Message from IDF CEO Ann Keeling
13 May 2010 - a date I won’t forget in a hurry. It was a year ago today that UN Member States unanimously voted to hold the first ever UN High-Level Summit on Non-Communicable Diseases (NCDs) in September 2011. We weren’t exactly taken by surprise. IDF had been calling for such a Summit since January 2009 and had lobbied hard with our member associations and NCD Alliance partners to get that decision. But we were surprised that so many UN Member States – around 130 – cosponsored the resolution, showing their deliberate support for the Summit. And it certainly happened faster than we expected.
In one short year, the NCD landscape has changed permanently. There is no going back. The ‘NCD label’, which we would not have chosen, is here to stay. There continues to be debate about what that NCD label should include, particularly around mental health. But there is no doubt that the NCD label covers the big ‘four by four’ - diabetes, cancer, chronic respiratory and cardiovascular diseases and their shared risk factors of physical inactivity, unhealthy diet, tobacco use and harmful use of alcohol.
And in one short year, we have built a strong NCD civil society movement – four federations, 900 member associations, 7 supporting NGO partners, 10 supporting private sector partners – and nearly 350 NGOs in the NCD Alliance Common Interest Group. We have worked together sharing strategy and information. We have broken the myth that NGOs can’t work together across diseases for a common cause. We don’t feel any less passionate today about the diseases we each speak for but in addition, we feel passionate about NCDs.
And we have built the NCD Alliance into a respected brand, so much so that people often assume we have a building full of staff somewhere. It surprises many when they realise this global movement was built and driven by a small group of us as our ‘night job’. I was delighted when Peter Piot wrote in a recent article:
"It is critical to take account of the special challenge facing the NCD sector and leverage strategically the special political assets that are at hand: notably the UN Secretary General, the WHO Director General, and the NCD Alliance."
When I have time I intend to have the words ‘NCD Alliance: special political asset’ printed on the front of a t-shirt. It seems almost ridiculous that we can have come this far in one year. But we stepped in to fill a critical political niche and have unrivalled legitimacy grounded in the work of our member associations in 170 countries.
In one year the Summit has catalysed discussions on diabetes and NCDs at national, regional and global levels that simply were not happening before – amongst NGOs, governments, international organisations and the private sector. I never understood why NCDs were in the shadows but undoubtedly the international spotlight is on us now.
There is a strong consensus building around outcomes from the Summit. It is widely acknowledged that concerted action is needed to eradicate tobacco. We have a strong public health instrument in our hands already– the Framework Convention on Tobacco Control – and the time has come to strengthen political resolve to implement it. There is also broad agreement that action is needed to reduce salt, sugar and transfats in processed foods. Less agreement on how to do that but the goal is one that could have a huge impact on public health. There is also growing understanding that measures to prevent NCDs must be paired with measures to control NCDs.
Step one is early diagnosis followed by affordable, quality treatment. There is less agreement at this stage on the essential medicines and technologies that should be in the package, but it is acknowledged that NCDs need a health system that addresses prevention, patient education and continuous care and that a health system fit for NCDs will benefit all other conditions and diseases, infectious or not. All of this will take planning at national level and cross-government coordination since NCDs are every minister’s business – urban planning, sports, food and agriculture – with health, of course.
But one year on and around 130 days to go before the Summit, there are influential actors we still need to get on side and issues we still need to raise.
First, we still need to convince some high-income governments with overseas aid programmes that NCDs are a development issue. I am disappointed that we still hear the same myths and misconceptions that we heard a year ago – that NCDs are not diseases of the poor, we have too little evidence and no cost effective solutions, and they are a distraction from the Millennium Development Goals. I say we have put enough evidence on the table to confront those myths and they just aren’t listening. No need to listen to us, I ask donor agencies to start listening to the people and countries they aim to serve. Four out of five cases of NCDs are now in low- and middle-income countries and this isn’t going to get better if we continue to ignore the problem.
Secondly, we hear loud support for prevention – and we applaud that – but still shaky support for treatment. It’s a very simple point. We must do everything in our power to prevent NCDs. If we start now we will see huge benefits in 20 or 30 years. More if we are determined, united and smart. But focussing on prevention cannot mean ignoring the hundreds of millions of people who have NCDs now. With early diagnosis and some simple cost effective treatments we can save lives, prevent NCDs or delay their onset, and prevent the devastating complications that accompany untreated NCDs. And where we can’t save lives, we can enable others to have what we would all want for ourselves – a dignified and pain free death.
Thirdly, stop asking us where the money is going to come from to fix NCDs. Start asking why governments, families and individuals are spending so much money now on preventable sickness and premature death? We don’t need to do the sums to understand the extent of the cost to governments, employers, families of 300 million people with diabetes, rising to 500 million within a generation. Add to that the cost of the other NCDs: cardiovascular disease, cancer, asthma, lung disease, and the cost of diabetes complications – kidney disease, blindness, amputations, increased tuberculosis, increased maternal mortality and morbidity. Start asking what your government spends and wants to spend on renal dialysis when that particular diabetes complication could largely be averted. Start thinking differently about the benefits of healthy children, mothers, employees. Start thinking about growing old, very old and not being sick for 20 or 30 years before you die. Start asking why 43 million children under the age of five are overweight and ask how we got where we are now? We didn’t plan it. We don’t want a sick future for our children. We can avoid it.
Fourthly, we are still looking for a forum where we can dialogue and plan with governments and the private sector since we will need to move forward together to fix the problem.
One year on from 13 May 2010 we have come a long way in getting NCDs further up the global agenda and the NCD movement is unstoppable now. Importantly, 130 days out from the Summit there is no strong opposition to what we want but strangely, no strong support either. The discussion and debates are still polite and quite dispassionate. Rarely a sense of outrage that is seen in other health and development issues such as HIV/AIDS, and a bizarre lack of urgency given that the NCD epidemic is not just a possibility, it’s already upon us.
Two years ago NCDs were most definitely off the global health agenda, one year ago the world changed. Now NCDs are no longer the global health Cinderella, we’ve bought the glass slippers and we are dressing for the ball.