The UN High-level Meeting on Non-communicable Diseases held on 19-20 September 2011 in New York was a major milestone in the history of the global diabetes and non-communicable diseases (NCDs) epidemic. Building on the achievement of UN Resolution 61/225 on diabetes in 2006, and drawing from the lessons and successes of the HIV/AIDS UN General Assembly Special Session a decade ago, IDF saw the UN High-Level Meeting on NCDs as an opportunity to engage heads of state and governments to secure a comprehensive set of commitments at the highest political level and accelerate global progress on diabetes and the other non-communicable diseases.

The impact of the process

Since the unanimous decision to hold the UN High-level Meeting on NCDs, IDF and its sister federations in the NCD Alliance worked to lay the foundations for a successful summit and maximize this once-in-a-generation opportunity. The official process and preparations for the summit have changed the global health landscape forever. It has catalyzed high level discussions on diabetes and NCDs at national, regional and global levels that were not happening before – amongst non-governmental organisations (NGOs), governments, international organisations, and the private sector.

As part of preparations for the summit, IDF consulted national member associations and experts in diabetes to align priorities and bring a united voice for diabetes to the discussions. The top priorities identified by more than 115 member associations in 160 countries who responded to this consultation are presented in Box 5.1.  Informed by these consultations, IDF and the NCD Alliance published a Proposed Outcomes Document setting priorities for negotiations.

Official negotiations

The official process for the summit included WHO Regional Consultations on NCDs, many resulting in official Declarations which highlighted the similarities and differences in priorities of governments and political blocs. WHO also held a number of multi-sectoral consultations, co-hosted the First Global Ministerial Conference on NCDs, and worked with the UN to convene a Civil Society Hearing at UN Headquarters which provided further opportunities for government decision-makers to familiarize themselves with NCDs evidence and issues, and hear the priorities of civil society, including those put forth by the NCD Alliance. As part of the process, the WHO, the UN Secretary General, and the World Economic Forum all published reports strengthening the evidence for NCDs and highlighting cost of inaction.

Building and strengthening alliances

Another significant marker of Summit preparations was the strengthening of alliances and partnerships to tackle the global NCDs epidemic. IDF and the NCD Alliance created a NCD civil society movement in an unprecedented time, working together across diseases for a common cause. This civil society movement is here to stay and will be integral to continuing momentum and monitoring commitments post-Summit. Influential relationships were built with Governments, the private sector, and NGOs working in inter-related development issues such as maternal and newborn child health (MNCH), HIV/AIDS and TB. IDF and NCD Alliance partners produced two influential articles on NCDs priorities and solutions with the Lancet NCD Group. These alliances have promoted exchange of best practice and innovative solutions in diabetes and NCDs prevention and control. 

The future of diabetes after the UN High-level Meeting on NCDs

These preparations fed into to the drafting of a Political Declaration for agreement at the High-level meeting.  negotiations were drawn-out due to a lack of consensus on many important issues. However, the 193 Un member States finally agreed on a strong document with a comprehensive set of political commitments. This ground-breaking Declaration marks world leaders’ recognition of the magnitude and impact of NCDs and positions them as a development issue that reaches beyond the health sector. A record 34 Heads of government and State attended and 120 member States made statements. The High-level meeting has undoubtedly inspired political will and leadership for diabetes and NCDs and the resulting Political Declaration provides a framework for saving millions of people from preventable death and disability.

Areas of Success

Leadership and International Cooperation   Diabetes and NCDs are now seen as a development issue.  The Declaration encourages their inclusion in development agendas and urges international organisations to provide technical assistance and capacity building for NCDs to developing countries. National leadership is a strong component with a specific commitment for governments to establish or strengthen multi-sectoral national Policies or plans by 2013.

Essential medicines and technologies

Importantly for people with diabetes, the Declaration commits governments to increasing access to affordable, safe, effective and quality-assured medicines and diagnostic technologies. It includes specific language on the use of generics and patent licensing flexibilities to improve access, availability and affordability.

Health Systems

The Declaration recognises the importance of a well-functioning health system to deliver care to people with nCDs and of universal coverage in national health systems, particularly through primary healthcare and social protection mechanisms. The Declaration also includes commitments to promote training and retention of health workers.

Prevention

Focus is put on health-promoting environments with action on promoting healthy diets and increasing physical activity through urban planning, active transport, and work-site healthy lifestyle programmes. Governments have committed to reducing salt, sugar, and saturated fats, and eliminating industrially produced trans-fats in foods although without agreed targets. The Declaration recognises the links between maternal under-nutrition during pregnancy and gestational diabetes and increased risk of the infant developing diabetes later in life.  The Declaration promotes the inclusion of NCDs in reproductive, maternal and new-born child health programmes.

Follow-up

The UN Secretary general is required to report on progress in 2013 at the general Assembly and member States will hold a comprehensive review and assessment in 2014. This review will enable the tracking of commitments made in the present Declaration and of progress on future global targets and indicators that member States should deliver on. It is also an opportunity to ensure that diabetes and NCDs are integrated with other health priorities in future internationally agreed development goals when the current Millennium Development Goals (MDGs) end in 2015.

Areas for Further Action

Targets

The Declaration lacks overarching goals and time-bound targets. As the 2001 HIV/AIDS Political Declaration demonstrated bold goals and targets inspire leadership, ensure broad action and create a political action plan for stakeholders to measure progress. Member States have missed this opportunity, postponing the decision until 2012 when they will agree a comprehensive global monitoring framework for NCDs and voluntary global targets and indicators.

Resourcing

While the Declaration recognises that resources for diabetes and NCDs are not commensurate with the magnitude of the problem, it falls short of concrete commitments, only requesting member States investigate options for potential sources of funding. Encouragingly, it does specify bilateral and multilateral channels, which to date have been limited for diabetes and NCDs, as well as innovative long-term financing approaches.

Partnership

Governments recognised the importance of multi-sectoral action, but failed to commit to a high-level nCD partnership to coordinate and drive follow-up action. Instead they requested the Un Secretary-general present recommendations in 2012 outlining options for such a partnership. NGOs must be involved in this process.

Next Steps

The UN High-Level meeting on NCDs is a watershed event, but it is just the beginning of a new era for diabetes. The Political Declaration opens the door for advocacy efforts in 2012 on the development of global targets, a monitoring framework and a high-level NCDs partnership. With the MDGs Review in 2013, the global diabetes community must campaign to ensure diabetes and NCDs are integrated into future internationally agreed development goals. Governments are now looking to civil society for guidance and technical expertise on implementing elements of the Declaration. IDF is ready to lend expertise to governments to deliver the necessary actions, as well as play a ‘watch dog’ role holding governments accountable for the promises made.  IDF is proud to have led the movement to this achievement but the campaign goes on for the millions of people with diabetes worldwide. 

[2]