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Time to Deliver in 2018: Bolder Commitments and Action Needed to Reverse the Tide of Noncommunicable Diseases and Mental Health Disorders

6 June 2018

The NCD Alliance and over 200 civil society organisations welcome the Report of the WHO Independent High Level Commission on Noncommunicable Diseases (NCDs), Time To Deliver, launched on Friday 1 June in Geneva, Switzerland, ahead of crucial negotiations for the United Nations High-Level Meeting on NCDs (UN HLM) taking place in New York this coming September.

The Commission’s report draws a line in the sand on the need for political leaders to accept that progress to date has been severely inadequate and out of step with the growing burden of NCDs and mental and  neurological health. All evidence points to the same unpleasant reality: that if the current pace of progress continues unabated, by 2030 the agreed Sustainable Development Goal (SDG) target to reduce NCD mortality will remain a distant reality, failing millions of people and challenging the achievement of all other SDG targets and goals within and beyond health.

The consequences of these projections are real and devastating. Millions more people and communities will have lost loved ones of all ages to avoidable death. Millions more will have witnessed the carnage of amputations and disability that these conditions cause when undiagnosed and untreated. Millions more will have struggled with the entrenched poverty and untold misery that are often the product of weak health and social protection systems.

The 40 million people who die every year due to NCDs and are repeatedly referenced in reports are not just numbers on a page. They are people, with families and stories, and a right to the enjoyment of the highest attainable standard of physical and mental health. But accidents of geography and poverty are still tragically cutting lives short.

As civil society organisations and people living with, affected by, or at risk of NCDs, we are all too familiar with the realities on the ground and the consequences of political inertia to people, communities and the most vulnerable. Collectively, we have had enough of political inaction and the glacial progress on NCDs. We are impatient for change, and we not only join the Commission in saying is it time for our governments to deliver, but that delivery on commitments is overdue and vital. If countries want to avoid sleepwalking into a sick future, the 2018 UN High-Level Meeting on NCDs must result in bold commitment and action.

Strengths of the HLC Report

Civil society strongly supports the Commission’s recommendations to governments to scale up resources  commensurate with the burden of NCDs, adopt a life course and human rights-based approach and sharpened focus on implementing a priority set of evidence-based and cost-effective interventions, galvanise more effective and meaningful engagement with civil society, integrate health promotion and the prevention, treatment and care of NCDs and mental health services into universal health coverage (UHC) packages, and establish stronger accountability for commitments and resources.

A highlight of the report is the Commission’s call for ownership of national NCD responses from the very top – Prime Ministers and Presidents. This is crucial, given the causes and solutions for NCDs extend well beyond the health sector and require a whole-of-government response, and timely given that we can currently count on two hands the number of Presidents and Prime Ministers who have been courageous and visionary when it comes to their citizens’ health. We implore leaders to heed the call to step up and truly demonstrate commitment to putting people first.

We are particularly pleased to see the recognition of the importance of civil society at all levels for NCD prevention and control, and the need to invest in strengthening civil society and alliances, particularly in low and middle-income countries. The rationale for investing in civil society is clear: a vibrant and strong NCD civil society movement capable of delivering its four primary roles—advocacy, awareness raising, improving access, and accountability—are prerequisites for progress.

Another highlight is the specific focus on accountability. For too long, accountability has been an afterthought in the response, rather than a driving force for political and programmatic change. As a result, the last decade has seen important commitments and declarations made, but a significant lack of implementation and follow up. Strong national surveillance and accountability systems are critical to meaningfully assess progress and ensure the most effective use of limited resources. The inclusion of initiatives such as NCD  Countdown is also an important step forward for accountability, drawing upon the experiences of women and children’s health and HIV/AIDS of the value that independent accountability can provide and the vital role of civil society. Civil society shadow reports can also be a key instrument to hold governments to account.

Where the HLC Report Falls Short

We believe the Commission’s report provides a valuable framing for the upcoming negotiations of the UN HighLevel Meeting on NCDs. However, it falls short on a number of issues that are crucial if the UN HLM is to be a true turning point in the response to NCDs. We highlight five specific points:

1. Put people first and meaningfully involve people living with NCDs and young people: Whilst there are recommendations on civil society and the importance of meaningfully involving people living with NCDs (PLWNCDs) and youth, we believe the report should have gone further. In many countries, involvement of PLWNCDs and civil society including youth remains tokenistic at best, and completely absent at worst. Drawing upon the experience of HIV/AIDS, we call upon governments to commit to developing a set of global principles and standards for involvement of PLWNCDs and young people. These principles would aim to realise the rights of PLWNCDs and the voices of the next generation, including their right to participation in decision-making processes that affect their lives, as well as seek to enhance the quality, effectiveness and sustainability of the NCD response. Young people are agents of change, and should be  empowered and enabled to participate in decision-making processes at all levels.

