UN's Efforts on Noncommunicable Disease Historic, but Flawed



NEW YORK – For the first time ever, the United Nations formally recognized and set an agenda to reduce the burden of noncommunicable diseases globally. However, to many observers anticipating the historic event, the effort fell short of setting tangible targets for driving change.

At the September meeting of the UN General Assembly – the second high-level meeting ever to address a health issue since a 2001 meeting on HIV/AIDS – the UN issued a consensus document recognizing that "the global burden and threat of NCDs constitutes one of the major challenges for development in the twenty-first century, which undermines social and economic development throughout the world."

Dr. Derek Yach

In the consensus document, known as a political declaration, UN members pledged to promote the reduction of salts and sugars; to eliminate trans fats in foods; to increase access to affordable, quality-assured medicines and technologies; and to strengthen health care systems so they can address NCD prevention and treatment.

The UN also endorsed WHO efforts to combat smoking, to improve diet and physical activity, to reduce the harmful use of alcohol, and to halt the marketing of unhealthful foods and beverages to children.

The UN Secretary-General Ban Ki-moon urged UN representatives at the meeting to carry out the provisions of the document and to "bring NCDs into our broader global health and development agenda."

Nearly two-thirds (63%) of deaths worldwide result from NCDs such as cardiovascular disease, diabetes, chronic respiratory disease, and cancer, and nearly 80% of those deaths occur in developing countries, according to the WHO. Because half of individuals who die of NCDs are in their working-age years, the issue is recognized as an economic and developmental problem, as well as one of public health. Success will need to involve many sectors beyond health, including finance, agriculture, transportation, urban development, and trade, UN members agreed.

NCDs are "the diseases that break the bank," said Dr. Margaret Chan, WHO’s director general. They are anticipated to cost more than $30 trillion in U.S. dollars over the next 20 years, representing 48% of global gross domestic product in 2010, according to a report issued by the World Economic Forum.

Yet just days before the meeting was held, several contentious revisions to the final draft of the political declaration took place, essentially stripping the document of specific and time-bound targets.

The NCD Alliance, a lobbying coalition of global NCD-related organizations, opposed the removal of the goal to cut by 25% all preventable deaths from cancer, cardiovascular disease, diabetes, and chronic respiratory disease by 2025, an element that did not make it into the final document.

"Emblematic figures have been excised, such as the aim to reduce salt intake to less than 5 g per day," according to an editorial that blamed conflicts of interest for the lack of compulsory targets (Lancet Oncol. 2011 Sept. 22 [doi:10.1016/S1470-2045(11)70272-8]).

"Groups from the food and drink industry ... were invited to participate in the meeting, although they were excluded from any decision-making. Unsurprisingly, these industry representatives urged a voluntary, rather than a regulatory approach," the authors wrote.

Instead of compulsory targets, the UN tasked the WHO to establish a comprehensive global monitoring framework and to prepare recommendations for voluntary global targets before the end of 2012, as well as to report initial progress in 2013, enabling a lack of accountability that the editorial authors deemed "a missed opportunity."

In a similar expression of concern, Paul Lincoln of the National Health Forum in London and colleagues issued a statement calling for the conflicts of interest to be "explicitly recognized and addressed. ...Failure to do this will undermine the development of competent policy; the effectiveness and efficiency of programs; and the confidence the global health community and the public at large have in the UN and WHO’s ability to govern and advance public health, which will severely impair capacity to help member states address NCDs" (Lancet 2011 [doi:10.1016/S0140-6736(11)61463-3]).

Dr. Derek Yach, senior vice president for global health and agriculture policy at PepsiCo, said that industry agrees with the principle of reducing conflicts of interest. But, he noted, "the reality is that conflicts occur not just in relationship between industry and [the UN], but between academic bodies, foundations, and other entities. They all bring their own particular backgrounds, interests, prejudices and perspectives. All forms of conflicts need to be addressed."

Dr. Yach, formerly a professor of public health and head of the division of global health at Yale University in New Haven, Conn., and a former executive director of the WHO, said he disagrees that industry should be barred from policy development. "I think that industry has to be involved in the development of the options for policy, and in the implementation. The middle bit – when final decisions are made on policy – is probably best left in the hand of government and the UN. But if industry is not at the table, even talking about the options, the UN and the government will simply be lost in terms of knowing the full range of possibilities that are out there."


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