Echoes of the United Nations High-Level Meeting on Noncommunicable Diseases10/10/2018
Heads of State and Government met at the Third United Nations High-Level Meeting on NCDs on September 27th 2018, where a Political Declaration was adopted, in which they made a commitment to the fight against noncommunicable diseases and to promote mental health1,2. The purpose of the meeting was to review the progress made in reducing the risk of premature death caused by NCDs, agreed upon since previous meetings (2011 and 2014), in the context of the 2030 Agenda for Sustainable Development. In addition to broadening the implementation of the actions agreed at the previous meetings, the commitment made at this meeting includes the adoption of 13 new measures to combat NCDs – including cancer, cardiovascular diseases, chronic respiratory diseases and diabetes – and to promote mental health and welfare.
Based on the commitment to exercise strategic leadership for the prevention and control of NCDs and related health promotion, providing greater coherence and coordination through comprehensive policies and a health approach in all policy, the Heads of State and Government have made a commitment to a set of measures, among which we highlight2:
- The promotion and adoption of legislative, fiscal and regulatory policies and measures to protect people against tobacco, unhealthy foods (especially to reduce childhood obesity), other harmful products, polluted air, among other risk exposures, in addition to promoting regular physical activity. Proposed measures include limiting the advertising of alcoholic beverages, prohibiting tobacco use in certain spaces, levying taxes on sugary drinks, promoting healthy diets and reducing air pollution;
- To accelerate implementation of the WHO Framework Convention on Tobacco Control by its States Parties, continue to implement tobacco control measures without the interference of the tobacco industry, and encourage other countries to consider joining the Convention. In this regard, the president of Uruguay, Tabaré Vázquez, who was recognized by the WHO for his fight against tobacco use, emphasized that “we do not accept the involvement of the tobacco industry, which is the only industry that kills its own consumers”3;
- Implementation of education and public awareness campaigns on: the harmful effects of tobacco use (including passive smoking), harmful use of alcohol, use or exposure to other harmful substances, excessive consumption of fats, particularly saturated fats and trans fats, sugar and salt; the benefits of adopting a healthy lifestyle through a sustainable and balanced diet, including fruit and vegetable intake, as well as regular physical exercise;
- To develop, as appropriate for each national context, a case of national investment on the prevention and control of noncommunicable diseases to raise awareness of the national public health burden caused by NCDs, health inequities, the relationship between NCDs and poverty and social and economic development, the number of lives that could be saved and the return on such an investment;
- Adoption of necessary measures related to human rights obligations and addressing the specific health needs of children, women, the elderly, persons with disabilities and others who are most vulnerable to NCDs;
- Adopt measures to better prepare health systems to meet the needs related to rapid aging of the population, considering the disproportionate burden of noncommunicable diseases on the elderly, and that population aging is a contributing factor to the increased incidence and prevalence of NCDs;
- Increase global awareness, action and international cooperation on environmental risk factors, including air, water and soil pollution, exposure to chemicals, climate change and extreme weather events; and the promotion of healthy communities by addressing the impact of environmental determinants on NCDs, to reduce the high number of premature deaths due to these diseases, attributable to human exposure to these determinants;
- Implement measures to improve mental health and well-being, including through comprehensive services and treatments for people living with mental disorders and other mental health conditions. Address their social determinants and other health needs while fully respecting their human rights;
- Promote greater access to affordable, safe, effective and quality medication, vaccines, diagnostic methods and other technologies, including for the prevention, diagnosis and treatment of cervical and breast cancer, hypertension and diabetes, for which the private sector is invited to contribute to the process;
- The agri-food industry is also called upon to reduce the levels of salt, free sugars, saturated fats and trans fatty acids from industrial production; to improve nutritional labeling of foods and limit the marketing of unhealthy food and beverages to children.
The WHO World Conference on Non-Communicable Diseases in Montevideo
The High-Level Meeting reflected and deepened the discussions at the WHO World Conference on Non-Transmissible Diseases in Montevideo, held October 18-20, 2017, and organized by the World Health Organization and the Presidency of Uruguay. This Conference approved the “Montevideo Roadmap 2018-2030 on Non-Communicable Diseases as a Sustainable Development Priority” 4.
The “Roadmap” highlighted the need for coordinated and coherent action by all sectors of society, given that many of the major determinants of health are outside the scope of the Ministries of Health, health systems and even out of reach of solution by health professionals. Several issues, that should be overcome, were highlighted, including: unequal and insufficient progress in reducing premature deaths by NCD; the influence of the private sector on governments to prioritize trade to the detriment of public health objectives; the lack of high-level political leadership to ensure that health promotion, prevention and control of noncommunicable diseases are integrated into all areas of public policy. It was also noted that most of the deaths from NCDs could have been avoided by adopting measures against tobacco, air pollution, unhealthy diets, sedentary lifestyle and harmful use of alcohol, as well as improved detection and treatment of these diseases. 4
With these clear messages and the contributions made in previous editions of the High-Level Meetings, progress was made in proposing the measures contained in the Political Declaration of the 3rd High-Level Meeting. 2
Current epidemiological situation and achievement of the goal established in the ODS
As already identified at the Montevideo Conference and indicated in the Third Report on NCDs Country Profiles prepared by the WHO5 and the Report of the WHO High-Level Independent Commission on Noncommunicable Diseases6, it is noted that the risk of premature of death by NCDs has decreased, albeit unequally and insufficiently.
