General Assembly High-Level Meeting on Non-Communicable Diseases Urges National Targets, Global Commitments to Prevent Needless Loss of Life
Sixty-eighth General Assembly
100th & 101st Meetings (AM & PM)
General Assembly High-Level Meeting on Non-Communicable Diseases Urges
National Targets, Global Commitments to Prevent Needless Loss of Life
Member States today pledged to intensify efforts towards a world free of the avoidable burden of non-communicable diseases, which claims the lives of 36 million people each year, during day one of the General Assembly’s high-level review of progress made in preventing and controlling those diseases.
By the terms of a wide-ranging draft resolution — the meeting’s outcome document — Governments committed to addressing non-communicable diseases as a matter of priority in national development plans, for which they agreed to consider setting national targets for 2025, by 2015, and by 2016, to reduce risk factors and underlying social determinants for those diseases. They aimed, by 2016, to strengthen and orient health systems to address prevention and control issues through people-centred primary health care and universal health coverage.
Further to the text (document A/68/L.53), Member States were urged to take steps for that purpose, including effective legislation, mainstreaming non-communicable disease in development schemes, and, among others, measure and track economic, social, and environmental determinants and disparities in health.
Outlining international commitments, the document invites the Development Assistance Committee of the Organization for Economic Cooperation and Development to consider formulating a “purpose code” for non-communicable diseases to help track official development assistance (ODA) in support of national efforts.
The authors reiterated their commitment in the text to actively promote national and international investments and strengthen national capacity for quality research and development. They also agreed that due consideration should be given to addressing non-communicable diseases in the elaboration of the post-2015 development agenda, taking into account the diseases’ serious socioeconomic consequences and determinants, and their links to poverty.
They called on the World Health Organization (WHO), in consultation with Member States, to develop, before the end of 2015, an approach that could be used to register and publish contributions of the private sector, philanthropic entities and civil society to the achievement of the nine voluntary targets set out in a comprehensive global monitoring framework, adopted in 2013.
Looking to the future, the text requested the Secretary-General to submit to the General Assembly, by the end of 2017, a report on the progress achieved in the implementation of the outcome document and of the 2011 Political Declaration, in preparation for a comprehensive review in 2018.
Opening the meeting, General Assembly President John Ashe (Antigua and Barbuda) stressed that much had been achieved at the global level since the adoption of the Political Declaration, including the endorsement by the World Health Assembly in May 2013 of a Global Action Plan for the Prevention and Control of NCDs 2013-2020, as well as the adoption of comprehensive global monitoring framework and the establishment in July 2013 of the United Nations Interagency Task Force on prevention and control and a global coordination mechanism.
Yet, he said, despite the increase of national multisectoral plans and dedicated units in many developing countries, a significant number were struggling to move from commitment to action, attributing the situation, not to a lack of political will, but to a lack of technical and financial resources.
United Nations Secretary-General Ban Ki-moon, through a message delivered by his Chef de Cabinet, said the actions identified in the outcome text, he said, could help remove the barriers to good health that blighted the lives of too many people. With that, he urged a set of simple, effective and affordable solutions tailored to each country’s needs, so as to prevent the deaths of more than 12 million people a year between the ages of 30 and 70 in developing countries alone.
In that vein, said Margaret Chan, Director-General of the World Health Organization (WHO), 85 per cent of premature deaths from non-communicable diseases occurred in developing countries, which lacked the capacity to act. Non-communicable diseases had overtaken infectious diseases as the world’s leading cause of morbidity and mortality, she declared, describing that as a “seismic shift” that calls for sweeping changes in the very mindset of public health.
Also in opening remarks, Helen Clark, United Nations Development Programme (UNDP) Administrator, said that understanding the far-reaching development consequences was crucial. For low- and middle-income countries, economic costs from the four main non-communicable diseases — cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes — were predicted to exceed $7 trillion between 2011 and 2025, or the rough equivalent to $500 billion per year.
Speaking on behalf of civil society, Tezer Kutluk, International Union against Cancer, said those diseases were the leading killer globally, claiming the lives of an estimated 36 million people per year. Acceleration of the crisis, he said, was largely man-made, as humanity had created a world in which more people were overweight than underweight, and where children were at risk for disease due to factors beyond their control. He said it “makes no sense” that only 1.2 per cent of the $31 billion in development assistance was earmarked for health.
Following the opening segment, more than 50 speakers took the floor, with many insisting that no matter the challenge of the objectives, there was no reason to lower the bar. There was broad agreement to set the global family on a healthier, development-oriented trajectory.
Michel Blokland, Minister of Public Health of Suriname, who spoke on behalf of the Caribbean Community (CARICOM), emphasized the profound threat non-communicable diseases posed to the development of small States. In his region, those diseases, though preventable, were responsible for the loss of 5 to 8 per cent of gross domestic product (GDP). Given the rapid increase in overweight and obese children, which had doubled or tripled in the last 20 years in several countries, it was imperative to give urgent attention to nutrition.
David Acurio, Deputy Minister of Governance and Health Surveillance of Ecuador, said that it was impossible to speak of development without human well-being. His Government considered health care to be a “right, not merchandise”. Measures undertaken in his country included imposing taxes on sweet beverages, regulating aggressive marketing of unhealthy foods, and labelling of processed foods showing fat, sugar and salt levels. “We may not achieve those objectives in the short term, but there is no reason to lower the bar,” he said.
Also speaking at the ministerial level were representatives of Colombia, Jamaica, Mexico, Congo, Mongolia, Argentina, Russian Federation, Kuwait and Chile.
The European Commissioner for Health spoke on behalf of the European Union Delegation.
