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Burgess COMMENTARY
Peter Burgess
Gmail Peter Burgess
christopher macrae
To: Bhim Gopal
Congratulations Bhim to you and all your peer networks and their testimony to what courageous medical students alumni of the university of tokyo can be -do tell us if you are ever passing through eg new york or other cities where we know masses of medical students could most learn from your experiences and collaboration networks. Other people circulated could add places where their access to millennials (and leaders of sustainability develppment goal 3 good health and well being) would most like to linkin with your practices and goals
also a bottom up report (or dialogue opener, relevant bkmarks) of where nepal has current;y reached as a place that sustains its peoples out of poverty and towards a safe environment would be welcome at any time-
best chris
ps one of my urgent challenges in trying to open space where the goal3 interfaces between youth and the UN exist is to update who in the UN collaborates with YPN - all advice welcome as i intend to revisit boston in january for the first chunky time in 18 months and I know that many of jim kim's young professional heroes interconnect through ypn
medical youth of ypn provide a benchmark fr all young professionals as i hope this typical debrief from 2 years ago shows
The Young Professionals Forum for Action on NCDs: Mobilizing a Movement for Solidarity on Trade
On July 11, 2014 prior to receiving a standing ovation from civil society for his statement, YP-CDN Founder and resident physician at Yale School of Medicine, Sandeep Kishore, stood before the United Nations General Assembly at its High-level Non-communicable Disease (NCD) Review and called for swift and targeted action to prioritize health and mitigate corporate influence in trade agreements:
“Whether it is access to medicines, tobacco control, salt reduction, reduction of marketing of sugary drinks to children, we understand behind the scenes the enormous pressures you face to stand up for the public’s health. We get it. As civil society, our avowed responsibility is to respectfully stand with you. But please know that we are also watching you. We are mobilizing a people’s movement.”
Delivering on this promise, YP-CDN held the Young Professionals Forum for Action on NCDs two days prior to Dr. Kishore’s statement, which brought together individuals who are working tirelessly to mitigate the negative impacts of trade and investment agreements on health. At the forum, we put forth a declaration demanding action on this issue, and heard from emerging leaders and established experts in the areas of health, law, and economics. Testifying to the damaging influence that vested corporate interests can have on health, these authorities cited specific examples of big business efforts to hinder government regulatory actions in some countries, such as attempts by pharmaceutical lobbies to block patent reforms in South Africa that would allow for greater access to affordable treatments.
The forum gave an overview on how the international trade and investment system works, highlighting both positive and negative outcomes that result from free trade agreements, but focused mainly on two major health concerns related to trade: access to medicines, and regulation of harmful risk factors like unhealthy food, tobacco, and alcohol. Kicked off by Ariella Rojhani, Senior Advocacy Manager at NCD Alliance, the forum began with an overview of gains and progress still needed on 25x25—the goal of reducing mortality from NCDs by 2025.
James Love, Director of Knowledge Ecology International (KEI), a veteran of the AIDS access to medicines movement in the 1990s and a current activist for access to cancer medicines, expanded on Maybarduk’s sentiments. Of pharmaceutical makers and the rising cost of cancer medicines- which are untouchable for those in developing countries- Love said, “If they think they haven’t quite exhausted the patients and the public, it’ll be higher next time.” Love touched on the dearth of cancer medicines on the WHO Essential Medicines List and the convoluted explanation provided by governments for this glaring absence: “They say there’s no problem with cancer, because there are no patented drugs on the EM list, but there are no patented drugs on the list, because they’re really expensive. They’re expensive because of the patents.”
This problem was the same which we ran into in the early days of AIDS, in which those in low- and middle income countries lacked any chance of access to vital drugs. Both Peter Maybarduk and Keegan Hall, President of the International Diabetes Federation’s Young Leaders and a native South African, touched on this, citing South Africa’s 1999 battle for access to AIDS drugs. Love stressed the importance of an idea that he has pioneered and has gained traction within the WHO, which is to de-link the cost of research and development for drugs from the price of the drugs themselves. Love further asserted that the public is unjustly paying for the 10 to 15 years of research and trials that often go into drug production, when we should be considering new business models that reconcile both innovation and access to health technologies. “As long as there’s a monopoly on the paradigm for funding R&D, people will keep dying,” said Love, “This is not acceptable. It’s unfair. It’s morally repugnant. It’s inefficient in a thousand ways. And you can change it.”
Anthony So, Director of Duke University Sanford School’s Program on Global Health and Technology Access, tied together the access to medicines movement and that of tobacco control, pointing to a lack of transparency in areas concerning trade where FTAs have allowed for lowered tariffs on tobacco products, as well as the seizure of lower priced generic drugs while in transit. Dr. So highlighted the difficulties in addressing these violations in a global arena, citing cases of governments unsuccessfully going up against the WTO, and stating that he was told “it would not be possible to add tobacco control to the Millennium Development Goals.” Dr. So also touched on the power of young people to change the world, citing the AffordableMedsNow, a campaign by our colleagues at Universities Allied for Essential Medicines (UAEM) and the American Medical Students Association (AMSA) to grant affordable access to biologic alternatives to those who cannot afford vital medications.
We heard from young professionals who have done their own part to drive change. Seun Adebiyi of YP-CDN told of his successful efforts to start the first bone marrow registry in Nigeria as a patient who was given a 17% chance of finding a marrow donor match. Kavitha Kolappa of YP-CDN spoke of South Africa’s recent battle to lessen intellectual property laws on pharmaceuticals within FTAs to grant free access to cancer medications. Bryan Collinsworth of UAEM talked about breaking down the traditional barriers between academia and activism, with a story of a Nepali immigrant and his UAEM colleagues, who were able to successfully convince Central Michigan University Medical School to adopt progressive medical research licensing and commercialization policies. Divya Dhar discussed her founding of the P3 Foundation, a youth movement that quickly took hold in New Zealand to end poverty within our generation. Though each story was different, the message which came through was common across all narratives: a small group of committed individuals with passion can change the world: “Advocacy is coming from a place where you’re willing to risk everything,” said Adebiyi.
