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The how: a message for the UN high-level meeting on NCDs

For a country with a long and successful record on preventive health, Australian governments seem startlingly indifferent about the forthcoming United Nations High-Level meeting on NCDs – the third of these meetings since the first adopted a resolution in 2012 to reduce noncommunicable disease (NCD) by 25 per cent by the year 2025.

The Prevention 1st report Preventing Chronic Disease: how does Australia score?, which was released at Parliament House in Canberra on 19 June 2018 highlights that indifference. Apart from efforts to reduce smoking, Australia needs to do very much better.

NCDs are responsible for more than 30 million deaths worldwide each year. In Australia, the Australian Institute of Health and Welfare says a third of these are preventable.

Civil society organisations and public health experts from around the world have become increasingly agitated by the indifference of too many OECD countries on NCD prevention, including Australia.

The World Health Organization (WHO) shares that concern, and under its new Director General Dr Tedros Adhanom Ghebreyesus, an independent commission was established earlier this year to “advise him on bold recommendations on how countries can accelerate progress towards…the prevention and treatment of NCDs and the promotion of mental health and well-being”.

The commission’s report, Time to Deliver, should help to guide states in their approach to the High-Level Meeting when it convenes in New York in September.

In the article below, The Lancet (28 June 2018) some of the world’s leading public health advocates have added their voice to the recommendations of Dr Tedros’ independent commission. Their eight-point agenda for taking positive action is clear and to the point.

FARE will be stressing this agenda in its ongoing representations to Australian governments and their officials.

This September’s UN General Assembly high-level meeting (HLM) on non-communicable diseases (NCDs) provides a strategic opportunity to propel the response—from “where do we want to be” to “how do we get there”.

The WHO Independent High-Level Commission on NCDs made a number of solid proposals to inform HLM negotiations. These include a call for governments to enhance regulatory frameworks to protect health, for example, through a code on the marketing of some health-harming products and a full–cost accounting of these products.

The draft of the HLM’s political declaration prioritises universal health coverage, including affordable treatment, and promotion of mental health but falls short on the primary prevention of NCDs and promoting healthy societies as per Agenda 2030. The transition from health-harming to health-enhancing products and processes requires action across multiple sectors and strengthened public institutions. We propose an agenda for member state HLM negotiators.

First, accountability must be assigned at the highest political levels. The WHO NCD Commission called on heads of government to lead the NCD response, as was the case with effective AIDS responses. This will ultimately empower ministers of health by ensuring all government departments are accountable to national leadership and are enabled to manage political opportunities, barriers, and trade-offs for NCD prevention. Rather than create new vertical structures, the NCD agenda should be integrated into national Sustainable Development Goal (SDG) plans. The declaration must commit to distributed ownership, impact assessments, policy coherence, and accountability across ministries.

Second, improving fiscal policies should be prioritised. Countries should implement a synergistic approach to taxing sugar (not just sugar-sweetened beverages but also sugary snacks3), tobacco and alcohol, as well as unhealthy nutrients. The international community should provide technical advice on taxation and removing subsidies for processed foods, alcohol, and fossil fuels, and for divesting from tobacco, alcohol, and fossil fuels; governments should also support healthy local food systems.

Third, additional financial resources must be mobilised. The declaration should call for dramatic financial increases for NCDs over the US$1 billion currently spent annually. Domestic resource mobilisation, in line with the Addis Ababa Action Agenda, along with development assistance and catalytic external funding, is necessary to address issues of equity, provide public goods, and ensure value for money through evidence–informed resource allocation.

Fourth, the commercial determinants of health should be more rigorously regulated. Evidence suggests that self–regulation cannot be relied on to deliver healthy outcomes. Building on experience from tobacco control, governments must regulate the alcohol, processed, and ultra–processed foods industries. Access to healthy foods demands effective regulation to improve production and formulation, restrict harmful marketing (particularly to children), mandate better labelling, and set price incentives for healthier consumption. This requires building country capacity, creating strong health provisions in international trade agreements, as well as strengthening international institutions to counteract interference in establishing and implementing evidence-informed standards.

Fifth, the growing impact of pollution and urbanisation on NCDs, injuries, and mental health must be addressed. The declaration should call on governments and partners to (re)design and build healthy communities that enable people to exercise freely and safely, access healthy foods easily, and reduce their exposure to household, traffic, and industrial pollution.

Sixth, support shoud be provided for meaningful civil society engagement. Agenda 2030 is premised on effective partnerships, including with civil society. The declaration must ensure meaningful engagement with and by affected communities, citizens, and public interest groups, explicitly highlighting their role in national multi-sector planning and coordination platforms and independent accountability mechanisms. Countries should increase investment in the advocacy and service delivery functions of civil society and its networks.

Seventh, principles of equity, human rights, and gender equality must be upheld. Recognising that burden of NCDs and mental health is inequitably distributed across populations, responses must address differential circumstances—for example, socio-economic position, gender, ethnicity, and geography. Explicit commitment to a rights-based approach to prevention and treatment can help empower and protect populations living in vulnerable circumstances. As with previous UN General Assembly political declarations on AIDS,7 this would entail non-discrimination in access to information, services, affordable care, medicines, and technology; meaningful participation of people affected by NCDs or mental health problems; and ensuring affected people know their rights (including to prevention) and have access to legal services to challenge violations.

Finally, independent accountability should be fostered. The declaration should call for an NCD Countdown 2030 that would encompass framing the response under existing human rights treaties, reliable reporting systems, independent monitoring, and review, and mechanisms to enhance and enforce compliance. Negotiators should embed NCD accountability structures in existing sub-national, national, and global SDG monitoring processes, ensuring the declaration highlights principles of transparency, accessibility, and inclusion.

The 2018 declaration must focus on concrete measures that countries can adopt to implement, at a minimum, WHO “best buys”. Negotiators must make strong commitments to act on the above approaches to NCD prevention. They should seize the opportunity to situate the NCD and mental health response within commitments to a more healthy and sustainable future, embracing food and transport systems, urban planning, conflict mitigation, and pollution control, with the ultimate goal of achieving planetary health.

For the complete article, including references see The Lancet (published 28 June 2018).

Michael Thorn

Michael Thorn

Michael is the Chief Executive of the Foundation for Alcohol Research and Education (FARE), and tweets from @MichaelTThorn.

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