Also delivering statements were representatives of Bolivia (on behalf of the “Group of 77” developing countries and China), Indonesia, Monaco, Sweden, Israel, China, Brazil, United States, Italy, Iran, Denmark, Switzerland, Pakistan, Niger, Qatar, Barbados, Iraq, Malaysia, El Salvador, Norway, South Africa, Spain, Peru, Morocco, Australia, Japan, Canada, Guyana, Trinidad and Tobago, Botswana, Cuba and Montenegro.
The General Assembly will meet again at 10 a.m. Friday, 11 July, to conclude its comprehensive review and assessment on non-communicable diseases.
JOHN ASHE (Antigua and Barbuda), General Assembly President, reviewing developments three years into the implementation of the 2011 “Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases”, said much had been achieved at the global level, namely the endorsement by the World Health Assembly in May 2013 of a Global Action Plan for the Prevention and Control of NCDs 2013-2020, and the adoption of comprehensive global monitoring framework, which included nine voluntary global targets and 25 indicators to be achieved by 2025. He also cited the establishment in July 2013 of the United Nations Interagency Task Force on the Prevention and Control of NCDs and of a Global Coordination Mechanism on non-communicable diseases.
Yet, regrettably, he said, despite the increase of national multisectoral plans and non-communicable disease units in many developing countries, a significant number of them were struggling to move from commitment to action. “It must be conceded, however, that this is not the result of lack of political will,” he said, adding that many developing countries did not have the resources – neither technical nor financial. This meeting and the policies and actions that would emanate from it could and must be used to set the global family on a healthier, development-oriented trajectory.
SUSANA MALCORRA, Chef de Cabinet, delivering a message on the Secretary-General’s behalf, said the global epidemic of non-communicable diseases was a major and growing challenge to development. Each year, in developing countries alone, strokes, heart attacks, cancer, diabetes and asthma killed more than 12 million people between the ages of 30 and 70. “It is possible to prevent most of these deaths,” she said, stressing the need for a set of simple, effective and affordable solutions for all Member States that could be tailored to each country’s needs. The draft outcome document to be adopted today would help chart the way forward.
Agreement was reached three years ago that stated it was time to act, she said, further noting that Governments had been asked to protect their citizens from risk factors, provide responsive health systems and track the trends of the epidemic. Civil society and the private sector were called on to help implement new policies, so the scale of the problem would not block the achievement of the Millennium Development Goals. As a result, more Governments were now providing institutional, legal, financial and service arrangements to prevent and control the diseases.
Last year, she noted, the Secretary-General had established the United Nations Interagency Task Force on Non-Communicable Diseases, with the World Health Organization (WHO) in the lead. It was assisting countries to implement WHO’s Global NCD Action Plan, which aimed for a 25 per cent reduction in premature deaths resulting from those diseases by 2025. Today’s high-level meeting could help frame the concrete actions that countries should take between now and the third high-level meeting on non-communicable diseases in 2018. The actions identified in the draft outcome text could help remove the barriers to good health that blighted the lives of too many people.
MARGARET CHAN, Director-General of the World Health Organization, said the 2011 political declaration on the prevention and control of non-communicable diseases was “a watershed event”, whereby Heads of State and Government recognized the threat those diseases posed to health, economies and societies. WHO had completed its assignments set by the declaration, establishing global mechanisms and a road map for coordinated multisectoral action and monitoring. At the country level, despite some clear improvements, overall progress remained insufficient and uneven. Developing countries lacked the capacity to act, and 85 per cent of premature deaths from non-communicable diseases occurred in those countries.
Non-communicable diseases had overtaken infectious diseases as the world’s leading cause of morbidity and mortality, she said, describing that as a “seismic shift” that calls for sweeping changes in the very mindset of public health. Health systems in developing countries must move the focus away from cure to prevention, from short-term to long-term management, from delivering babies to also administering vaccines and antibiotics, to changing human behaviours, and from acting alone to acting in concert.
Socioeconomic progress itself created the conditions that favoured the rise of non-communicable diseases, she said, adding that the risk factors were part of the very fabric of modern society. More collaboration with the private sector was needed to change the way unhealthy foods were marketed, and measures such as taxes on alcohol were also crucial, along with advertising bans. Primary responsibility for prevention lay with Governments, while social environments should change across the board. High-level political commitment was the only way to engender the broad-based collaboration needed for substantial progress, especially on prevention.
HELEN CLARK, United Nations Development Programme (UNDP) Administrator, said that for too long, non-communicable diseases were regarded as a problem for high-income countries. Thus, the ways in which they impeded development progress and impacted the lives of the poorest people had yet to be fully addressed, and today, low- and middle-income countries were bearing the brunt. Understanding the far-reaching development consequences, therefore, was crucial. For those countries, economic costs from the four main non-communicable diseases — cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes — were predicted to exceed $7 trillion between 2011 and 2025, or the rough equivalent to $500 billion per year. One study in Sudan showed that for a family with a diabetic child, 65 per cent of the family’s annual health spending went to the child’s diabetic care.
Recognizing significant social determinants of non-communicable diseases, UNDP, she noted, had advocated for strong action beyond the health sector as a complementary effort. More than half of the recommended policy options and cost-effective interventions included in WHO’s Global Action Plan required steps beyond the health sector. UNDP stood ready to work with WHO, other United Nations agencies, civil society and other partners to support Member States in accelerating the implementation of comprehensive national responses.
