NEW YORK – For the first time ever, the United Nations formally recognized and set an agenda to reduce the burden of noncommunicable diseases globally. However, to many observers anticipating the historic event, the effort fell short of setting tangible targets for driving change.
At the September meeting of the UN General Assembly – the second high-level meeting ever to address a health issue since a 2001 meeting on HIV/AIDS – the UN issued a consensus document recognizing that "the global burden and threat of NCDs constitutes one of the major challenges for development in the twenty-first century, which undermines social and economic development throughout the world."
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Dr. Derek Yach
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In the consensus document, known as a political declaration, UN members pledged to promote the reduction of salts and sugars; to eliminate trans fats in foods; to increase access to affordable, quality-assured medicines and technologies; and to strengthen health care systems so they can address NCD prevention and treatment.
The UN also endorsed WHO efforts to combat smoking, to improve diet and physical activity, to reduce the harmful use of alcohol, and to halt the marketing of unhealthful foods and beverages to children.
The UN Secretary-General Ban Ki-moon urged UN representatives at the meeting to carry out the provisions of the document and to "bring NCDs into our broader global health and development agenda."
Nearly two-thirds (63%) of deaths worldwide result from NCDs such as cardiovascular disease, diabetes, chronic respiratory disease, and cancer, and nearly 80% of those deaths occur in developing countries, according to the WHO. Because half of individuals who die of NCDs are in their working-age years, the issue is recognized as an economic and developmental problem, as well as one of public health. Success will need to involve many sectors beyond health, including finance, agriculture, transportation, urban development, and trade, UN members agreed.
NCDs are "the diseases that break the bank," said Dr. Margaret Chan, WHO’s director general. They are anticipated to cost more than $30 trillion in U.S. dollars over the next 20 years, representing 48% of global gross domestic product in 2010, according to a report issued by the World Economic Forum.
Yet just days before the meeting was held, several contentious revisions to the final draft of the political declaration took place, essentially stripping the document of specific and time-bound targets.
The NCD Alliance, a lobbying coalition of global NCD-related organizations, opposed the removal of the goal to cut by 25% all preventable deaths from cancer, cardiovascular disease, diabetes, and chronic respiratory disease by 2025, an element that did not make it into the final document.
"Emblematic figures have been excised, such as the aim to reduce salt intake to less than 5 g per day," according to an editorial that blamed conflicts of interest for the lack of compulsory targets (Lancet Oncol. 2011 Sept. 22 [doi:10.1016/S1470-2045(11)70272-8]).
"Groups from the food and drink industry ... were invited to participate in the meeting, although they were excluded from any decision-making. Unsurprisingly, these industry representatives urged a voluntary, rather than a regulatory approach," the authors wrote.
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