO Executive Board.

The resolution endorses the Moscow Declaration (outcome of the First Global Ministerial Conference on Healthy Lifestyles and Non-communicable Disease Control held in Moscow on 28-29 April 2011), which is annexed to the resolution, as a key input for the preparations leading to the HLM. It urges Member States to continue to support the preparations at national, regional and international levels for the HLM, including situation analyses of NCDs and their risk factors as well as an assessment of national capacity and health systems' response to address NCDs.

It also urges Member States to be represented at the level of Heads of State and Government at the HLM and reiterates the UN General Assembly (UNGA) call for action through an action-oriented outcome document. It also urges Member States to consider as appropriate and relevant to include representatives of civil society, non-governmental organisations, academia and networks working on the control and prevention of NCDs.

The resolution requests the WHO Director-General (DG, Dr Margaret Chan) to continue her existing lead role to coordinate UN specialised agencies, funds and programmes, other relevant intergovernmental agencies to support Member States. This would include undertaking concerted action and coordinating responses in order to promptly and appropriately address the challenges posed by NCDs, including further building up of situation analyses on NCDs and risk factors as well as highlighting the social and economic impact of NCDs, including financial challenges, in particular in developing countries.

It also requests the DG to prepare a report on the outcome of the Moscow ministerial conference and the September HLM for the 65th WHA session in 2012; and to develop an implementation and follow-up plan for the outcomes including the financial implications for submission to the 65th WHA.

The resolution also requests the UN Secretary-General to submit a global status report on NCDs with a particular focus on the developmental challenges faced by developing countries, to the GA at its 65th session in collaboration with Member States, WHO and other relevant funds, programmes and specialised agencies of the UN system.

Further to the May 2010 Resolution, the GA passed another resolution (65/238) inviting the WHO to hold regional multi-sectoral consultations in cooperation with regional commissions and other relevant agencies to provide input to the preparatory process for the HLM.

Pursuant to this key role, WHO has organized regional consultations as well as the Moscow ministerial conference.

The Moscow Declaration states that, in order to secure an ambitious and sustainable outcome, "we commit to actively engage with all relevant sectors of Government, on the basis of this Moscow Declaration, in the preparation of and the follow-up to the United Nations General Assembly High-level Meeting on the Prevention and Control of NCDs in September 2011 in New York". The Declaration sets out actions at three levels: the whole governmental, the ministry of health level and the international level.

Forty-seven Member States, 16 intergovernmental organisation and NGOs participated in the NCDs discussion on 21 May. The Secretariat, in its opening remarks, said that the role of WHO is to provide evidence-based solutions and also to have a key role in implementation of outcomes of the HLM.

Congo, on behalf of the African region, said that risk factors as well as social determinants of health have to be tackled. It also noted that NCDs are a huge burden and impair society and possibility of achieving the Millennium Development Goals (MDGs). It proposed the setting up of a global fund for NCDs, stressing that the financial support to tackle NCDs should not remove the support for (tackling) communicable diseases. It stated that the burden of NCDs blocks development and urged for work on the social determinants of NCDs. It also stressed the need to prioritise and strengthen political commitment for promoting prevention, access and care and monitoring of NCDs. In addition, it stressed the need for access to safe, effective and high quality medicines.

Paraguay underlined the strong relationship between NCDs and development as well as environment. It said that NCDs have a great impact in furthering social inequality. It said that addressing SDH is important to address NCDs, and stressed on poverty reduction programmes, private sector regulation, prioritising access to health systems through strengthening of public health and access to essential medicines.

Brazil said that while risk factors have to be addressed, medication is an important element for addressing the challenges of NCDs. It recalled its national initiative such as "health has no price" which guarantees free medicines through popular pharmacies. Brazil also added that social conditions where people live are closely linked to the prevalence of NCDs. It said that underprivileged people are trapped in a circle of poverty and disease and these root causes of ill health have to be tackled to address the issue effectively.

