Elsevier

The Lancet

Volume 381, Issue 9866, 16–22 February 2013, Pages 575-584
The Lancet

Series
Country actions to meet UN commitments on non-communicable diseases: a stepwise approach

https://doi.org/10.1016/S0140-6736(12)61993-XGet rights and content

Summary

Strong leadership from heads of state is needed to meet national commitments to the UN political declaration on non-communicable diseases (NCDs) and to achieve the goal of a 25% reduction in premature NCD mortality by 2025 (the 25 by 25 goal). A simple, phased, national response to the political declaration is suggested, with three key steps: planning, implementation, and accountability. Planning entails mobilisation of a multisectoral response to develop and support the national action plan, and to build human, financial, and regulatory capacity for change. Implementation of a few priority and feasible cost-effective interventions for the prevention and treatment of NCDs will achieve the 25 by 25 goal and will need only few additional financial resources. Accountability incorporates three dimensions: monitoring of progress, reviewing of progress, and appropriate responses to accelerate progress. A national NCD commission or equivalent, which is independent of government, is needed to ensure that all relevant stakeholders are held accountable for the UN commitments to NCDs.

Introduction

The political declaration of the UN high-level meeting on non-communicable diseases (NCDs), held in 2011, committed member states to a comprehensive set of actions to prevent and treat NCDs, with a specific goal to strengthen national multisectoral plans by the end of 2013.1 The declaration emphasised the need for a whole-of-government policy response, and recognised that to be effective, national actions need to go beyond the health system to address the social determinants of health and prevent exposure to NCD risk factors that are common to the four major NCDs: cardiovascular disease (heart disease and stroke), cancer, chronic obstructive pulmonary disease, and diabetes. National governments should also collaborate with other sectors in society, such as civil society, academia, and, when relevant and appropriate, the private sector.2 Cost-effective interventions are essential to achieve the agreed global target of a 25% reduction in premature NCD mortality by 2025 (the 25 by 25 goal).3

An appropriate response needs both population-wide and individual-level strategies. Major reductions in NCD mortality have occurred in many high-income countries because of investment in both prevention and treatment programmes.4, 5 In addition to health advantages, economic,6, 7 environmental,8, 9 and other benefits can be gained from interventions to reduce the burden of preventable NCDs. Through a focus on a select set of interventions (so-called best buys) that are feasible, scalable, affordable, and cost effective, all countries can achieve rapid and substantial reductions in rates of death and disability.10 Countries can adopt a more comprehensive approach after the priority set of interventions is implemented.

Many approaches to NCD prevention and treatment have been described, including the WHO NCD Action Plan, 2008–2013,11 which is being updated, and regional plans. These plans are often presented as action lists, with little clarity about the relative importance of their components.12, 13 Responses to NCDs should be set in the context of overall health systems and national development planning,14 since NCDs are only one of many issues that need to be addressed.

In this paper, we focus on a small set of interventions, using a stepwise approach to NCD planning and action that is appropriate for all countries, but especially for low-income and middle-income countries. High-income countries can also benefit from optimum planning to achieve the best outcome from available resources. Case studies show how progress can be made.

Key messages

  • •

    Strong leadership by heads of state and government is needed to meet national commitments to the UN political declaration on non-communicable diseases (NCDs) and to achieve the agreed goal of a 25% reduction in premature NCD mortality by 2025 (the 25 by 25 goal)

  • •

    A simple, phased national response to the political declaration needs three key steps: planning, implementation, and accountability

  • •

    Planning involves mobilisation of a multisectoral response to develop and support the national plan of action, and build capacity for human, financial, and regulatory change

  • •

    Implementation of a few feasible and cost-effective interventions for the prevention and treatment of NCDs would achieve the 25 by 25 goal, yet would need few additional financial resources

  • •

    National accountability involves monitoring and reviewing of progress, and acceleration of progress based on locally appropriate accountability mechanisms

Section snippets

A stepwise approach to national action

A clear, simple, and logical plan of action is more likely to be implemented than is a list of all possible actions. Panel 1 shows the proposed approach, which can be adapted to the local context.