TEZER KUTLUK, International Union against Cancer, said civil society was united in a common cause: to address non-communicable diseases together. Those diseases killed an estimated 36 million people annually, including 300,000 people in his country, Turkey. Many people lacked the preventive interventions, treatment and palliative care they desperately needed. Low- and middle-income populations were hardest-hit. The acceleration of those diseases was largely a man-made crisis; humanity had created a world in which more people were overweight than underweight, and where children were at risk for disease due to factors beyond their control. Economic transition, rapid urbanization and the twenty-first century lifestyle levied a huge cost on the health and development of current and future generations.
Speaking as a paediatric oncologist, researcher and advocate of the global cancer community, he said childhood cancer exemplified the gross inequity experienced by those living with non-communicable diseases in low- and middle-income countries. Children with cancer in high-income countries had an 80 per cent cure rate, but that rate dropped to as low as 10 per cent in other places. Even in Turkey, where treatment and care existed, there were significant challenges, he said, citing cases in which children were diagnosed too late to save their lives and in which they had to end treatment or lacked access altogether to palliative care and support. “Health is a basic human right. We cannot ignore those who are desperately in need,” he said, calling for scaled-up action to prevent millions of premature deaths from non-communicable diseases.
He urged Governments to take ownership and responsibility for the response, and called for its coordination through multisectoral national plans, a multisectoral commission for non-communicable diseases, and country—level monitoring and evaluation systems. Non-communicable diseases must also be central to the post-2015 development agenda and be embedded as a stand-alone goal. The international community must close the global resource gap for non-communicable diseases, which, despite being the leading killer globally, only received 1.2 per cent of the $31 billion in development assistance allocated to health. “It just makes no sense. By investing up front in non-communicable [disease] prevention and control, we can guarantee saving, not only human lives and misery, but also dollars spent on costly avoidable complications,” he said, calling on Governments to maximize innovative financing mechanisms and raise significant revenue — particularly through a tobacco tax — and urge bilateral development agencies to start taking those diseases seriously.
MICHEL BLOKLAND (Suriname), speaking on behalf of the Caribbean Community (CARICOM) and associating with the “Group of 77” developing countries and China emphasized the profound threat that non-communicable diseases posed to the development of small States. CARICOM recognized that the problem was linked to other major development challenges, such as food security, climate change, and poverty reduction. In the CARICOM region, non-communicable diseases were responsible for the loss of 5 to 8 per cent of gross domestic product (GDP), representing significant, yet preventable, impediments to economic growth.
He expressed deep concern about the rapid increase in overweight and obese children, which had doubled or tripled in the last 20 years in several countries. Given such trends, it was imperative that nutrition was given urgent attention. With that in mind, a joint meeting of CARICOM health, trade and economic development ministers was being organized. Partnerships and technology transfers to promote the production of healthier foods were needed, while the transnational companies that supplied most of it for the region must progressively reduce salt and sugar content, introduce clear labelling schemes and launch educational and awareness-raising programmes on nutrition.
SACHA SERGIO LLORENTTY SOLÍZ (Bolivia), speaking on behalf of the Group of 77 developing countries and China, said the burden of non-communicable diseases was not just a health issue, but also a challenge to countries’ abilities to attain their development objectives. He stressed the need for the continued deep involvement of the United Nations in that effort and called for increased measures in prevention and control, particularly against cardio-vascular disease, cancer and chronic respiratory diseases. Steps were also needed to prevent the development of such diseases to ensure they did not cause death.
He appealed for strengthened cooperation and intensified commitment at all levels, adding the need for the establishment and strengthening of effective systems to monitor and evaluate commitments and advances in the treatment and control of such diseases, particularly given that progress since 2011 had been insufficient and unequal. Several challenges remained, such as capacity-building and increased access to resources, for which North-South and South-South cooperation could help to meet those needs. Prevention and control efforts, along with expansion of national capacities, required the involvement of international organizations and financial institutions, along with the private sector and civil society. Access to medication and diagnostics was important, and generic medicines, especially in developing countries, were vital. He appreciated WHO’s efforts to develop new tools and strategies for tackling non-communicable diseases globally and he welcomed establishment of the Interagency Task Force.
Action on Draft
Then, acting without a vote, the Assembly adopted a draft resolution, as orally revised, (document A/68/L.53) titled “outcome document of the high-level meeting of the General Assembly on the comprehensive review and assessment of the progress achieved in the prevention and control of non-communicable diseases”.
ANTHONY BORG, European Commissioner for Health, European Union, said that addressing non-communicable diseases could lead to enormous gains in health and socioeconomic development. A great deal of the burden of non-communicable diseases was preventable through action on risk factors like tobacco, harmful alcohol consumption, diet and lack of exercise, as well as through understanding underlying social, economic and environmental determinants, like air pollution.
He pledged the Union’s support to other countries in addressing the extraordinary challenges, while stressing the need for national Governments to integrate the prevention and control of non-communicable diseases in the overall strengthening of their health systems. At the same time, he cautioned that fragmentation into separate disease-specific activities should be avoided. He welcomed progress that had been made and looked to the WHO for leadership on next steps, including implementation of the Action Plan, monitoring, and strengthening global cooperation. He trusted that the United Nations Interagency Task Force and the coordination mechanism would further enhance coordination in that respect.
ALEJANDRO GAVIRIA URIBE, Minister of Health and Social Protection of Colombia, said that non-communicable diseases accounted for 80 per cent of the total diseases in his country. The Government had gathered more than 100 organizations to launch a participatory process to combat those diseases. As a result, a 10-year national plan had been drawn up, with a focus on healthy lifestyles and quality of health care, among other objectives. The Government also put in place a 10-year plan targeting cancer, which aimed to provide high-quality oncological care. Health coverage was now available to 98 per cent of Colombians. The Government regulated monopolies to lower the cost of medication, and it had conducted a national survey as an analytical instrument. Challenges shared by both the developed and developing countries included sustainability and equity of resources, quality of health services, competence of health professionals, and the challenge of rallying the support of other sectors for health policies.