Image: Seun Adebiyi
Addressing access to affordable medicines
Peter Maybarduk, Global Access to Medicines Program Director at Public Citizen, outlined the consequences of free trade agreements (FTAs), which often give big business free rein to sue governments for regulatory efforts to amend medication patent laws or pass stricter laws to control access to substances like tobacco. One such agreement going through current negotiations is the Trans Pacific Partnership Agreement (the TPP), which- if passed- would strengthen companies’ abilities to have monopolies. Specifically, pharmaceutical companies would own exclusive patents to essential drugs for diseases such as cancer and diabetes, and thus able to charge any price they wish for these drugs, which are already financially out of reach for many in low- and middle- income countries. Within the parameters of the TPP, biosimilar competition- or the manufacture of cheaper versions of expensive drugs- would be blocked, giving pharmaceutical companies unfettered power over drug prices in the absence of competition. “It’s certainly quite obvious that in this battle money and politics are an obstacle,” stressed Maybarduk, who noted that the majority of these agreements are conducted in secrecy and not shown to public until they have already been finalized.
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What does trade have to do with NCD risk factors?
Benn McGrady, Project Director for the Initiative on Trade, Investment and Health of the O’Neill Institute at Georgetown University, further fleshed out complications of trade and health, pointing out that trade has positive effects as well in that it grants wider access to products such as food to marginalized populations. Within that access, he stated, also comes access to harmful substances like unhealthy, highly processed food and tobacco, citing “coca-colonization” of countries. McGrady highlighted the handcuffing of governments by corporations that occurs when they try to regulate such dangerous products. One such example is the implementation of plain packaging for cigarettes in Australia, or packs that would depict the health consequences of tobacco products: lip cancer, etc. These efforts were challenged at the World Trade Organization (WTO) on the basis that it interferes with trademark rights and is more trade restrictive than necessary.
Gregg Haifley, Director of Federal Relations of the American Cancer Society’s Cancer Action Network, elaborated on the fight for tobacco control, citing particular cases in which tobacco company Phillip Morris sued countries to thwart governmental and public health efforts to stop the spread and decline of tobacco use, which will kill one billion people in this century. Tobacco companies argue that despite having no positive attributes, tobacco is “just another product,” and that singling out products as harmful or illicit leads way to a slippery slope in which more and more products could get banned. Using this logic, they maintain their stronghold on governments and their influence in the global marketplace.
Image: Gregg Haifley
Ashley Schram, a PhD candidate at the University of Ottawa, further reiterated previous points, drawing parallels between the food, tobacco, and alcohol industries and their tactics to inhibit government and public health influence and push their products forward. “If tobacco, alcohol, and food didn’t have so many negative health consequences, we wouldn’t be talking about them today,” said Schram, who cited corporations’ use of “personal responsibility” as a justification for keeping their unhealthy products unrestricted to the public. The difficulty with this logic, she pointed out, is that- especially in the case of food- unhealthy “choices” are often the only accessible choices for the poorest populations. “When a parent is deciding between trying to keep the electricity on and putting healthy food on the table, are they responsible? Did they really have a choice?” Schram asked. Citing obesity of the new face of food insecurity and malnutrition, Schram said, “Food has gone from a source of life to a source of death for many.”
Galvanizing a new generation of allies and change advocates
The forum ended with an interactive conversation around the Declaration on NCDs and International Trade and Investment, a statement which YP-CDN issued as a call to action for governments and policy makers around trade. The document, which reiterates Dr. Kishore’s respectful but honest advisory on behalf of civil society, “We are watching you,” asserts that there is not enough being done to combat trade’s negative consequences on health. Within the document, we demand greater transparency in negotiation of FTAs, stricter regulations of harmful risk factors, and other measures to protect health. Out of the discussion on the declaration, audience members affirmed its importance as a living document to provide guidance on trade negotiations from a generation of advocates and thought leaders. One suggestion that was made by an audience member was to create an online database on trade and health, a place for individuals and civil society groups to share their thoughts, create events, and collaborate across advocacy areas. Another suggestion was to put into place an action plan for a path forward. The declaration will be updated accordingly and shared widely to continue the dialogue around how to mitigate trade’s negative effects on health and provide those in developing countries to greater access to the opportunity to live longer, more productive lives.
Related links:
UN Press release Sixty-eighth General Assembly Plenary
Sandeep Kishore Civil Society Statement
From: Bhim Gopal
http://www.un.org/press/en/2014/ga11532.doc.htm
11 JULY 2014
GA/11532
‘Can We and Should We Not Do Better’, Panellist Asks General Assembly as It Concludes High-Level Meeting on Non-Communicable Diseases
GENERAL ASSEMBLY
MEETINGS COVERAGE
Sixty-eighth General Assembly
Plenary
102nd & 103rd Meetings (AM & PM)
Funding of the global coordination mechanism to fight disease averaged just $10,000 per Member State — a paltry $1.8 million in total — the General Assembly heard today as it concluded its two-day high-level review of progress achieved in the prevention and control of non-communicable disease.
“Respected leaders, can we and should we not do better?” asked Sandeep Kishore, a physician at the Yale School of Medicine and Former Chair of the Young Professional Chronic Disease Network, during a panel discussion on “Strengthening national and regional capacities, including health systems, and effective multi-sectoral and whole-of-government responses for the prevention and control, including monitoring, of non-communicable diseases”.
He asked how it was possible that a country spending as little as $19 to $40 per person per year on health could have any measurable impact on preventing, controlling or monitoring non-communicable diseases. One concrete step in the right direction, he said, was the development of national non-communicable disease units that instituted action across clinical, public health and regulatory domains. But that initiative had not even scratched the surface of their true potential, he said, urging investment in human capital to rectify that.
