Sixty-eighth General Assembly

Plenary

102^nd & 103^rd Meetings (AM & PM)

 ‘Can We and Should We Not Do Better’, Panellist Asks General Assembly

as It Concludes High-Level Meeting on Non-Communicable Diseases

 

Funding of the global coordination mechanism to fight disease averaged just $10,000 per Member State — a paltry $1.8 million in total — the General Assembly heard today as it concluded its two-day high-level review of progress achieved in the prevention and control of non-communicable disease.

“Respected leaders, can we and should we not do better?” asked Sandeep Kishore, a physician at the Yale School of Medicine and Former Chair of the Young Professional Chronic Disease Network, during a panel discussion on “Strengthening national and regional capacities, including health systems, and effective multi-sectoral and whole-of-government responses for the prevention and control, including monitoring, of non-communicable diseases”.

He asked how it was possible that a country spending as little as $19 to $40 per person per year on health could have any measurable impact on preventing, controlling or monitoring non-communicable diseases.  One concrete step in the right direction, he said, was the development of national non-communicable disease units that instituted action across clinical, public health and regulatory domains.  But that initiative had not even scratched the surface of their true potential, he said, urging investment in human capital to rectify that.

Pressing countries to ensure that health issues were not “pigeon-holed” as the responsibility solely of health ministries was Tonio Borg, Commissioner for Health and Consumer Policy of the European Union, who said fighting the risk factors required broad partnerships across ministries.  Urban planning ministries should be involved to ensure that cities were designed in a way that promoted physical activity.  Further, finance ministries must recognise that budgetary savings would result in the long-term if adequate investment was made now.

Anna Lartey, Director of the Nutrition Division of the Food and Agriculture Organization (FAO), made the case for strengthening the response to non-communicable diseases.  Doing so was vital, she said, because such diseases had the potential to push households into poverty and derail efforts to tackle hunger and malnutrition.  Addressing the problem sustainably required an examination and analysis of the entire food system to ensure that agricultural production, retailing and consumption were all geared towards healthy nutrition. 

In a second round table, on “Fostering and strengthening national, regional and international partnerships and cooperation in support of efforts to address non-communicable diseases”, panellists described the complexity of those unions and the need for incentives to encourage cooperation.  Creativity was required, they said.  There was discussion of the pharmaceutical industry and its long history of partnering to fight disease, as well as consideration of the need for partnerships in combating the effects of drug addiction, which, itself, should be considered a non-communicable disease, one speaker said.

The General Assembly also heard the conclusion of its debate, begun yesterday.  Among today’s contributions, the representative of Maldives drew a link between globalization, trade liberalization, increased affluence, personal freedom, urbanization and congested living conditions and unhealthy lifestyles, urging States to confront the powerful business interests likely to interfere with their efforts to overcome risk factors. 

In closing, Mohamed Khaled Khiari (Tunisia), summing up on behalf of the General Assembly President, commended delegates for having fulfilled the mission set out for the meeting by adopting a robust outcome document.  There was broad agreement about the constraints non-communicable diseases posed to global development, and he believed there would be ample opportunity for States to begin changing the landscape of non-communicable diseases before the next review.  The Chairs of the respective round tables also delivered summaries of those meetings.

Also delivering statements in the debate, including at the ministerial level, were representatives of Thailand, Nicaragua, India, New Zealand, Uruguay, France, Republic of Korea, Bangladesh, Egypt, Zimbabwe, Bahrain, Paraguay, Finland, Libya, Philippines, Nigeria, Guatemala, Kenya, Zambia and Panama.

The Minister of Health of the State of Palestine also spoke.

Statements

AHMED SAREER (Maldives) aligning himself with the “Group of 77” developing countries and China, noted that non-communicable diseases accounted for 78 per cent of the total disease burden in the Maldives.  Globalization, trade liberalization, increased affluence, personal freedom, urbanization and congested living conditions were all contributing to unhealthy lifestyles and posing risk factors.  He highlighted the need for regional and international collaboration in efforts to reach non-communicable disease and capacity-building targets.  He also stressed the need for cohesive implementation plans that incorporated international agreements and instruments as well as the imperative to recognize and agree that tobacco control remained the most challenging but cost-effective strategy to control non-communicable diseases.  As efforts to control non-communicable diseases would pit Governments against powerful business interests, interference would always be a challenge to confront “head on” and overcome.

