Helen Clark: Opening Statement at the United Nations High-Level Meeting to Undertake the Comprehensive Review and Assessment of the Progress Achieved in the Prevention and Control of NCDs
Helen Clark, UNDP Administrator
High-level Meeting to Undertake the Comprehensive Review and Assessment of the Progress Achieved in the Prevention and Control of NCDs
United Nations, New York
I am delighted to be speaking alongside my colleague Dr. Margaret Chan, Director General of WHO, at this High Level Meeting, which aims to assess progress made in the prevention and control of non-communicable diseases (NCDs) since the September 2011 Political Declaration. As UNDP Administrator and Chair of the UN Development Group, I acknowledge fully that the major challenge which NCDs pose to public health is also a challenge to human development overall.
Health is inseparable from human development. The great health challenges of today – among them infant, child, and maternal mortality, malaria, HIV, and NCDs – all impact on the capacity of people to survive and thrive. Advancing better health is a gateway to development progress. And development progress is a gateway to improving health. It is vital that the social determinants of health are addressed.
For too long NCDs were regarded as a problem for high-income countries. Thus, the ways in which they impede development progress and impact on the lives of the poorest people have yet to be fully addressed. The 2011 Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases did much to correct misperceptions about NCDs by explicitly noting that developing countries are home to eighty per cent of the world’s NCD-related deaths.
Today, low and middle-income countries are bearing the brunt of NCDs. Therefore, understanding the far-reaching development consequences of this is very important. For example, for lower and middle income countries, economic costs from the four main NCDs [cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes] are predicted to exceed US$7 trillion between 2011 and 2025. This is roughly equivalent to 500 billion US dollars per year, or four per cent of the Gross Domestic Product of low- and middle-income countries in 2010.
Looking ahead, it will be critical to understand the changing patterns of NCD distribution, and to ensure that all relevant actors are involved and adequate resources are made available to combat this disease epidemic.
Understanding the Trends
With respect to disease distribution overall, disparities in health outcomes tend to mirror existing inequalities and inequities within and between countries. This also holds true for NCDs, with the disease burden falling on the most vulnerable and least able to manage the long-term impacts of these diseases.
Thus, what may be a treatable or manageable condition in a high income setting can be life threatening in a low income one. The average age of death from cardiovascular disease in sub-Saharan Africa, for example, is at least ten years below that in developed countries. The death rate among women in Africa because of NCDs is twice as high as the rate in high-income countries.
The developmental costs of NCDs also have a disproportionate impact on poor families and poor countries. One study in Sudan, for example, showed that for a family with a diabetic child, 65 per cent of the family’s annual health spending was on the child’s diabetic care. A 2012 report from the World Bank estimates that dialysis for patients with diabetes-related kidney failure cost the Government of Samoa $38,700 per patient per year in 2010/11. That is twelve times higher than the country’s per capita Gross National Income.
The key behavioural risk factors, including tobacco and alcohol use, poor nutrition, and physical inactivity, are strongly determined by broader social, legal, and environmental factors – for example the concentration of alcohol advertising, or the absence of parks in poorer areas. In this country, the term “food desert” has been coined for areas where there is no ready supply of fresh fruit and vegetables. Tobacco use, which alone costs the world 1-2 per cent of its GDP every year, is concentrated among the poorest, whatever the income level of the country.
Recognizing these significant social determinants of NCDs, UNDP has advocated for strong action beyond the health sector, to complement action taken within it. Indeed, more than half of the recommended policy options and cost effective interventions included in the WHO’s Global Action Plan for the Prevention and Control of NCDs require action outside the health sector. The good news is that measures like those outlined by Dr. Margaret Chan today cost very little – as against the huge costs of treatment. But they do require major political will and commitment from top leadership of countries.
The need for Action Beyond the Health Sector and Better Financing
So, let us see health in the broader sustainable development context. Sustainable development calls for integrated policy-making across the economic, social, and environmental spheres. This approach is highly consistent with the multi-sectoral approaches which are required to address NCDs. To make progress, we will need to revisit patterns of trade, consumption, governance, and urbanization – to name a few, and not only to treat and manage disease through medical interventions.
Discussion here today, and around the post-2015 development agenda, offers opportunities to ensure that NCDs are not seen as a 'health' challenge alone, but also, more broadly, as a development challenge. UNDP welcomes the ongoing discussions on proposed targets to reduce NCD-related mortality and strengthen implementation of the WHO Framework Convention on Tobacco Control, the world’s first international treaty on a health issue.
But accelerating efforts on NCDs need not wait. NCDs are placing an enormous burden on health systems now, accounting for approximately three-quarters of global health care spending. Governments in countries at all income levels can initiate cross-sectoral interventions immediately. For example, zoning ordinances which restrict the density of fast-food restaurants in low-income urban areas can address inequities and be implemented at little to no cost.
With no global financing mechanism for NCD responses, innovations in the use of domestic sources of revenues, such as through national trust funds or greater taxation on unhealthy products, will be needed. Indeed, measures which incentivize the production, trade, and consumption of healthy food, as opposed to those high in processed sugars, salt, and fat, must become the norm. Tonga, recently raised duties on unhealthy foods, while also decreasing import duties on fresh fish, and it has introduced higher excise tax rates on tobacco products. I applaud these measures.
More broadly, as national incomes and revenue flows to state treasuries grow, governments must direct more of the benefits of that growth towards national NCD responses, as well as work to reduce the impact of unhealthy products.
No country, however, can fight NCDs alone. The 2011 Political Declaration recognized: “the important role of the international community and international co-operation in assisting Member States, particularly developing countries, in complementing national efforts to generate an effective response to non-communicable diseases.” Managing the growing burden of NCDs is especially challenging for already overburdened health systems in countries where the battle against preventable communicable diseases and low life expectancy is ongoing.
Some countries, including Small Island Developing States, have particular NCD issues to address. Diabetes is almost fifty per cent more prevalent in Pacific Island countries than it is in lower- and middle- income countries globally. While life expectancy across developing countries as a whole is rising, in some, it appears to be dropping with the devastating impact of NCDs playing a role in that regression.
I believe that support for countries tackling these NCD epidemics must be seen as a broader global responsibility, not only because of the inherent injustice in persisting disparities in health across countries, but also because patterns of globalization and international trade contribute to these inequities. For example, although lower and middle income countries bear the brunt of NCD mortality, it is often upper income countries which are home to the largest producers and exporters of tobacco and unhealthy foods which contribute to these disease patterns.
UNDP stands ready to work with the World Health Organization, other UN agencies, civil society, and other partners to support Member States to accelerate the implementation of comprehensive national responses for the prevention and control of NCDs. Our collective responsibility and action must match the scale of the challenge which NCDs now present to countries rich and poor alike. Without more dramatic action, the threat to sustained human development from these diseases is very high.