Since the United Nations (UN) high-level Meeting on non-communicable diseases (NCDs) in September 2011 things have got busy—and potentially confusing. Running in parallel to the establishment of a new “global framework for NCDs” are negotiations at UN and World Health Organization (WHO) level on what will replace the Millennium Development Goals (which are due to expire in 2015). Add to this the ongoing discussions on a set of ‘sustainable development goals’, and the field begins to feel very crowded indeed.
However, for anyone with an interest in NCDs (and particularly their impact on developing countries), keeping on top of what is happening is essential for focusing advocacy efforts. This blog unpicks – as succinctly as possible – developments in all three of these areas, focusing on their relevance to NCDs. The processes are complicated, but will drive the NCD agenda for many years to come.

(There is more information, including further links, on the website of C3 Collaborating for Health. I have made every effort in this blog to be accurate and up to date – but things are moving fast!)

Global framework for NCDs

First, good progress is being made in establishing a “global framework” for NCDs, as called for at the UN High-level Meeting last year. At the World Health Assembly in May 2012, an overarching goal was set to reduce premature mortality from NCDs by 25 per cent by 2025 (‘25 by 25’), and in early November a formal meeting of WHO member states additionally agreed a voluntary framework for targets and monitoring. The eight latest targets are:

• risk factors: 30 per cent reduction in tobacco use among those aged over 15; 10 per cent reduction in insufficient physical activity; at least 10 per cent decrease in harmful alcohol use; 25 per cent reduction in prevalence of raised blood pressure; 30 per cent reduction in salt consumption; halt rises in diabetes and obesity,
  national systems response: 80 per cent availability of affordable technologies and essential medicines to treat major NCDs, and at least 50 per cent of those eligible to receive drug therapy and counselling to prevent heart attack and stroke.

The targets are supported by 25 indicators, on which member states will report progress. The official report of the meeting, including a full list of targets and indicators, is available here (document number A/NCD/2).

In another important move, in October the WHO published a ‘Zero Draft Action Plan for NCDs 2013–2020’ (here). The revised ‘first draft’ will be submitted to the WHO Executive Board in January, and there will be an informal online consultation in 2013. This Plan will supersede the current WHO Global Action Plan 2008–2012 (here).
Finally, working in partnership across sectors is recognised as being essential for making progress on NCDs, and a coordinating mechanism for this is being discussed.

MDG successors

The next set of international negotiations relevant to NCDs is the successors to the Millennium Development Goals (MDGs), which are due to expire in 2015. When the MDGs were established, the growing burden of NCDs was not reflected in the Goals. Morbidity and mortality (often premature) due to NCDs is estimated to cost the global economy a staggering $30 trillion by 2030 (here) – and tackling them will be essential for continuing progress to be made in developing countries. The new global monitoring framework has shown that targets can be agreed – and there are lobbying efforts for NCD targets to be included in the new MDGs. The official global platform for the process is here and the WHO’s web portal is here – and the processes are multilayered and complicated.

• A new UN System Task Team on the Post-2015 UN Development Agenda (representatives of over 50 UN organisations and other international bodies) has published a major report on the post-2015 world, Realising the Future We Want for All: Report to the Secretary-General (here) and a series of 18 thematic thinkpieces. The health thinkpiece (here) puts forward the idea of a single overarching health goal – namely, universal health coverage (which would include primary prevention, screening and treatment).
• In addition, there is the wonderfully-monikered UN High-level Panel of Eminent Persons, co-chaired by the presidents of Indonesia and Liberia and the UK’s prime minister, David Cameron. This Panel held formal meetings in London in early November, and more meetings are planned ahead of May 2013, when the Panel is due to release its report.
• There are also more than 100 national consultations, which aim to produce clear recommendations for governments on the next steps for the international development agenda. It is not yet clear how the national consultations will be published or how they will be announced.
• Finally, there will be a series of thematic consultations, including one on “health,” to be led by the WHO and UNICEF (United Nations Children’s Fund). The WHO published a concept note on health post-2015 (here), and has issued a call for papers in this area (deadline 15 December: here).

Proposed SDGs

The third set of international discussions concern ‘sustainable development goals’ (SDGs). Climate change – and the need to switch to a radically lower-carbon economy – will have many health repercussions, and some of the steps that can be taken to counter climate change are win–wins with the prevention of NCDs (here). These include encouraging a nutrition transition and increasing physical activity – notably, a diet lower in red meat (which is carbon-intensive) and moves to encourage a shift away from car use and towards active travel (walking and cycling).
The proposed SDGs are being developed following the UN ‘Rio+20’ conference on sustainable development in summer 2012, and will be applicable to all countries, probably based on the key themes of the conference: jobs, energy, cities, food, water, oceans and disasters.

The SDGs will be developed simultaneously with and separately from the post-2015 work – the two strands are likely to be formally merged only in late 2013 or early 2014. Civil society will have access to the processes, but there is, we understand, as yet no mechanism for the United Nations to synthesise civil-society input into the two processes.

Finally…

Just to complicate matters further, there are two more processes of ongoing relevance to NCDs internationally: reform of the WHO itself, which will shape WHO’s programmes, priorities and resources from 2014 to 2019, and the development of the 2013–20 Global Mental Health Action Plan, the Zero Draft of which has been released (here).

Action

For those of us working in this field, keeping decision-makers aware of the benefits for individuals and economies of prevention and treatment of NCDs is essential. There are, of course, many competing priorities for inclusion in international frameworks – equity issues, carbon reduction, other neglected diseases, human rights, and so on – and we strongly encourage finding synergies with these areas, rather than becoming stuck in disease ‘silos’.
The NCD Alliance is currently holding an e-consultation in three languages, to stimulate discussion on how health and NCDs relate to the MDGs and future development goals, and other critical issues. This is open until 18 November (here) and responses will help the Alliance to develop a common position on asks and must-haves to submit to the WHO.

In addition, the NCD Alliance is advocating three main actions: encourage governments to i) embrace the idea of a global NCD framework (more here); ii) support the targets and monitoring framework (more here); and iii) engage with the Global Action Plan (more here).

Katy Cooper, Senior Project Manager, C3 Collaborating for Health (katy.cooper@c3health.org)

 

The author has completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request) and declares: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years. Katy Cooper works with C3 Collaborating for Health, a global NGO that undertakes projects with a variety of organisations, which can be seen on C3’s website.
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