Ambassadors, invited speakers, experts in public health, representatives of sister UN agencies, professional associations, civil society, and philanthropies, ladies and gentlemen,
Welcome to this high-level dialogue where you will be discussing the response to noncommunicable diseases as an issue for development cooperation and a route to poverty reduction.
The challenges facing public health have changed dramatically in character and complexity since the start of this century, when NCDs were not included among the Millennium Development Goals.
Since then, a number of events and reports, and a host of research studies and economic estimates have increased the visibility of NCDs as a development issue and caused several long-standing assumptions to crumble.
Fifteen years into the 21st century, the health community is grappling with some game-changing statistics.
Worldwide, NCDs have overtaken infectious diseases as the leading cause of mortality. This shift challenges traditional development thinking, which has long focused primarily on infectious diseases and maternal and child mortality as priorities for international action. We continue to support this focus, but need to make space for additional challenges.
Around 70% of the world’s poor now live in middle-income countries, where economic growth and modernization have opened wide the entry point for the spread of unhealthy lifestyles. This is likely the first time in history that economic growth threatens to damage health rather than improve it.
NCDs can no longer be conceptualized as a rich-country problem. WHO estimates that 80% of the burden from NCDs now falls on low- and middle-income countries, where people develop these diseases earlier, fall sicker, and unfortunately die sooner than their counterparts in wealthy nations.
Nor can we continue to think of NCDs as the killers of the old and frail. WHO estimates that NCDs are responsible for 14 million premature deaths in the developing world each year.
In some developing countries in Asia, the number of deaths from cardiovascular disease before the age of 55 is twice that in wealthy countries. The reference to type 2 diabetes as “adult onset diabetes” is no longer apt, as so many children are now being diagnosed with this disease. Just two decades ago, type 2 diabetes was almost never seen in children.
The responsibility for the rise in NCDs does not fall on individuals who choose to eat, smoke, and drink too much or opt for a sedentary lifestyle. The responsibility falls on the environments in which these choices are made.
Can children be blamed for an addiction to nicotine when single cigarettes are sold at the gates of their schoolhouse? Can parents be blamed for their overweight children when cities have no green spaces or the crime rate is so high that children are not safe playing outdoors? For the millions of people living in so-called “urban food deserts”, healthy eating is simply not an option.
Ladies and gentlemen,
This is the first big challenge. The evidence, statistics, and arguments you put forward for international cooperation must stress the need for policy solutions that shape social environments. These solutions must be supported at the highest level of government, and they need to be put in place through a whole-of-government approach.
A second big challenge is competition. With 17 goals and 169 targets currently proposed for the post-2015 development agenda, this is competition for a sliver or some crumbs from the pie, not a piece.
You are being asked to sharpen the evidence showing the two-way links between NCDs and poverty. You are being asked to make a stronger case for viewing the prevention and control of NCDs as an explicit poverty-reduction strategy.
You are being asked to provide an inventory of international agencies that have integrated NCDs into their development policies and extract the lessons learned. We want to hear your proposals about how official development assistance can be used to strengthen prevention and control, yet without compromising funding for other health priorities.
We ask you to do all of these things because of your expertise, knowledge, and experience.
A third big challenge is the opposition. This is opposition from powerful economic operators who strongly oppose any regulatory control or restrictions on their marketing of health-harming products.
This is a formidable obstacle to prevention. Economic power readily translates into political power. We rely on civil society for support in many areas, but most especially in this one.
The public health community has some tools in hand to respond to these challenges. The 2011 UN Political Declaration on NCDs sets out some compelling arguments.
It positions these diseases as one of the major challenges for development in the 21st century. It points out their threat to economies and their contribution to inequalities.
It gives the primary role and responsibility of responding to these challenges to governments. And it underscores how strongly prevention and control depend on the engagement of multiple non-health sectors.
To guide work, we have an action plan through 2020, a monitoring framework with 9 global targets, and a set of effective and affordable interventions, known as “best buys”, that can make a difference in any resource setting.
As the root causes of NCDs lie beyond the direct purview and responsibility of the health sector, combatting these diseases is a complex task involving multiple sectors. Here, too, we have support from the Global Coordination Mechanism and a UN Interagency Task Force.
Ladies and gentlemen,
Let me conclude by repeating two points made in the discussion paper prepared for this meeting.
First, the UN General Assembly’s 2014 progress review found no lack of high-level government commitment to NCDs. But it witnessed, in far too many countries, a lack of capacity to act, largely because of insufficient national expertise in low- and middle-income countries. International cooperation can provide this expertise.
Second, efforts to prevent and control NCDs depend on a well-functioning health system, ideally one that aims to reach universal health coverage. Any look at the interactions between NCDs and poverty must also look at ways to increase access to care and reduce the catastrophic medical bills that push so many millions of families below the poverty line each year.
Thank you.