Noncommunicable diseases: the slow motion disaster
Of all the major health threats to emerge, none has challenged the very foundations of public health so profoundly as the rise of chronic noncommunicable diseases. Heart disease, cancer, diabetes, and chronic respiratory diseases, once linked only to affluent societies, are now global, and the poor suffer the most. These diseases share four risk factors: tobacco use, the harmful use of alcohol, unhealthy diets, and physical inactivity. All four lie in non-health sectors, requiring collaboration across all of government and all of society to combat them.
At the turn of the century, chronic noncommunicable diseases were not widely recognized as a barrier to development and were not included in the Millennium Development Goals. In terms of gaining attention and financial support, these diseases were overshadowed by the devastating epidemics of HIV, tuberculosis, and malaria and the large number of maternal and childhood deaths. In 2010, only US$ 18.2 million in development assistance was devoted to NCD prevention and control, amounting to just 0.8 % of total aid for health.
Much of WHO’s work in the earliest years of the decade involved collecting the data and making the arguments that would elevate NCDs on the global health and development agendas. On their part, countries – especially those with emerging economies – used the WHO STEPwise approach to gather standardized data on the true burden of these diseases. Those efforts culminated in 2011, when the UN General Assembly held a high-level meeting on NCDs and adopted a far-reaching Political Declaration.
The Political Declaration acknowledged that the threat of NCDs constitutes one of the major challenges for development in the 21st century, undermining social and economic progress throughout the world , and made WHO the principal agency for leading the global response. Several relevant WHO resolutions and regional initiatives were cited as providing a framework for stepped-up action on multiple fronts. WHO was specifically asked to prepare recommendations for a set of voluntary global targets. Despite the existence of low-cost, feasible, and high-impact interventions, WHO’s so-called “best buys”, the Political Declaration recognized the complexity of these diseases, the challenges facing prevention and control, and the need for a whole-of-government and whole-of-society approach.
"The threat of NCDs constitutes one of the major challenges for development in the 21st century, undermining social and economic progress throughout the world."
Dr Chan, WHO Director-General
So began a period of intense demands for WHO leadership and expectations for guidance that would deliver a measurable impact. The number of initiatives under WHO leadership soon grew to reflect the magnitude of the challenges, the breadth of the issues that needed to be addressed, and the large number of partners with something unique to contribute.
In 2013, the World Health Assembly adopted a comprehensive global monitoring framework for NCDs, with nine voluntary targets and 25 indicators. The Health Assembly also approved the WHO Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020, which provided a roadmap and menu of options for taking coordinated and coherent action to attain the targets. For each of the global targets and indicators, WHO issued an array of practical tools to facilitate implementation in countries, often adapted to regional settings. Of central importance was the STEPwise guide to the development, implementation and monitoring of national multisectoral action plans.
That same year, a UN Inter-Agency Task Force on the Prevention and Control of Noncommunicable Diseases was established by the UN Secretary-General and placed under the leadership of WHO to coordinate the engagement of UN agencies. The Task Force built on the work of the Ad Hoc Inter-Agency Task Force on Tobacco Control as another problem requiring collaboration from multiple non-health agencies.
In 2014, the WHO Member States established the Global Coordination Mechanism on the prevention and control of NCDs, to coordinate the engagement of nongovernmental organizations, philanthropies, business associations and academic institutions around coherent policy objectives, while also protecting public health and the integrity of WHO from potential conflicts of interest.
In 2016, ECOSOC encouraged members of the Task Force to provide support to countries in reflecting the new NCD-related targets in the 2030 Agenda for Sustainable Development in their national responses.
However, as one country after another – whether rich or poor – struggled to make progress, many obstacles emerged. The complexity of the task ahead, concealed by so many years of inadequate attention, became readily apparent.