FENTON FERGUSON, Minister of Health of Jamaica, associating with the Group of 77 and China and with CARICOM, said he prioritized improving access to health care because lack of it magnified the diseases’ impact. Universal health care was, for Jamaica, “a journey, not a destination” requiring a “delicate balance” between resources for meeting long-term goals and for addressing immediate needs. Resourcing universal health coverage was particularly difficult for small island developing States, he noted, adding that his country had started tackling non-communicable diseases by targeting tobacco use. Preliminary reports suggested that respiratory illness admissions were down as a result. He noted Jamaica’s Strategic Plan on non-communicable diseases for 2013-2018, as well as efforts to address risk factors, such as unhealthy diets and harmful use of alcohol. To reduce premature deaths from non-communicable diseases by 25 per cent by 2025 would require scaled-up responses, he said.
MERCEDES JUAN LOPEZ, Minister of Health of Mexico, said her country’s society was ageing and facing health risks, including tobacco consumption, unhealthy diets, physical inactivity, and harmful consumption of alcohol. The Government had undertaken many measures, including requiring restaurants and other public places to be tobacco-free, imposing a tobacco tax, as well as a regulation to reduce the use of salt in bread. Alcohol regulation had reduced road accidents by 20 per cent. Mexico had one of the world’s highest obesity and diabetes rates, with 70 per cent of adults and 30 per cent of children overweight or obese. In October 2013, the President had announced a national strategy to control that problem, by promoting the establishment of public policy and healthy lifestyles. Measures undertaken included a ban on certain ingredients in school meals, a commercial ban for chocolate and candies, a special tax on sugar and high-calorie drinks, and requiring food labels to show the total number of calories. Mexico was also combating non-communicable diseases through cooperation at all levels.
FRANÇOIS IBOVI, Minister of Health, Congo, noted Africa’s huge burden in dealing with communicable diseases such as HIV/AIDS, malaria and tuberculosis, with the rapid rise in non-communicable diseases. The Luanda Declaration showed African Governments’ commitment to combating non-communicable diseases, he said, stressing the need for campaigns to extend beyond health ministries to civil society and anyone working in the health sector. Non-communicable diseases were on the rise in the Congo, so dealing with them was a priority for the Government. As well as preparing epidemiology guidelines, he was also preparing a legal framework for cooperation to harmonize the work of all actors in the health-care field. He supported the plan for 2013-2020 adopted by the World Health Assembly and underlined the need for a focus on prevention and for multisectoral campaigns.
NATSAG UDVAL, Minister for Health of Mongolia, said non-communicable diseases accounted for 72 per cent of the total disease burden in her country. The Government this year established the National Committee on Health, headed by the Prime Minister, as well as adopted a policy document for multisectoral coordination. In 2012, the Parliament had amended the Law on Tobacco Control. It also had ratified the WHO Protocol to Eliminate Illicit Trade in Tobacco Products. Now, smoking in public places, including bars, restaurants and schools, was prohibited. Cigarette packages bore larger health warning signs on both sides, and penalties for violation of the law had been raised. Local governments had been initiating health-friendly community movement on maternal and child health care, while civil society had initiated a forum on citizen’s participation and ownership for health, and it had been advocating nationwide public awareness of blood pressure control and health education on common risk management.
EDUARDO BUSTOS VILLAR, Vice-Minister and Secretary of Health, Argentina, associating himself with the Group of 77, said the growing epidemic of non-communicable diseases was not a medical or public health problem, but a political one, because it related to the development of the world’s peoples. He described progress since 2011 in controlling different aspects of the diseases, which included Government provision of a structured space for the coordination of diverse actors’ efforts. Argentina was a regional leader in the regulation of trans-fat and was about to become a trans-fat-free country. The country’s legally binding food code had been modified and guidelines set to curtail the country’s production or marketing of any foods using hydrogenated vegetable oil. Efforts to reduce salt consumption and to broaden coverage to people with diabetes were also under way. A significant decline in tobacco use had been recorded since 2003 and Argentina’s Third Survey of Risk Factors would paint a clearer picture of the situation on the obesity epidemic.
DMITRY KOSTENNIKOV, Deputy Minister of Health, Russian Federation, said that last year his Government had completed a two-year $19 billion health-sector modernization programme. Among its key priorities were strengthening primary health-care services; expanding preventive care; improving specialized and high-technology services; strengthening of drug policies; ensuring sanitary and epidemiological well-being; and combating infectious diseases. Priority attention had been given to improving the compulsory medical insurance system. Such efforts had led to an increase in life expectancy to 70.8 years and, for the first time since 1991, to natural population growth, while the birth rate had declined. The population had grown thanks to a reduction in mortality rates. The Russian Federation actively supported international programmes for preventing and controlling non-communicable diseases, and attached great importance to the Second International Conference on Nutrition, scheduled for 19 to 21 November in Rome. He expected its results would contribute to the achievement of agreed indicators on obesity prevention and reduction of salt intake and harmful alcohol use.
EKOWATI RAHATENG, Director of Non-Communicable Diseases Control, Ministry of Health of Indonesia, associating herself with the Group of 77 and China, pointed to scaled-up Government efforts to tackle non-communicable diseases as they were responsible for 60 per cent of all deaths in the country. There was a national policy framework, which included preventive, curative, palliative and rehabilitative programmes, and concrete action plans developed through multi-stakeholder engagement. Community was key, she said, and it was vital that prevention and intervention were initiated at that level. Access, particularly to services and coverage, was also of the utmost importance, as were collaboration and partnerships across sectors that involved all stakeholders. She also stressed the imperative of regulatory and institutional frameworks through cross-sector collaboration. She added that framing the non-communicable diseases target in the post-2015 development agenda should aim for strengthening commitments and actions, particularly at the global level, and for creating enabling environments.
