Priority actions for the non-communicable disease crisis

Summary

The UN High-Level Meeting on Non-Communicable Diseases (NCDs) in September, 2011, is an unprecedented opportunity to create a sustained global movement against premature death and preventable morbidity and disability from NCDs, mainly heart disease, stroke, cancer, diabetes, and chronic respiratory disease. The increasing global crisis in NCDs is a barrier to development goals including poverty reduction, health equity, economic stability, and human security. The Lancet NCD Action Group and the NCD Alliance propose five overarching priority actions for the response to the crisis—leadership, prevention, treatment, international cooperation, and monitoring and accountability—and the delivery of five priority interventions—tobacco control, salt reduction, improved diets and physical activity, reduction in hazardous alcohol intake, and essential drugs and technologies. The priority interventions were chosen for their health effects, cost-effectiveness, low costs of implementation, and political and financial feasibility. The most urgent and immediate priority is tobacco control. We propose as a goal for 2040, a world essentially free from tobacco where less than 5% of people use tobacco. Implementation of the priority interventions, at an estimated global commitment of about US$9 billion per year, will bring enormous benefits to social and economic development and to the health sector. If widely adopted, these interventions will achieve the global goal of reducing NCD death rates by 2% per year, averting tens of millions of premature deaths in this decade.

Introduction

The spread of non-communicable diseases (NCDs) presents a global crisis; in almost all countries and in all income groups, men, women, and children are at risk of these diseases.¹ Worldwide, substantial gains have been achieved in economic growth, health, and living standards in the past century. This progress is now threatened by crises of our own creation—climate change, finance and food insecurities,² and the crisis in NCDs, principally heart disease, stroke, diabetes, cancers, and chronic respiratory disease.³

The UN High-Level Meeting (UN HLM) on NCDs in September, 2011,⁴ provides an unrivalled opportunity to create a sustained rights-based global movement to tackle NCDs,⁵ analogous to the UN General Assembly Special Session on HIV infection and AIDS a decade ago, which concluded that dealing with the disease was central to the development agenda.⁶ Political leadership at the highest level, with international coordination and consensus for priority actions and interventions are crucial responses to the crisis in NCDs and to facilitate national action.⁷ A successful meeting will generate high-level and sustained political commitments to the priority actions needed globally and nationally to prevent and treat NCDs. It will ensure that NCDs become central to the long-term global development agenda.

In the interests of promoting a unified political message and a common voice, The Lancet NCD Action Group—an informal collaboration of academics, practitioners, and civil society organisations—and the NCD Alliance—comprising four key international non-governmental organisations (Union for International Cancer Control, International Union Against Tuberculosis and Lung Disease, International Diabetes Federation, and World Heart Federation)—propose a shortlist of priority actions for NCDs: political leadership at the highest level, globally and nationally; immediate implementation of the priority interventions; building international coordination and consensus for priority actions and interventions; and establishment of monitoring, reporting, and accountability mechanisms for assessment of progress.

In this report, we synthesise and expand the evidence reported in four series in The Lancet in the past 5 years (panel 1) and focus on what matters most for NCDs.18, 19, 20, 21 These reports, initiated by WHO and produced in collaboration with almost 100 leading scientists, support WHO's action plan for the prevention and control of NCDs.²² Here we address the topics of three round-table discussions proposed in the UN Modalities Resolution at the UN HLM: the NCD crisis; priority actions; and international cooperation. We conclude with a set of recommendations for the outcomes document from the UN HLM.