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01 December, 2017

Fighting an inferno with a garden hose: Addressing slow progress in beating NCDs

A report on attendance at the WHO Global Conference on NCDs: Pursuing Policy Coherence to achieve SDG Target 3.4 on Noncommunicable diseases. Montevideo, Uruguay, 18-20 October 2017

The Montevideo WHO Global Conference on Noncommunicable Diseases (NCDs) provided a sombre reminder of the magnitude of the NCD crisis - 40 million deaths, 80% of these in low-and middle-income countries! It also provided an opportunity to reflect on slow progress and the reasons for this.
Despite the well-known impacts of NCDs on health and development only 40% of countries have multi-sector plans. Political action is still weak, with poor systems and financing for prevention and health promotion and insufficient regulation of industries that are causing harm. NCD measures require technical know-how, capacity building, strong health promotion systems and institutions, and robust attention to commercial conflicts of interest.

Above all, progress requires political leadership.  The advocacy role for civil society organisations is more important than ever, especially as prevention and health promotion continues to attract only a tiny proportion of health funding and is not afforded the institutional and policy support that its burden would warrant.  

The WHO Global Conference on NCDs in Montevideo, Uruguay was attended by approximately 400 invited delegates including 5 Heads of State, 20 Ministers, heads of UN Agencies and the WHO Director General, Dr Tedros. This was a vital conference in building momentum for the Third United Nations High-Level Meeting on NCDs to be held in September 2018. The good attendance by Ministers and heads of state was encouraging, as was the political leadership provided by Co-Chairs President Tabare Vasquez of Uruguay, who is also a medical practitioner and oncologist, and the Health Ministers from the Russian Federation and Finland. 

There were positive developments from the conference. The Montevideo Roadmap 2018-2030 on NCDs as a Sustainable Development Priority was adopted, WHO Director General Tedros announced the appointment of Co-Chairs of the WHO Commission on NCDs Dr Tabare Vasquez, President of Uruguay (Governmental Co-Chair) and Dr Sania Nishtar (Technical Co-Chair). 

NCDs is as much a political issue as a technical issue. The term ‘political determinants’ was used in conjunction with ‘commercial determinants’ and ‘social determinants’ emphasising that policy and regulatory interventions are key strategies for NCD prevention and control. It follows that a key advocacy goal for the 3rd UN High Level Meeting on NCDs in New York in September 2018 is to ensure as many heads of state as possible are motivated to attend. The Chairman summed it up well: “With political commitment we can beat NCDs” (Tabare Vasquez, President of Uruguay). 

It was pleasing to see political leaders and other speakers alike embracing health promotion principles such as the need for comprehensive approaches, robust advocacy for combating commercial determinants, the importance of social determinants, inter-sectoral action and the fundamental importance of human rights. It was also good to see commitment to the importance of civil society engagement through the WHO NCD Global Coordinating Mechanism (GCM) where global NGOs were invited as ‘full-access’ delegates to the conference. This is working and would be further strengthened through establishment of a Civil Society Taskforce on NCDs. 

Industry opponents argue that NCD prevention is a matter of individual choice and the primary strategy is education. The reality is education is important but insufficient to beat NCDs. Accelerating progress will require an evidence-based combination of education, community engagement, policy, regulation, healthy environments and the provision of programs in settings such as schools and workplaces. These are political matters and it is only political decision making that can deliver the institutional arrangements, legislative supports and funding to beat NCDs.   

There are many pockets of excellence in NCD prevention. For example, from the Latin American region the conference heard about robust tobacco regulation in Uruguay and strong protection of children from ultra-processed foods in Chile. What is now needed is a concerted effort to implement at scale and across nations. Governments need to take bold, smart steps in implementing innovative policies and programmes and learning from the successes of others. Michael Bloomberg summed it up well when he said, “This needs bold intervention on cost effective proven initiatives” (Michael Bloomberg, WHO NCD Ambassador). 

A negative aspect of the conference was lack of attention to physical activity in the conference program and in the key addresses. Unfortunately, physical activity remains a Cinderella risk factor, especially relative to its powerful NCD impact. Strong advocacy will be required to ensure a strengthened focus on physical activity in the New York HLM, including a call for accelerated implementation of the new WHO Global Action Plan on Physical Activity. 

There was strong will from this conference to address the commercial determinants of health and for this to be reflected strongly in the statement from the UN HLM on NCDs in September 2018. WHO Director General Dr Tedros said, “.. corporations are seeing children as opportunities for profit, not as needing our support.  When will we say enough is enough and push back?”. He added “We must protect health at its root causes, or we are fighting an inferno with a garden hose” (Dr Tedros, Director General WHO).

A key lesson for us all from the conference was to develop our own strong and consistent 
narrative around NCD prevention. It was telling to note the narrative of the politicians, so often framing NCD prevention in human rights terms. It requires putting the health rights of citizens and children over the profits of corporations. Minister for Health form the Russian Federation, Veronika Skvortsova said, “Health is a political issue and decision, it is a human rights issue and social justice issue, for children and for the poor”. 
Partnership with other sectors is also vital and this requires politicians to lead policies that go beyond the health system and recognize the co-benefits for sustainable development. This is especially true for physical activity

A final key issue for NCD prevention and control is advocacy directed at ensuring that system supports for health promotion are put in place. Current lack of progress is typically characterised by lack of funding, absence of sufficiently strong health promotion institutions, insufficient technical capacity, lack of an appropriately skilled and supported workforce, lack of political support and leadership. 

Clearly, there are important system imperatives – technical, financial, political and institutional, that, when adequately supported will accelerate achievement of the 2025 NCD Targets and the 2030 SDG Agenda. 

Trevor Shilton, 21 November 2017

Chairman of GAPA, the Advocacy Council of ISPAH, Co-Director of GlobalPANet. Trevor Shilton attended the conference representing the IUHPE.

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