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
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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)
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A simple, phased national response to the political declaration needs three key steps: planning, implementation, and accountability
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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
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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
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National accountability involves monitoring and reviewing of progress, and acceleration of progress based on locally appropriate accountability mechanisms