We Have a Global NCD Target: Now What?

As those who have followed the United Nations proceedings on non communicable diseases (NCDs) know, one piece of unfinished business is the establishment of global targets to help quantify the global response to this increasing epidemic. On May 25, the delegates to the World Health Assembly took a large step in that direction, by agreeing to the world's first NCD target.  As widely reported, including here and here, delegates from 194 countries agreed to the goal of slashing premature deaths from NCDs such as cardiovascular disease, chronic lung disease, cancer and diabetes by 25 percent by the year 2025. The resolution also laid out a timetable through the end of October 2012, during which the international community will discuss and perhaps adopt other targets related to NCDs, including on obesity, alcohol, tobacco, physical inactivity.

Organizations including the NCD Alliance trumpeted the adoption of the global NCD mortality reduction goal as a singular achievement that will have a lasting impact. This is certainly an accomplishment, based upon the fact that fewer than five years ago, the idea of attacking the scourge of NCDs might have seemed quixotic at best. World leaders meeting in 2007 would not have been aware of the problem of NCDs increasing dramatically in low- and middle-income countries, let alone able to come to agreement on a numerical target. 

But what does it actually mean that there is now such a target? In fact, many other targets have come and gone with varying success.  The Millennium Development Goals, for example, adopted at the dawn of the 21st century with much fanfare by the governments that make up the United Nations, were supposed to be achieved by 2015, a scant three years from now.  But many of these are far from achieved, and several -- including the goal of reducing maternal mortality by 75 percent -- seem completely out of reach. The new NCD target is entirely voluntary and unenforceable.  There is no sanction against nations that do not meet it. And there are also significant data collection challenges since the majority of countries do not keep accurate statistics on cause of death.

And yet, most global health experts agree that having such a target will certainly spur action.  Organizations including the UN Development Program and the World Bank are beginning to factor NCD prevention and treatment into their country planning on the assumption that countries where they work will request additional assistance.  And some nations may take the additional step of adopting national programs and frameworks to reduce the prevalence of NCDs. Regional organizations such as the Pan American Health Organization are adopting strategies to help nations better plan for their own NCD mortality reduction work.

Of the 36 million deaths attributable to NCDs in 2008, the World Health Organization estimates that "a large percentage" are preventable through the reduction in four risk factors: tobacco use, physical inactivity, harmful use of alcohol and an unhealthy diet. These factors together account for at least 11.5 million deaths. In addition, at least 2 million fatal cases of cancer are attributed to infections that are preventable. And millions more people die because of disease stemming from eating unhealthy foods high in salt, sugar and fat.  In all, reducing these factors by 25 percent could save at least 3.3 million lives every year.  

As WHO Director General Margaret Chan said during the UN High Level Meeting in September 2011, quoting management expert Peter Drucker, "What gets measured gets done." Put another way, until we start measuring the problem, we don't even know how large a problem we have to solve.  That alone should be enough to get us started.

    

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