The UN High-level Meeting (HLM) on 27 September 2018 marked the latest opportunity for the leaders of the international community to review progress on non-communicable diseases (NCDs) under the 2030 Agenda for Sustainable Development and the Sustainable Development Goals (SDGs).
Addressing the burden of non-communicable disease constitutes an integral part of achieving SDG 3, “Good Health and Well-Being”. Premature deaths (before 70 years of age) owing to Cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes totalled about 12.5 million in 2016, accounting for 43 per cent of all premature deaths globally. However, there were 27.3 million deaths from all NCDs in all people aged less than 80. The target set out in SDG 3 is to reduce premature mortality from non-communicable diseases, through prevention and treatment, by one-third by 2030. SDG 3 also notes that indoor and ambient air pollution is the greatest environmental health risk. Household air pollution from cooking with unclean fuels or inefficient technologies leading to an estimated 4.3 million deaths worldwide in 2012, while ambient air pollution from traffic, industrial sources, waste burning or residential fuel combustion resulted in an estimated 3 million deaths.
The final agreed text from the HLM has been eliciting a number of responses. The text reiterates governments’ commitment to the 2030 Agenda goal of reducing deaths from non-communicable diseases by one-third, and reaffirms the Addis Ababa Action Agenda of the Third International Conference on Financing for Development. It acknowledges that, at present, commitments and progress made towards the prevention and control of NCDs are insufficient to put governments on track to meet SDG target 3.4 – it makes a number of recommendations going forward, and sets the next comprehensive review for 2025.
The NCD Alliance is one of the groups that have released a review of the proposals, focused on several key shortcomings.
“We are particularly concerned at the lack of accountability mechanisms to track, measure and report on progress on the agreed targets for 2025 and 2030,” said Katie Dain, CEO of the NCD Alliance and Board Member of the Defeat-NCD Partnership.
“We also deplore the absence of references to effective WHO Best Buys and policy measures like sugar, alcohol and tobacco taxes (STAX), and the extremely long timeline between now and the next proposed HLM, which not only throws the gate wide open for prolonged procrastination and further preventable suffering and loss of life, but also squanders any opportunity for the world’s political leaders to realign the current trajectory of progress on NCD prevention and control if governments remain off track to achieving global targets agreed for 2025.”
Kent Buse, Chief of Strategic Policy Directions at UNAIDS and a member of Friends of the UN High-Level Meeting on NCDs, also criticised the lack of references to WHO Best Buys and other approaches to regulating commercial challenges around NCDs.
According to the NCD Alliance, meeting the SDG 3 targets will require analysis of unmet commitments made in the outcome documents of the 2011 and 2014 UN HLMs on NCDs, as well as examination of fiscal measures and the use of price and taxation as effective public health policies. Other NCDs such as renal, oral and eye diseases, as addressed in the Report of the WHO High-level Commission on NCDs, must be monitored as well. Independent and transparent accountability mechanisms are needed, as is a new call to action on the engagement and responsibilities of the private sector, and a commitment to safeguard against industry interference and incompatible partnerships at national and UN levels.
Finally, there must be recognition that, while lifestyles can have a significant impact on the prevalence of NCDs, people cannot make healthy choices if the environments in which they live do not provide such choices. This is one area in which SDG 3.4 connects to other goals, and presents opportunities for synergistic approaches to development.
As the text states in Paragraph 3, “health is a precondition for and an outcome and indicator of all three dimensions of sustainable development.”
Healthy choices in diet are only possible when good food is available and affordable – so SDG 1, No Poverty, and SDG 2, Zero Hunger, are inseparable from SDG 3. The need for wide understanding of causes and treatment of NCDs, both among the general public and health practitioners, necessitates linkages with SDG 4, Quality Education, as well as SDG 5, Gender Equality, and SDG 10, Reduced Inequalities. By creating systems and structures to reduce the burden of NCDs, countries can maintain healthier workforces able to fulfil SDG 8, Decent Work and Economic Growth, SDG 9, Industry, Innovation and Infrastructure, and SDG 12, Responsible Consumption and Production.
SDG target 3.8 establishes the need for universal access to healthcare and medicines, and of course NCDs are a prominent concern for advocates of universal coverage. The creation of the Defeat-NCD Marketplace helps to move this goal forward.
A great deal of progress is required to bring the kinds of health services needed by sufferers of NCDs in disadvantaged regions, and to ensure that, when care is made available, the sufferers themselves (or their families) are not left to bear the full burden of cost for their treatment.