2. Call out the commercial determinants of health as a major obstacle to progress: The report sidestepped the well-documented history of unhealthy commodity industries (big tobacco, alcohol, and food and beverage) of infiltrating public health organisations, subverting science, and interfering with and undermining public policies that promote health. The report recommends that “a fresh relationship be explored with the food, non-alcoholic beverage, catering, technology, transportation, and media industries,” and we agree that a new kind of relationship is needed due to the poor track record of voluntary commitments and self-regulation. The striking contrast between the Commission’s references to avoiding engagement with the tobacco industry with its explicit encouragement for engagement with industries such as alcohol, and food and beverage is counterproductive and will empower these industries to assert a position of credibility in policymaking. The Commission failed to acknowledge that, even in the absence of a legal treaty that prescribes interactions between government and the industry, the same principles should apply to engagement with other industries whose commercial interests are at odds with public health. We call on governments to learn from past experiences and adopt effective regulatory measures, as well as establish and enforce strict engagement principles that manage conflicts of interest, ensure transparency, limit private sector involvement and influence on public health policymaking, and ensure that any engagement is restricted to policy implementation.

3. Adopt a comprehensive approach to sugar, tobacco and alcohol taxes (STAX): The Commission’s report encourages governments to implement fiscal measures including raising taxes on tobacco and alcohol, but falls short of explicitly mentioning taxation of sugar-sweetened beverages (SSBs). This runs contrary to WHO’s evidence-based guidance, which WHO Director-General Dr Tedros as consistently reinforced. Sugar, added sugars, and, in particular, sugar-sweetened beverages (SSBs), are leading drivers of the
obesity and NCD epidemic. There is promising evidence from many countries to demonstrate that taxation on SSBs should be included as part of a comprehensive approach to NCD prevention and control that both reduces consumption and provides a source of domestic revenue. Civil society urgently calls for governments to take a step further at the UN HLM and adopt a more comprehensive approach to
taxation – including of sugar, tobacco and alcohol (referred to as STAX). STAX are gaining more attention as an indispensable policy tool to improve public health, save millions of lives, and generate resources to invest in health, nutrition and other sustainable development priorities.

4. Tackle the NCD risk factors in a comprehensive manner, ensuring not to overlook two particular areas:

  • Take a tougher stance on alcohol control: Harmful use of alcohol remains marginalised in the report in spite of its severe threat to public health worldwide, with links to NCDs, gender-based violence, road traffic injuries, and mental health disorders. Taxation and the regulation of marketing and sales are critically important interventions that need to be scaled up, but have been consistently blocked by the alcohol industry in many countries.
  • Build upon the momentum for action on physical activity: The new WHO Global Action Plan on Physical Activity (GAPPA) seeks to help more people be active for a healthier world by recommending 20 enabling actions for diverse stakeholders including multiple government sectors. GAPPA exemplifies the need to optimise the UN HLM and the work of the HLC to make bold commitments on co-benefit solutions for people, the planet and prosperity.

5. Maintain a balanced approach to prevention and treatment in the NCD response: Civil society welcomes the inclusion of a dedicated recommendation on health system strengthening and UHC for NCD prevention and control. It will be impossible to achieve SDG 3.4 without addressing the gaping chasm in access and availability to NCD diagnosis, treatment and care services for millions of people living with NCDs today in LMICs. It will be crucial that UN HLM deliberations balance both prevention and treatment. In addition, for UHC to truly deliver for people living with NCDs, palliative care and rehabilitative services must be included, and services must be strengthened at secondary and tertiary levels in addition to beyond primary care.

The High-Level Commission has provided important guidance and recommendations into the UN HLM process. Civil society is ready to work with WHO and governments in the lead up to the HLM and beyond to build on these recommendations and set the bar higher for people at risk of and living with NCDs worldwide. The clock is ticking.  It is well past the time to deliver on NCD prevention and control and mental health, to end preventable suffering and death, and to stand up to the powerful industries that shape the environments in which we live.