PAISAN RUPANICHKIJ (Thailand) said it was now time to “walk the talk”.  He advocated an increased investment to tackle non-communicable diseases, adding that combating them would promote economic growth in the long-run and lead to social well-being.  Thailand had taken steps to develop national programmes to address the situation, he said, noting that the sixth National Health Assembly of the countries in the South-East Asia region had adopted a resolution in June on regional targets for tackling the scourge, which had already led to strengthening regional health information systems.  Thailand had cooperated with other countries in the Association of South-East Asian Nations (ASEAN) on universal health coverage.  During their first meeting on the matter, held in April, ASEAN leaders discussed a regional action plan and a network to support it.  Thailand also supported the inclusion of non-communicable diseases as a stand-alone in the new development agenda.  Thailand had implemented health coverage nationwide in 2002 and it was poised to cooperate with other countries to ensure that such coverage was global. 

MARÍA RUBIALES DE CHAMORRO (Nicaragua), associating with the “Group of 77” and China, urged countries to undertake commitments to address non-communicable diseases.  Nicaragua had developed a strategy to enable its citizens to live a good, clean, health life, which was implemented by the Labour Ministry and Health Ministry.  The Government also had instituted policies on good nutrition and environmental well-being.  Last year, the public health service had increased its network of health clinics to 1,300, including for non-communicable diseases.  In 2013, the country had hosted a regional public-health meeting aimed at formulating strategies with neighbouring countries.  That had led to the creation of the 2015 Central American health programme, which focused on, among others, issues related to child nutrition, teen pregnancy, dengue fever and tobacco use.  Nicaragua had already implemented the programme in 100 communities, and understood that, in the long-term, an adequate response to non-communicable diseases and their prevention was crucial.

ASOKE KUMAR MUKERJI (India), associating with the “Group of 77” and China, outlined India’s expenditure on fighting non-communicable diseases.  The priority areas were boosting general awareness of the diseases and promoting healthy lifestyles, with community and media involvement important.  Screening for diabetes and cancer were allied with a referral mechanism, and efforts were being made to improve capacities for prevention, treatment and rehabilitation.  A monitoring framework had been established to track morbidity and mortality rates, and primary health care was being revitalized to integrate responses to both communicable and non-communicable diseases.  He also described medical innovation made in India, which included a “polypill”, a “clot-buster” and a special heart valve.

JIM MCLAY (New Zealand) said his country was addressing non-communicable diseases at home, but was also heavily engaged in assisting the Pacific region as a whole.  Doing so was a key part of New Zealand’s aid policy, he said.  There was a regional non-communicable disease crisis in the Pacific, he said, adding that he was optimistic about efforts to address it because the diseases were generally preventable.  Effective control meant reducing risk factors, beginning at a child’s conception.  He outlined efforts made by the Government, working with academia and civil society, to reduce smoking and said New Zealand was at the forefront of creating smoke-free environments, educating the population on dangers and beginning to ban advertisements and sponsorship.

GONZALO KONCKE (Uruguay) said it was crucial to address the main risk factors, notably harmful consumption of alcohol and tobacco use.  All sectors of society must be involved in order to ensure that policies intended to reduce and control non-communicable diseases were effective.  Uruguay had specific policies in the four main risk-factor levels that were coordinated by the Health Ministry and other sectors.  It had shown great leadership in tackling the problem and had almost fully implemented the framework convention on tobacco control, as well as instituted a ban on smoking in public areas; it also had imposed new tax policies on tobacco use.  In that connection, it prohibited the use of colours and names on cigarette packaging that would confuse consumers about the harmful effects of tobacco products, and it had set up a tobacco-control sector within the Health Ministry, which helped to draft rules on tobacco control.  The Ministry attached particular importance to South-South cooperation, and had exchanged good practices with the Pan-American Health Organization.  He stressed the importance of the 2013-2020 global plan of action for control of non-communicable diseases as well as including their impact as a specific goal in the post-2015 agenda.