Pressing countries to ensure that health issues were not “pigeon-holed” as the responsibility solely of health ministries was Tonio Borg, Commissioner for Health and Consumer Policy of the European Union, who said fighting the risk factors required broad partnerships across ministries. Urban planning ministries should be involved to ensure that cities were designed in a way that promoted physical activity. Further, finance ministries must recognise that budgetary savings would result in the long-term if adequate investment was made now.
Anna Lartey, Director of the Nutrition Division of the Food and Agriculture Organization (FAO), made the case for strengthening the response to non-communicable diseases. Doing so was vital, she said, because such diseases had the potential to push households into poverty and derail efforts to tackle hunger and malnutrition. Addressing the problem sustainably required an examination and analysis of the entire food system to ensure that agricultural production, retailing and consumption were all geared towards healthy nutrition.
In a second round table, on “Fostering and strengthening national, regional and international partnerships and cooperation in support of efforts to address non-communicable diseases”, panellists described the complexity of those unions and the need for incentives to encourage cooperation. Creativity was required, they said. There was discussion of the pharmaceutical industry and its long history of partnering to fight disease, as well as consideration of the need for partnerships in combating the effects of drug addiction, which, itself, should be considered a non-communicable disease, one speaker said.
The General Assembly also heard the conclusion of its debate, begun yesterday. Among today’s contributions, the representative of Maldives drew a link between globalization, trade liberalization, increased affluence, personal freedom, urbanization and congested living conditions and unhealthy lifestyles, urging States to confront the powerful business interests likely to interfere with their efforts to overcome risk factors.
In closing, Mohamed Khaled Khiari (Tunisia), summing up on behalf of the General Assembly President, commended delegates for having fulfilled the mission set out for the meeting by adopting a robust outcome document. There was broad agreement about the constraints non-communicable diseases posed to global development, and he believed there would be ample opportunity for States to begin changing the landscape of non-communicable diseases before the next review. The Chairs of the respective round tables also delivered summaries of those meetings.
Also delivering statements in the debate, including at the ministerial level, were representatives of Thailand, Nicaragua, India, New Zealand, Uruguay, France, Republic of Korea, Bangladesh, Egypt, Zimbabwe, Bahrain, Paraguay, Finland, Libya, Philippines, Nigeria, Guatemala, Kenya, Zambia and Panama.
The Minister of Health of the State of Palestine also spoke.
Statements
AHMED SAREER (Maldives) aligning himself with the “Group of 77” developing countries and China, noted that non-communicable diseases accounted for 78 per cent of the total disease burden in the Maldives. Globalization, trade liberalization, increased affluence, personal freedom, urbanization and congested living conditions were all contributing to unhealthy lifestyles and posing risk factors. He highlighted the need for regional and international collaboration in efforts to reach non-communicable disease and capacity-building targets. He also stressed the need for cohesive implementation plans that incorporated international agreements and instruments as well as the imperative to recognize and agree that tobacco control remained the most challenging but cost-effective strategy to control non-communicable diseases. As efforts to control non-communicable diseases would pit Governments against powerful business interests, interference would always be a challenge to confront “head on” and overcome.
PAISAN RUPANICHKIJ (Thailand) said it was now time to “walk the talk”. He advocated an increased investment to tackle non-communicable diseases, adding that combating them would promote economic growth in the long-run and lead to social well-being. Thailand had taken steps to develop national programmes to address the situation, he said, noting that the sixth National Health Assembly of the countries in the South-East Asia region had adopted a resolution in June on regional targets for tackling the scourge, which had already led to strengthening regional health information systems. Thailand had cooperated with other countries in the Association of South-East Asian Nations (ASEAN) on universal health coverage. During their first meeting on the matter, held in April, ASEAN leaders discussed a regional action plan and a network to support it. Thailand also supported the inclusion of non-communicable diseases as a stand-alone in the new development agenda. Thailand had implemented health coverage nationwide in 2002 and it was poised to cooperate with other countries to ensure that such coverage was global.
MARÍA RUBIALES DE CHAMORRO (Nicaragua), associating with the “Group of 77” and China, urged countries to undertake commitments to address non-communicable diseases. Nicaragua had developed a strategy to enable its citizens to live a good, clean, health life, which was implemented by the Labour Ministry and Health Ministry. The Government also had instituted policies on good nutrition and environmental well-being. Last year, the public health service had increased its network of health clinics to 1,300, including for non-communicable diseases. In 2013, the country had hosted a regional public-health meeting aimed at formulating strategies with neighbouring countries. That had led to the creation of the 2015 Central American health programme, which focused on, among others, issues related to child nutrition, teen pregnancy, dengue fever and tobacco use. Nicaragua had already implemented the programme in 100 communities, and understood that, in the long-term, an adequate response to non-communicable diseases and their prevention was crucial.
ASOKE KUMAR MUKERJI (India), associating with the “Group of 77” and China, outlined India’s expenditure on fighting non-communicable diseases. The priority areas were boosting general awareness of the diseases and promoting healthy lifestyles, with community and media involvement important. Screening for diabetes and cancer were allied with a referral mechanism, and efforts were being made to improve capacities for prevention, treatment and rehabilitation. A monitoring framework had been established to track morbidity and mortality rates, and primary health care was being revitalized to integrate responses to both communicable and non-communicable diseases. He also described medical innovation made in India, which included a “polypill”, a “clot-buster” and a special heart valve.
JIM MCLAY (New Zealand) said his country was addressing non-communicable diseases at home, but was also heavily engaged in assisting the Pacific region as a whole. Doing so was a key part of New Zealand’s aid policy, he said. There was a regional non-communicable disease crisis in the Pacific, he said, adding that he was optimistic about efforts to address it because the diseases were generally preventable. Effective control meant reducing risk factors, beginning at a child’s conception. He outlined efforts made by the Government, working with academia and civil society, to reduce smoking and said New Zealand was at the forefront of creating smoke-free environments, educating the population on dangers and beginning to ban advertisements and sponsorship.
