By Ann Keeling, CEO International Diabetes Federation
This week history was made at the United Nations. World leaders agreed a Political Declaration at the first UN High Level Meeting on Non-Communicable Diseases (NCDs) that will change the global health and development landscape forever. Political will and leadership to accelerate global progress on diabetes and NCDs has finally been achieved. IDF was one of the earliest voices calling for a UN Summit and has worked tirelessly to keep diabetes visible and ensure strong outcomes. We are celebrating success, but the campaign goes on.
Impact of the UN Summit
The Summit had an enormous impact even before it happened. For over a year official preparations focused attention on diabetes and NCDs like never before. A range of important WHO Regional Consultations, ministerial meetings and civil society hearings have all provided powerful platforms to make the case for urgent and concerted action.
The Summit process has also helped strengthen the evidence base with the production of a number of focused publications. Reports such as WHO’s Global Status Report on NCDs, the UN Secretary General’s Report on NCDs, and the complementary World Economic Forum’s Cost of Inaction Study and WHO’s Cost of Action Report that have provided much needed data and insight. IDF and the NCD Alliance have also produced a number of policy briefs to raise awareness among policy makers about topics such as women and NCDs, essential medicines and technologies, tobacco control, physical activity and nutrition, and NCDs as a human rights issue.
And it has been a period marked by the strengthening of alliances and partnerships. IDF and sister federations in the NCD Alliance created a NCD civil society movement in record 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 have been built with Governments, the private sector and NGOs working in related development issues. IDF and NCD Alliance partners have worked closely with the influential medical journal, The Lancet.
Outcomes of the UN Summit
The Political Declaration signed by Heads of State and Government was the result of a hard-fought battle. It does not contain everything we asked for but it undoubtedly marks a major milestone for diabetes and NCDs. World leaders have recognised the magnitude and impact these diseases and the urgent need for action.
In some key areas we wanted stronger commitments and without targets and timetables many lack teeth, but the Declaration will accelerate international progress on diabetes and NCDs, saving millions of people from preventable death and disability.
Importantly for people with diabetes, it commits governments to increasing access to affordable, safe, effective and quality-assured medicines and technologies. It also achieves a balance of commitments on medicines and improving diagnostic services and recognises the contribution of a well-functioning health system with commitments to promote universal coverage in national health systems and training and retention of health workers among others.
On diabetes prevention, we have commitments to promote healthy diets and increase physical activity through urban planning, active transport and work-site healthy lifestyle programmes. No targets have been agreed but governments have taken a step forward and committed to reducing salt, sugar, and saturated fats, and eliminating industrially produced trans-fats in foods. There is a strong focus on reducing childhood obesity, with restrictions on the marketing to children of foods high in fats, sugar and salt agreed. Furthermore, the Declaration promotes a life course approach to prevention and the inclusion of NCDs in reproductive, maternal and newborn child health programmes due to the link between maternal under-nutrition and increased risk of the infant developing diabetes later in life.
The Declaration’s major weaknesses are the lack of time-bound targets to shape a shared political vision for the future and the failure to agree a high-level multi-sectoral partnership to drive follow-up action. Decisions on these have been postponed until 2012 when governments will agree to a comprehensive global monitoring framework for NCDs and a set of voluntary global targets and indicators as well as define the partnership required.
A third weakness - not surprising in the current global economic climate - is the lack of concrete commitments on resources. The Declaration recognises that resources for dealing with NCDs fail to match the magnitude of the problem but it only requests Member States to investigate options for funding. Encouragingly however, 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 and taxation policies.
Member States have agreed to hold a comprehensive review and assessment in 2014 to track progress on Summit commitments and assess progress on the global targets and indicators they agree in 2012. This will provide an opportunity to ensure that diabetes and NCDs are integrated with other health priorities in future internationally-agreed development objectives when the current Millennium Development Goals end in 2015.
No Magic Bullets
IDF called for a UN Summit to kick-start change; we have achieved this but one Summit will not resolve the diabetes and NCDs crisis. There are no magic bullets for this epidemic. It will take decades to turn this global catastrophe around so world leaders have to recognise the need for a long-term vision, sustained leadership and political will. To provide the necessary support, IDF has launched the first Global Diabetes Plan, developed by world experts. Covering ten years from 2011 to 2021, the Plan presents cost-effective solutions in a framework of action to guide governments, healthcare providers, and civil society. As a federation of 220 member associations in 160 countries, IDF is ready to lend expertise to governments to deliver the necessary actions in the post-Summit world.
Translating commitments into action will also require a new level of partnership. Beyond the Summit IDF envisages ‘Triple P Partnerships’ involving public, private and people. The involvement of people living with HIV has been vital to the global response to this disease. The NCD movement still has work to do to ensure people with diabetes and NCDs are involved at all levels, from global policy to services design on the ground necessary to achieve effective partnerships and real change for people with diabetes. Politicians need to be confronted with a strong sense of outrage; people with these diseases must stand up and demand their right to health and the right to universal access to medicines. No more should we accept accidents of geography that determine whether people with diabetes live or die. Insulin was discovered 90 years ago but children in low-income countries are dying from type 1 diabetes while in high-income countries they can live long and healthy lives.
A New Era for Diabetes
The UN Summit on NCDs and its Political Declaration mark the beginning of a new era for diabetes. Two years ago it was inconceivable that diabetes and other NCDs would have achieved today’s prominence without the catalyst of the Summit. With courage, leadership and a long-term vision, a new future is possible for people with diabetes and NCDs. IDF is proud to have led the movement to this achievement but the campaign goes on for the millions of people with diabetes worldwide.
Read the Political Declaration adopted by consensus at the UN General Assembly in New York.