4 key steps to cure global healthcare challenges

Significant strides have been made in the last five years, which have placed non-communicable diseases (NCDs) on the global health and development agenda.

The United Nations Political Declaration (2011) sets out the enormous challenge and the required response. In 2013, governments adopted the first set of global targets for NCDs, including an ambitious target to reduce premature mortality from NCDs by 25% by 2025 (also known as 25 x 25).

The world has rallied behind a Global NCD Action Plan for 2013-2020, which includes six objectives and a set of cost-effective interventions for preventing and controlling this growing epidemic. And in 2014, a United Nations review of progress on NCDs reaffirmed that governments are elevating NCDs on their national agendas – through national NCD targets, national plans and national commissions.

But despite this, progress is slow, inconsistent and frustrating for those of us who believed that the fine words heard in New York and Geneva would result in greater impact on the ground than we have seen to date. So where are the gaps?

First, we need political leadership at the national level on NCDs. The best indicator of political leadership is the presence of a national NCD plan, and a sustainable budget. Currently, only 36% of countries have a national NCD plan. National plans must be developed and placed at the heart of all national health and development agendas. They should be funded as part of the national health spend, or, in the case of low-income countries, supported through Overseas Development Assistance. In the short term, we accept that there will be resource constraints as countries build up their capacity to manage the NCD burden in their country. However, all countries can take steps now to improve planning and budgeting which will help prevent and control NCDs.

Second, we must recognize that dealing with NCDs involves more than just treatment and cure. The major risk factors that cause NCDs must become enemies of every state – and tobacco stands out as the evil we know it to be. Addressing all NCD risks factors is important, but if we have to focus on one risk factor, then it has to be tobacco control. Accelerating the implementation of the WHO Framework Convention for Tobacco Control (FCTC), with the rapid adoption of plain packaging in all countries, will send a message to all that we will not sleepwalk into a conclusion which reduces the average number of healthy life years experienced by future generations in their lifetime – an outcome which is likely if we do nothing.

Third, we should turn our attention to where the NCD burden is hitting hardest – low- and- middle income countries (LMICs). Unfortunately, NCDs are increasing faster in developing countries, in younger people, and with worse outcomes than in wealthier countries. The majority of premature deaths from NCDs occur in developing countries, and this is only projected to get worse over the next 20 years if we don’t act now. For cancer, this entails improved and more widely available screening, the implementation of national vaccination programmes (particularly for the Human Papilloma Virus, which causes the majority of cervical cancer cases) and dispelling the myths and misconceptions that discourage individuals from presenting for treatment early – when most cancers are far easier to treat with success, even in resource-challenged environments.

Fourth, we need to improve monitoring and surveillance systems for NCDs. Information on the burden and progress being made is critical to reaching 25 x 25. According to the WHO, 19% of countries do not have adequate vital registration systems. This is why my organization (UICC) and the International Agency for Research on Cancer (IARC) have campaigned for all countries to establish a robust population-based cancer registry, to understand the existing country cancer profile and to plan a cost-effective response, drawing on the advice available from WHO and others.

This then, is the challenge. The “25 x 25” NCD target is dependent on national action. It is dependent on addressing risk factors, early detection and treatment. And critical to global health more generally, we must dramatically reduce tobacco use in this and future generations.

Author: Cary Adams, CEO, the Union for International Cancer Control, Switzerland

Image: Pharmaceutical tablets and capsules in foil strips are arranged on a table in this picture illustration taken in Ljubljana September 18, 2013. REUTERS/Srdjan Zivulovi