GONZALO KONCKE (Uruguay) said it was crucial to address the main risk factors, notably harmful consumption of alcohol and tobacco use. All sectors of society must be involved in order to ensure that policies intended to reduce and control non-communicable diseases were effective. Uruguay had specific policies in the four main risk-factor levels that were coordinated by the Health Ministry and other sectors. It had shown great leadership in tackling the problem and had almost fully implemented the framework convention on tobacco control, as well as instituted a ban on smoking in public areas; it also had imposed new tax policies on tobacco use. In that connection, it prohibited the use of colours and names on cigarette packaging that would confuse consumers about the harmful effects of tobacco products, and it had set up a tobacco-control sector within the Health Ministry, which helped to draft rules on tobacco control. The Ministry attached particular importance to South-South cooperation, and had exchanged good practices with the Pan-American Health Organization. He stressed the importance of the 2013-2020 global plan of action for control of non-communicable diseases as well as including their impact as a specific goal in the post-2015 agenda.
FABIENNE BARTOLI (France) noted that people worldwide had unequal access to health care, adding that the poor, marginalized, elderly and the disabled often were unable to obtain treatment. That situation must be rectified through greater actions to prevent non-communicable diseases and ensure treatment for all in need. It was also necessary to reduce prejudices about those diseases. France had always championed the need to prioritize the fight against those. It supported good nutrition policies, had forbidden tobacco in all public places since 2009 and had taken vigorous steps to prevent alcohol use in pregnant women. The country was also committed to bringing the campaign against those diseases to the global level, she said, noting the country’s dedication to advance two guidelines: strengthening health systems and adopting an inter-ministerial, multisectoral approach to the issue. At a recent meeting held under the World Health Organization’s (WHO) auspices, France had championed complementarity between vertical funds and attached great importance to universal health coverage.
HAHN CHOONGHEE (Republic of Korea) described how the Seoul Declaration on non-communicable disease prevention and control in the Western Pacific region included a commitment to high-level political action on the matter. He welcomed development of the Western Pacific Regional Action Plan for prevention and treatment of non-communicable diseases for the period 2014-2020 and described his country’s efforts to control cardiovascular disease, including through surveillance, prevention, early warning, treatment and rehabilitation. The Ministry of Health had adopted a collaborative approach, setting targets to reduce salt in food and working with private partners to conduct a Cardiac Arrest Surveillance System. The Ministry was also promoting high-quality research, and the Government was applying the World Health Organization Choice methodology, providing information on cost-effectiveness to guide policy decisions. Among national challenges was coordinating local and national efforts.
ABULKALAM ABDUL MOMEN (Bangladesh) shared key features of the national health sector, pointing to the “double burden” the country faced in terms of the high prevalence of both communicable and non-communicable diseases. Despite constraints, Bangladesh had made remarkable progress in attaining the Millennium Development Goals. Life expectancy had increased sharply but non-communicable diseases were on the rise as urbanization grew. Slum dwellers were especially at risk, he said, noting that non-communicable diseases made up 61 per cent of the total disease burden. He pointed to the Government’s efforts to address the situation, which included legislative initiatives such as an amendment to the Mental Health Act and a tobacco control law. In order to establish large-scale efforts, technical skills were necessary, but many developing countries could not afford the investment. A global resource pool could be a major boon, allowing more confidence in target setting for poor countries such as his own.
MOOTAZ AHMADEIN KHALIL (Egypt) said non-communicable diseases were still responsible for some two-thirds of premature deaths globally. Despite recent efforts, more must be done. An equitable, nationally owned framework was vital to ensure the response was tailored to each country’s specific needs. He called for strengthening national capacities for diagnostic technologies and palliative care. Treatment must be affordable, particularly in developing countries. It was vital to enhance the ability of developing countries to launch awareness campaigns about the dangers of tobacco and alcohol use, he said, urging the tobacco, medical and beverage industries to contribute to the promotion of healthy lifestyles. Egypt’s Health Ministry was working on a plan towards that end, he said, citing its signing of a cooperation protocol with WHO to train doctors on how to treat such diseases. Those contributed to poverty, with an estimated cost of treatment expected to reach $47 trillion in the next three decades. The international community must work on successful prevention, and support must be given to develop adequate health-care infrastructure. Such concerns should be adequately reflected in the post-2015 development agenda and the sustainable development goals.
The representative of Zimbabwe said financial constraints had contributed to a high incidence of mortality from non-communicable diseases in her country. Despite that and other challenges, the Ministry of Health and Child Welfare had developed non-communicable disease and alcohol control policies, which were pending approval by the Cabinet. Her Government had set up a non-communicable disease unit. As it strengthened the national response for such diseases, the Government was increasingly paying attention to mental health issues, and it had put in place a mental health policy and strategy as well as mental health indicators. Zimbabwe had also focused on integrating issues related to non-communicable diseases into the national HIV/AIDS response. The national anti-retroviral therapy guidelines had incorporated issues concerning early detection of non-communicable diseases as well. Additionally, the Government had overseen the integration of cancer screening and, in that connection, was promoting breast cancer screening in public and private institutions. Efforts also were under way to secure funding to carry out a survey on risk factors to non-communicable diseases.
The representative of Bahrain said his Government had developed and approved a comprehensive national plan to fight non-communicable diseases, inspired by the Gulf Cooperation Council’s plan. Its strategic goals focused on primary and secondary interventions, increasing treatment and research on non-communicable diseases, as well as increasing partnerships to fight them. The Government had taken steps to implement a related economic plan and had asked the Cabinet to create a committee on the issue. It had set up a chronic disease unit in the Ministry of Health and had appointed a national coordinator to oversee efforts. In 2009, a tobacco control policy had been developed, he said, pointing to additional initiatives under way to enhance health-care services and education nationwide. One example was the establishment of clinics to treat obesity. The Government had issued periodic reports, based on WHO guidelines, on non-communicable diseases. He reiterated Bahrain’s commitment to implement the 2011 Political Declaration.