DAVID ACURIO, Deputy Minister of Governance and Health Surveillance of Ecuador, said that it was impossible to speak of development without human well-being. His country undertook measures to improve basic services and housing conditions towards bringing out a healthy life. His Government considered health care to be a “right, not merchandise”, and the vision of development must be broadened to include health. Fiscal policy and regulation of trade in tobacco and alcohol also were essential. His country strengthened health authorities and provided free and universal health care to its citizens, and it had a national strategy to control cancer. About 5 million people were overweight or obese in Ecuador, and measures undertaken included imposing taxes on sweet beverages, regulating aggressive marketing of unhealthy foods, and labelling of processed foods showing fat, sugar and salt levels. “We may not achieve those objectives in the short term, but there is no reason to lower the bar,” he said.
KHALED AL-SAHLAWI, Deputy Minister and Undersecretary at the Ministry of Health of Kuwait, described efforts since the 2011 Political Declaration to apply measures for integrating the national development plan and mobilizing resources. A high-level, cross-sectoral committee had been established under the leadership of the Minister of Health, which was dedicated to evaluating objectives and the cross-cutting change resulting from the Declaration and WHO resolutions. Outlining specific efforts, he said the salt content of bread had been reduced by 20 per cent and efforts to deal with the risk factors associated with smoking and lack of physical activity were also under way. For example, tobacco products were required to display labels and schools were directed to intensify their sports activities. He described improvements to detection of non-communicable diseases and the establishment of clinics to treat them.
JAIME BURROWS, Vice-Minister of Health of Chile, said that addressing non-communicable diseases was a priority for his Government as those were the main cause of deaths. At the same time, the Government needed to address social inequality because those diseases were concentrated among the poor. That was not a problem within the health sector, but rather a cross-cutting issue, which should be addressed by public policy. Over the past 15 years, Chile had made considerable efforts, including establishment of a health-care guarantee system that provided timely medical care for 80 designated diseases. Inspired by WHO’s Global Action Plan, his Government had created a national health strategy through 2020, with a priority on non-communicable diseases. A ban on driving under the influence had resulted in a 30 per cent decrease in traffic accidents, and more bicycle paths had been created to promote physical activity. Among other steps, labelling that showed the proportion of unhealthy ingredients was visible on the front of food packages, and a tax scheme was proposed to control unhealthy foods.
ISABELLE PICCO ( Monaco) said the cost of human lives lost too early as a result of non-communicable diseases was distressing, and those diseases also exacerbated economic problems and contributed to poverty. Multisectoral strategies were essential for tackling them, and reducing alcohol consumption and tobacco use, and promoting exercise could help cut public health expenses. The Global Plan of Action and the Taskforce would help countries to combat the prevalence of the diseases, and she welcomed WHO’s initiative to form partnerships with United Nations bodies, which would aid data collection and policy implementation.
JOHAN CARLSON ( Sweden) praised WHO’s work in establishing a monitoring framework, an inter-agency network, a global coordination mechanism and action plan for dealing with non-communicable diseases. From those foundations, Member States had to engage the right actors and sectors of society in the goal of response and prevention. Sweden had addressed risk factors with a cohesive strategy on alcohol, narcotics, doping and tobacco, including measures to combat supply and to provide care and treatment. National guidelines had been published to prevent disease and support people’s efforts to change unhealthy lifestyles. There was also a strategy for chronic-disease treatment, which, developed with patient groups and professional organizations, was patient-centred and evidence-based. The post-2015 development agenda should aim to reduce exposure to risk.
DANIEL MERON, Head of the United Nations and International Organization Bureau in the Ministry for Foreign Affairs of Israel, noted some of the country’s successes, including the creation in 2011 of a comprehensive national health promotion programme. Public health experts worked closely with the Ministries of Education, Environment and Welfare on the matter, as well as cooperated with the private sector, academia and civil society to conduct national awareness campaigns on public health matters. Public health organizations worked in concert to achieve national targets, he said, adding that the Education Ministry was expected to pass legislation this month banning the provision and sale of unhealthy food in schools. The leading television network was helping to protect children from “junk-food” marketing. Tax increases on tobacco products, free smoking-cessation plans, and increased enforcement of smoking bans in public places had prevented 2,000 unnecessary deaths alone in 2013. MASHAV, Israel’s global development cooperation agency, worked with partners in Kenya to fully renovate and re-equip the children’s oncological ward at the Kenyatta hospital in Nairobi. Israel was joining the global “Grand Challenges” initiative aimed at fostering scientific and technological innovation to solve key health problems in the developing world.
HU HONGTAO, Commissioner of the National Health and Family Planning Commission of China, said that his Government had incorporated the prevention and control of non-communicable diseases into its latest national development plan. He described the country’s strategy, which he called comprehensive, with stepped-up measures to tackle root causes and raise awareness. To confront the serious threat to health and development posed by those diseases, he said that the primary responsibility of Governments should be further emphasized, and health issues should be incorporated into all social policies and all sectors of society. The struggle against the diseases should also be integrated into the post-2015 development agenda and WHO’s leading role should be given full play. He encouraged developed countries to increase financial and technical support to developing countries in order to enhance the global capacity to prevent and control the diseases. His country stood ready to participate actively and to work closely with other Member States on the issue.
