Richard Smith: Lunch with 90 health ministers in Moscow

Richard SmithLast week I enjoyed myself facilitating a lunchtime meeting of 90 health ministers at a meeting in Moscow on non-communicable disease. The meeting, like all global meetings, was something of a trial—see previous blog—but the lunch was fun.

I wasn’t clear exactly who was there, but the meeting included ministers from China, India, Russia, US, Kenya, Uganda, Egypt, Greece, Chile, and Britain—so much of the world’s population was represented. Margaret Chan, director general of WHO, was also there—so the whole world was represented in some way.

We had two questions to try and answer (see below), and my job had three parts—get as many ministers as possible to speak, not let anybody speak for too long, and oblige them to stick to the question. (I was warned before that “ministers like to speak a lot and often not on the point.”)  I think that I did not too badly, and I was pleased that we heard from several ministers from smaller countries, particularly those from islands in the Western Pacific, which have some of the world’s highest rates of NCDs. The same ministers, mostly those from big countries, dominated the conference set pieces.

One disappointment was that there weren’t more jokes, but the Italian minister quipped that Berlusconi would certainly come to the UN’s September meeting because his friend Putin was coming. (“A fairly distasteful couple,” I thought to myself.) I tried pinning down Kathleen Sebelius, the US minister, on whether Obama would come. Understandably she didn’t make any commitment but did say that even if Obama didn’t come his wife might because she has such an interest in obesity. She then added that if Will and Kate were to come everybody would come.

About 25 ministers spoke, but sadly nobody wrote down what they said. I couldn’t as I was skipping from table to table with the microphone, but after the meeting I tried to remember as many answers as I could, and here they are:

Question one: How to get heads of state or government to attend the UN High Level Meeting on NCDs in New York in September?

1. Send a personal invitation from Ban Ki-Moon, Barack Obama, and Margaret Chan
2. Let it be known as heads of state or government declare that they will go. (Did Prime Minister Putin accept? It wasn’t quite clear.)
3. Make an economic case for high level action on NCDs
4. Convince them that it’s a development issue
5. Convince them that the meeting will lead to practical, affordable steps that will make a difference
6. Show them how the issue of NCDs relates to climate change and food security, other issues they worry about
7. Pay their fare
8. Reassure them that the meeting won’t be just talk
9. Recognise how little time the heads of state and government have and structure the meeting accordingly
10. Convince them that this is a public health emergency, worse even than HIV/AIDS
11. Generally messages must be shaped around the major concerns of leaders—hence perhaps the emphasis on economics

Question two: What outcomes do ministers hope for from the UN meeting?

1. Action on tobacco, energetic implementation of the Framework Convention on Tobacco Control. But recognition of the problem of poor countries that have substantial income from growing tobacco.
2. Action on other risk factors
3. Access to essential drugs and technology
4. Training of health workers
5. Strengthening of health systems, particularly primary care
6. No diminution in efforts on communicable disease, recognition of the importance of both
7. Support for low and middle income countries to implement changes
8. Something practical that makes a difference
9. Generally there were many issues and no clear agreement on priorities (but little time was available and the emphasis was on hearing from many rather than nailing down priorities)

Competing interest: RS is the director of the UnitedHealth Chronic Disease Initiative. UnitedHealth Group is a for-profit organisation, but its chronic disease initiative is a philanthropic programme. UnitedHealth paid RS’s expenses for attending the meeting, but he facilitated the meeting of ministers on behalf of WHO.

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