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U.N. Declaration on Non-Communicable Diseases: How Can We Move Faster?

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Three years have elapsed since world leaders adopted the Political Declaration on Non-Communicable Diseases (NCDs) at the United Nations General Assembly (UNGA) in New York.  In doing so, they committed to develop national plans to prevent and control NCDs, along with targets to monitor the progress achieved.

Last week, a similar high-level meeting took place at the UNGA to assess efforts made since 2011 to implement those commitments.   So what is the score card?

The progress achieved thus far appears to be mixed. Indeed, as the World Health Organization (WHO) Director General, Dr. Margaret Chan, stressed in her opening remarks at the meeting, “I see no lack of commitment. I see a lack of capacity to act, especially in the developing world”.   

She backed up this observation with both information about efforts made by governments to move this agenda forward and recent data from a 2014 country profiles report prepared by WHO that shows the current high and increasing global mortality from NCDs.  It is estimated that 38 million people die each year from NCDs, mainly from cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes, and that over 14 million deaths from NCDs occur between the ages of 30 and 70, of which 85% are in developing countries. 

The unfortunate fact behind this situation is that these premature deaths are largely preventable if simple, cost-effective and affordable interventions to reduce biological and behavioral risk factors for NCDs are implemented. Health systems should be retooled and strengthened to respond effectively to this challenge, taking into account evidence from accumulated knowledge and experience across the world, and recent scientific and technological developments.

Given the many political declarations and government commitments, what is hindering a scaled up and sustainable response to the NCDs (and I would add road traffic injuries) challenge? 

As NCDs and road traffic injuries overtake communicable diseases as the leading causes of mortality and morbidity in most of the world, Dr. Chan advocates for a major shift from the prevailing biological, clinical and curative-oriented paradigms that have governed the way societies organize and fund health systems, to one that stresses health promotion and disease prevention. This new model would focus on social determinants of health and changing behaviors; move from short-term management of  acute episodes of ill health to long-term management of chronic health conditions, with their complications and comorbidities; and  be driven by  concerted action involving multiple sectors, business partners, and community actors.   

The above shift is inescapable.  As Dr. Chan noted, while health systems bear the brunt of NCDs (and road traffic injuries), they have little control over their causes. Indeed, as she said, “The health and medical professions can plead for strong tobacco and alcohol legislation, more exercise, and healthier diets. We can treat the diseases and issue the bills, but we cannot re-engineer social environments to promote healthy lifestyles.”

Therefore, it should be clear to all of us working in the health sector that an effective, government-led, multisectoral effort needs to be advocated, launched, supported, strengthened and operationalized to deal with NCDs (and road traffic injuries) as we move through the second decade of the 21st century. 

When reading Dr. Chan’s remarks, I was struck by the revolutionary tone and wisdom in her words. They vividly brought back to me lessons and inspiration  from my student days, when I read the work of 19th century public health pioneers such as Rudolph Virchow, one of the founders of social medicine movement, and John Snow, one of the fathers of modern epidemiology. The more recent writings of a generation of social medicine practitioners in Latin America and the Caribbean further stress that successful health promotion and disease prevention depends upon a population-based strategy that tackles the social and environmental causes of ill health, premature mortality, and disability, and not only individual risk factors and the clinical manifestation of disease -- symptoms and signs observed by physicians or felt by the patient. 

Those of us who work in health and across many other sectors at the World Bank Group, as well as in coordination with WHO and other international agencies, now have an unprecedented opportunity to help countries design and introduce coherent, evidence-based, multisectoral policies and actions to push forward the strategy of health promotion and disease prevention to deal with NCDs (and road traffic injuries).  In doing so, World Bank Group teams can become major contributors to the improvement of the health status and the well-being of populations, and hence to end poverty and reduce inequalities, across the world in years to come.

Follow the World Bank health team on Twitter: @worldbankhealth



Patricio V. Marquez

Former World Bank Group (WBG) Lead Public Health Specialist

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