FABIENNE BARTOLI (France) noted that people worldwide had unequal access to health care, adding that the poor, marginalized, elderly and the disabled often were unable to obtain treatment.  That situation must be rectified through greater actions to prevent non-communicable diseases and ensure treatment for all in need.  It was also necessary to reduce prejudices about those diseases.  France had always championed the need to prioritize the fight against those.  It supported good nutrition policies, had forbidden tobacco in all public places since 2009 and had taken vigorous steps to prevent alcohol use in pregnant women.  The country was also committed to bringing the campaign against those diseases to the global level, she said, noting the country’s dedication to advance two guidelines:  strengthening health systems and adopting an inter-ministerial, multisectoral approach to the issue.  At a recent meeting held under the World Health Organization’s (WHO) auspices, France had championed complementarity between vertical funds and attached great importance to universal health coverage.

HAHN CHOONGHEE (Republic of Korea) described how the Seoul Declaration on non-communicable disease prevention and control in the Western Pacific region included a commitment to high-level political action on the matter.  He welcomed development of the Western Pacific Regional Action Plan for prevention and treatment of non-communicable diseases for the period 2014-2020 and described his country’s efforts to control cardiovascular disease, including through surveillance, prevention, early warning, treatment and rehabilitation.  The Ministry of Health had adopted a collaborative approach, setting targets to reduce salt in food and working with private partners to conduct a Cardiac Arrest Surveillance System.  The Ministry was also promoting high-quality research, and the Government was applying the World Health Organization Choice methodology, providing information on cost-effectiveness to guide policy decisions.  Among national challenges was coordinating local and national efforts.

ABULKALAM ABDUL MOMEN (Bangladesh) shared key features of the national health sector, pointing to the “double burden” the country faced in terms of the high prevalence of both communicable and non-communicable diseases.  Despite constraints, Bangladesh had made remarkable progress in attaining the Millennium Development Goals.  Life expectancy had increased sharply but non-communicable diseases were on the rise as urbanization grew.  Slum dwellers were especially at risk, he said, noting that non-communicable diseases made up 61 per cent of the total disease burden.  He pointed to the Government’s efforts to address the situation, which included legislative initiatives such as an amendment to the Mental Health Act and a tobacco control law.  In order to establish large-scale efforts, technical skills were necessary, but many developing countries could not afford the investment.  A global resource pool could be a major boon, allowing more confidence in target setting for poor countries such as his own.

MOOTAZ AHMADEIN KHALIL (Egypt) said non-communicable diseases were still responsible for some two-thirds of premature deaths globally.  Despite recent efforts, more must be done.  An equitable, nationally owned framework was vital to ensure the response was tailored to each country’s specific needs.  He called for strengthening national capacities for diagnostic technologies and palliative care.  Treatment must be affordable, particularly in developing countries.  It was vital to enhance the ability of developing countries to launch awareness campaigns about the dangers of tobacco and alcohol use, he said, urging the tobacco, medical and beverage industries to contribute to the promotion of healthy lifestyles.  Egypt’s Health Ministry was working on a plan towards that end, he said, citing its signing of a cooperation protocol with WHO to train doctors on how to treat such diseases.   Those contributed to poverty, with an estimated cost of treatment expected to reach $47 trillion in the next three decades.  The international community must work on successful prevention, and support must be given to develop adequate health-care infrastructure.  Such concerns should be adequately reflected in the post-2015 development agenda and the sustainable development goals.