The representative of Paraguay described alarming figures on the prevalence of risk factors in her country. There was a 57 per cent obesity rate and high levels of physical inactivity and tobacco and alcohol use, as well as a poor rate of fruit and vegetable consumption. The Government was aware and was trying to address those figures. Programmes had been introduced to increase people’s activity, including by encouraging bicycle use. As well as a law to treat obesity, there were efforts in schools to arrest tobacco consumption, and 82 municipalities had introduced smoke-free environments. The national programme for tackling non-communicable diseases had been developed in harmony with WHO’s own strategy and institutions, and health-care organizations were working to address the problem of primary health care to ensure a more integrated method of operation.
The representative of Finland described the country’s experiences in tackling its high rate of cardiovascular disease deaths in the 1960s. The rate, having been the second-highest mortality rate in the world, was now a tenth of what it was, owing to efforts to reduce tobacco use and improve diets. The success story was based on translating innovation into policy, but past success did not guarantee future ones. There were new challenges to meet and existing tools like fiscal measures to curb budgets and simultaneously steer consumer behaviour would be used but it also was important to find new methods. Finland would completely eliminate tobacco products by 2040, was aiming to reduce the amount of time people spent sitting each day, and had been the first country to limit alcohol advertising on social media.
The representative of Libya, associating with the Group of 77 and China, said WHO’s statistics showed that the mortality rate for non-communicable diseases was higher than for other illnesses. He stressed the importance of national and global cooperation to tackle those diseases and of sufficient funding in that regard. His Government provided free essential medicines and universal health coverage for the Libyan population. Non-communicable diseases were not only a medical concern; they were also a socioeconomic problem that thwarted sustainable development. Affordable medicines were vital to contain and combat those diseases and promote long, healthy lives. He expressed hope that countries would demonstrate strong political will in that effort.
IRENE SUSAN BARREIRO NATIVIDAD (Philippines) said that, since 2009, there had been an alarming increase of non-communicable diseases in her country, where the WHO found that they were the cause of 85 per cent of premature deaths. Governments had a primary role to play in prevention and control, and for that reason, the Philippines was strongly committed to strengthening multisectoral national health policies to achieve national targets. She described a raft of programmes under those polices that would be brought together into a healthy lifestyle programme, along with the establishment of universal health care and other measures. The Government could not face such health challenges by itself, but partnership with local stakeholders and support from development partners was making it possible. She stressed that the problem of non-communicable diseases affected all humanity, but could be overcome through multisectoral efforts
ANTHONY BOSAH (Nigeria), associating with the Group of 77 and China, said that the importance of discussions on non-communicable diseases could not be over-emphasized as the global burden of those diseases continued to grow while undermining social and economic development. In that regard, he recognized WHO’s leadership in addressing the increasingly complex challenge of public health and called for renewed political will and multisectoral action by all stakeholders on non-communicable diseases. Towards that end, his country had launched a national action plan in December 2013, followed by legislation towards the development of a national health system in February 2014. To ensure that global health remained a priority, non-communicable diseases and the range of health challenges must be included in the post-2015 development agenda.
GERT ROSENTHAL (Guatemala) was aware that health was vital to human rights and development, and it was committed to obtaining a proper standard of life for its citizens, including by establishing a more inclusive and democratic health system. A commitment was in place to incorporate non-communicable diseases into the national political agenda for development, and efforts to step up coverage of health services had continued, with a stress on primary health care. She recognized the need for strengthening health systems at all levels and her Government was developing a system to better monitor diseases and their risk factors. The burden of dealing with non-communicable diseases was particularly heavy on low- and middle-income countries, so she urged inclusion of the issue in the post-2015 development agenda.
MACHARIA KAMAU (Kenya) highlighted the country’s progress in addressing non-communicable diseases, for example, through the new Constitution, which positioned health as a right, and the ratification of WHO’s Framework Convention on Tobacco Control, along with comprehensive tobacco control legislation and the National Tobacco Control Action Plan. Non-communicable diseases were central to Kenya’s Second Health Policy Framework (2011-2030) and to its Second Medium-Term Plan for Health 2013-2017. A national nutrition action plan was in place for 2012-2017, and a non-communicable diseases strategy had been drafted to drive the agenda in a coordinated and strategic manner.
SILVESTER MWANZA (Zambia) said fulfilling the commitments of the 2011 Political Declaration must remain at the top of the global agenda. Towards that end, his Government was focusing on combating cancer, cardiovascular diseases, diabetes and chronic respiratory diseases. Those services were linked to the Government’s strategy to provide universal access to health services. It was developing a strategic plan to combat non-communicable diseases that included introducing and bolstering sports activities in schools; promoting healthy diets; and strengthening enforcement of legislation on tobacco and alcohol use. The Government was creating an additional 650 health posts in order to enable families to access the services. But the high cost of treatment was a challenge, he said, noting that drugs to treat HIV infection cost less than $50 per month, while drugs to treat asthma cost $400 per month. Universalizing health coverage required a broader definition of health-care workers to include dieticians, social workers and physical therapists. There also must be investment in training and career development and enhanced diagnostic services, as well as stronger bilateral and multilateral public-private health partnerships.