ANTONIO DE AGUIAR PATRIOTA (Brazil), associating with the Group of 77 and China, acknowledged the work of the World Health Organization and the increased prevalence on the national level of action plans and special bodies to tackling non-communicable diseases. Brazil’s action plan, through 2022, aimed at addressing each of the four major risk factors for non-communicable diseases, had already yielded positive results. Monitoring and statistics were important as was examination of the social determinants of health, he said, underlining the impact that universal health systems could have on reducing inequality. In the post-2015 development agenda, he envisaged a greater role for non-State actors, including the private sector, philanthropists and non-governmental organizations, noting that Brazil had eliminated the presence of trans-fats and had reduced salt in food through agreements with food companies. It had also tackled the most dangerous modifiable risk factor — tobacco — with graphic warnings on cigarette packets.
MARGARET HAMBURG ( United States) said chronic diseases such as heart disease, cancer, stroke, chronic respiratory diseases and diabetes accounted for 7 out of 10 deaths, cutting lives short by decades, often after prolonged disability or reduced quality of life. Non-communicable diseases limited the activities of millions of people and cost her country’s economy billions of dollars every year; it also accounted for 75 per cent of the nation’s health spending. She highlighted many initiatives, including the Tobacco-Free College Campuses, which had made more than 1,300 campuses smoke-free. All segments of society had a role to play in turning the tide of chronic disease.
SABRINA DE CAMILLIS ( Italy) said it was time to renew Governments’ commitment to implement the 2011 Political Declaration, as non-communicable diseases posed a great threat to economic and social structures. WHO’s Global Action Plan confirmed the effectiveness of measures undertaken in Italy. In 2007, her Government had created a national programme of health, using a multisectoral approach. Italy also had been the first European country to regulate tobacco consumption in public areas and by pregnant women. There was a close link between food and health, and she highlighted Italy’s traditional Mediterranean diet. Based on scientific studies, Italy was considering a ban on poor-quality products.
AMIRHOSSEIN TAKYAN, Deputy Director-General of the Ministry of Health and Medical Education of Iran, associating with the Group of 77 and China, affirmed that non-communicable diseases were among the greatest challenge to health and development. His Government was fully committed to engage with global society to control and prevent them. Nationally, his Government had instituted a multisectoral approach, including regulation of intake of tobacco and detrimental foodstuffs accompanied by a plan to achieve universal health coverage. At the global level, the transfer of health technologies was particularly important, and WHO and other relevant United Nations agencies and organizations had a pivotal role in assisting Member States, particularly developing countries. Addressing these diseases was everyone’s business, given the complexity of the task.
ELSE SMITH (Denmark), associating with the European Union, contested the adequacy and accuracy of the term “non-communicable diseases”, particularly given that some did have infectious profiles. She preferred the term “preventable and manageable diseases”. Denmark had recently launched its National Health Targets for all Danes in the coming decade, which aimed to encourage longer lives and reduce inequality. Funds for the coming years had already been allocated for multisector partnerships, locally and nationally, and municipalities had been tasked with offering services to those living with diseases, particularly important given Denmark’s ageing population. The Danish Health and Medical Authority had developed health promotion packages to assist planners at the local level in setting priorities and developing prevention strategies.
PAUL SEGER ( Switzerland) said that in his country, national programmes for the prevention of non-communicable diseases were based on the main risk factors and involved all stakeholders. A national strategy was now being drafted that would also take a participative approach. At the global level, WHO must assume a lead role in dealing with the diseases, but it remained the primary responsibility of Member States to implement the global road map. Recognizing that States had differing capacities in that context, Switzerland stressed reinforcement of health systems and fighting inequality in its international cooperation. As for inclusion of non-communicable diseases in the post-2015 development agenda, he advocated a health objective that was linked to goals in other areas, such as those relating to food safety and nutrition, education and water.
MASOOD KHAN ( Pakistan) said non-communicable diseases caused suffering in both developed and developing countries, traumatizing families and stunting economic growth. Governments must be in the driver’s seat. His country had made strategic interventions in such areas as governance, infrastructure, generation of resources through taxes, and surveillance based on WHO’s framework. Its health-care programme took a cost-effective approach, with emphasis on early detection and improved access to medicine and technology. Pakistan was pursuing a comprehensive health plan in cooperation with the private sector. Pharmaceutical companies must fulfil their corporate social responsibility by offering medicines at affordable prices in developing countries.
DARI ISSIFI ALZOUMA (Niger), associating with the Group of 77 and China, noted the predominance of communicable diseases in his country, but said that non-communicable diseases were gaining ground and placing an onerous burden on the health-care system. Several risk factors for those diseases scored highly in the Nigerien population and many showed three or more risk factors for developing a non-communicable disease. A National Integrated Plan had been adopted, focusing on combating cardio-vascular disease, cancer, diabetes and chronic respiratory illnesses. He outlined ways the strategy sought to tackle the diseases and the many constraints it faced, such as lack of financing and data, and limited technical platforms for treatment. He was counting on stronger and more targeted support from development partners.
YOSSEF LARM ( Qatar), associating with the Group of 77 and China, said there was an urgent need for national, regional and international efforts and measures to combat non-communicable diseases, given their impact on development. Qatar’s accomplishments in the field included equitable provision of health care for all and a 13 per cent increase in the health-care budget to improve the standard of care. Progress was integral to the 2013 National Vision and the “Saha”, or health programme was the main pillar for achieving that vision. At its cornerstone were efforts to encourage healthier lifestyles and to provide higher standards of health care. Tackling non-communicable diseases was important because they hampered productivity and, therefore, had a direct negative impact on efforts to achieve the Millennium Development Goals.
