Richard Smith: More on the United Nations meeting on NCDs

Richard Smith In September the United Nations will hold a high level meeting on the prevention and control of non-communicable diseases (NCDs). This is only the second such meeting that the UN has held, and the first in 2001 led to the Global Fund to Fight AIDS, TB, and Malaria. The UN Secretary General Ban Ki-Moon has said that NCDs represent a ‘public health emergency in slow motion.’

Our global network of centres in low and middle income countries working to counter NCDs has written an article for the BMJ on the UN meeting, which was posted yesterday on, but more has happened since we wrote the article. This blog provides an update.

The most important thing that has happened is that the United Nations has posted the draft outcome document of the meeting. This document will now be considered by all the member states—and negotiations will begin to reach the final outcome document. In addition, the UN Secretary General has published his report on the prevention and control of NCDs.

Our article describes what various groups have been asking for from the meeting, and, although there is not complete agreement, there is considerable overlap. One group which has been prominent in preparing for the meeting is the recently created NCD Alliance, which includes some 900 non-governmental and professional organisations. We were critical of them for their 35 ‘asks’ as we thought it important to prioritise. The alliance has since come down to 10 asks, although some like ‘reduce risk factors’ and ‘strengthen health systems’ are broad and ambitious.

We quoted approvingly Sir George Alleyne, former director-general of the Pan-American Health Organisation (PAHO) and one of the people who has made the meeting happen, who argued that there should be just four asks—action on risk factors, particularly tobacco and possibly salt, monitoring and surveillance, access to simple technologies like drugs for hypertension, and health system strengthening, concentrating on funding, human resources, and information.

There has also been much talk of a half page, action-oriented outcomes document, so it’s surprising that the first draft—the zero draft in UN jargon—is eight pages long and has 56 paragraphs. Everything that our network asked for is there—and much more.

The first two pages of the document describe what meetings, programmes, and reports have gone before, and the next page and half outlines the scale and importance of the burden of NCDs, including saying “the global burden and threat of non-communicable diseases constitutes one of the major challenges for development in the twenty-first century.” These pages also link NCDs to the global financial and economic crisis, continuing food insecurity, and climate change.

Importantly the draft says that the problem of preventing and controlling NCDs requires a “whole of government and whole of society effort.” (I predict that you’ll be hearing this phrase a lot—and not just in the context of NCDs.)  Policies on “trade, taxation, education, agriculture, urban development, food, and pharmaceutical production” are needed, and there is a role not just for governments but for “civil society, academia, industry, the private sector, and other stakeholders.”

Then come the commitments, which include strengthening national policies and health systems, improving access to medicines and diagnostics, reducing risk factors (tobacco, poor diet, physical inactivity, and the harmful use of alcohol), encouraging international cooperation, promoting research, and monitoring and evaluating. All that surprised me apart from the number and range of commitments—including a ‘gender based approach,’ protecting indigenous peoples, and promoting health literacy—was the considerable emphasis on treatment. Most groups tend to emphasise prevention because of its reach and affordability.

A major sticking point may be resources. Heads of government are likely to be reluctant to sign an outcomes document that commits them to large expenditure—or perhaps even any expenditure. The draft “acknowledge[s] that resources devoted to combating the epidemic, both at national and international levels are not commensurate with the magnitude of the problem.” Later the draft “solemnly commit[s] to provide adequate and sustained resources through domestic, bilateral and multilateral channels, including innovative financing mechanisms” and to “mobilise additional resources.” These passages may be the ones that receive the most attention.

The 192 member states will now get to work on this document, and I must say that I’m glad that it’s not me who has to fit 192 responses, no doubt some of them contradictory, into one document. Most of us in health are also conscious that we are ignorant of how global diplomacy works, which is why Ilona Kickbusch’s article in the BMJ on health diplomacy is so important.

What is clear is that the meeting is most likely to be successful if heads of state and government actually attend, and the more clamour and concern that there is around the meeting the more likely they are to attend. It was impossible to stay away from the AIDS meeting. You can help create the clamour and concern by writing to your political representatives, pushing your organisation to make its voice heard, tweeting, blogging, and shouting in the street.

Competing interest: Richard Smith is the director of the UnitedHeath Chronic Disease Initiative, which together with the National Heart, Lung, and Blood Institute funds the 11 centres of excellence that make up the network. The leaders of all the centres were involved in writing the BMJ article, but RS has written this update alone.