Inevitably, actions taken will overlap and a linear process might not be possible or desirable. An accountability mechanism should be established from the outset, and, crucially, all sectors should develop an understanding of their roles and responsibilities early in the process, including how their

Build the case for action

The first planning step is to build the case for sustained action by estimation of the burden of NCDs and their main risk factors, the unmet need for prevention and treatment services, and the need for interventions outside the health sector. Academics can help ministries of health to estimate the disease burden by combining data from mortality statistics with surveys of the prevalence of the four major risk factors that predict NCD epidemics: tobacco and alcohol use, unhealthy diets, and

Priority interventions

There are three high-priority interventions, which, if applied rigorously, will achieve the 25 by 25 goal: tobacco control, salt reduction to reduce blood pressure in the whole population, and the management of people at high risk of heart attack or stroke. All countries can improve their implementation of these three interventions.

Tobacco control measures

Although 175 countries have now ratified the FCTC, worldwide coverage of the key tobacco control policies is low and accelerated implementation is a global and

Step three: account for progress

Accountability, in the sense of holding governments responsible for implementing policies and programmes to meet the UN commitments, is an essential aspect in the assessment of progress towards the 25 by 25 goal. WHO and member states have developed a set of voluntary global targets and indicators.78 This process will be finalised in May, 2013, and countries will be requested to develop national targets aligned to the global targets. Establishment of national targets is one step towards

Conclusions

This paper presents a simple, structured, sequential process for countries to consider as they work towards implementation of the commitments made at the UN high-level meeting on non-communicable diseases in September, 2011. It focuses on a subset of the interventions recommended by WHO member states.78 Governments should consider implementing these interventions first, since they are affordable and cost effective and will have the greatest return in terms of reduction of the NCD burden and in

References (79)

  • SS Lim et al.

    Prevention of cardiovascular disease in high-risk individuals in low-income and middle-income countries: health effects and costs

    Lancet

    (2007)
  • R Magnusson et al.

    Role of law in global response to non-communicable diseases

    Lancet

    (2011)
  • B Viswanathan et al.

    Linking Global Youth Tobacco Survey (GYTS) data to tobacco control policy in the Seychelles

    Prev Med

    (2008)
  • SS Lim et al.

    A comparative risk assessment of burden of disease and injury attributable to 67 risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010

    Lancet

    (2012)
  • S Yusuf et al.

    Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle-income, and low-income countries (the PURE Study): a prospective epidemiological survey

    Lancet

    (2011)

  • Political declaration of the high-level meeting of the general assembly on the prevention and control of non-communicable diseases. A/66/L.1

  • R Moodie et al.

    Prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries

    Lancet

    (2013)

  • May 26, 2012

  • P Bandosz et al.

    Decline in mortality from coronary heart disease in Poland after socioeconomic transformation: modelling study

    BMJ

    (2012)
  • M Suhrcke et al.

    Are cardiovascular diseases bad for economic growth?

    Health Econ

    (2010)
  • D Bloom et al.

    The global economic burden of non-communicable diseases

    (2011)
  • P Edwards et al.

    Population adiposity and climate change

    Int J Epidemiol

    (2009)
  • S Friel et al.

    Climate change, noncommunicable diseases, and development: the relationships and common policy opportunities

    Ann Rev Public Health

    (2011)

  • Scaling up action against non-communicable diseases: how much will it cost?

    (2011)

  • 2008–2013 Action plan for the global strategy for the prevention and control of noncommunicable diseases: working in partnership to prevent and control the four noncommunicable diseases

  • S Venkatapuram et al.

    Ethical tensions in dealing with noncommunicable diseases globally

    Bull World Health Organ

    (2012)

  • Preventing chronic diseases: a vital investment

    (2005)
  • T Armstrong et al.

    Capacity building for an integrated non communicable disease risk factor surveillance system in developing countries

    Ethn Dis

    (2003)

  • STEPwise approach to chronic disease risk factor surveillance (STEPS)

  • C Garg et al.

    What is the impact of non-communicable diseases on national health expenditures: a synthesis of available data. Discussion paper no. 3

    (2011)
  • DE Bloom et al.

    The global economic burden of noncommunicable diseases

    (2011)

  • From burden to best buys: reducing the economic impact of non-communicable diseases in low- and middle-income countries

    (2011)
  • KS Reddy

    Shouldn't every minister be a health minister?

  • E Blas et al.

    Social determinants approaches to public health: from concept to practice

    (2011)

  • Intersectoral action on health: a path for policy makers to implement effective and sustainable intersectoral action on health. April 26–29, 2011

  • JP Ruger

    Global health governance as shared health governance

    J Epidemiol Community Health

    (2012)
  • I Nikolic et al.

    Chronic emergency: why NCDs matter. HNP discussion paper, July 2011

    (2011)
  • S Wang et al.

    Towards a healthy and harmonious life in China: stemming the tide of non-communicable diseases

    (2011)

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