Richard Smith: Making 2018 the year of NCD

Progress has stalled over the past few years, but with better messaging, a simplified programme, and increased accountability then 2018 could be the year of NCD

richard_smith_2014We have a huge opportunity to make 2018 the year of NCD (non-communicable disease), said Robert Beaglehole, chair of the Lancet NCD Action Group, at a C3 Collaborating for Health breakfast seminar last month. The United Nations will be reviewing progress in reducing the burden of NCD this year, following on from its high level meeting in 2011 and first review in 2014.

Beaglehole, an emeritus professor of public health from Auckland, has been concerned with NCD for decades and described the Pacific Islands he visited long ago as the “epicentre of NCD.” Comparing the global journey in countering NCD to “paddling a canoe,” he said that we’ve been up and down but are now “back on the top of the wave . . . but with a long way to go.”

A previous top of the wave was the high level meeting of the United Nations in 2011, which was attended by 35 heads of state and produced a political declaration. In 2013 the World Health Organization (WHO) set targets for NCD, including reducing deaths under 70 from NCD by 25% by 2025. The Lancet Action Group showed that this target could almost be reached by achieving the targets set for the risk factors (tobacco, unhealthy diet, physical inactivity, and the harmful use of alcohol). Success, Beaglehole said, depends little on technological innovation but mainly on political action.

Unfortunately, since the 2011 meeting progress has been “dismal”—a message recently repeated in the UN secretary general’s report on NCD. At the 2014 follow-up meeting to the 2011 meeting there were no heads of state.

NCD is included in the Sustainable Development Goals with “mental health tacked on,” but there are 160 targets. WHO has established an independent commission on NCD, but it now has five cochairs. It will report in June before the 2018 UN meeting, which may happen in June or September. September would be better, said Beaglehole, because that’s when heads of state are in New York for the meeting of the general assembly, and the meeting on NCD could be held back to back with a meeting on TB—two pandemics that overlap. There is also a Bloomberg Task Force on Fiscal Policy for Health, which includes Helen Clark, the former prime minister of New Zealand, and Nicola Sturgeon, the first minister in Scotland. There is also a Civil Society Task Force on NCD. So “a lot is going on,” concluded Beaglehole.

Despite the dismal progress so far, Beaglehole remains optimistic. He sees three priorities: achieving political leadership and commitment; simplifying what countries need to do; and holding countries accountable.

Political leaders are overwhelmed, and NCD has slipped from their agendas. NCD has been framed as a major killer, very costly, and a development and a sustainability issue—and none of these framings has grabbed political leaders. It may be more effective to link NCD to the social determinants of health and universal health coverage, both of which are currently high on political agendas. Beaglehole emphasised the importance of gathering support from finance ministers as well as health ministers.

Currently, said Beaglehole, we have reviews, action plans, and statistical reports “coming out of our ears,” but we “cannot articulate a simple enough message.” Instead of the 16 “best buys” suggested by WHO for reducing the burden of NCD, we should have something simpler. He suggested increasing taxation on tobacco, reducing salt consumption, and making fixed drug combinations (polypills) available to people at high risk of cardiovascular disease. He would ignore the other best buys, including increasing physical activity.

Lastly, he insisted on the importance of accountability. Data need to be gathered on what countries have achieved or not achieved, and political leaders need to be held accountable.

With better framing of the importance of NCD, a simplified programme, and increased accountability then the UN meeting can be productive and 2018 the year of NCD.

Richard Smith was the editor of The BMJ until 2004.

Competing interest: Until 2015 RS headed the UnitedHealth Group part of a joint programme with the National Heart, Lung, and Blood Institute to create centres in low and middle income countries to conduct research, build capacity, and develop policy in relation to NCD. He is currently the chair of icddr,b [formerly International Centre for Diarrhoeal Disease Research, Bangladesh], which includes a group working on NCD. He was until recently a member of the board of C3.