The representative of Zimbabwe said financial constraints had contributed to a high incidence of mortality from non-communicable diseases in her country.  Despite that and other challenges, the Ministry of Health and Child Welfare had developed non-communicable disease and alcohol control policies, which were pending approval by the Cabinet.  Her Government had set up a non-communicable disease unit.  As it strengthened the national response for such diseases, the Government was increasingly paying attention to mental health issues, and it had put in place a mental health policy and strategy as well as mental health indicators.  Zimbabwe had also focused on integrating issues related to non-communicable diseases into the national HIV/AIDS response.  The national anti-retroviral therapy guidelines had incorporated issues concerning early detection of non-communicable diseases as well.  Additionally, the Government had overseen the integration of cancer screening and, in that connection, was promoting breast cancer screening in public and private institutions.  Efforts also were under way to secure funding to carry out a survey on risk factors to non-communicable diseases.

The representative of Bahrain said his Government had developed and approved a comprehensive national plan to fight non-communicable diseases, inspired by the Gulf Cooperation Council’s plan.  Its strategic goals focused on primary and secondary interventions, increasing treatment and research on non-communicable diseases, as well as increasing partnerships to fight them.  The Government had taken steps to implement a related economic plan and had asked the Cabinet to create a committee on the issue.  It had set up a chronic disease unit in the Ministry of Health and had appointed a national coordinator to oversee efforts.  In 2009, a tobacco control policy had been developed, he said, pointing to additional initiatives under way to enhance health-care services and education nationwide.  One example was the establishment of clinics to treat obesity.  The Government had issued periodic reports, based on WHO guidelines, on non-communicable diseases.  He reiterated Bahrain’s commitment to implement the 2011 Political Declaration.

The representative of Paraguay described alarming figures on the prevalence of risk factors in her country.  There was a 57 per cent obesity rate and high levels of physical inactivity and tobacco and alcohol use, as well as a poor rate of fruit and vegetable consumption.  The Government was aware and was trying to address those figures.  Programmes had been introduced to increase people’s activity, including by encouraging bicycle use.  As well as a law to treat obesity, there were efforts in schools to arrest tobacco consumption, and 82 municipalities had introduced smoke-free environments.  The national programme for tackling non-communicable diseases had been developed in harmony with WHO’s own strategy and institutions, and health-care organizations were working to address the problem of primary health care to ensure a more integrated method of operation.

The representative of Finland described the country’s experiences in tackling its high rate of cardiovascular disease deaths in the 1960s.  The rate, having been the second-highest mortality rate in the world, was now a tenth of what it was, owing to efforts to reduce tobacco use and improve diets.  The success story was based on translating innovation into policy, but past success did not guarantee future ones.  There were new challenges to meet and existing tools like fiscal measures to curb budgets and simultaneously steer consumer behaviour would be used but it also was important to find new methods.  Finland would completely eliminate tobacco products by 2040, was aiming to reduce the amount of time people spent sitting each day, and had been the first country to limit alcohol advertising on social media.

The representative of Libya, associating with the Group of 77 and China, said WHO’s statistics showed that the mortality rate for non-communicable diseases was higher than for other illnesses.  He stressed the importance of national and global cooperation to tackle those diseases and of sufficient funding in that regard.  His Government provided free essential medicines and universal health coverage for the Libyan population.  Non-communicable diseases were not only a medical concern; they were also a socioeconomic problem that thwarted sustainable development.  Affordable medicines were vital to contain and combat those diseases and promote long, healthy lives.  He expressed hope that countries would demonstrate strong political will in that effort. 

IRENE SUSAN BARREIRO NATIVIDAD (Philippines) said that, since 2009, there had been an alarming increase of non-communicable diseases in her country, where the WHO found that they were the cause of 85 per cent of premature deaths.  Governments had a primary role to play in prevention and control, and for that reason, the Philippines was strongly committed to strengthening multisectoral national health policies to achieve national targets.  She described a raft of programmes under those polices that would be brought together into a healthy lifestyle programme, along with the establishment of universal health care and other measures.  The Government could not face such health challenges by itself, but partnership with local stakeholders and support from development partners was making it possible.  She stressed that the problem of non-communicable diseases affected all humanity, but could be overcome through multisectoral efforts

ANTHONY BOSAH (Nigeria), associating with the Group of 77 and China, said that the importance of discussions on non-communicable diseases could not be over-emphasized as the global burden of those diseases continued to grow while undermining social and economic development.  In that regard, he recognized WHO’s leadership in addressing the increasingly complex challenge of public health and called for renewed political will and multisectoral action by all stakeholders on non-communicable diseases.  Towards that end, his country had launched a national action plan in December 2013, followed by legislation towards the development of a national health system in February 2014.  To ensure that global health remained a priority, non-communicable diseases and the range of health challenges must be included in the post-2015 development agenda.