Co-signing organisations as of 19:00 CET Wednesday 6 June:

1 Access Chapter 2
2 ACT Health Promotion
3 Action Nepal
4 Action on Smoking and Health ASH US
5 Africa & Middle East Congress on Addiction (AMECA)
6 African Institute for Health and Development
7 AIDS Accountability International
8 Alcohol & Drug Information Centre (ADIC) – India
9 Alcohol and Drug Information Centre (ADIC)
10 Aliança Pela Alimentação Adequada e Saudável – Alliance for Healthy Diets
11 Alianza Antitabaco Ecuador
12 Alianza Juvenil Antitabaco Ecuador
13 Alzheimer’s Disease International
14 Alzheimer’s South Africa
15 Amardeep India
16 American Heart Association
17 Antigua and Barbuda Diabetes Association
18 APDP Diabetes Portugal
19 Aprofe – Associação Pró – Falcemicos – Brazil
20 Asia Pacific Cities Alliance for Tobacco Control and NCD Prevention (AP-CAT)
21 Asociación Argentina de Medicina y Cuidados Paliativos
22 Asociacion Boliviana de Cuidados Paliativos
23 Asociación Colombiana de cuidados paliativos ACCP
24 Asociacion Dominicana para el Estudio Tratamiento de Dolor y Cuidados Paliativos
25 Asociación Latinoamericana de Cuidados Paliativos
26 Asociación Omega
27 Asociacion Panamena de Cuidados Paliativos (APCP)
28 Asociacion Paraguaya de Medicina y Cuidados Paliativos
29 Association of General Practitioners of Jamaica
30 Association of Palliative Care of Kyrgyz Republic
31 Australian Chronic Disease Prevention Alliance
32 Barbados Association of Palliative Care
33 Beat Rheumatic Heart Disease Zambia
34 Belize Cancer Society
35 Bermuda Cancer and Health Centre
36 Bindindissamtökin IOGT á Íslandi
37 Brain Society
38 Bwalo Global Development Trust
39 Cancer Association of South Africa
40 Cancer Soceity of Maldives
41 Cancer Society of Finland
42 Caribbean College of Family Physicians Jamaica Chapter
43 Cayman Islands Cancer Society
44 Celiapenny Foundation for the Prevention of Malnutrition in Africa
45 Centar za edukaciju mladih
46 Center Action against Alcoholism – Mexico
47 Center for Community and Educational Responses CRECE
48 Center Of Excellence For Tobacco Control And Lung Health
49 Centre for Epidemiology and Health Development
50 Centre for Youth Work
51 Coalition for Access to NCD Medicines & Products
52 Conselho Federal de Nutricionistas (CFN)
53 Consortium for Nonc Communicable Diseases Prevention Africa (CNCD-A)
54 ContraPESO
55 Dementia Care Initiatives
56 Diabetes Philippines, Inc.
57 Diabetis Society of Maldives
58 Dominica Diabetes Association
59 East Africa Alcohol Policy Alliance
60 East African Health Platform (EAHP)
61 East African NCD Alliance (EANCDA)
62 Eastern Mediterranean NCD Alliance
63 Egypt Health Foundation
64 EMR-NCD Alliance
65 European Chronic Disease Alliance
66 European Public Health Alliance (EPHA)
67 Faculdade de Ensino Superior da Amazônia Reunida (FESAR)
68 FDI World Dental Federation
69 Foppesp – Forum dos portadores de patoligias do Estado de São Paulo
70 Forum of International Respiratory Societies
72 Foundation for Alcohol Research and Education
73 Friends Of Cancer Patients UAE
74 Fundación Ellen Riegner de Casas
75 Fundación Salud “Dr. Augusto Turenne”
76 Ghana NCD Alliance
77 Global Alcohol Policy Alliance
78 Global Mental Health Peer Network
79 Grenada Heart Foundation
80 Growth Dimensions Africa (GDA)
81 Health and Global Policy Institute (HGPI)
82 Health Horizons International
83 HealthBridge Foundation of Canada
84 HealthJustice Philippines
85 Healthy Caribbean Coalition
86 Healthy India Alliance
87 Healthy Latin America Coalition / Coalición Latinoamérica Saludable CLAS
88 Heart & Stroke Foundation of Barbados
89 Heart and Stroke Foundation South Africa
90 Hope for Future Generations Ghana
91 Hospice Africa
92 HRIDAY (Health Related Information Dissemination Amongst Youth)
93 Humanity&Inclusion
95 Innovating Health International
96 Institute of Alcohol Studies
97 Institute of Leadership and Development
98 Instituto Desiderata
99 Inter-American Heart Foundation
100 Inter-American Heart Foundation Mexico
101 International Federation of Medical Students’ Associations
102 International Society for Physical Activity and Health (ISPAH)
103 International Society of Nephrology