KENNETH GEORGE, Senior Medical Officer of Health of Barbados, said that one quarter of all adults in the country had at least one non-communicable disease and the rate continued to rise. It was a national development issue that engaged the country at the highest levels. There had been some success over the last decade, particularly in tobacco control and better surveillance and awareness of diseases and factors that contributed to them; a new road map was being instituted to combat the disease. He underscored the need for a multisectoral approach, through which targets were achievable, but due to the magnitude of such health problems in the Caribbean, continued international cooperation and assistance was urgently needed in Barbados, despite its classification as a high-income country. He urged relevant United Nations entities to strengthen their support to the Pan American Health Agency and to Member States, and to do much more to realize a truly multisectoral approach.
MOHAMED ALI ALHAKIM ( Iraq), associating with the Group of 77 and China, called for bolstered efforts to rid the world of non-communicable diseases and measure progress achieved since 2011. He noted national and global efforts to implement the outcome of the 2013 World Health Assembly. Alcohol and tobacco use, poor nutrition and lack of physical activity were major factors contributing to those diseases. Iraq and other countries in the Mediterranean region had ensured that health was at the forefront of development strategies. Iraq was aware of the danger of non-communicable diseases and the risk factors associated with them, and it had a national strategy and plan of action to combat the diseases, based on the principles of WHO’s action plan. As part of efforts to fight cancer, the Government would establish a cancer registry, and it was devising plans to curtail tobacco consumption. Sufficient financing to combat those diseases was vital, as was expediting implementation of WHO’s framework to reduce and prevent tobacco consumption. Non-communicable diseases should become a priority in all development-related agendas.
HUSSEIN HANIFF (Malaysia), associating himself with the Group of 77 and China, said his country remained committed to tackling the burden of non-communicable diseases and had introduced a number of interventions into the national health system in an effort to reduce the level of exposure of individuals and populations to risk factors. Tobacco and alcohol excise duties, commonly referred to as “sin tax” in Malaysia, were dramatically increased over the last five years. The country had also developed and implemented its National Strategic Plan for Non-Communicable Diseases. However, it faced the major challenge of identifying a common regional response, owing to the complexities of non-communicable diseases and its risk factors, which cut across borders. Building the capacities of other Member States in response was indeed a grave challenge.
HÉCTOR E.J. CALDERÓN ( El Salvador) said chronic non-communicable diseases were the major challenge for the Salvadorian health-care system. There were many such diseases and there was difficulty reaching all those who suffered from them. Underlining the need for multisectoral engagement, he also noted the potential impact of the Pan-American Health Organization (PAHO) and WHO on reducing modifiable risk factors. He noted that chronic kidney failure was especially prominent in El Salvador and Central America as a whole due to occupational factors. It was also the main reason for hospital deaths and the fifth most prominent cause of all deaths countrywide. It stemmed from exposure to heavy metals in agriculture, and to deal with that properly, the country required international assistance.
BJORN GULDVOG ( Norway) said it was time to translate increased international political awareness of non-communicable diseases into implementation of national policies. He urged multisectoral action, and went on to describe how “pedestrianization” of city centres could reap benefits in reducing risk factors, not just by improving the environment and reducing people’s exposure to polluted air, but also by encouraging walking and physical activity. Acknowledging financing difficulties, he noted that many interventions were low-cost and often increased Government coffers. Tobacco taxation was one such example, he said, underscoring the need for political will.
MELVYN FREEMAN ( South Africa), associating with the Group of 77 and China, said it was vital to employ strategies to combat non-communicable diseases and to facilitate public awareness about their risk factors. Those diseases must be integral to the post-2015 development agenda, as their health implications were far-reaching and had not been included in the Millennium Development Goals. South Africa’s health budgets had been strained by those diseases, while other diseases, such as HIV/AIDS and maternal mortality also demanded attention. South Africa had introduced legislative and regulatory steps to combat non-communicable diseases, he said, citing as one example, the adoption of regulations on trans-fat and salt levels in food, which was supplemented by a major awareness campaign. The Government also had set up an interministerial committee to target accessibility, enforcement, the legal drinking age and taxation. The health platforms developed to care for HIV/AIDS victims were being adapted to benefit people suffering from non-communicable diseases. South Africa had introduced an HPV vaccination to prevent cervical cancer in young girls, and in its first round, more than 350,000 girls had been vaccinated, she said, urging other countries to follow suit.
PILAR F. ABADÍA ( Spain) welcomed WHO’s leadership, and noted the provision of free national health care in her country. It had worked for many years to reduce the impact of non-communicable diseases and, in 2010, had adopted new health-related laws to limit tobacco consumption in public spaces, which had helped to reduce cardiovascular disease significantly. Between 2009 and 2011, there had been a 90 per cent reduction in tobacco use in restaurants and public rest spaces. In December 2013, the Government had adopted a strategy to prevent and control non-communicable diseases and to promote healthy lifestyles. Health care had been prioritized in all areas of public policy and, in 2005, the Government had launched strategies to combat child obesity by reducing salt and fat content in food. Information exchange would contribute to mitigating the problem.
GUSTAVO MEZA-CUADRA ( Peru) expressed concern that tobacco and alcohol could be linked to 16,000 deaths per year in the country. New regulations had been adopted to reduce consumption and to protect individuals and families against the health, and social and economic impacts of exposure to tobacco products. He noted that one in two Peruvians did not engage in any sports activities; that figure was higher in urban areas and among the less educated. The Government had organized an initiative to promote the healthy conduct of the population, including physical activity and better nutrition.