GERT ROSENTHAL (Guatemala) was aware that health was vital to human rights and development, and it was committed to obtaining a proper standard of life for its citizens, including by establishing a more inclusive and democratic health system.  A commitment was in place to incorporate non-communicable diseases into the national political agenda for development, and efforts to step up coverage of health services had continued, with a stress on primary health care.  She recognized the need for strengthening health systems at all levels and her Government was developing a system to better monitor diseases and their risk factors.  The burden of dealing with non-communicable diseases was particularly heavy on low- and middle-income countries, so she urged inclusion of the issue in the post-2015 development agenda. 

MACHARIA KAMAU (Kenya) highlighted the country’s progress in addressing non-communicable diseases, for example, through the new Constitution, which positioned health as a right, and the ratification of WHO’s Framework Convention on Tobacco Control, along with comprehensive tobacco control legislation and the National Tobacco Control Action Plan.  Non-communicable diseases were central to Kenya’s Second Health Policy Framework (2011-2030) and to its Second Medium-Term Plan for Health 2013-2017.  A national nutrition action plan was in place for 2012-2017, and a non-communicable diseases strategy had been drafted to drive the agenda in a coordinated and strategic manner.

SILVESTER MWANZA (Zambia) said fulfilling the commitments of the 2011 Political Declaration must remain at the top of the global agenda.  Towards that end, his Government was focusing on combating cancer, cardiovascular diseases, diabetes and chronic respiratory diseases.  Those services were linked to the Government’s strategy to provide universal access to health services.  It was developing a strategic plan to combat non-communicable diseases that included introducing and bolstering sports activities in schools; promoting healthy diets; and strengthening enforcement of legislation on tobacco and alcohol use.  The Government was creating an additional 650 health posts in order to enable families to access the services.  But the high cost of treatment was a challenge, he said, noting that drugs to treat HIV infection cost less than $50 per month, while drugs to treat asthma cost $400 per month.  Universalizing health coverage required a broader definition of health-care workers to include dieticians, social workers and physical therapists.  There also must be investment in training and career development and enhanced diagnostic services, as well as stronger bilateral and multilateral public-private health partnerships.

MYRNA MCLAUGHLIN DE ANDERSON (Panama), associating with the Group of 77 and China, said non-communicable disease were the primary cause of death in her country, accounting for 59.6 per cent of deaths in 2010 alone.  The Health Ministry was focusing on improving access to comprehensive health care on an equitable basis and implementing a national plan to control non-communicable diseases, chronic disease and cancer, as well as a plan on palliative care.  The 16/18 HPV vaccine was being given to girls aged 10 and up.  The Ministry’s strategies focused on promotion of healthy diets in school, capacity-building for teachers on the early warning signs of cancer, and prevention of breast, prostate and skin cancer, among other areas.  Panama was setting up a cancer registry in the Oncology Institute and finalizing a strategic plan for preventing non-communicable diseases and reducing their risk factors.  It had adopted public policies that supported the framework convention for tobacco control, and had outlawed smoking in all public places, as well as set up clinics to help smokers quit.  It had plans to build a modern oncology hospital, and was working on a national draft law for access to opiates and pain relief.