MYRNA MCLAUGHLIN DE ANDERSON (Panama), associating with the Group of 77 and China, said non-communicable disease were the primary cause of death in her country, accounting for 59.6 per cent of deaths in 2010 alone. The Health Ministry was focusing on improving access to comprehensive health care on an equitable basis and implementing a national plan to control non-communicable diseases, chronic disease and cancer, as well as a plan on palliative care. The 16/18 HPV vaccine was being given to girls aged 10 and up. The Ministry’s strategies focused on promotion of healthy diets in school, capacity-building for teachers on the early warning signs of cancer, and prevention of breast, prostate and skin cancer, among other areas. Panama was setting up a cancer registry in the Oncology Institute and finalizing a strategic plan for preventing non-communicable diseases and reducing their risk factors. It had adopted public policies that supported the framework convention for tobacco control, and had outlawed smoking in all public places, as well as set up clinics to help smokers quit. It had plans to build a modern oncology hospital, and was working on a national draft law for access to opiates and pain relief.
JAWAD AWAD, Minister of Health, State of Palestine, said youth in Palestine suffered chronic diseases, owing to exposure to two to three risk factors. The Israeli occupation and its dire economic consequences were the primary cause of non-communicable diseases in Palestine, particularly psychological disorder among children, youth and the elderly. Seventy per cent of deaths in 2013 were due to chronic diseases, with cardiovascular and heart disease the leading killer, followed by brain haemorrhage, cancer and complications from diabetes. In cooperation with WHO, the Ministry of Health had undertaken a State-wide surveillance plan on citizens aged 18 to 65 in the West Bank to help formulate a national plan to control non-communicable diseases; it would soon be expanded to Gaza. The Ministries of Health and Education had developed a scheme to combat obesity and reduce salt intake, and the Government also aimed to introduce HPV vaccination. It had introduced testing of foods to ensure they were free from carcinogens and pesticides, and a special law had been adopted to combat smoking. The continued Israeli raids in Gaza were a major contributor to psychological problems among the population, he said, calling on the global community to take action to put an end to the raids.
Round Table I
Fenton Ferguson, Minister of Health of Jamaica, chaired a roundtable on “Strengthening national and regional capacities, including health systems, and effective multisectoral and whole-of-government responses for the prevention and control, including monitoring, of non-communicable diseases”.
Panellists included Tonio Borg, Commissioner for Health and Consumer Policy of the European Union; Anna Lartey, Director of the Nutrition Division of the Food and Agriculture Organization (FAO); Vash Mungal-Singh, Chief Executive Officer of the Heart and Stroke Foundation in South Africa; and Sandeep Kishore, Physician at the Yale School of Medicine and Former Chair of the Young Professional Chronic Disease Network.
Mr. BORG said that any Health Minister would agree that health issues should not be the responsibility only of Health Ministries. To combat such pigeon-holing, the European Union’s basic law made specific reference to Member States’ duties to integrate health policy considerations in all measures and legislation. He noted the existence of a strategy for dealing with cancer as well as efforts being made to develop one on diabetes. Such strategies were usually based on addressing the major risk factors like physical activity, nutrition, and tobacco and alcohol consumption. Fighting those factors required, among others, partnerships with other ministries, he said, adding that urban planning ministries should be involved to ensure that cities were designed in a way that promoted physical activity, while finance ministries also needed to recognise that increased investment in tackling non-communicable diseases could yield enormous savings in national budgets.
Ms. LARTEY observed that eating correctly and teaching children to eat right was part of being a good citizen. It was essential to reduce the risks of non-communicable diseases as they could push households into poverty and also derail efforts to tackle hunger and malnutrition. To sustainably address the issue, it was necessary to examine and analyse the current food system from agricultural production through retailing and consumption, in order to consider how to ensure that those were working towards healthy nutrition. She stressed the need to strengthen national capacities, especially on communications, as well as to dispel myths about non-communicable diseases. Research capacities should be expanded, particularly in lower-income countries. The context of the diseases in developing countries was different than in developed countries, owing in part to malnutrition. Sharing lessons learned was vital, and States needed to take the leadership in addressing and preventing the diseases, convincing policy-makers about the magnitude of the problems and about their preventability.
Ms. MUNGAL-SINGH, highlighting South Africa’s efforts in tackling non-communicable diseases, noted that, in March 2013, it had become the first country to legislate salt levels in a range of foodstuffs, and it now was undertaking a public education programme to reduce discretionary salt use through strong leadership, multisectoral action and sufficient funding. Both the Minister of Health and the Head of the Non-communicable Diseases Directorate had championed that cause. Advocating for funding was a multisectoral working group comprising researchers in public health and nutrition; food science and technology experts; the non-governmental organization Heart and Stroke Foundation South Africa; Directorate officials; the food industry; and consumer groups. The Chamber of Baking worked on targets, and also pressed for financing. The Department of Health was funding a campaign on heart disease and stroke, while industry had helped to fund a high-level summit on the matter, which had helped to engage with other sectors like the media, the catering industry and the health-care sector. South Africa’s second breakthrough had been the creation of the Non-communicable Diseases Alliance, which provided a common platform for multisectoral action.
Ms. KISHORE discussed how WHO’s Director-General and Member States, such as Australia, had rallied behind South Africa’s Director General of Health, when the latter testified that a United States-based public relations firm representing more than two dozen pharmaceutical companies was planning a subversive campaign to halt reforms to South Africa’s intellectual property and trade policy aimed at safeguarding access to medicines for all diseases. Australia had relayed its own battle to invoke Trade-Related Aspects of Intellectual Property Rights (TRIPs) flexibilities in its fight against tobacco, including the landmark 2011 Plain Packaging Act. Three major tobacco firms had responded by funding a $9 million campaign to counter those efforts. Noting that some Member States had called for “no new resources”, he said funding of the global coordination mechanism to fight disease averaged $10,000 per Member State — a paltry $1.8 million in total.
“Respected leaders, can we and should we not do better?”. At the national level, how could a country with an expenditure of just $40 per person per year on health — or as low as $19 — do anything on non-communicable diseases? he asked. Such diseases must be part of a broader health and human development agenda in order to have an impact. One concrete step in the right direction was the development of national non-communicable disease units that instituted action across clinical, public health and regulatory domains. Such units, however, had not even scratched the surface of their true potential. Investment in human capital was needed to rectify that, he said, proposing the creation of a Fellowship for the Future, a non-communicable diseases core fund that was resourced modestly to equip and position 10 young leaders from each Member State to staff non-communicable disease units in all Member States by 2018.
