Elsevier

The Lancet

Volume 378, Issue 9789, 30 July–5 August 2011, Pages 449-455
The Lancet

Health Policy
UN High-Level Meeting on Non-Communicable Diseases: addressing four questions

https://doi.org/10.1016/S0140-6736(11)60879-9Get rights and content

Summary

Non-communicable diseases (NCDs), principally heart disease, stroke, cancer, diabetes, and chronic respiratory diseases, are a global crisis and require a global response. Despite the threat to human development, and the availability of affordable, cost-effective, and feasible interventions, most countries, development agencies, and foundations neglect the crisis. The UN High-Level Meeting (UN HLM) on NCDs in September, 2011, is an opportunity to stimulate a coordinated global response to NCDs that is commensurate with their health and economic burdens. To achieve the promise of the UN HLM, several questions must be addressed. In this report, we present the realities of the situation by answering four questions: is there really a global crisis of NCDs; how is NCD a development issue; are affordable and cost-effective interventions available; and do we really need high-level leadership and accountability? Action against NCDs will support other global health and development priorities. A successful outcome of the UN HLM depends on the heads of states and governments attending the meeting, and endorsing and implementing the commitments to action. Long-term success requires inspired and committed national and international leadership.

Introduction

In recognition of the global threat of non-communicable diseases (NCDs)—mainly heart disease, stroke, cancer, diabetes, and chronic respiratory diseases—the UN High-Level Meeting (UN HLM) on NCDs will be held in September, 2011.1 The world's heads of states and governments will attend the meeting, creating a unique opportunity to advance globally the prevention and treatment of NCDs. An urgent and collective response is required because no country alone can address a threat of this magnitude. We know what needs to be done, and have set out five overarching actions—ie, leadership, prevention, treatment, international cooperation, and monitoring and accountability—in a previous report.2 These are needed to enable the implementation of five priority interventions—ie, tobacco control, salt reduction, improved diets and physical activity, reduction of hazardous alcohol intake, and access to essential drugs and technologies.2 However, despite substantial evidence in favour of concerted action, some countries, development agencies, and individuals still express concerns about how to achieve the best response to NCDs.3 To ensure the UN HLM results in consensus for an effective global response to NCDs, four questions need to be addressed—ie, are NCDs a global crisis; in what way is NCD a development issue; are affordable and cost-effective multisectoral and health-system interventions available; and why are high-level leadership and accountability necessary?

In this report, we address these questions by providing evidence for the realities of the NCD situation, and summarise key messages for heads of state and governments. Specifically, we show that the burden of global NCDs is huge, and will undermine current development efforts if it remains unaddressed; a strong business case exists for investment in NCDs; cost-effective and feasible multisectoral and health-system interventions are available for all countries; and progress requires sustained leadership and accountability.

Section snippets

NCDs and the global crisis

NCDs pose a global threat and require a global response. The burden of death and disability attributable to NCDs is rising everywhere because of the changing patterns in the way we live and work; millions of people are dying needlessly every year.4 NCDs are not just a domestic challenge, but also cause and entrench poverty, and are a threat to human, social, and economic development. The 36·1 million deaths per year as a result of NCDs represent almost two of three deaths per year worldwide.5

NCD crisis and development

NCDs are more than just a health issue, they are essential to the development of individuals and improved societies.1, 14 Because NCDs increase poverty and are a major economic drain on individuals, families, and businesses,15 the crisis threatens social, economic, and environmental development, and women's empowerment.

Poverty causes NCDs, but NCDs also cause and entrench poverty. In all countries, payment for NCD treatment and care traps vulnerable households in cycles of debt, impoverishment,

Cost-effective and feasible interventions

Prevention of NCDs is essential to reduce the immediate burden, and protect future generations by providing an environment that supports people to remain healthy. Multisectoral preventive interventions, including policy changes, regulation, and market intervention, are of highest priority; once an NCD develops, the burden on health systems, already ill prepared and equipped in many countries, is substantial.32 Several affordable and adaptable cost-effective, pro-poor, and feasible multisectoral

Leadership and cooperation

Success in addressing the NCD crisis will depend on strong and effective leadership; a strong leader can catalyse and lead change.38 Sustained leadership by heads of states and governments is needed to coordinate the many sectors involved in implementing national NCD plans and whole-of-government approaches.39 Civil society can support, encourage, and strengthen the necessary leadership.

A primary reason for the UN HLM was the recognition that to address the main causes of NCDs, the involvement

Conclusions

The UN HLM has the potential to advance NCD prevention and treatment rapidly, while ensuring an integrated response to all priority diseases. In the lead up to the meeting, several actions by heads of states and governments are necessary.

The case for strong action must be fully appreciated and endorsed without doubt about the magnitude of the global NCD crisis, and the availability of affordable and rapidly effective interventions. Member states, as they prepare the crucial outcome document,

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