Global Leadership, Local Solutions: Mobilizing for NCDs
A Statement of the Global Health Council NCD Roundtable June 2011
NCDs (non-communicable diseases) are a threat to public health systems and economies everywhere. Populations are aging and living longer; globalization is expanding markets, altering production and consumption patterns, and expanding the reach of information and marketing; and urbanization is altering lifestyles and diets. These transitions are all contributing to an increasing burden of NCDs, particularly in lowand middle-income countries (LMICs). To respond effectively, common infectious disease-focused platforms must be adapted to build capacity for NCDs that respond to patient needs and increasingly reflect the double burden of disease. In addition, non-health sectors and stakeholders, including businesses, strongly influence health outcomes associated with NCDs.1 The upcoming United Nations (UN) High-Level Meeting on NCDs in September 2011 is an opportunity to focus international attention and garner the leadership needed for a coordinated, multi-sectoral response to NCDs. In coordination with the World Health Organization (WHO), the UN has prioritized four specific disease categories (cardiovascular disease, diabetes, chronic lung diseases, and cancer) with common and modifiable risk factors (tobacco use, unsafe use of alcohol, physical inactivity, and unhealthy diet). There are valuable global NCD policy frameworks firmly in place that require full implementation, such as the Framework Convention on Tobacco Control (FCTC) treaty, and broader development partnerships, such as the Millennium Development Goals (MDGs), that could incorporate NCDs and rally political will around specific targets. Linkages between NCDs and MDG targets for infectious diseases, nutrition, maternal and child health are becoming increasingly clear, and provide strategic opportunities to address interconnected health and development issues more effectively and efficiently. NCD policies and programs can
More than 80% of deaths from NCDs occur in low- and middle-income countries.Between 2006 and 2015, deaths due to NCDs are expected to increase by 17%.
complement, not divert attention from the aims of other health and development priorities. As an integrated component NCD programs can help achieve better health and development outcomes. Global fiscal pressures exist, but the cost of inaction is even greater. NCDs continue to increase health costs, and the macroeconomic impact is just as profound â€“ resulting in lost economic productivity and GDP in all countries (see figure). This document offers support for existing global health and NCD-specific principles and adds specific recommendations on behalf of the Global Health Council NCD Roundtable for the UN system, governments, civil society and other stakeholders. Recognizing the unmet health needs in other NCD areas, such as mental health, injuries, and NCDs that primarily affect the extremely poor, these recommendations are specific to the scope of the upcoming High-Level Meeting on NCDs and consistent with the WHO Action Plan for NCDs.
Abegunde & Stanciole 2006
1 For the purposes of this document, all references to businesses and the private sector assumes the exclusion of the tobacco industry.
The Global Health Council NCD Roundtable Supports… Country-led, inclusive, coordinated and accountable governance Country-led policies and programs, facilitated by national and local governments, inclusive of communities and businesses, and aligned with international partners and donors, that define implementation strategies to integrate NCD prevention, treatment and care with other health and development aims.
The top six leading risk factors for global mortality are all associated with NCDs.
Clear, inclusive and independent accountability mechanisms at the global, national and community levels to allow civil society and other stakeholders to ensure Member States are held to account for commitments made at the UN High-Level Meeting on NCDs and beyond.
structural and individual health promotion interventions, particularly in urban areas. Prevention strategies should include the specific needs of vulnerable populations, such as the poor, women and girls, children and youth and indigenous populations.
Coordination at all levels, between state and non-state actors, including the private sector, and across sectors, especially ministries of finance, agriculture, education, transportation, urban planning/development, youth and sport.
Prioritization of cost effective, high-impact NCD interventions based on the country and regional NCD context, and in congruence with the WHO Package of Essential Noncommunicable (PEN) Disease Interventions for Primary Health Care in Low-Resource Settings.
Strengthening health systems and their capacity to address NCDs Continued investments, support, and incentives to strengthen all health system components, including national planning and governance, policy development and service delivery, referral systems, workforce capacity, research and laboratory capacity, supply chain management, medicines and medical technology, surveillance and social mobilization. Integrating NCD interventions into existing health and development goals, policies and systems based on country priorities to capitalize on existing platforms and adapt strategies to respond efficiently and effectively to the health needs of local populations, including the immediate and continued need for treatment and care. Prevention as the central strategy for NCDs through both
Partnerships to achieve existing goals and innovate for the future Universal ratification and full implementation of the FCTC by UN Member States, in partnership with civil society, and supported by sufficient international and domestic resources for sustained compliance. Partnerships for innovative solutions to equip health systems with the unique tools required to prevent, diagnose and treat NCDs and their risk factors within a populationspecific context, including medical technologies, surveillance tools, including electronic and mobile technology, and prevention approaches.
The Global Health Council NCD Roundtable Recommends… Leadership and Accountability A global partnership, negotiated by Member States, that is (1) mandated to coordinate activities related to NCDs across UN specialized agencies, other UN partnerships, the UN secretariat, Member States, civil society (including the private sector), and (2) allows for sufficient and flexible funding by Member States, foundations, the private sector, NGOs, and philanthropists to support its activities. Global and national targets for NCD prevention, treatment and care, and monitoring by a new accountability task force to track commitments and targets established at the UN High-Level Meeting. The World Health Assembly establish a global forum, to lead the engagement of non-state and non-health Ministries and stakeholders around globalized, multi-sectoral challenges such as NCDs.
