The good news is that there are simple, cost-effective and often politically feasible solutions to NCDs. It is not necessary to wait years to see the benefits of prevention and control. We know the solutions. Here we outline a set of recommendations proposed by the Young Professionals Chronic Disease Network and a series of mutually reinforcing recommendations for interventions from other world leading experts.
Youth Manifesto on Non-Communicable Diseases: Position Statement and Recommendations to all Nations and Relevant Stakeholders
The Young Professionals Chronic Disease Network (YP-CDN), which is the parent organization of the NCD Action Network, aims to inform policy-makers about the role for young people and young professionals in tackling the NCD epidemic. Recently, the YP-CDN released it's Youth Manifesto on Non-Communicable Diseases: Position Statement and Recommendations to all Nations and Relevant Stakeholders targeted at world leaders and ministers attending the UN High Level Meeting this September. The manifesto outlines a set of seven evidence-based recommendations to governments and key stakeholders, and a set of pledges the YP-CDN will in turn promise to deliver. Below are the seven recommendations. The shorter PDF version of the manifesto can be downloaded here: Manifesto_on_NCDs.pdf.
Here, we ask governments, civil society organizations, development agencies, and the global public health community at large to strive to reduce the age-adjusted mortality and disability adjusted life years (DALYs) due to NCDs by 20% over the next 10 years, as targeted by the WHO, to enhance the productivity of all countries. Specifically, we request that the UN representatives to the 2011 UN General Assembly High-Level Meeting on NCDs and other key stakeholders consider the following seven recommendations, which are the result of nine months of dialogue among YP-CDN network members, and which focus on capturing the wide-ranging societal and life-course drivers of NCDs.
Re-frame NCDs as a development issue
- 1.1 Governments, civil society organizations, development agencies, and the global public health community at large should re-frame NCDs as a barrier to development by explicitly including NCDs as a target for “technical assistance, capacity building, program implementation, impact assessment of development projects, funding, and other activities,” as recommended by the Institute of Medicine.
- 1.2 Governments, civil society organizations, development agencies, and the global public health community at large should expand the next round of development targets beyond MDG-specific targets to a combination of human and economic development goals that explicitly address primordial, primary, secondary, and tertiary prevention of NCDs.
The social determinants of health as the foundation for NCD Action
- 2.1 Governments should include “health across the lifespan” as a central pillar of all policies (“health in all policies”) to enhance the conditions and health system in which people are born, grow, live work and age.
- 2.2 Governments should implement the Framework Convention on Tobacco Control in its entirety to reduce global tobacco consumption by 30% in 10 years. Special commissions should be instituted to target informal sector tobacco consumption practices.
- 2.3 Governments should implement programmes that tackle the social determinants of NCDs with particular reference to the following: health in early childhood, the health of the global poor, fair financing, and equitable access to primary health care services and essential medicines.
- 2.4 Governments should engage local, regional, national and global communities in health-related priority setting, ensuring fair representation.
- 2.5 Governments should adopt evidence-based global strategies developed by the WHO including the Global Strategy on Diet, Physical Activity and Health and the Global Strategy to Reduce the Harmful Use of Alcohol and other programs such as the Disease Control Priorities Project as the foundation of future evidence-informed policies to reduce the burden of NCDs.
- 2.6 The private sector should improve the quality and sustainability of food to reduce salt and sugar intake and should eliminate trans fat intake, with an emphasis of minimizing pricing shocks that disproportionately affect poor populations.
Assert the rights of the child: tackle NCDs across the life course
- 3.1 Governments, civil society organizations, development agencies, and the global public health community at large should promote and expand maternal and child health programs to reduce maternal and infant mortality rates by 75% as a means to assert women and children’s health rights using a life course approach to policy development.
- 3.2 Governments should include NCDs and NCD risk factor data collection across all age groups, including biospecimen sub-samples, as part of country-level demographic health surveys to understand the current burden of NCDs and to provide more reliable future projections of the NCD burden.
- 3.3 Governments and private sector actors should implement recommendations from the WHO policy document, “Set of Recommendations on the Marketing of Foods and Non-Alcoholic Beverages to Children”.
Augment capacity through interdisciplinary education of the future public health workforce.
- 4.1 Governments and development agencies should actively seek input from young professionals on global development issues to harness their energy, creativity and leadership and recognize their role as a key partner in combating NCDs.
- 4.2 Governments should invest in health professional education at the primary, secondary, undergraduate, graduate, and postgraduate level, stressing: 1) intellectual capital, 2) communication skills, and 3) cross-disciplinary networks.
- 4.3 Educational institutions should build leadership capacity in young professionals by developing and implementing cross-disciplinary and trans-national leadership programs that address NCDs.
- 4.4 The WHO and civil society should improve accessibility, affordability, and availability of global level internships, scholarships and other training opportunities for young people, particularly trainees in LMICs.
Adopt innovative funding mechanisms and financing.