In the ensuing interactive dialogue, the representative from Nepal said the country faced communicable and non-communicable diseases and the impact of natural disasters on health, as well the fall-out from recent conflict. In addressing that burden under severe financial constraints, he described the efforts being made to implement sustainable and cost-effective interventions.
A representative from Mexico said voluntary measures to improve public health had not achieved much, but obligatory, mandatory legal issues like banning unhealthy food had really brought about key changes. Education was vital, he said, adding that homes and schools were the most important places for developing healthy lifestyles.
A representative of Federated States of Micronesia said the impact of climate change was underreported as a risk factor with relation to non-communicable diseases. For small island developing States, however, the impact was clear: climate change affected agricultural production and, in turn, nutrition, which increased the risk of developing a non-communicable disease.
A representative of the Joint United Nations Programme on HIV/AIDS (UNAIDS) described how the experience many developing countries had combating HIV/AIDS could be brought to bear in the battle against non-communicable diseases.
Ms. LARTEY said non-communicable disease prevention programmes had yielded results, noting that Finland had promoted dietary changes and smoking cessation programmes alongside effective messaging, and had managed to reduce heart disease deaths by over 70 per cent.
Mr. BORG noted that many representatives had mentioned fiscal measures like tobacco price rises that could help to combat risk factors like prevalence of smoking. Education had also been spotlighted. Also important was to intervene to prevent children from forming bad habits.
Ms. MUNGAL-SINGH said much could be learned from experiences in combating HIV/AIDS. By mobilizing people on the ground, a stronger voice was raised. She said it was time to focus on the role of industry, having already agreed on the roles of Government and civil society. As industry was profit-driven, it was necessary to find ways to encourage its engagement with efforts to tackle risk factors and help to prevent non-communicable diseases.
Mr. KISHORE, noting the impact of focusing in the twentieth century on sanitation for extending life expectancy in the United States, wondered what the twenty-first century equivalent of that would be, and he suggested that it was important to change the way that health workers were educated and trained.
Mr. FERGUSON, in closing, said he subscribed to the view that health should be integral to the post-2015 development agenda and that non-communicable diseases should be addressed adequately within that framework.
The Vice-Minister for Health of Spain also delivered a statement, as did representatives of Barbados, Iran, Costa Rica, Congo, Republic of Korea, Chile, Denmark and Argentina.
A representative of the Center for Science in the Public Interest also participated in the discussion.
Round Table II
The afternoon roundtable, entitled “Fostering and strengthening national, regional and international partnerships and cooperation in support of efforts to address non-communicable diseases”, was chaired by Howard Koh, Assistant Secretary of Health of the United States, and featured the following panellists: Lochan Naidoo, President of the International Narcotic Control Board (INCB) of the United Nations Office on Drugs and Crime; Sania Nishtar, Founder of Heartfil of Pakistan; and Mr. Mario Ottiglio, Director of Public Affairs and Global Health Policy at the International Federation of Pharmaceutical Manufacturers and Associations.
Mr. NAIDOO said that, like other non-communicable diseases, drug addiction, which affected millions, was best treated by prevention first, then treatment, recovery and rehabilitation. Treatment of addiction disorders needed to be seen as treatment of a primary disease and not merely related to intravenous drug use or psychiatric disease. A mental health issue and a non-communicable disease itself, drug addiction caused untold suffering and loss of potential, particularly among young people, society’s most precious resource. In treating drug addiction and making sure that medications were used properly, there was a paramount need for training health-care professionals to ensure accurate diagnoses, rational prescribing and adequate availability, as well as good cooperation with and responsible action by the pharmaceutical industry. The Control Board stood ready to support those efforts at both the national and international levels.
Ms. NISHTAR said that partnerships in the context of non-communicable diseases were a complex web of relationships and synergies in pursuit of common goals. Those relationships were not formed naturally, and therefore incentives for cooperation should be provided. Listing the relevant networks and task forces, she said each had its own priorities and implementation mechanisms. For a coordinating mechanism among all of them, she proposed the model of an observatory that gathered and shared information. In regard to bilateral and multilateral development assistance, which was crucial in building capacity, she said that the Millennium Development Goals had been an effective mechanism for mobilizing funds, although the post-2015 agenda would exist in a different milieu. Creative means must be developed nationally and internationally. Within Governments, targeted commissions could bring together the various sectors needed. At the national level, there was a point of convergence between coordinating efforts to combat non-communicable diseases and to provide universal health coverage. Systems set up to coordinate chronic care for HIV infections could be a model in that context.
Mr. OTTIGLIO said that the pharmaceutical industry was able to promise solutions to most non-communicable diseases, but the major problems were development of, access to and correct application of therapies. The industry had a long track record of partnerships in fighting disease in low- and middle-income countries for those purposes. He described programmes that included free medicine, assistance in gaining access, leveraging the use of mobile phones to ensure correct use and awareness programmes, as well as partnerships designed “by people for people”, which he called an important consideration. In future partnerships, clear objectives and deliverables were now needed that were agreed by all parties and were timebound. The WHO coordination mechanism should strengthen its work in that area. Programmes should focus on systemic issues and should be designed around the core competencies of each partner. His industry was willing to work within inclusive collaborative frameworks under WHO’s leadership.
In the discussion that followed, topics ranged from the importance of an international framework convention in fostering national regulations to results-based partnerships to the status of alcohol as a drug. The representative of Denmark spoke about the importance of non-governmental organizations in all efforts to curb non-communicable diseases, while Spain’s representative spoke about the importance of cooperation for training in the proper use of pharmaceuticals. The representative of Niger discussed the return on investments for various kinds of interventions, while Iran’s representative discussed accountability for groups providing interventions and the alternatives available in that regard. Canada’s representative noted a consensus around the need for a multisectoral, collaborative approach in fighting non-communicative diseases, and related his country’s experiences in that area.
