The fight against NCDs: multi sectoral convergence as a ‘best buy’

The recently concluded 71st World Health Assembly brought a spotlight on NCDs.  Dr Lisa Murphy and Dr. Lujain Al-Qodmani discuss the NCD dialogues at the 71st WHA and what this means for global health .

Non-communicable diseases (NCDs), and the burden they have on populations and health systems across the globe, have been a recent focal point of discussion in the international health community. At the Seventy-first World Health Assembly (WHA), there was much anticipation surrounding the planned High Level Meeting on NCDs at the 2018 United Nations General Assembly, and reflection on the progress of the ‘Montevideo Roadmap’, an agreement by Member States in October 2017 to reduce premature deaths due to NCDs by one-third by 2030 through coordinated and coherent multi-sectoral action.

The social determinants driving NCDs, including its intersections with climate change, trade and development, was a common theme in both the assembly discussion and related side events. It is no secret that socioeconomic inequality plays a crucial role in determining the distribution of NCDs, with the poor disproportionately affected by both disease and disability burden. Health infrastructure and essential medicines will go a long way in relieving this, but success will be limited if we do not also achieve food security, wage equality and gender parity. Not only would multi-sectoral action improve lives and increase resilience, but a healthier and more productive population will bring economic gains crucial for development. Thus, the importance of multi sectoral collaboration to achieve NCD targets is paramount. Discussions at WHA centered on how civil society might be engaged as leaders in intervention design and implementation.

Yet there are vital interventions for mitigating and reversing the NCD impact that can only be realised at a governmental level. The commercial determinants of health, strategies and approaches used by the private sector to promote products and choices that are detrimental to health, although absent from the WHA report, were highlighted and addressed by many actors. States and NCD activists at numerous WHA discussions raised proposals for marketing regulations, taxation on unhealthy substances and legislation surrounding food labelling. However, some states, notably Italy and the USA, emphasised their disquiet around potential economical and societal harm of imposing fiscal measures on the food industry. This consistent US focus on protection of private industry was a frustrating theme at the WHA. As young public health professionals, we do not believe that governments should advocate on behalf of industry extended into negotiations on nutrition, climate change and access to medicines. The persistent push from such a powerful player to mandate the World Health Organization (WHO) into limiting itself to action on communicable diseases was concerning, and poses a potential threat to achieving both targets on NCDs and the sustainable development goals.

The WHO has detailed a number of ‘best buy’ interventions for tackling NCDs. These are policies and programs that are believed to be highly cost-effective, and which they recommend member states adopt. They range from tobacco taxation to cervical screening, and purportedly are evidenced to improve health outcomes and maximise resource utilisation. However, these are grounded in research carried out in high-income settings, with many requiring technical expertise, skills and infrastructure that many low and middle-income countries highlighted during WHA that they are lacking. They also arguably fail to adequately address the socioeconomic factors underpinning many NCDs, and are therefore lacking an important dimension to eradicate, rather than just mitigate, their impact.

Member states of WHO appear united in their passion to both tackle NCDs and the determinants that conduce them. The world is looking forward to the upcoming high level meeting to witness strong political will transform into not just action, but innovation – to will develop de novo ‘best buys’ and retrofit the existing ones. With an investment return of $9 for every $1 spent on NCDs, engagement in this area will be pivotal for achievement of the Sustainable Development Goals. The 71st WHA provided a platform to harness national and global momentum behind tangible action, and progress towards implementation will be closely scrutinised by the international community.

Competing interests: We have read the BMJ Group Conflict of Interest form and declare that we have no conflict of interests to declare.

About the authors:

Dr. Lisa Murphy is a Thames Academic Foundation Program doctor, specialising in public health. Her research post was completed at WHO, working on double duty actions for malnutrition and NCDs.



Dr.Lujain AlQodmani is a physician with Master of International Health Care Management, Economics and Policy, Bocconi University. She also acts as International Officer of Kuwait Medical Association and Membership Director of Women in Global Health.

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