- 5.1 Augment and align global health funding from donor agencies, member countries and private industry with areas of greatest public health gains, as measured through estimated age-adjusted death rates and DALYs.
- 5.2 Governments should identify regional- and country-level secondary economic gains or losses from interventions that impact NCDs, including interventions outside the health system, in order to achieve a “health in all policies” policy.
- 5.3 Governments should introduce NCD Action plans at the ministerial level including NCDs as a line-item in national budgets.
- 5.4 Governments and international could foster interest in translation trials that can add externally valid evidence to support extensive implementation of science-based findings into real-life settings.
Enable global access to essential drugs and health technologies
- 6.1 Governments should mandate generic substitution of medicines and utilize compulsory licenses to reduce the cost of managing chronic diseases by expanding global financing bodies like The Global Fund and UNITAID for the provision of essential NCD medicines and diagnostics.
- 6.2 The WHO should enable pre-qualification for the 34 NCD medicines in the WHO Primary Essential Medicines for NCDs (PEN).
- 6.3 Government finance and health ministries should support local supply chain management through increased accountability and incentives (www.stopstockouts.org).
- 6.4 The WHO should survey the availability and financial cost of diagnosis and treatment of NCDs, including catastrophic health spending, among WHO member states.
- 6.5 National health ministers and international health bodies should take action to reorient health systems away from the acute care model and towards a model of care that supports long term care and follow-up.
Develop a common vision for equitable global development
- 7.1 Governments, civil society, development agencies and global public health practitioners should empower and engage communities, particularly youth, to promote equitable access to education and leadership.
- 7.2 Governments, development agencies, and global health practitioners should incorporate the voice of the empowered community in decision-making.
Priority actions for the non-communicable disease crisis: The Lancet
The following five recommendations have been proposed by the worlds leading experts on the prevention of non-communicable diseases (NCDs). Their article can be downloaded for free from the Lancet website. The interventions with the most impact are those targeted at the population level such as tobacco control and salt reduction in foods. For most countries these are politically feasible, benefit the poor and will reduce social inequalities. They are also very inexpensive to implement (see table below).
Table: High-impact interventions for the prevention of NCDs are affordable in almost all countries. Adapted from: Beaglehole et al. (2011) Priority actions for the non-communicable disease crisis. Lancet, April 6
- Reduce tobacco use: Among current consumers, and prevent others from taking up tobacco use, through full implementation of the World Health Organization’s Framework Convention on Tobacco Control.
- Reduce salt in the diet: Because salt can damage blood vessels, lowering the level of salt in foods will dramatically lower blood pressure across entire populations, and thereby reduce the risk of heart disease and stroke. The food industry is a key partner here.
- Improve diets and physical activity: Introduce controls on the marketing of food and drinks high in sugar, fat and salt to protect children from the powerful effects of advertising on diets. Encourage food manufacturers to reformulate processed food products to reduce the levels of saturated fat, trans fat, salt and sugar, and clearly label these to enable consumers to make informed choices.
- Reduce hazardous alcohol intake: Introduce controls on the marketing of alcoholic drinks that targets young people. Introduce restrictions and controls on availability of alcohol to purchase, and introduce measures to increase the price of alcohol as an effective way of reducing consumption.
- Access to essential medicines and technologies: Universal access to health care, irregardless of ability to pay, is essential. In many low-income settings cheap and effective medications can be made widely available. Scalable treatments for cancer, cardiovascular disease and diabetes are now widely available and supported by strong evidence. Program integration with treatment for HIV/AIDs and other infectious diseases is also critical, requiring health systems reorientation.
In order for the above priority interventions to be implemented, a number of critical actions are needed.
- Strong political leadership at the highest levels: This is the most vital criteria for successful action against NCDs. Political champions are needed. Leadership is essential for achieving health in all policies by aligning national policies on agriculture, trade, industry, and transport to promote improved diets, increased physical activity, and reduced alcohol use.
- Prevention: The upstream causes of NCDs need to be averted. A strong focus on primary prevention is the only approach that will ensure future generations are not at risk of premature death from these diseases.
- Access to treatment services: Tackling NCDs requires functioning health care systems aligned for these diseases, proper financing, well-trained health workers, access to essential medicines (especially low-cost generic medicines) and technologies, and health-information systems. Universal coverage through removal of financial and other barriers to access, particularly for people who are poor, is a priority.
- International cooperation: Stronger global health governance mechanisms are needed, with WHO taking a leading role but with strong engagement from international partner organizations. The private sector (especially food companies) and non-profit organizations (the NCD Alliance for example) must also take leading roles.
- Monitoring, reporting and accountability: Unless the NCD epidemic is monitored it will go unnoticed by policy and decision-makers (why NCDs are sometimes called the 'silent epidemic'). National and global monitoring frameworks are essential to ensure accurate targeting of the problems and to measure successes. Functioning registers for cause of death, and health information systems is essential here.
Source: Beaglehole et al. (2011) Priority actions for the non-communicable disease crisis. Lancet, April 6