Outcomes of the 73rd Session of the UN General Assembly
September, 2018 New York - The UN General Assembly is the main deliberative, policymaking and representative organ of the United Nations. 193 Countries come together to deliberate on national and global policies. This year the Sustainable Development Goals (SDGs) were discussed in every meeting proving that all Sectors are beginning to use the SDGs as a measurement of progress. This is a summary by the World Heart Federation of some the themes from key UN meetings in the field of public health and non-communicable diseases.
Antimicrobial Resistance (AMR)
A global AMR challenge led by the U.S. Centers for Disease Control and Prevention (CDC) was launched. This is aimed at committing action to deliver results and combat one of the greatest public health threats in the world. In the U.S alone, at least 2 million people get infections caused by antibiotic resistance and at least 23,000 die as a result. Unfortunnately, the global burden is still unknown.
Mental Health and the 2030 SDGs
The UN meeting on Mental Health shed light on the inadequate services and infrastructure available to tackle this growing issue in all countries globally. More than 300 million people suffer from depression globally and suicide is the second highest cause of death for ages 15 to 29 years old. Mental Health is being tackled by WHO as part of Non-Communicable Diseases (NCDs). An onus was also placed on employers to promote good mental health and well-being at work.
2nd Ministerial high-level meeting on Cervical Cancer: A world free of Cancer
It was agreed that better co-ordination is required to achieve the global elimination of cervical cancer. Governments and organisations dealing with NCDs, maternal, newborn and child health, women and girls and HIV came together to deliberate how to work together. It was noted that local data is important in eliminating HPV for the prevention of cervical cancer.
UN High-level meeting on Non-Communicable Diseases (NCDs)
It was noted that there is a lack of financing for NCDs. The challenge put forward is how can governments ensure NCDs are covered in Universal Health Coverage (UHC)? What are the options for International Financing? Primary Healthcare strengthening is required.
The challenge of working with Food and Alcohol industry needs to be overcome. This is the year of innovation. It is time to “Act and Deliver”.
In addition to that, IAPO member, Dakshamahealth notes that the focus was on the political declaration and statements made by representative countries and members. The high was the focus on “Healthcare no longer being an option but a right of every human being” and to this effect the commitment by most member countries to work on UHC and making it a reality. There was active participation of civil society, industry and patient organisations in several power packed side events that called for “call to action” on issues related to prevention, access to medicines, research and sustainable financing. However the focus on ageing and youth centered interventions wasn’t discussed much. Ensuring civil society engagement and participation of people living with NCDs did not translate into action, with almost no speaking opportunity for civil society or PLWNCDs at official side events. There were No financial commitments from governments to accelerate national responses. Focus on research for new medicines and investing for research did not find mention in the main event or the side events.
The political declaration by Heads of State and governments (Presidents & Prime Ministers)
H.E. Ms Maria Garce’s President of the General Assembly opened the UN high-level meeting on NCDs. The meeting was attended by Heads of State and governments, Ministers of Health, Civil Society, Multilateral agencies and the private sector. H.E. appealed to Heads of State and governments to prioritise NCDs and work towards achieving Goal 3.4 of the Sustainable Development Goals (SDGs) which is by 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being. Currently, effects of NCDs leads to annual GDP losses of about 6%.
The UN General Assembly (UNGA) adopted a political declaration titled "Time to Deliver: Accelerating our response to address NCDs for the health and well-being of present and future generations." It includes commitments to reduce premature mortality by one-third from NCDs by 2030, in line with the 2030 Agenda for Sustainable Development of the UN. While acknowledging the progress achieved by some countries in controlling four major NCDs, which are cardiovascular disease, diabetes, cancer and chronic respiratory diseases; the declaration stated that actions so far have been inadequate.
Heads of State and governments committed to 13 new steps to tackle NCDs including cancers, heart and lung diseases, stroke, and diabetes, and to promote mental health and well-being. They also agreed that these efforts should include robust laws and fiscal measures to protect people from tobacco, unhealthy foods, and other harmful products, for example by restricting alcohol advertising, banning smoking, and taxing sugary drinks.
