The UN High Level Meeting (UN HLM) on Non Communicable Diseases owes its origins to strong pleas of the CARICOM countries (Healthy Caribbean Coalition) to the UN for scaling up political efforts in order to tackle the Non Communicable Diseases (NCD) epidemic. Once their pleas had been taken on board by a special alliance of 4 forceful disease interest groups (cancer, diabetes, heart, lung), this so-called NCD Alliance was able to galvanize broad societal support during the preparation phase of this first ever major political summit on NCD. Using its financial resources and the professional expertise of its members and through engaging with WHO experts, the Alliance’s concerns were voiced in the Lancet and many other influential media. The result was an unstoppable campaign which has “finally” succeeded in giving a label plus a voice to (what had been until now) rather scattered and diverse health topics. The campaign has turned these into a recognizable ‘package’ of with its own place on the international political agenda now. It is fair to say that without the massive effort by the NCD Alliance (with intensive preparatory meetings for the summit, their resourceful website and their ‘outcry’ campaigns), we probably wouldn’t be talking about an NCD momentum at all. Anyway, it all contributed to the unusually high profile of this UN summit. Did the UN HLM meet the campaign’s expectations? Four members of the ‘SWIHPS network’ were in New York in the UN HLM and side-events and report.
The recognition of NCDs as a “slow motion epidemic” (Margaret Chan) has brought NCDs a lot closer to the core of national and global health agendas and they can no longer be ignored in developing countries. The use of the term “epidemic” in the declaration and the need for a formal “review” in 2014 indicate a raised level of political significance, and this will likely remain so in coming years and decades. Despite the different interests at stake, actors managed to establish some common ground:
- NCD are not only a big health concern but also an important development problem, given their negative impact on human and economic development, worsening poverty and exclusion.
- The importance of investment in tackling the NCD epidemic (financially, technically, socially, institutionally) in the health sector and other sectors. The notion of ‘best buys’ with an estimated annual cost of USD 12 billion could help to push for the urgently needed delivery of cost-effective interventions in all low and lower middle-income countries. In this figure there is USD 2 billion foreseen for “public interventions” and USD 10 billion for “individual care”. International cooperation is necessary to set standards, provide technical support and fight common risk factors.
- Based on the success of priority interventions in developing countries many people appeared to call for expanding these to include NCDs as part of an integrated approach in primary care, otherwise known as the diagonal approach and incorporate NCDs in the broader framework of Health Systems Strengthening, including them into already reformed and improved surveillance systems, improved access to essential medical supplies etc.
- The use of telephone messages, e-health and social media in order to spread health messages has been strongly recommended.
- National leadership by governments who also push for inter-sectorial collaboration is needed. The role of the private sector is important, but also risky because of conflicts of interests. How to involve the private sector is still not yet clear.
- The UN General Assembly has asked WHO to develop a framework for monitoring global progress and to prepare, before the end of 2012, recommendations for a set of global targets to monitor trends and assess the progress in countries. A follow-up HLM will be organized in 2014, to formally “review” progress.
The meeting was mainly political and about high level political advocacy, so discussions focused on coherence of strategies and feasibility. Yet we identified some gaps and/or controversial issues:
– Voices of southern countries could have been stronger, at least when it comes to patients and social movements. Civil society movements were present, but they came predominantly from the north. Social movements from the South were conspicuously absent. However, there was a strong CARICOM voice, and many country representatives (for example, Uruguay, Indonesia) spoke forcefully on behalf of country coalitions from the South.
– Unlike at the UNAIDS Summits, the voices of patients were largely absent, apart from Lance Armstrong’s (as a former (and cured) cancer patient).
– The implementation strategy under which the new ambitions are to be successfully delivered as well as required changes to the health systems and health care perspectives are not clear. Constraints in financing and human resources loom as large as before. Countries will need support when they have to translate political and technical agreements into real policies; they will have to make good choices as plans for horizontal Health Systems Strengthening and Priority interventions require integration and tackling NCDs as part of primary care. Feasibility concerns remain, but this was absolutely not a ‘technical’ forum to explore these and propose solutions.
– The strong emphasis on involving the private sector in public-private partnerships threatens a public interest oriented approach in policy making for NCDs. The world has to remain cautious for (hidden) interests and “dirty tricks” (in the words of Margaret Chan) of big industry. There is a difference between reasonable profit and greed.
Despite the above, we conclude that the UN High level meeting on NCDs was an important landmark event that stretched beyond the field of public health.
For our own SWIHPS Network, there were opportunities to point out the importance of a Primary Health Care approach for chronic conditions, which implies the strengthening of local health systems. In order to ensure effective and integral national responses to the NCD epidemic, health systems have to provide quality health care, where opportunity, continuity and effectiveness are key features of lifelong care.
Quality chronic care for all is possible. Let’s strengthen local health systems
and empower people.
Esteban Londoño, Josefien Van Olmen, Maurits Van Pelt and Slim Slama
Representatives of the SWIHPS Network at the UN High Level Meeting and Side Events in New York.