Elsevier

The Lancet

Volume 377, Issue 9775, 23–29 April 2011, Pages 1438-1447
The Lancet

Health Policy
Priority actions for the non-communicable disease crisis

https://doi.org/10.1016/S0140-6736(11)60393-0Get rights and content

Summary

The UN High-Level Meeting on Non-Communicable Diseases (NCDs) in September, 2011, is an unprecedented opportunity to create a sustained global movement against premature death and preventable morbidity and disability from NCDs, mainly heart disease, stroke, cancer, diabetes, and chronic respiratory disease. The increasing global crisis in NCDs is a barrier to development goals including poverty reduction, health equity, economic stability, and human security. The Lancet NCD Action Group and the NCD Alliance propose five overarching priority actions for the response to the crisis—leadership, prevention, treatment, international cooperation, and monitoring and accountability—and the delivery of five priority interventions—tobacco control, salt reduction, improved diets and physical activity, reduction in hazardous alcohol intake, and essential drugs and technologies. The priority interventions were chosen for their health effects, cost-effectiveness, low costs of implementation, and political and financial feasibility. The most urgent and immediate priority is tobacco control. We propose as a goal for 2040, a world essentially free from tobacco where less than 5% of people use tobacco. Implementation of the priority interventions, at an estimated global commitment of about US$9 billion per year, will bring enormous benefits to social and economic development and to the health sector. If widely adopted, these interventions will achieve the global goal of reducing NCD death rates by 2% per year, averting tens of millions of premature deaths in this decade.

Introduction

The spread of non-communicable diseases (NCDs) presents a global crisis; in almost all countries and in all income groups, men, women, and children are at risk of these diseases.1 Worldwide, substantial gains have been achieved in economic growth, health, and living standards in the past century. This progress is now threatened by crises of our own creation—climate change, finance and food insecurities,2 and the crisis in NCDs, principally heart disease, stroke, diabetes, cancers, and chronic respiratory disease.3

The UN High-Level Meeting (UN HLM) on NCDs in September, 2011,4 provides an unrivalled opportunity to create a sustained rights-based global movement to tackle NCDs,5 analogous to the UN General Assembly Special Session on HIV infection and AIDS a decade ago, which concluded that dealing with the disease was central to the development agenda.6 Political leadership at the highest level, with international coordination and consensus for priority actions and interventions are crucial responses to the crisis in NCDs and to facilitate national action.7 A successful meeting will generate high-level and sustained political commitments to the priority actions needed globally and nationally to prevent and treat NCDs. It will ensure that NCDs become central to the long-term global development agenda.

In the interests of promoting a unified political message and a common voice, The Lancet NCD Action Group—an informal collaboration of academics, practitioners, and civil society organisations—and the NCD Alliance—comprising four key international non-governmental organisations (Union for International Cancer Control, International Union Against Tuberculosis and Lung Disease, International Diabetes Federation, and World Heart Federation)—propose a shortlist of priority actions for NCDs: political leadership at the highest level, globally and nationally; immediate implementation of the priority interventions; building international coordination and consensus for priority actions and interventions; and establishment of monitoring, reporting, and accountability mechanisms for assessment of progress.

In this report, we synthesise and expand the evidence reported in four series in The Lancet in the past 5 years (panel 1) and focus on what matters most for NCDs.18, 19, 20, 21 These reports, initiated by WHO and produced in collaboration with almost 100 leading scientists, support WHO's action plan for the prevention and control of NCDs.22 Here we address the topics of three round-table discussions proposed in the UN Modalities Resolution at the UN HLM: the NCD crisis; priority actions; and international cooperation. We conclude with a set of recommendations for the outcomes document from the UN HLM.

Section snippets

NCD burden

The global burden of NCDs is increasing (panel 2), and is a major barrier to development and achievement of the Millennium Development Goals (MDGs). The underlying causes of these diseases are shared and modifiable risk factors; they are also major causes of health inequalities.25

Shared risk factors and their causes

The main risk factors for NCDs for individuals are well known and are similar in all countries.26 Tobacco use, foods high in saturated and trans fats, salt, and sugar (especially in sweetened drinks), physical

Selection criteria

The priority interventions chosen for immediate attention need to meet rigorous, evidence-based criteria: a substantial effect on health (reduction in premature deaths and disability); strong evidence for cost-effectiveness; low costs of implementation; and political and financial feasibility for scale-up. There are many possible interventions for NCDs.42, 43 However, the most robust available evidence for the effectiveness and effect of interventions is to lower the prevalence of the major

Key to progress

Although policies, strategies, plans, and calls to action are common in international and national reports,16, 63, 64 implementation has been slow. The reason for the delay is partly the pressing nature of other global health issues, and the long time for the messages about the global burden and preventability of NCDs to be developed and effectively disseminated. To achieve visibility on the global health agenda is difficult, but recognised ways for making progress do exist.15, 65, 66

A

Conclusions

Many possible actions for the prevention and treatment of NCDs could be discussed in the lead-up to the UN HLM on NCDs in September, 2011. A clear and focused set of requests for consideration at the meeting will have the best chance of success.66 The principles of simplicity and focus have informed this report, with the secure evidence base used to select the priority interventions for NCD, which will also have enormous ancillary benefits within the health sector and reduce comorbidities (

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