NCDs As Global Policy Concern: WHO Approves Plan To Tackle Scourge

The prevention and control of non-communicable diseases (NCDs) stands high on the agenda of World Health Organization member countries, many of them said last week. Governments called for a multi-stakeholder approach to tackle the problem, governed by firm rules, and some asked for ways to regulate products that increase risk factors.

The 67^th World Health Assembly (WHA) took place from 19-24 May.

The report [pdf] of the WHO director general on terms of reference for a global coordination mechanism on the prevention and control of NCDs, and a report [pdf] by the director general on a proposed work plan for the global coordination mechanism covering the period 2014-2015, was examined earlier in the week

Members endorsed the terms of reference for the coordination mechanism and noted the work plan with some amendments. The work plan included terms of reference for a series of working groups under the mechanism.

The focus of the global action plan for the prevention and control of NCDs 2013-2020 is on four types of NCDs: cardiovascular diseases, cancer, chronic respiratory diseases and diabetes, and four shared behavioural risk factors: tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol.

Amendments to Work Plan

According to the WHO report, the work plan “aims to facilitate and enhance the coordination of activities, multi-stakeholder engagement and action across sectors at local, national, regional and global levels, in order to contribute to implementation of the global action plan for the prevention and control of noncommunicable diseases 2013–2020.”

A number of amendments were proposed to the work plan, most of them by Brazil. In particular, Brazil asked that members of working groups be chosen from a roster of experts proposed by member states, that each working group be co-chaired by two representatives of two member states, one from a developed country and one from a developing country, to be appointed in consultation with member states. Brazil also suggested that a briefing for member states be held after each meeting of the working groups.

A number of countries supported Brazil’s amendments to the work plan, such as South Africa, China, Colombia, New Zealand, and Ecuador.

A proposed framework governing the engagement of non-state actors (private sector, international business groups, nongovernmental organisations, foundations, and academics) was a key topic of discussion at this year’s WHA.

Multi-stakeholder Approach, Non-State Actors

A number of developed and developing countries underlined the importance of the involvement of non-state actors in the fight against NCDs.

Algeria, on behalf of the African region, said the burden of non-communicable diseases is particularly high in Africa. Particular attention should be paid to the fact that capacities of countries will have to be boosted if the African region is to meet the challenges of the fight against NCDs.

Special attention should be paid to access to drugs and to innovative mechanisms which will guarantee access to available drugs, he said.

Greece on behalf of the European Union said, “Engaging with non-state actors, including NGOs and businesses, is expected to tap into the potential for all partners to make a significant contribution to reduce the NCD burden.”

The EU added that “WHO and public health must be protected from undue influence by any form of real, perceived or potential conflict of interest and in line with the ongoing discussion on the WHO^s engagement with non-state actors.”

The United States said “the global coordination mechanism should encourage the meaningful and constructive engagement of non-state actors in all relevant sectors in implementing evidence-based strategies.” Canada also supported a multisectoral and a multi-stakeholder approach.

Brazil said the WHO needs a well-structured process of dialogue to be established with different actors and stakeholders for an immediate implementation of the WHO global action plan. In Brazil, the delegate said, fruitful dialogue has been established with industry and civil society alike and “the same can be achieved at the global level.”

Kenya said while it is important to engage with non-state actors, due diligence should be exerted to avoid “actors whose products and policies may erode, undermine, jeopardize or ultimately circumvent policies envisaged in this action plan.”

Risk Factors, Food Industry Influence

Some countries underlined the fact that multinational food and beverage companies through global advertising and lobbying might hinder efforts to prevent and control NCDs.

Malaysia said the implementation of many cost-effective interventions to prevent NCDs, as recommended by the WHO, rely on legislation and regulatory changes, which might be hampered by regional and bilateral trade agreements. This might be the case, in particular, because those agreements open the domestic market for entry of transnational food companies with global advertising, which can affect populations’ diets.

Trade agreements are usually negotiated through trade ministries, the delegate said, and health ministries have to advocate to their counterparts. “There is a need to align profit-oriented activities more closely to public health goals,” he said.

Thailand said that free markets often give way to unethical practices by industry, which weakens national health policies, and quoted WHO Director General Margaret Chan’s opening statement that “something is fundamentally wrong in this world when a corporation can challenge government policies introduced to protect the public from a product that kills.”

Trade and investment agreements can reduce policy space, said the delegate, as the population is exposed to products increasing the risk factors, such as alcohol, high-calorie food and beverages.

The Philippines and Mexico mentioned taxes on high calorie food and beverages.

Industry, Civil Society Concerned

NGO statements at the WHA can be found on the WHO website.

In their statement, the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA) criticised the terms of reference. From their perspective, “a global coordination mechanism should have been able to operate under clear objectives and deliverables that would be time-bound, sufficiently resourced and outcome-focused.”

“Multi-stakeholder, multisectoral action is a too-much-needed component in the fight against NCDs,” IFPMA said. “The recent partnerships and activities initiated by many international organisations and non-state actors, including the IFPMA, have proven the value of these approaches.”

The Union for International Cancer Control (UICC) expressed “great disappointment” with the terms of reference. The structure is not fit for purpose, the representative said, and “fails to ‘walk the talk’ on multisectoral action,” as there is little opportunity for participation for other stakeholders in the structural components of the coordination mechanism and its working groups.

Medicus Mundi International, meanwhile, said in their statement that the control of NCDs relies on national and global policies that “constrain the tobacco, alcohol, food and beverages industries, from promoting their products in ways that are damaging to public health.”

“A major barrier to adopting such policies lies in the power of these industries to influence governments and the decisions adopted by WHO in advising governments,” they said.