Editorial

Two days in New York: reections on the UN NCD summit

On Sept 1920, 2011, heads of state and government ministers gathered in New York City, NY, USA at the UNs high-level meeting on the prevention and control of non-communicable diseases (NCDs). This long-awaited once in a generation opportunity to put NCDs on the global agenda generated as many fears of a missed opportunity as it did hopes of a turning point for the health of millions around the world. The unanimous agreement by UN member states to hold the summit on NCDs signalled recognition of a growing global emergency and, at long last, a willingness to act. With 36 million people dying annually from NCDs (63% of all deaths globally), the challenge ahead is unequivocal. No country is immune. Although often thought of as diseases of rich countries, NCDs now disproportionately aect more people in poorer nations, accounting for 80% of all NCD-related deaths. NCDs include cancers, cardiovascular diseases, diabetes, and chronic respiratory diseases: all are largely preventable and share common risk factors, such as tobacco use, unhealthy diet, physical inactivity, and harmful use of alcohol. Furthermore, the World Economic Forum identied NCDs as a severe threat to economic development and put a price tag of $30 trillion on the expected burden of these diseases over the next 20 years. The aim of the meeting was to secure commitment from heads of government for a coordinated global response, to raise awareness among the general public, and to adopt a comprehensive political declaration for health strategies. The declaration, issued on Sept 20, 2011, clearly acknowledges the economic and epidemic scale of the challenge. Common risk factors were recognised; prevention must be the cornerstone of the global response, and any strategy requires eective leadership. Notably, governments decided to commit to multisectoral national and international policies to control NCDs, to reduce individual exposure to NCD risk factors through international agreements such as the WHO Framework Convention on Tobacco Control, the WHO Global Strategy on Diet, Physical Activity and Health, and the WHO Global Strategy to Reduce the Harmful Use of Alcohol, to give greater priority to early detection, screening and diagnosis, to increase access to vaccines as part of national immunisation programmes, and to improve access to palliative care. These commitments should be applauded as a good start in tackling the serious burden that NCDs represent, and signal the start of attempts to reverse the undue long-term neglect the political arena has aorded such issues. However, the declaration has clearly come under multiple pressures from governments and lobbyists resulting in a watered-down document reective of national and industry interests. For example, emblematic gures have been excised, such as the aim to reduce salt intake to less than 5 g per day. Indeed, although the fundamental conict of interest between the tobacco industry and public health is fully recognised in the declaration, other groups from the food and drink industrywhich the UN euphemistically refers to as civil society alongside organisations such as academiawere invited to participate in the meeting, although they were excluded from any decision-making. Unsurprisingly, these industry representatives urged a voluntary, rather than a regulatory approach. Rightly, one NCD advocate likened this to, letting Dracula advise on blood-bank security. Crucially, the declaration lacks tangible targets. The outcome document should have included a set of feasible actions and interventions with specic deadlines and indicators upon which progress will be measured. In preparation for the meeting, the UICCas part of the NCD Allianceproposed very specic targets that could have been included, such as a commitment by 2025 to reduce avoidable deaths from NCDs by 25%a target WHO believes is achievable. Instead, the document calls on WHO simply to set up a comprehensive global monitoring framework and prepare recommendations for voluntarynot compulsoryglobal targets before the end of 2012, and to report initial progress in 2013. This is a missed opportunity. Ultimately, events in New York were underwhelming. An opportunity to create political cohesion to tackle the biggest health challenge facing future generations has been missed. Although the declaration sets out the scale of the challenge, it lacks ambition and is more a politically correct declaration than a political declaration of war. Individual countries must now take bold steps to accelerate their responses beyond the slow timetable the UN proposes if real progress is to be made. The Lancet Oncology

Published Online September 23, 2011 DOI:10.1016/S14702045(11)70272-8 For the UN political declaration on the prevention and control of NCDs see http://www.un.org/ ga/search/view_doc. asp?symbol=A/66/L.1 For the UICC proposed cancer outcomes statement see http:// www.uicc.org/advocacy/canceroutcomes-statement-unsummit-ncds For more on the NCD Alliance see http://www.ncdalliance.org

www.thelancet.com/oncology Published online September 23, 2011 DOI:10.1016/S1470-2045(11)70272-8

UN Photo/Marco Castro