ABDERRAHMANE MAAROUFI (Morocco), associating with the Group of 77 and China, noted a strong political will to tackle non-communicable diseases in the country, as well as great progress in prevention and control, especially on cancer. A plan of action had been adopted in line with WHO’s recommendations, identifying national objectives in the context of the health organization’s nine targets. He insisted on the imperative to include the need to fight non-communicable diseases in the post-2015 development agenda, and he called for mobilization of more financial means for developing countries to support the high costs of such interventions. In addition, he called for increased South-South and triangular cooperation in tackling non-communicable diseases in developing countries.
NATHAN SMYTH ( Australia) said non-communicable diseases were a major cause of poverty and were undermining development worldwide. WHO’s framework had been very effective in tracking Australia’s progress, and the aid programme improved access to medicines and skilled interventions, and worked to combat non-communicable diseases in the region. Several countries continued to face high numbers of undernourished children while responding to obesity, which resulted from poor nutrition. Australia would continue to pursue partnerships with multilateral health agencies to ensure achievement of its health outcomes in a cost-effective manner. The Government was developing a national diabetes strategy, and it had developed a new voluntary food labelling system to be rolled out in the next five years. The sporting schools initiative also aimed to combat child obesity. Australia had been a strong supporter of the framework convention on tobacco control and had taken steps to implement it and now boasted national tobacco consumption from cigarettes at its lowest levels ever.
MITSUHIRO USHIO, Assistant Minister for Global Health, Japan, said that it was essential to ensure a comprehensive and multisectoral approach to non-communicable diseases that included prevention, diagnosis and treatment. For that purpose, universal health coverage was indispensable. Japan had been able to establish such an equitable system at an early stage of its economic development, making it possible to achieve exemplary health indicators. The country was now also strongly addressing lifestyle factors that affected health. It regarded health as a crucial element in sustainable development, he said, voicing ardent hope that non-communicable diseases would garner significant attention as the post-2015 development agenda was shaped.
RODNEY GHALI ( Canada) expressed concern over the rate of non-communicable diseases, which was a significant cause of death in Canada. Government tobacco control measures had reduced tobacco use to historic lows, and there was a focus on childhood obesity and promoting healthy weight. In 2010, Canada’s Health Minister had affirmed that health promotion was everyone’s business. Public health challenges such as non-communicable diseases required collaborative action. By working together, the Government and private sector, academic and civil society partners were working towards the shared goal of producing better health outcomes. The Canadian Partnership against Cancer brought together various partners to stamp out the disease, focusing on common risk factors and broadening engagement with the public and decision makers, with greater access to data. The Government had adopted a new multisectoral approach, but more funding was needed to target real behaviour change. Investments were tied to performance and results.
SHAMDEO PERSAUD, Chief Medical Officer Representative of the Ministry of Health of Guyana, associating with the Group of 77 and China, and CARICOM, called for continuing efforts at all levels to address the threat to sustainable development posed by non-communicable diseases. He described in that context the multisectoral strategies launched by his country to address lifestyle factors and sensitize the public. At the global level, he recognized the good work of WHO, but at the same time, he pointed out that national health efforts presented stringent challenges to the national budgets of developing countries. He, therefore, supported mobilization of adequate resources from both domestic and external sources to buttress those efforts. In discussions of the post-2015 development agenda, he called for a renewed focus on non-communicable diseases as part of a global health agenda of preventable ill-health and death.
CLIVE TILLUCKDHARRY, Principal Medical Officer of the Ministry of Health of Trinidad and Tobago, associating with the Group of 77 and China, and CARICOM, said that heart disease, cancer, diabetes, cerebrovascular disease and other non-communicable diseases accounted for over 60 per cent of all deaths in his country. In recent years, the country had implemented several strategies to counter the diseases via a multisectoral approach, with measures to, among others, reduce exposure to the four common risk factors, provide integrated care in health centres, and put in place educational, screening and disease-management programmes. He stressed the need for strengthening legislation for the prevention and control of non-communicable diseases and the need to establish a supportive global environment to bolster such action, particularly in small States such as his own. His country remained fully committed to addressing the diseases and ensuring that they remained on the international agenda to improve cooperation to counter both their resultant health consequences and development challenges.
CHARLES T. NTWAAGAE (Botswana), associating with the Group of 77 and China, pointed to national progress, including on maternal and child health, surveillance of non-communicable diseases and their risk factors, monitoring and evaluation, as well as on lifestyle modification. A strategic plan was in place for 2011 to 2016, as well as a national alcohol policy. An integrated disease surveillance and response system provided baseline data on diseases and risk factors, and the second non-communicable diseases survey was being prepared. He noted collaboration between the Government and media to raise awareness, and stressed the need for continued global support to help countries enhance national capacities and to ensure that development progress was not reversed by the increase in non-communicable diseases.
OSCAR LEÓN GONZÁLEZ ( Cuba), associating with the Group of 77 and China, said his country had made efforts despite limitations imposed by the embargo and financial crisis. Cuba’s health-care system was internationally recognized and its recent chairing of the World Health Assembly was testament to the high standard of its work in health care. He underlined the need to include specific health targets in the post-2015 development agenda. He also called for more material and financial resources, which, he said, would already be available if the necessary political will existed. Vast military expenditure could be better directed to improving well-being and eradicating poverty, and a global ban on nuclear weapons could free up resources for preserving life.
MILORAD ŠĆEPANOVIĆ (Montenegro), associating with the European Commissioner for Health, said that combating non-communicable diseases required a comprehensive approach, including action on the social determinants from all sectors, particularly education, agriculture, trade, urban planning and transportation. Montenegro had made great progress in prevention and control of the diseases, adopting a framework and specific strategies on alcohol use and excessive salt intake. In addition, the country had added courses on healthy lifestyles to the curricula of elementary and high schools. It was also working with regional coordinating bodies on the issue.
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