In response to questions raised in the discussion, Mr. NAIDOO said that alcohol abuse was related to many other factors. It was most important to encourage “smart families” to handle such issues, since they were all connected. Ms. NISHTAR said expectations in revenue mobilization should be managed. She added that many intervention strategies were revenue-generating in their own right, including tobacco taxes. She noted a lack of appetite for a vertical funding flow for non-communicable diseases in the current economic climate. At the national level, she stressed the importance of the regulatory pathway as well as the need for comprehensive health systems to tackle all health problems.
Mr. OTTIGLIO spoke of the importance of cooperating at the community level in regard to training and other efforts. He said that the importance of data should not be underestimated in providing all interventions in health. He stressed again the importance of the WHO framework for cooperation.
Also participating in the discussion were representatives of Argentina, Republic of Korea, Norway, Suriname and Sweden.
Sandeep Kishore, Young Professionals Chronic Disease Network & Yale School of Medicine 1
Thank you for the kind introduction Mr. President.
I am honored to be here as a physician and a scientist, but most of all as an advocate.
And I represent a social movement to tackle NCDs as the social justice issue of our generation.
As part of your deliberations for the NCD response, I want to focus on two short points for the Future of our Health.
First, Solidarity on Trade & Health Just six months ago, I bore witness to the testimony of South Africa's Director General of Health at the WHO.
She testified, powerfully, that a US-based public relations firm enlisted by over 2 dozen pharmaceutical companies was planning a subversive campaign to halt reforms to South Africa's intellectual property and trade policy.
These reforms, if passed, would have safeguarded access to medicines for all diseases – from HIV/AIDS to cancer, from diabetes to dengue.
I stood so very proud of what happened next.
Director General Margaret Chan and Member States rose in solidarity with South Africa to speak out against undue corporate influence.
One such ally to South Africa was Australia.
Australia relayed it's own battle to invoke TRIPS flexibilities in their fight against tobacco, including the landmark Plain Packaging Act in 2011.
Australia dared to challenge the tobacco industry.
The storyline of what happened next is all too familiar. 3 major tobacco firms came together to fund a $9 million campaign to destroy Australia's efforts. Lawsuit after lawsuit.
Sandeep Kishore, Young Professionals Chronic Disease Network & Yale School of Medicine 2
Whether it is access to medicines, tobacco control, salt reduction, reduction of marketing of sugary drinks to children, we understand behind the scenes the enormous pressures you face to stand up for the public’s health.
We get it.
As civil society, our avowed responsibility is to respectfully stand with you.
But please know that we are also watching you. We are a mobilizing a people’s movement.
We will seek to hold you accountable and transparent through initiatives such as Countdown 2025, building off the success of Countdown 2015 for maternal and child health.
Second, Money
I am painfully aware that some Member States in this austere hall have called for ‘no new resources.'
Yesterday, I spoke with a colleague from the private sector who is leading a charge on funding for NCDs.
He asked, pointedly: 'where is the public sector investment on this?'
Member States, where are you?
• At the international level. I understand the contributions for the global coordination mechanism - a unique partnership to address the greatest disease burden in mankind’s history — averages to $10,000 per member state.
$10,000. That’s it. That is a paltry $1.8 million in total. Or. 0.00002 cents per person.
Sandeep Kishore, Young Professionals Chronic Disease Network & Yale School of Medicine 3
Respected leaders, can we and should we not do better!?
• At the country level, How can a country with just $40 per person/year on health - or as low as $19— do anything on NCDs?
We know that to have impact on NCDs we must be part of a broader agenda on health and human development.
And while calls for increased financing go on, one concrete step is the development of NCD units at the country level whose mandate is to institute action across clinical, public health and regulatory domains.
But our experience is that these NCD Units have not even scratched the surface of their true potential.
One way to help these Units to actualize their potential is to invest in human capital to lead these units.
From my work with the Young Professionals Chronic Disease Network, with members in over 130 countries, I can affirm there are nutritionists from Dhaka to Delhi, lawyers from London to Lagos, and physicians from Nairobi to New York and people living with NCDs who are stepping up with p passion – but have little support. No outlet.
This generation has untold and untapped human capital to lead on NCDs, but needs guidance. And we need it now.
To this end, what if the global coordination mechanism, the NCD partnership, could help address this gap at the country level?
Imagine this: A Fellowship for the Future, an NCD Core Fund, that is resourced, modestly, to equip and position 10 young leaders from each Member State here to staff NCD Units in all Member States by 2018
Finally, I would like to take step back to remind ourselves how we came to this moment.
Sandeep Kishore, Young Professionals Chronic Disease Network & Yale School of Medicine 4
I would not be speaking to you were it not for the transformative advocacy of people living with NCDs in the first instance.
In 2011, when you met for the first ever High Level Meeting on NCDs, our collective peacefully assembled outside UN HQ in a demonstration for equity, action and targets.
One of the people standing with us was a close friend, Gloria Borges.
At the tender age of 28, she was diagnosed with Stage IV colon cancer After dozens of surgeries and over 40 rounds of chemotherapy, she summoned the strength to travel to NYC.
She took the bullhorn. And this was her message to you on Sep 19, 2011:
Do something.
Ladies and gentleman, On Jan 5 of this year, Gloria Borges passed away.
I dedicate this statement on behalf of civil society to her and all the Gloria’s around the world.
And right here and right now I want to give voice to her soulful plea directly to you, the decision makers.
Let us not succumb to the chronic disease of inaction; to the cancer of empty rhetoric.
Do something.
We can start with solidarity on trade, leveraging platforms to empower the next generation in a Fellowship for the Future, and tapping into the soul of a generation -- of your people – to obliterate the social injustice of NCDs.
Thank you.