They committed to promoting greater policy coherence and coordination through whole-of-society approaches, as well as health–in-all-policies approaches. They also committed to working with the private sector and promote Public-Private Partnerships (PPPs) to scale up innovative solutions.
They further committed to implement a series of WHO recommended policies to prevent and control NCDs - such as public health education campaigns to promote healthier lifestyles, vaccinating against HPV virus to protect against cervical cancer and treating diabetes and hypertension. WHO estimates that implementing all these policies could generate US $350 billion in economic growth in low and lower-middle-income countries between now and 2030.
Other specific commitments focus on integrated healthcare delivery, halting the rise of childhood obesity, promoting regular physical activity and reducing air pollution. There was a call for food manufacturers to reduce salt, sugar, saturated and industrially produced trans fats, using nutrition labelling on packaged food to inform consumers, and restricting the marketing of unhealthy foods and beverages to children.
Finally, the declaration requested the UN Secretary-General, in collaboration with WHO and other relevant parties, to submit to UNGA a report on the progress achieved in its implementation by the end of 2024.
Dr Tedros, Director-General of the World Health Organization (WHO) stated that tackling NCDs is a living reality for millions of people as they kill 41 million people each year. By 2025, we could prevent 10 million NCD deaths if we adopt the WHO best buys. Dr Tedros suggested a presidential coalition among 6 to 12 Heads of State. They would act as Presidential Champions of NCDs initiatives globally. A website could be established.
WHO renewed the appointment of Michael Bloomberg, Founder of Bloomberg Philanthropies as WHO Global Ambassador for NCDs for another 2 years. Dr Tedros outlined 3 actions that governments required for NCDs:
- Political commitment – political intervention is a necessity;
- Domestic investment – spending to build a healthy population is not a cost but an investment for human capital;
- Focus on Universal Health Coverage: Next year there is a UN High-level meeting on UHC.
Highlights of Commitments by Governments
President of Switzerland
Switzerland has a national nutrition strategy and a focus on Dementia. Switzerland will continue the commitment to global goals. The Swiss will host the Global coordination mechanism meeting on NCDs on 5-6 November, 2018 in Geneva.
President of Kenya
A National NCD Committee has been established which includes sectors outside health. Stressed that access to essential medicines is important in addressing SDG’s. Kenya calls on the private sectors to improve access to medicines. UHC is one of Kenya’s big agendas.
President for Republic of Honduras
Honduras has quadrupled their budget for health. Equipment and referral hospitals for diagnostics have been established to build a robust healthcare system. Their focus is on leaving no one behind.
Minister of Health, Canada
2 in 5 Canadian adults have an NCD thus the government is focused on helping Canadians quit smoking and live healthy life styles. To enable more Canadians to get physically active, the government launched Let’s Get Moving – the country’s first ever policy aimed at sedentary living. The Government has committed 5 billion dollars over the next ten years to improve mental health and addiction services.
Canada is taken a whole-of-government approach to tackle NCDs. They are therefore investing in infrastructure that promotes active transportation and fighting climate change to clean up the air they breathe and teach children about nutrition. The government is working with the private sector, civil society and Indigenous groups to improve the health of all Canadians.
Minister of Health, Japan
To address NCDs, Japan noted that changing individual behaviour is the key to success. For example, since 2008, Japan has made insurers conduct health check-ups for those insured. These are accompanied by health education programs to raise awareness and enhance behavioural changes. Furthermore, incentives are provided to insurers to enhance these check-ups and medical data accumulated through this health check-ups are analyzed to develop new policies. In Japan, it is said that some 70% of the people are not interested in their health. It is vital to encourage these people to become aware of their well-being.
Japan pointed out that in an aging society, addressing the issue of NCDs should be integrated with promoting healthy aging, which will not only benefit each individual, but also reduce medical and health care expenses. It will also increase tax and social insurance revenue by enabling those who wish to work even when they are old.