JAWAD AWAD, Minister of Health, State of Palestine, said youth in Palestine suffered chronic diseases, owing to exposure to two to three risk factors.  The Israeli occupation and its dire economic consequences were the primary cause of non-communicable diseases in Palestine, particularly psychological disorder among children, youth and the elderly.  Seventy per cent of deaths in 2013 were due to chronic diseases, with cardiovascular and heart disease the leading killer, followed by brain haemorrhage, cancer and complications from diabetes.  In cooperation with WHO, the Ministry of Health had undertaken a State-wide surveillance plan on citizens aged 18 to 65 in the West Bank to help formulate a national plan to control non-communicable diseases; it would soon be expanded to Gaza.  The Ministries of Health and Education had developed a scheme to combat obesity and reduce salt intake, and the Government also aimed to introduce HPV vaccination.  It had introduced testing of foods to ensure they were free from carcinogens and pesticides, and a special law had been adopted to combat smoking.  The continued Israeli raids in Gaza were a major contributor to psychological problems among the population, he said, calling on the global community to take action to put an end to the raids.

Round Table I

Fenton Ferguson, Minister of Health of Jamaica, chaired a roundtable on “Strengthening national and regional capacities, including health systems, and effective multisectoral and whole-of-government responses for the prevention and control, including monitoring, of non-communicable diseases”.

Panellists included Tonio Borg, Commissioner for Health and Consumer Policy of the European Union; Anna Lartey, Director of the Nutrition Division of the Food and Agriculture Organization (FAO); Vash Mungal-Singh, Chief Executive Officer of the Heart and Stroke Foundation in South Africa; and Sandeep Kishore, Physician at the Yale School of Medicine and Former Chair of the Young Professional Chronic Disease Network.

Mr. BORG said that any Health Minister would agree that health issues should not be the responsibility only of Health Ministries.  To combat such pigeon-holing, the European Union’s basic law made specific reference to Member States’ duties to integrate health policy considerations in all measures and legislation.  He noted the existence of a strategy for dealing with cancer as well as efforts being made to develop one on diabetes.  Such strategies were usually based on addressing the major risk factors like physical activity, nutrition, and tobacco and alcohol consumption.  Fighting those factors required, among others, partnerships with other ministries, he said, adding that urban planning ministries should be involved to ensure that cities were designed in a way that promoted physical activity, while finance ministries also needed to recognise that increased investment in tackling non-communicable diseases could yield enormous savings in national budgets. 

Ms. LARTEY observed that eating correctly and teaching children to eat right was part of being a good citizen.  It was essential to reduce the risks of non-communicable diseases as they could push households into poverty and also derail efforts to tackle hunger and malnutrition.  To sustainably address the issue, it was necessary to examine and analyse the current food system from agricultural production through retailing and consumption, in order to consider how to ensure that those were working towards healthy nutrition.  She stressed the need to strengthen national capacities, especially on communications, as well as to dispel myths about non-communicable diseases.  Research capacities should be expanded, particularly in lower-income countries.  The context of the diseases in developing countries was different than in developed countries, owing in part to malnutrition.  Sharing lessons learned was vital, and States needed to take the leadership in addressing and preventing the diseases, convincing policy-makers about the magnitude of the problems and about their preventability.

Ms. MUNGAL-SINGH, highlighting South Africa’s efforts in tackling non-communicable diseases, noted that, in March 2013, it had become the first country to legislate salt levels in a range of foodstuffs, and it now was undertaking a public education programme to reduce discretionary salt use through strong leadership, multisectoral action and sufficient funding.  Both the Minister of Health and the Head of the Non-communicable Diseases Directorate had championed that cause.  Advocating for funding was a multisectoral working group comprising researchers in public health and nutrition; food science and technology experts; the non-governmental organization Heart and Stroke Foundation South Africa; Directorate officials; the food industry; and consumer groups.  The Chamber of Baking worked on targets, and also pressed for financing.  The Department of Health was funding a campaign on heart disease and stroke, while industry had helped to fund a high-level summit on the matter, which had helped to engage with other sectors like the media, the catering industry and the health-care sector.  South Africa’s second breakthrough had been the creation of the Non-communicable Diseases Alliance, which provided a common platform for multisectoral action. 

