"Enough is Enough. Act on NCDs Now!"



By Ann Keeling, CEO International Diabetes Federation and Chair NCD Alliance

Enough is enough. Act on NCDs Now!

I am speaking today on behalf of the NCD Alliance which is comprised of the International Diabetes Federation, The Union for International Cancer Control, The International Union against TB and Lung Disease, and World Heart Federation. 

Together our federations have 1,000 member associations that are at the heart of NCD health service delivery, awareness raising and education, prevention, and patient support in almost every country in the world.

In the last 9 months the NCD Alliance network has been joined by another thousand NGOs. The record growth of the NCD NGO movement has been driven by our collective outrage at the neglect of the NCD epidemic, and the suffering and untimely deaths we see in our work everywhere, especially in low and middle income countries.

We have 6 messages today for national governments:

1. Enough is enough. The NCD epidemic is everywhere and it is out of control. Over 366 million people today have diabetes and that number will grow to over half a billion in a generation - and this is only one NCD.  The Political Declaration agreed this morning finally acknowledges the NCD epidemic and need to act. We look to governments to lead immediate action both at national and global levels to put this right – and the NCD Alliance will put our resources behind governments with the vision and courage to do so.

2. Most NCDs can be prevented or delayed.  Only governments have the power to put in place social environments where healthy food, smoke free places and physical activity are the norm and not the exception. NCD prevention is a sound short term and long term investment. It can save both lives and suffering. We expect governments to regulate unhealthy food content – salt, transfats and sugar - and harmful use of alcohol. In addition, we want all governments to protect children from tobacco use and from food and alcohol advertising.  We want you to accelerate implementation of the Framework Convention on Tobacco Control (FCTC). We urge all governments to tax tobacco to the level recommended by the WHO as a ‘win win strategy’ to both deter smoking and at the same time raise revenue for health.

3. We also expect you to protect the most vulnerable and marginalised: NCDs are often described as diseases of affluence  - but it is poverty and inequality that denies large numbers of people with NCDs the health care they need, and exposes millions to NCD risk factors they would rather avoid. The social determinants of health are critical to understanding the NCD epidemic. Increasing evidence now links poor maternal and infant health with higher adult risk of cardiovascular disease and diabetes in later life. This gives us yet another reason to focus on the maternal health and early childhood, and demonstrates one of the many critical linkages between NCDs and the MDGs. NCDs have never been in opposition to the MDGs. We are part of the same human and economic agenda.

4. Universal access to NCD medicines, technologies and care is a human right.  Today, over 100 million people with NCDs are denied access to the basic medicines, technologies, education and care they need to stay alive and stay healthy. Individuals and families in many contexts are being tipped into poverty by catastrophic expenditure on NCD care. NCDs are not new diseases and most can be treated cost effectively with off patent medicines. Insulin for example was discovered 90 years ago yet children who develop Type 1 diabetes in some low income countries have a life expectancy of just 6 months because they lack access to insulin. A child with type 1 diabetes in Europe, on the other hand could be expected to live a long and healthy life. Governments have an obligation to get affordable, high quality NCD treatment to their people – including vaccines, rehabilitative and palliative care to enable the terminally ill to die in dignity and without pain. Large numbers of people with NCDs are diagnosed late once they have developed serious, expensive and often life threatening complications. NCD prevention is a sound economic strategy and investment in early NCD diagnosis and treatment is similarly both morally right and sound economics.

5. Learn the lessons from AIDS and integrate NCDs. We are not asking for new vertical NCD programmes at national level or a new UN agency. We ask that all governments adopt the AIDS ‘three ones strategy’ and have one NCD coordinating body, one costed NCD plan and one national monitoring and evaluation framework so that all actors, including NGOs, can work together to one strategy and without duplication.  Those plans must be across the whole of government because NCDs go beyond health. And those plans need timebound measureable targets so we can all measure progress. Establishing global and national targets and indicators must be one of the immediate actions after this meeting.  We urge governments to integrate NCDs into existing health policies and health systems strengthening initiatives, refocusing health systems on prevention, health education and chronic disease care. In this way we believe that health systems will be strengthened to benefit all other diseases and conditions, including AIDS which is now essentially a chronic disease. In particular, we want all governments with major overseas aid programmes to low and middle income countries to end the policy ban on funding NCDs that most bilateral donors operate now. Bilateral donors countries must live by the commitment made in the Paris Declaration on Aid Effectiveness. You promised to follow the national priorities of your partner governments in low income countries. If those governments prioritise NCDs then you must respond with the financial and technical assistance they request.

6. Finally, we ask governments to protect human rights and listen to the people. No-one chooses to get an NCD and it is time to end the blame and discrimination in many areas of life that people with NCDs can face. And we ask you to go further and include people with NCDs in the design and monitoring of the policies and services that will affect them because they will be your best source of advice.

I want to end with the message that when we all return home from this meeting it cannot be business as usual for NCDs. We have been sleepwalking into a sick future where obesity will be normal and the majority of adults will suffer with an NCD like diabetes.  That is what the world will look like if we allow present trends to continue. There is energy and expertise in civil society and we bring you a message of hope.  These are not new diseases. We know how to prevent and treat NCDs. Engage us as partners and NGOs will be with you.

Listen to Round Table 2.