In Tanzania, 34% of deaths are due to NCDs. Their health financing strategy and UHC, calls for the establishment of mandatory National Health Insurance scheme for all Tanzanians at all levels of care. As a result, all Tanzanians will now have access to standard minimum health care benefits, packages, which are aligned to the National Essential Health Care Intervention Package of 2013. There is a massive campaign on promoting physical activity led by the Vice President.
European Union Commission
The E.U. is working on initiatives linked to poverty and inequality. as health promotion is essential for all including children, they are focusing on addressing unhealthy food promotion to children. They are also developing a new IT system to collect best practices.
Germany is focusing on the implementation of 2030 SDGs. Germany, Norway and Ghana have formed a joint Action Plan for UHC 2030.
There is a focus on Schools, education and advertising guidelines. National steps challenge was introduced to tackle physical activity. It has been found that 40% of Singaporeans do not have sufficient physical activity. To encourage more Singaporeans to be physically active and reap the benefits of regular exercise, the world’s first population-level pedometer-based physical activity initiative, the National Steps ChallengeTM was launched last year.
U.S. Deputy Secretary of the Department for Health and Human Services
U.S. stressed on the need to work with the private sector. Simple telecommunication and telehealth are tools that can be utilised. U.S. wants to focus on health education in remote and inner cities to address premature mortality. Evidence-based strategies need to be adopted which also demonstrate the health benefits of technologies. Minister of Health, India India hopes to increase access to primary care with the introduction of 150,000 wellness centres. They want to promote yoga and life style changes. They need technologies and affordable medicines to tackle NCDs.
Minister of Health, Finland
In the 1960’s, Finland had the 2nd highest cardiovascular mortality in the world. Today the figures for the working aged population have decreased to one tenth. Health monitoring, reducing smoking and improving dietary habits have had a huge impact on their NCD burden. The Finnish educational system provides health education, physical activity and free healthy school meals. The agricultural sector promotes the production of healthier foods and the Ministry of Finance carries excise duties on soft drinks, alcohol and tobacco. The implementation of health in all policies has produced good results for Finland.
Italy is investing in Agricultural practices and efforts to promote healthy and active life styles. They want to improve nutrition. Italy wants alliances with companies to harness technologies for the improvement of health outcomes.
Argentina Minister of Health
Argentina wants an intersectoral approach to tackling health as a top national priority. They will use scientific evidence to form the basis of their interventions in health. They will focus on health in schools, controlling tobacco and reducing processed foods. One of the Presidential priorities is to stop the epidemic of childhood obesity. The government also plans to broaden healthcare coverage towards Universal health coverage. The government is convening a digital research programme.
The government has increased health expenditure to 20% of GDP. Alcohol and unhealthy diets are being addressed by implementing national food and nutrition policies targeted at school children. There is also a focus on primary healthcare.
China has a 1.39 billion population and death by NCDs has increased to 88% of total deaths. China wants partnerships with Member States to tackle NCDs.
Dr. Svetlana Axelrod, Assistant Director General for Non-Communicable Diseases and Mental Health
WHO has also launched its third NCDs Country Profiles report to assess national progress in meeting targets to prevent and control NCDs. The report found that the risk of premature death from one of the four main NCDs had declined to 18% in 2016, a relative reduction of 5% from 2010. But the rate of progress is unlikely to meet the Sustainable Development Goal target of a one-third reduction in premature deaths from NCDs by 2030. The report also found that significant gaps remain in health services and access to medicines and technologies to manage NCDs.
NCDs, primarily cardiovascular and respiratory diseases, cancers and diabetes, currently account for the deaths of seven in every 10 people worldwide (41 million), including 15 million in the prime of their lives (aged 30-69), mostly from developing countries. Mental conditions and disorders are a related concern, with depression alone affecting 300 million people.
WHO’s Thirteenth General Programme of Work 2019-2023 places strong emphasis on responding to the epidemic of NCDs and promotion of mental health, with investment in universal health coverage being at the core of national responses. WHO has committed, during this period, to ensure 1 billion more people benefit from universal health coverage; 1 billion more people enjoying better health and well-being; and 1 billion more people being better protected from health emergencies.