World's poor hardest hit by chronic diseases, says top UN health official

Kicking off the two-day meeting at Headquarters, Ms. Chan called the Assembly’s 2011 Political Declaration on the prevention and control of non-communicable diseases “a watershed moment”, highlighting that it enticed bold commitments to act while putting prevention forward as the cornerstone of a global response.

That political declaration gave WHO a leadership role, together with several time-bound assignments to tackle non-communicable diseases, which include such chronic ailments as cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. These assignments, which have been completed, established global mechanisms and a roadmap for coordinate multi-sectoral action and monitoring of results.

The progress within countries matters most, she stressed, calling some of the achievements to emerge from a survey conducted by WHO last year “striking”. For example, of the 172 countries reporting data, 95 per cent have a unit or department in the Ministry of Healthy responsible for non-communicable diseases. Half now have an integrated operational plan along with a dedicated budget. In the same vein, the number of countries conducting recent surveys of risk factors jumped from 30 percent in 2011 to 63 percent last year.

“More and more countries are getting the basics in place,” she said, but while the progress report shows that some very cost-effective and affordable interventions have worked well in many countries, it found that overall progress is insufficient and highly uneven.

“I see no lack of commitment. I see a lack of capacity to act, especially in the developing world,” she said, pointing to data showing that 85 percent of premature deaths from NCDs occur in developing countries.

“Challenges remain enormous and demand a fundamental change in the way social progress is measured, the way Governments work, the way responsibilities are assigned and the way boundaries of different government sectors are defined,” Ms. Chan said.

Highlighting that these chronic diseases have overtaken infectious diseases as the world’s leading cause of morbidity and mortality, she urged a “seismic shift” that calls for sweeping changes in the very mind-set of public health.

Health systems in the developing world must be better equipped for long-term management of chronic conditions with their costly and demanding complications. “Public health must shift its focus from cure to prevention, from short-term to long-term management, from delivering babies, vaccines and antibiotics to changing human behaviours, from acting along to acting in concert with multiple sectors,” Ms. Chan urged.

She went further to say that the dynamics of socioeconomic progress have changed and are actually creating the conditions that favour the rise of non-communicable diseases. Economic growth, modernization and urbanization foster unhealthy lifestyles and the world’s obesity epidemic is getting worse, compounded by the marketing of unhealthy foods and beverages.

Healthier food options are neither affordable nor accessible in large parts of the developing world, she continued, and too often, the unhealthiest food is often the cheapest and most convenient. More must to be done to educate people about the health effects of smoking, harmful use of alcohol and physical inactivity, she said, stressing the importance of an alcohol tax and enforcing advertising bans, particularly in developing countries.

The health sector cannot be responsible for it all, she said, urging all ministries to get involved. Giving targeted examples, she said that Ministers of education could improve school meals, remove vending machines selling unhealthy snacks and make programmes for physical activity part of the school curriculum. Ministers of agriculture could continue to ensure the abundance and safety of food supply. And Ministers of trade could be better equipped to confront the tobacco industry when it takes legal action against governments introducing anti-tobacco measures.

“Governments cannot assume that [non-communicable diseases] are a health problem that the health sector can manage on its own. We cannot,” she said.

Delivering opening remarks, General Assembly President John Ashe said the comprehensive review took place against the “stark recognition” that non-communicable diseases are now the largest single cause of death and disability worldwide, killing some 36 million people, or 63 percent of a total 57 million in 2008. And the outlook remains grim. By 2020, the number of related deaths is expected to grow to 44 million per year.

He highlighted achievements since 2011, including endorsement by the World Health Assembly in 2013 of a Global Action Plan for the Prevention and Control of the diseases 2013-2020 as well as the adoption of a comprehensive global monitoring framework, which includes nine global targets to be achieved by 2025.

Despite these positive developments, developing countries were struggling from commitment to action and not because of lack of political will but rather lack of resources- technical and financial. The burden is disproportionately placed on the developing world, where 80 percent of global deaths from non- communicable diseases occur, said Mr. Ashe.

The health and economic burdens of non-communicable diseases severely undermine development, particularly in the Pacific and Caribbean regions where as much as 25 per cent of both populations suffer from one or more of those diseases. He said it was critical to provide sustainable financing and technical support to these regions and beyond. “Tackling [non-communicable diseases] is good for human health, as well as development,” The Assembly President decalred.

Margaret Chan, Director-General of the World Health Organization (WHO). UN Photo/Eskinder Debebe