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22 September, 2017

Montevideo Roadmap 2018-2030 on NCDs as a sustainable development priority

International Society for Physical Activity and Health (ISPAH) Submission:
Montevideo Roadmap 2018-2030 on NCDs as a sustainable development priority

Trevor Shilton, Chairman, Advocacy Council, ISPAH

Physical activity has never been more relevant and central to the achievement of common global agendas. Physical activity is a central issue in realizing the goals of the WHO’s Global Action Plan on the Prevention and Control of NCDs 2013-2020 and the aspirations in the Montevideo Roadmap 2018-2030.

Physical activity has multiple synergies with the global Sustainable Development Goals (SDG)

The SDG 2030 agenda provides a platform for extending the synergies and co-benefits between the physical activity elements of the NCD agenda within SDG 3, with SDG 11 (Sustainable Cities), SDG 13 (Climate Action), SDG 10 (Reduced Inequalities), SDG 15 (Life on the Land), SDG 4 (Quality Education) and SDG 5 (Gender Equity).

1. The focus of the NCD Plan

ISPAH strongly supports a continued focus on the four main behavioral risk factors for NCDs, namely tobacco use, physical inactivity, harmful use of alcohol and unhealthy diets. The strong synergies and opportunities for investment in physical activity implementation (for both NCDs and the SDG Agendas) is outlined further in this submission. However, physical activity needs a stronger focus and more specific reference.

2. Physical activity is insufficiently referenced in the Montevideo Roadmap, relative to is importance

There are numerous appropriate specific reference in the Montevideo Roadmap to energy dense and nutrient poor foods and a call for global strategies strengthening national food and nutrition policies. Like-wise the Roadmap calls for specific action on Tobacco including acceleration of implementation of the FCTC there are insufficient such direct references to physical activity. 

ISPAH Recommends inclusion in the Roadmap of specific points that relate to physical activity and, in particular, accelerated implementation of Global and National Physical Activity Polices and funded Action Plans. ISPAH’s recommendations are further outlined in the text that follows.

3. Evidence-based strategies

ISPAH recommends acceleration of the implementation of the physical activity strategies in the WHO’s Global Action Plan on NCDs, and the robust evaluation of effectiveness to inform the modelling of cost-effective interventions using WHO CHOICE (i.e. a tool for priority setting in health). The forthcoming Global Action Plan for Physical Activity 2018-2030 is a further opportunity to accelerate and prioritize implementation of effective physical activity interventions and polices.  

4. Implementation is the key

In keeping with the above and the momentum gained around the forthcoming Global Action Plan for Physical Activity 2018-2030, ISPAH notes the affirmation of commitment to implementation in the Montevideo Roadmap. Political commitment, leadership and resources for implementation are the key to meeting the ambitious NCD goals and SDG 3.

Implementation will require forthright attention by member states and other players to allocate sustainable resources, provide supporting infrastructure and build robust systems that prioritize and enable high quality and accelerated implementation to achieve the necessary population shifts to achieve the NCD physical activity Target.  

ISPAH recommends: insertion of text that calls for accelerated implementation of National Physical Activity Plans and physical activity-related recommendations in the WHO Global Action Plan on NCDs.

5. Increase efforts to engage sectors beyond health 

Physical activity presents a wonderful opportunity for inter-sectoral action. ISPAH recognizes the powerful co-benefits across other sectors and other sustainable development goals of effective action to increase physical activity. For example, prudent action on active transportation can increase physical activity and benefit SDG 3, while at the same time benefit SDG 13 (climate action) and SDG 11 (sustainable cities and communities) and contribute to reducing inequalities by making services more accessible to women and to others that do not have access to a car.

ISPAH Recommends inclusion in this part of the Montevideo Roadmap specific points that relate to physical activity and in particular accelerated implementation.

6. Economic, social and environmental determinants of health

ISPAH strongly supports a focus on the economic, environmental and social determinants of health to address inequity, noting the disproportionate burden of NCDs and physical inactivity still borne by low- and middle-income countries. For cost-effective interventions to be available to ‘all’ countries, to women and girls and to marginalized groups will require affirmative action. This should ensure investment in infrastructure, systems and a skilled workforce capable of carrying out evidence-based physical activity strategies. Without investing in these systems and infrastructure in the countries that need it most we will see continued widening of equity gaps.

7. Reinvigorate political action

The focus of political action should be governance and leadership. Health, NCDs and health promotion must be a political priority if the NCD and SDG Agendas are to be successfully addressed. Physical activity strategies require political leadership to be enacted. These include political backing for policy priorities such as mandating quality physical education for all children; prioritizing walking, cycling and public transport infrastructure in transport and urban planning policy; implementing urban planning regulations to ensure adequate public open space and funding robust public education.

8. Enable health systems to respond more effectively to NCDs

ISPAH supports the prioritization of initiatives that are population focused. These are more likely to benefit low- and middle-income communities, individuals and families

9. Increase significantly the financing of national NCD responses and international cooperation

ISPAH fully endorses the call for adequate, predictable and sustained financing commensurate with the socio-economic burden of NCDs.

10.  Seek measures to address the negative impact of products and environmental factors harmful for health and strengthen the contribution and accountability of the private sector

ISPAH commends specific exclusion of industries that cause harm (tobacco, arms, sugary drinks, junk foods, alcohol) and the implementation of regulatory and fiscal measures to combat the impacts of unhealthy products without industry interference through legal disputes. However, ISPAH also commends the approach to commit to enhancing the national capacity to engage constructively with the private sector for NCD prevention and control in a way that maximizes health gains. The private sector has a lot to gain from investment in NCD prevention, including higher profitability through healthy and fitter workers, reduced injuries at work, productivity gains and reduced absenteeism. This should extend to increased investment in workplace health and physical activity programs, including active transport programs and programs designed to reduce sedentary behaviour.

11. Reinforcing the role of non-state actors

ISPAH is a unique global organization that specifically represents the physical activity workforce. We look forward to a continued robust engagement with the NCD strategy as a non-state actor in the Global Coordination Mechanism (GCM).

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