Ms. KISHORE discussed how WHO’s Director-General and Member States, such as Australia, had rallied behind South Africa’s Director General of Health, when the latter testified that a United States-based public relations firm representing more than two dozen pharmaceutical companies was planning a subversive campaign to halt reforms to South Africa’s intellectual property and trade policy aimed at safeguarding access to medicines for all diseases.  Australia had relayed its own battle to invoke Trade-Related Aspects of Intellectual Property Rights (TRIPs) flexibilities in its fight against tobacco, including the landmark 2011 Plain Packaging Act.  Three major tobacco firms had responded by funding a $9 million campaign to counter those efforts.  Noting that some Member States had called for “no new resources”, he said funding of the global coordination mechanism to fight disease averaged $10,000 per Member State — a paltry $1.8 million in total.

“Respected leaders, can we and should we not do better?”.  At the national level, how could a country with an expenditure of just $40 per person per year on health — or as low as $19 — do anything on non-communicable diseases? he asked.  Such diseases must be part of a broader health and human development agenda in order to have an impact.  One concrete step in the right direction was the development of national non-communicable disease units that instituted action across clinical, public health and regulatory domains.  Such units, however, had not even scratched the surface of their true potential.  Investment in human capital was needed to rectify that, he said, proposing the creation of a Fellowship for the Future, a non-communicable diseases core fund that was resourced modestly to equip and position 10 young leaders from each Member State to staff non-communicable disease units in all Member States by 2018.

In the ensuing interactive dialogue, the representative from Nepal said the country faced communicable and non-communicable diseases and the impact of natural disasters on health, as well the fall-out from recent conflict.  In addressing that burden under severe financial constraints, he described the efforts being made to implement sustainable and cost-effective interventions.

A representative from Mexico said voluntary measures to improve public health had not achieved much, but obligatory, mandatory legal issues like banning unhealthy food had really brought about key changes.  Education was vital, he said, adding that homes and schools were the most important places for developing healthy lifestyles.

A representative of Federated States of Micronesia said the impact of climate change was underreported as a risk factor with relation to non-communicable diseases.  For small island developing States, however, the impact was clear:  climate change affected agricultural production and, in turn, nutrition, which increased the risk of developing a non-communicable disease.

A representative of the Joint United Nations Programme on HIV/AIDS (UNAIDS) described how the experience many developing countries had combating HIV/AIDS could be brought to bear in the battle against non-communicable diseases. 

Ms. LARTEY said non-communicable disease prevention programmes had yielded results, noting that Finland had promoted dietary changes and smoking cessation programmes alongside effective messaging, and had managed to reduce heart disease deaths by over 70 per cent.

Mr. BORG noted that many representatives had mentioned fiscal measures like tobacco price rises that could help to combat risk factors like prevalence of smoking.  Education had also been spotlighted.  Also important was to intervene to prevent children from forming bad habits.

Ms. MUNGAL-SINGH said much could be learned from experiences in combating HIV/AIDS.  By mobilizing people on the ground, a stronger voice was raised.  She said it was time to focus on the role of industry, having already agreed on the roles of Government and civil society.  As industry was profit-driven, it was necessary to find ways to encourage its engagement with efforts to tackle risk factors and help to prevent non-communicable diseases.

Mr. KISHORE, noting the impact of focusing in the twentieth century on sanitation for extending life expectancy in the United States, wondered what the twenty-first century equivalent of that would be, and he suggested that it was important to change the way that health workers were educated and trained.

Mr. FERGUSON, in closing, said he subscribed to the view that health should be integral to the post-2015 development agenda and that non-communicable diseases should be addressed adequately within that framework.

The Vice-Minister for Health of Spain also delivered a statement, as did representatives of Barbados, Iran, Costa Rica, Congo, Republic of Korea, Chile, Denmark and Argentina. 

A representative of the Center for Science in the Public Interest also participated in the discussion.

Round Table II

The afternoon roundtable, entitled “Fostering and strengthening national, regional and international partnerships and cooperation in support of efforts to address non-communicable diseases”, was chaired by Howard Koh, Assistant Secretary of Health of the United States, and featured the following panellists:  Lochan Naidoo, President of the International Narcotic Control Board (INCB) of the United Nations Office on Drugs and Crime; Sania Nishtar, Founder of Heartfil of Pakistan; and Mr. Mario Ottiglio, Director of Public Affairs and Global Health Policy at the International Federation of Pharmaceutical Manufacturers and Associations.