Program Integration and NCDs • The Kakamega Provincial General Hospital in Kenya is using the MCH platform to integrate necessary services, including antenatal and postnatal care, immunizations, infectious disease testing, and cervical cancer screening. • In India, 15% of new pulmonary TB cases are caused by diabetes. In Mexico, the figure was as high as 25%. • Undernourished children in the first 2 years of life and who rapidly put on weight later in childhood and in adolescence are predisposed to developing nutrition-related chronic diseases.
Member States establish and use a cross-government coordinating mechanism for NCDs, reporting to the Head of Government, led by the Ministry of Health and facilitated by a lead NCD focal point within the Ministry of Health
A diagonal approach through evidence-based integration of NCD programs into existing service delivery platforms, particularly those for maternal, newborn and child health, HIV/AIDS, and tuberculosis.
WHO regional offices develop policy observatories for NCDs to monitor and share NCD-related policies and policy outcomes.
Governments leverage multi-sector partnerships, including NGOs and business, to inform and implement policies or programs and to mobilize resources, including technical and other non-financial support.
Integration in policy and programs
Technical organizations expand existing global health survey instruments, such as the Demographic and Health Surveys, the Multiple Indicator Cluster Survey and others, to include metrics related to NCDs, and their risk factors.
National health plans, informed through a whole-of-government approach, include specific references to the burden of NCDs; propose strategies to integrate NCDs into broader health and development objectives; propose specific interministry coordination mechanisms; identify institutionalize means to engage civil society (including the private sector); and identify targets and evaluation metrics.
Implementing local programs and interventions that consider the whole individual and lifespan, tailoring NCD interventions based on individual risk and entry points.
Human, Financial and Technical Resources Increased global resources for health and development, including adequate and flexible financial and other resources for NCDs generated through a diverse range of means and aligned with national health and development priorities. Sources should include national budgets (both health and other ministries, such as finance, agriculture, education, transportation, urban planning/development, youth and sport) donor governments, civil society (including the voluntary participation of the private sector and foundations), and innovative mechanisms. National governments continue and expand social protection and health insurance schemes that limit excessive out-of-pocket expenditures and reduce financial risk for those seeking NCD prevention, treatment, and care. Adaptation of health workforce training programs at all levels, including community health workers, to incorporate necessary public health and clinical competencies to manage and implement NCD prevention, treatment and care as part of primary health care services. Transnational research and technical cooperation partnerships that build national capacities to prevent and treat NCDs and facilitate human resource, data and information exchange in policy development and program implementation. Policies that incentivize expanding availability of safe, effective and affordable medicines, medical technologies, surveillance tools and other essential products at the primary health care level for NCDs.
Improving and developing NCD indicators and expand surveillance systems to track disease, risk factor, and policy and program implementation related to NCDs. Indicators should focus on disease incidence, morbidity, and mortality; risk factor prevalence, including rates of smoking and obesity; implementation and enforcement of policies that reduce risk factors and increase access to services; and implementation data that assess program impact, scalability and cost-effectiveness.
Equity and Human Rights The private sector and businesses promote policies that incentivize healthy lifestyles and choices within the workplace. Addressing the social determinants of health and the distinct socio-economic forces that affect predisposition to NCDs, their risk factors and access to NCD-related information and services. Health and development policies and programs that incorporate specific strategies to address the unique NCD needs of vulnerable populations, including women and children, adolescents, the aging, indigenous populations, and the poor. Adequate and appropriate health (including NCDspecific) information is made available through labeling, marketing, health promotion and education programs, particularly those targeting mothers, children and adolescents, to improve individual health literacy, reduce stigma, and empower individuals and their families.
References Abegunde D, Stanciole A. 2009. An estimation of the economic impact of chronic noncommunicable diseases in selected countries. World Health Organization Working Paper, Geneva, Switzerland. Fleischman J. 2011. Lessons from Kenya for the Global Health Initiative. Center for Strategic and International Studies, Washington, DC. Victora CG, Adair L, Fall C, Hallal PC, Martorell R, et. al. 2008. Maternal and child undernutrtion: consequences for adult health and human capital. Lancet, vol. 371, pp. 340-357. World Health Organization. 2009. Global Health Risks: Mortality and burden of disease attributable to selected major risks. Geneva, Switzerland. World Health Organization. 2010. Package of Essential Non-communicable (PEN) Disease Interventions for Primary Health Care in Low-Resource Settings. Geneva, Switzerland. Young F, Critchley JA, Johnstone LK, Unwin NC. 2009. A review of co-morbidity between infectious and chronic disease in Sub Saharan Africa: TB and Diabetes Mellitus, HIV and Metabolic Syndrome, and the impact of globalization. Globalization and Health, vol. 5, no. 9, doi:10.1186/1744-8603-5-9.
This document is endorsed by: Abbott
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Caring & Living as Neighbors Coempower
Oncology Consulting International
Corporate Council on Africa
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Global Health Council
Public Health Institute
International Medical Corps
University Research Co., Center for Human Services
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World Heart Federation
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About the Global Health Council NCD Roundtable The Global Health Council is the world’s largest membership alliance dedicated to saving lives by improving health throughout the world. Its NCD Roundtable is a coalition of civil society organizations, including NGOs, academia, research institutions and the private sector, working to raise the profile of NCDs through policy dialogue and engagement, partnership building, and grassroots mobilization. The NCD Roundtable is bringing together a diverse group of global health civil society and supporting other civil society efforts to engage the United Nations system, including the High-Level Meeting on NCDs, other international fora, national governments, and the broader global health and development community to prioritize NCDs as an important component of achieving positive health and development outcomes in all countries and securing a healthy future.
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