At last week's UN meeting on non-communicable diseases (NCDs), heads of state were told that cancers, heart disease and mental health issues, were critical to the future of the global economy: NCDs are forecast to cost $47 trillion, or 4% of global GDP, over the next 20 years.
This new headline figure, from the World Economic Forum, puts into context a political declaration which was lacking in targets, funds and action.
What have countries agreed to do?
The declaration sets out a broad range of factors affecting NCDs. These include the contribution of poor maternal and child health to high blood pressure and diabetes, and neglected modifiable risks such as indoor air pollution. It also recognises the multisectoral, multilevel response required.
What gets measured gets done, and this understanding led the UN General Assembly to call on the World Health Organization (WHO) to develop a global monitoring framework over the next 12 months. WHO is also tasked with developing a set of voluntary targets. Countries have agreed to strengthen national plans by 2013 and report to the UN Assembly the following year.
What have countries avoided?
There is little in the declaration that is specific on international cooperation or coordination. Most action is for sovereign interpretation and subject to domestic interests. Health system development, the regulation of industry, and key interventions across sectors such as education, environment, agriculture, and transport remain areas for intervention at the national level.
Trade issues concerning access to medicines, food regulation and tobacco control are affected by global policy. However, governments are divided in their interpretation of such policies. On the one hand, health ministries in both rich and poor countries now recognise the human and economic cost of overt protection of industries. On the other hand, commerce officials continue to promote consumption of goods domestically and internationally with simple assumptions about individual and social impact. As Health Minister Chen Zhu of China said, 'governments should attach as much importance to health as to economic development, and should play a leading role in creating a supportive policy environment'.
The WHO has shown how a package of basic prevention interventions can cost as little as $1 per person per year. This is well within the reach of most low-income countries. Domestic political will, strengthened governance and engagement of civil society will be vital – despite the already obvious returns on investment.
As aid becomes only a fraction of spending in low and middle-income countries, there remains much interest for international actors. Bilateral and regional information sharing and policy support are increasingly common. As networks strengthen, lessons are learnt. The slow steady progress on health systems is testament to this approach. There is also money to be made in the growing $5 trillion healthcare industry. Heart disease is amenable to cheap, off-patent drugs, although cancer and mental health interventions will remain out of reach for most.
The UN declaration is a call for vigilance as well as action. There remain risks that those who wish to benefit from consumption, yet not pick up the tab, are better resourced and more nimble at the international level than domestic policy-makers. Accelerated progress to implement the WHO Framework Convention on Tobacco Control will be an early sign that the UN and its member states can respond effectively to such long-standing tensions in international affairs.
UN Progress on Health to Hit a Wall of Domestic and Multinational Interest
Dr Sudeep Chand, 16 September 2011