Thailand stated that the global community should use every effective tool to fight the world's number one killer, i. e. NCDs. It said that global commitment for financial, human and technical support is not enough, that an increase in resources alone won't help, since what is needed are new ways of thinking. It advocated a SDH-based approach to the prevention and control of NCDs. Thailand also highlighted the need to regulate the private sector, which markets unhealthy food. It also stressed the need for avoidance of conflict of interest as a crucial element to ensure transparency in the policymaking process.

Samoa stated that NCDs should be placed high in the regional and global agenda. Samoa further highlighted the need to prioritise an agenda that promotes access to affordable and safe diagnostic and treatment for NCDs.

Kenya stressed the importance of improving access to medicines and diagnostics. It also suggested the establishment of a global mechanism to help developing countries to strengthen their health system to face the challenges of NCDs as well as a global funding mechanism to enable effective measures.

Indonesia suggested that measures related to NCDs should be part of the national development plan. China said that WHO should advocate for integrating NCDs in the development agenda and the MDGs. It urged Member States to take up the challenge of prevention and control of NCDs by providing sufficient funding to address the issue.

Hungary, on behalf of the EU, said that consideration and actions are required in all levels of governance in order to address the challenges of NCDs. The EU advocated for cost-effective primary health interventions, adding that health in all policy approaches are required to prevent and control NCDs. It also said that socioeconomic and environmental factors contribute and widen health inequities, thus NCDs should be tackled in a comprehensive manner and not through a vertical approach, which has been taken so far and which concentrates on four diseases (cancer, cardiovascular diseases, diabetes, chronic respiratory diseases). The EU also underlined the need to address the issue of mental health in the context of NCDs.

The United States said that it was strongly committed to raising the profile of NCDs as a major public health concern. It said that it introduced regulations for limiting tobacco use among young people. It also supported that mental health be included as part of a comprehensive strategy. Further, it noted that WHO has a key role in increasing awareness and sharing best practices and fostering global cooperation in the area of NCDs.

Canada expressed its support for multi-sectoral approaches for prevention and control of NCDs. Other sectors to be involved are environment, trade, labour, education etc.

Consumers International said that it is essential that while action is stepped up to address NCDs, care is taken to increase consumer protection and avoid giving the for-profit sector unprecedented opportunities to influence policies. The effect of insufficient vigilance will be felt most keenly in food-related NCDs - where Member States urgently need encouragement to take effective legislative action to control harmful food marketing. It also strongly urged that the critically important role of marketing controls and the protection of breastfeeding and optimal complementary feeding is recognized as an integral component of WHO's NCD strategy.

Medicus Mundi International said that "it is disappointing that there is no reference to the work of the Commission on Social Determinants of Health (CSDH) in the Secretariat report. Unhealthy behaviors do play an important role in determining NCDs, however there are structural determinants like education, income, gender and ethnicity which are underlying causes of NCDs and behavioral risk factors. It stressed the importance of equity dimensions of NCDs as emphasized by CSDH and that these are closely linked to the social and environmental factors; not just individual behaviors. Therefore, if the UNGA is to provide an action-oriented outcome document preventive measures for social and environmental factors must be included.

It also urged Member States to address the access to affordable treatment for NCDs by clearly spelling out the response of the Member States and WHO to initiate law and policy measures to ensure access to affordable diagnostic tools and treatment, in particular the full use of the flexibilities of TRIPS. 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 called for development of a code of conduct to regulate their advertisement and promotion of products.

Corporate Accountability International asked Member States to apply the safeguards in Article 5.3 of the Framework Convention on Tobacco Control creating clear and enforceable standards in relation to water, public health and nutrition. These measures must go beyond individual conflicts of interest, and address institutional conflicts of interest.

The Secretariat, in reply to the discussion, stated that mental health is a major issue and lacks appropriate intervention in many countries. It stressed the need to address the five building blocks of health systems and hoped that such an approach would in turn also help to address mental health. It also recalled that mental health is highlighted in the global status report on NCDs.

Regarding conflict of interest, the Secretariat stated that the WHO Guideline on working with the private sector would guide its work. Further, the DG called upon Member States to take a stand against the pressurising tactics of tobacco companies against the implementation of the framework convention.

(* K. M. Gopakumar is a senior researcher with Third World Network and Dr. Chiara Bodini is a public health expert from the Centre for International Health, University of Bologna.) +