WHO Director-General addresses high-level meeting on noncommunicable diseases
Dr Margaret Chan
Director-General of the World Health Organization
Excellencies, honourable ministers, distinguished delegates, representatives of civil society organizations, ladies and gentlemen,
The 2011 political declaration on the prevention and control of noncommunicable diseases was a watershed event. Heads of state and government formally recognized these diseases as a major threat to health, economies, and societies and placed them high on the development agenda.
Projected trends provoked deep concern, especially as poor populations, the least able to cope, are being hit the hardest. Bold commitments were made to act on multiple fronts. Prevention was put forward as the cornerstone of the global response.
The Secretary-General transmitted my progress report to you last December. We are here to take stock of this progress and gather consensus on the next steps, the priority actions needed to expedite progress.
The political declaration gave WHO a leadership role, together with several time-bound assignments. These assignments, which have been completed, established global mechanisms and a roadmap for coordinated multisectoral action and monitoring of results.
Progress within countries matters most. Some striking achievements emerge from a survey conducted by WHO last year.
Of the 172 countries reporting data, 95% have a unit or department in the Ministry of Health responsible for NCDs. Half now have an integrated operational plan with a dedicated budget. The number of countries conducting recent surveys of risk factors jumped from 30% in 2011 to 63% last year.
In other words, more and more countries are getting the basics in place. As shown in the progress report, some very cost-effective and affordable interventions have worked well in many countries.
However, the report found that overall progress is insufficient and highly uneven. This should come as no surprise.
I see no lack of commitment. I see a lack of capacity to act, especially in the developing world. Our latest data show that 85% of premature deaths from NCDs occur in developing countries.
The challenges presented by these diseases are enormous. They demand some fundamental changes in the way social progress is measured, the way governments work, the way responsibilities are assigned, and the way the boundaries of different government sectors are defined.
The fact that NCDs have overtaken infectious diseases as the world’s leading cause of morbidity and mortality has profound consequences. This is a seismic shift that calls for sweeping changes in the very mindset of public health.
Most health systems in the developing world were built for the management of brief events, like childbirth or acute infections. They were not built for the long-term management of chronic conditions with their costly and demanding complications.
Public health must shift its focus from cure to prevention, from short-term to long-term management, from delivering babies, vaccines, and antibiotics to changing human behaviours, from acting alone to acting in concert with multiple sectors and partners.
The dynamics of socioeconomic progress have changed. Much of human history was shaped by the struggle against infectious diseases, which gradually lost their grip as incomes rose and standards of living improved.
Today, the opposite is happening. Socioeconomic progress is actually creating the conditions that favour the rise of NCDs.
Economic growth, modernization, and urbanization have opened wide the entry point for the globalization of unhealthy lifestyles. Risk factors for NCDs are becoming part of the very fabric of modern society.
The obesity epidemic has been getting worse, not better, for more than three decades. Industry practices, especially the marketing of unhealthy foods and beverages to children, play a contributory role.
The article in the political declaration calling for collaboration with the private sector has not been fully implemented. Healthier food formulations are neither affordable nor accessible in large parts of the developing world. Unfortunately, the unhealthiest foods are usually the cheapest and most convenient.
As another concern, highly effective measures for reducing the harmful use of alcohol, like raising taxes on alcohol and enforcing advertising bans, are vastly underused in countries.
Ladies and gentlemen,
The health sector bears the brunt of these diseases but has very little control over their causes. The health and medical professions can plead for stronger tobacco and alcohol legislation, more exercise, and healthier diets. We can treat the diseases, but we cannot re-engineer social environments to promote healthy lifestyles.
This is another shift that needs to take place. Governments cannot assume that NCDs are a health problem and that the health sector can manage on its own. We cannot.
For prevention, the cornerstone of our response, governments need to take on a primary role and responsibility. Social environments need to change, population-wide, nation-wide. This will not happen without political commitment at the highest level of government.
Ministers of agriculture will remain primarily concerned about the abundance and safety of the food supply and the livelihoods of farmers.
Ministers of education will not automatically improve school meals, remove vending machines selling unhealthy snacks, or make programmes for physical activity part of the school curriculum.
Ministers of trade will continue to promote direct foreign investment agreements that let the tobacco industry take legal action against governments introducing strong anti-tobacco measures.
Only high-level political commitment can orchestrate the kind of broad-based collaboration needed to make substantial progress, especially on prevention. Heads of state and government are best placed to introduce coherent public policies, coordinate actions, and push for legislative support.
Unprecedented challenges need unprecedented commitments.