Seven out of ten people in the world die of cardiovascular disease, cancer, diabetes or chronic lung diseases, among other NCDs, which represents an average of 41 million people annually5,6. This number includes 15 million people dying from any NCD between 30 and 69 years. More than 85% of premature deaths occur in low- and middle-income countries. Hundreds of millions of people are affected by mental or neurological disorders or substance abuse: depression, alcoholism, anxiety, bipolar disorder, schizophrenia or dementia. Every year, approximately 800,000 people commit suicide.
In WHO’s third country profile report on NCDs5, which assesses the progress made at the national level in achieving these disease control goals, the risk of premature death for one of the four main NCDs (cardiovascular diseases, diabetes, cancer and chronic respiratory diseases) was reduced to 18% in 2016. An analysis of the behavior of this indicator shows that there was a 17% reduction between 2000 and 20156. Among the four diseases, mortality reduction occurred only in relation to deaths from cardiovascular and chronic respiratory diseases. At this rate of progress, according to the report, the risk of premature mortality by NCDs by 20307 is unlikely to be reduced by one-third, and therefore the target set in the Sustainable Development Goals will likely not be achieved. The report also shows that there are still many gaps in health services and access to technologies for the diagnosis and treatment of these diseases.
In the Americas, an estimated 5.2 million deaths in 2017 were caused by NCDs, representing 80% of all deaths in the region8. About 35% of all NCD deaths occurred in people between 30 and 70 years of age. In South America, the percentages of premature deaths are higher9. Data from 2016 indicates that only three countries had a percentage of premature death equal to or less than 35% (average for the Americas). When we analyzed the variation in the risk of premature death for the four main NCDs, between 2000 and 2015 (the last fifteen years for the Millennium Development Goals), the South American region showed a reduction of 18.9% on average, which means that if this pace of reduction is maintained, the target for ODS would also not be attained for this region.
If the main risk factors (in an individual approach) and the social, political and environmental determinants (in a collective approach) of NCDs are known, as well as which measures are most cost-effective, then why haven’t advances in reducing mortality (especially premature mortality), the occurrence of serious diseases and the suffering caused by a high burden been more significant?
The Montevideo World Conference pointed out some answers (and also identified other gaps) that the High-Level Meeting seeks to lead to a higher level of decision making and thus possibility of resolution.
When the report with the data presented at the High-Level Meeting states that “over 85% of premature deaths occur in low- and middle-income countries,” 5 this means that there is inequality in the distribution of the NCD burden in the world. This inequality is also reflected in each region and country, due to differences in access to healthier foods, exposure to harmful substances, regular physical activity and health technologies that allow early and effective diagnosis.
In this sense, as for the ODS as a whole, achieving the goals established in relation to NCDs and other related goals – which implies accelerating the pace of progress registered in recent years – will require the reduction of poverty and its consequences. and addressing inequalities.
The benefits are described in the literature and official documents and can be translated here as: “By applying life-saving economic measures, all countries can make progress in promoting the health of their citizens, reducing poverty and inequalities and taking substantive measures that guarantee health for all”10.
- OMS. Los Jefes de Estado se comprometen a liderar la lucha contra las enfermedades no transmisibles y la acción en pro de la salud mental. Comunicado de prensa. Available at: http://www.who.int/es/news-room/detail/27-09-2018-heads-of-state-commit-to-lead-response-to-beat-noncommunicable-diseases-promote-mental-health/ Accessed on: 04.10.2018
- Draft Political Declaration of the third high-level meeting of the General Assembly on the prevention and control of non-communicable diseases TIME TO DELIVER: Accelerating our response to address NCDs for the health and well-being of present and future generations.Available at: https://ncdalliance.org/sites/default/files/Political_Declaration_final_text_0.pdf. Accessed on: 04.10.2018
- ONU. Noticias ONU. Declaración de Guerra al alcohol, el tabaco y el azúcar. Available at: https://news.un.org/es/story/2018/09/1442632. Accessed on: 04.10.2018
- OMS. Presidencia de la República Oriental del Uruguay. Hoja de ruta de Montevideo 2018-2030 sobre las enfermedades no transmisibles. Conferencia Mundial de la OMS sobre las ENT: Promoción de la coherencia de las políticas para lograr la meta 3.4 de los ODS relativa a las ENT. (Montevideo, 18-20 de Octubre de 2017). Available at: http://www.who.int/conferences/global-ncd-conference/Roadmap-ES.pdf.Accessed on: 04.10.2018
- WHO. Noncommunicable diseases country profiles 2018. Geneva: World Health Organization; 2018. Available at: http://www.who.int/nmh/publications/ncd-profiles-2018/en/ Accessed on: 04.10.2018
- OMS. Es hora de actuar: Informe de la Comisión Independiente de Alto nivel de la OMS sobre Enfermedades no Transmisibles. Ginebra, Organización Mundial de la Salud, 2018. Available at: http://apps.who.int/iris/bitstream/handle/10665/272712/9789243514161-spa.pdf?ua=1&ua=1. Accessed on: 04.10.2018
- Programa de las Naciones Unidas para el Desarrollo. Objetivos del Desarrollo Sostenible. Available at: http://www.undp.org/content/undp/es/home/sustainable-development-goals.html. Accessed on: 04.10.2018
- The burden of NCDS in the Americas. Available at: https://www.paho.org/hq/dmdocuments/2017/ncds-eng-burden-mortality-infographic.pdf. Accessed on: 04.10.2018
- World Health Organization. Global Health Observatory. Available at: http://www.who.int/gho/en/. Accessed on: 04.10.2018
- ONU. OMS. Es hora de actuar. Tercera Reunión de Alto Nivel de las Naciones Unidas sobre las Enfermedades No Transmisibles. Available at: http://www.who.int/ncds/governance/third-un-meeting/brochure-es.pdf.Accessed on: 04.10.2018