Reflections on progress to reduce non-communicable diseases

Building viewed from a road lined with various national flagsIn September 2011, public health NGOs were gearing up for the High-Level Meeting of the United Nations on Non-Communicable Diseases (NCDs). This was only the second time that the UN General Assembly had met on a health issue. As such it was both a landmark occasion and an unprecedented opportunity to raise political awareness of the catastrophic impact of NCDs around the world.

Public health advocates wanted the meeting to bring a similar level of political attention and sense of urgency to NCDs as had previously been achieved for the HIV/AIDS epidemic. Critically, it was hoped that the Political Declaration that was to be agreed would secure much greater action worldwide on the prevention and control of NCDs. In so doing, all governments would set in stone their political ambition, commitment and accountability to addressing NCDs.

It was in this optimistic context that I joined the policy department at World Cancer Research Fund International. Thankfully, the Political Declaration was universally adopted by governments from around the world. In it they agreed a roadmap for international action. As such, my work at WCRF International has been influenced by the outcomes of this meeting.

As I sadly prepare to leave WCRF International to take on a new career challenge, it seems like a good moment to reflect on the impact of that High-Level Meeting and what has happened during this exciting period for NCD policy worldwide.

Action since the UN Declaration on NCDs

The UN Political Declaration has been instrumental in galvanising global action on NCDs. It has mandated international agencies such as the World Health Organization (WHO), Food and Agriculture Organization and the UN Development Programme to expand their work programmes on NCDs and to collaborate on this issue more than ever before.

While there is still a need to ensure that NCDs are truly integrated in all the relevant areas – such as the ongoing discussions around the post-2015 global development agenda, it is undeniable that the profile of NCDs has risen as a result. In the years since the Political Declaration, the WHO has successfully adopted a global policy architecture for NCDs, including a Global Action Plan, a set of global targets (designed to incentivise and drive action), a framework for monitoring progress, and a voluntary global target to reduce premature deaths from NCDs by 25% by 2025.

As a result, NCDs are well and truly established on the health policy map, and the WHO – as the lead agency on health – has articulated what it would like to see national governments do in terms of developing and implementing policies.

What has this meant for our work?

For World Cancer Research Fund International the new global policy architecture on NCDs galvanised our work advocating the wider implementation of effective policies for the prevention of cancer and other NCDs. We developed the NOURISHING Framework to bring together key areas where governments need to take policy actions to promote healthier eating and ultimately to help achieve the 25 by 25 goal.

Having an agreed policy framework is critical because it allows the political discussion to move from the “what” to the “how”, which is where there is most potential to support national governments in developing policies. As part of NOURISHING we pulled together the policy actions that countries are taking around the world (e.g. on nutrition labelling) so we could see – and share with others – what countries are doing to implement these global agreements.

“What are other countries doing?” is a question we heard often from government officials. Even more, I used to hear “what is the evidence that policy is effective?” So we developed a plan to collate, review and interpret the evidence base. This is work I will be excited to see WCRF International develop into the future, and which I look forward to using in my new role at the WHO’s Regional Office for Europe.

Working internationally is different to working at the national level. Nationally, policy actions have to be tailored to contexts and populations; internationally, it’s about identifying the core elements of well-designed policy that are transferable globally. One of those elements inevitably involves the law, which is why we explored the role of law in obesity prevention in our first working paper, and collaborated with the McCabe Centre for Law and Cancer.

Where are we going next and what are the challenges?

By its very nature, public health evidence is complex. This is particularly the case for multi-factorial issues such as obesity.  As I leave World Cancer Research Fund International my hope is that it ultimately does for policy what it has always done so well in its science programmes (notably for Second Expert Report and now with the Continuous Update Project). That is, to ensure that all the evidence is brought together in a way that we can learn from it and take action.

Communicating what has been learned to governments, including analysis of the real-world effects of innovative policies, should enable even more policy action on NCDs and a greater confidence in our understanding of the “how” part of the equation. This will be the true legacy of the Political Declaration.