104 International Union for Health Promotion and Education (IUHPE)
105 IOGT International
106 IOGT Switzerland
107 IOGT-NTO Movement Sweden
109 Iringa Development of Youth Disabled and Children Care (IDYDC)
110 Jhpiego
111 John E Sabga Foundation for Pancreatic Cancer
112 Kantonaler Abstinentenverband Zürich
113 Kenya Hospices and Palliative Care Association (KEHPCA)
114 Kenya Network Of Cancer Organizations
115 Kenyan Heart National Foundation (KHNF)
116 King Hussein Cancer Foundation
117 Kuwait Oncology Society
118 Lina and Green Hands Society
119 Maldives NCD Alliance
120 Medopal
121 Mental Health Awareness Foundation of Maldives
122 Mesa Colombiana por las Enfermedades Crónicas
123 Mexican Association for the Fight against Cancer
124 Mexico Salud-Hable Coalition
125 Michael and Francisca Foundation
126 Movement for Global Mental Health
127 Muhammadiyah Students Association
128 Nada India Foundation
129 National Alliance for Tobacco Control ALIENTO
130 National Heart Foundation of Bangladesh
131 NCD Alliance Indonesia
132 NCD Alliance Malawi
133 NCD Alliance Nigeria
134 NCD Child
135 NCD Malaysia
137 Networking HIV & AIDS Community of Southern Africa NPC (NACOSA)
138 New Vois Association of the Philippines
139 Nigeria Alcohol Prevention Youth Initiative
140 Nigerian Cancer Society
141 Nigerian Heart Foundation
142 No Tobacco Community, Indonesia
143 Non Communicable Diseases Alliance of Kenya
144 Observatory on Food and Nutrition Security Policies – University of Brasilia
145 Oncology Nurses Chapter
146 ONG Santé Diabète
147 People Against Drug Dependence and Ignorance
148 People’s Health Foundation
149 Philippine Alliance of Patient Organizations
150 Population Services International (PSI)
151 Portuguese Observatory of Palliative Care
153 Research and Training Center for Community Development (RTCCD)
154 Reseau Jeunesse Population et Developpement du Senegal RESOPOPDEV
155 RISE (St. Lucia) Inc.
156 Royal Health Awareness Society
157 Salud Crítica
158 Saudi Diabetes & Endocrine Association
159 SECPAL (Palliative Care Spanish Society)
160 Smoke Free Jakarta
161 Sociedad Hondureña para el estudio y tratamiento del dolor
162 Sociedad médica de Cuidados Paliativos Chile
163 Sociedad Peruana de Cuidados Paliativos
164 Sociedad venezolana de Medicina Paliativa
165 South African Federation for Mental Health
166 South African NCD Alliance
167 Southeast Asia Tobacco Control Alliance (SEATCA)
168 Southern African Alcohol Policy Alliance
169 Sport For All Federation I.R. Iran
170 St Vincent & The Grenadines Diabetes & Hypertension Association Inc.
171 St. Lucia Diabetes & Hypertension Association
172 StopDrink Network
173 Stroke Action Nigeria
174 Stroke Action UK
175 Stroke Association Support Network – Ghana
176 Stroke Care International
177 Tanzania NCD Alliance
178 Taskforce on Women & NCDs
179 Tata Memorial Hospital
180 The American Cancer Society, Inc.
181 The American College of Cardiology
182 The Barbados Association of Endometriosis and PCOS
183 The George Institute for Global Health
184 The Heart Foundation of Jamaica
185 The Jamaica Coalition for Tobacco Control
186 The National Cancer Society of Malaysia
187 The Wellbeing Initiative
188 Tiny Hearts of Maldives
189 Tobacco Control Support Centre, Indonesian Public Health Association
190 Tobacco Free Association of Zambia
191 UAE Genetic Diseases Association
192 UEDA
193 Uganda Cancer Society
194 Uganda Youth Development Link (UYDEL)
195 UK Health Forum
196 Vietnam NCD Alliance (NCD-VN)
197 Vision for Alternative Development
198 Vital Strategies
199 Voices of Community Action & Leadership (VOCAL-KE)
200 West African Alcohol Policy Alliance (WAAPA)
201 Women’s Coalition Against Cancer
202 Women’s Coalition Against Cancer in Malawi
203 World Cancer Research Fund International
204 World Child Cancer
205 World Stroke Organization
206 Worldwide Hospice Palliative Care Alliance
207 Yellow Warriors Society Philippines
208 Young Professionals Chronic Disease Network (YP-CDN)
209 Youth Against Alcoholism and Drug Dependency, Zimbabwe
210 Youth SRH Network Uganda
211 Zambia Heart and Stroke Foundation
212 Zambia Non Communicable Diseases Alliance

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