Mr. NAIDOO said that, like other non-communicable diseases, drug addiction, which affected millions, was best treated by prevention first, then treatment, recovery and rehabilitation.  Treatment of addiction disorders needed to be seen as treatment of a primary disease and not merely related to intravenous drug use or psychiatric disease.  A mental health issue and a non-communicable disease itself, drug addiction caused untold suffering and loss of potential, particularly among young people, society’s most precious resource.  In treating drug addiction and making sure that medications were used properly, there was a paramount need for training health-care professionals to ensure accurate diagnoses, rational prescribing and adequate availability, as well as good cooperation with and responsible action by the pharmaceutical industry.  The Control Board stood ready to support those efforts at both the national and international levels.

Ms. NISHTAR said that partnerships in the context of non-communicable diseases were a complex web of relationships and synergies in pursuit of common goals.  Those relationships were not formed naturally, and therefore incentives for cooperation should be provided.  Listing the relevant networks and task forces, she said each had its own priorities and implementation mechanisms.  For a coordinating mechanism among all of them, she proposed the model of an observatory that gathered and shared information.  In regard to bilateral and multilateral development assistance, which was crucial in building capacity, she said that the Millennium Development Goals had been an effective mechanism for mobilizing funds, although the post-2015 agenda would exist in a different milieu.  Creative means must be developed nationally and internationally.  Within Governments, targeted commissions could bring together the various sectors needed.  At the national level, there was a point of convergence between coordinating efforts to combat non-communicable diseases and to provide universal health coverage.  Systems set up to coordinate chronic care for HIV infections could be a model in that context.

Mr. OTTIGLIO said that the pharmaceutical industry was able to promise solutions to most non-communicable diseases, but the major problems were development of, access to and correct application of therapies.  The industry had a long track record of partnerships in fighting disease in low- and middle-income countries for those purposes.  He described programmes that included free medicine, assistance in gaining access, leveraging the use of mobile phones to ensure correct use and awareness programmes, as well as partnerships designed “by people for people”, which he called an important consideration.  In future partnerships, clear objectives and deliverables were now needed that were agreed by all parties and were timebound.  The WHO coordination mechanism should strengthen its work in that area. Programmes should focus on systemic issues and should be designed around the core competencies of each partner.  His industry was willing to work within inclusive collaborative frameworks under WHO’s leadership.

In the discussion that followed, topics ranged from the importance of an international framework convention in fostering national regulations to results-based partnerships to the status of alcohol as a drug.  The representative of Denmark spoke about the importance of non-governmental organizations in all efforts to curb non-communicable diseases, while Spain’s representative spoke about the importance of cooperation for training in the proper use of pharmaceuticals.  The representative of Niger discussed the return on investments for various kinds of interventions, while Iran’s representative discussed accountability for groups providing interventions and the alternatives available in that regard.  Canada’s representative noted a consensus around the need for a multisectoral, collaborative approach in fighting non-communicative diseases, and related his country’s experiences in that area.

In response to questions raised in the discussion, Mr. NAIDOO said that alcohol abuse was related to many other factors.  It was most important to encourage “smart families” to handle such issues, since they were all connected.  Ms. NISHTAR said expectations in revenue mobilization should be managed.  She added that many intervention strategies were revenue-generating in their own right, including tobacco taxes.  She noted a lack of appetite for a vertical funding flow for non-communicable diseases in the current economic climate.  At the national level, she stressed the importance of the regulatory pathway as well as the need for comprehensive health systems to tackle all health problems.

Mr. OTTIGLIO spoke of the importance of cooperating at the community level in regard to training and other efforts.  He said that the importance of data should not be underestimated in providing all interventions in health.  He stressed again the importance of the WHO framework for cooperation.

Also participating in the discussion were representatives of Argentina, Republic of Korea, Norway, Suriname and Sweden.

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