Addressing Non-Communicable Diseases Through Multilateral Engagement at the United Nations

Nerissa Cook
Deputy Assistant Secretary, Bureau of International Organization Affairs
2011 Global Health Council Meeting on "The Growing Burden of NCDs: Bridging the Equity Gap Through Research"
Washington, DC
June 15, 2011

Thank you for the opportunity to be with you today. As you all are aware, we come together to discuss non-communicable diseases at a pivotal moment, as we prepare for the UN General Assembly High-Level Meeting on NCDs. Once viewed as afflictions limited to the developed world, non-communicable diseases – including cardiovascular and respiratory diseases, diabetes, and cancers – are rising quickly in low- and middle-income countries. This growing prevalence of NCDs has significant health, economic and social implications on the individual, national, and global levels. Non-action is bad public health, and the cost of non-action is too high.

Yet NCDs receive too little attention given that they now represent the greatest global disease burden to all of humankind, and given the significant cost – both human and economic – that will result from inaction or an insufficient response. If we are effectively to reverse the increased global rates of NCDs, we will need to use all the tools at our disposal. And so I’d like to speak with you today about one set of tools that might not ordinarily arise in this setting: multilateral diplomacy.

The U.S. Government is pursuing several initiatives in terms of what can be called “health diplomacy” across the United Nations system, to increase the involvement of key international partners in the global response to non-communicable diseases. As I’ll expand on in a moment, these efforts to address NCDs and other global health challenges through multilateral diplomacy are part of a broader Administration approach to U.S. foreign policy, one that recognizes the broad range of challenges and threats that we collectively face in the twenty-first century, as well as the need to harness the power of collective responses to address those shared challenges.

When we talk about diplomatic engagement at the United Nations, it’s important to distinguish between what is often called the “two UNs.” On the one hand, there are political bodies, where national governments meet, discuss, and (sometimes) develop collective responses to shared challenges. On the other hand, there are a panoply of specialized and technical agencies, funds, and programs, many of which play roles on health issues in general. I’ll discuss each of these in turn, noting how the USG is pursuing objectives to help address NCDs.

First, the UN General Assembly is the political body with the broadest membership, with every government having a seat and a voice. As such, it plays a key role as the venue where a truly global conversation can be had. Although this makes achieving concrete gains more complex, working through the General Assembly can be critical to building worldwide awareness of a growing challenge like NCDs, and getting this issue into the global dialogue will be essential if we are to forge a collaborative response.

So the U.S. Government welcomed the news that this September, the General Assembly will be focusing on the issue of NCDs at the High-Level Meeting to be attended by Heads of State or Government, and foreign and health ministers from around the world. We see this as recognition that a concerted global response will be needed to address NCDs, and we are working to make the September meetings as productive and concrete as possible. The UN General Assembly High-Level Meeting on NCDs is both the culmination of a very informative multilateral process around these issues in the last few years and the beginning of concerted action, galvanized and energized by political commitment at the highest level.

In the process leading up to this September’s High Level Meeting at the UN General Assembly, we have seen thoughtful engagement and commitment to NCD prevention and control from a broad range of countries and the broad stakeholder community. There have been UN regional meetings over the last several months, an April Moscow Ministerial on Healthy Lifestyles, the May World Health Assembly sessions on NCDs, and tomorrow in New York a civil society interactive hearing to help inform the preparatory process for the High Level meeting. We have seen a convergence around forward-looking actions that countries can take as part of a new commitment at the national and international levels on NCDs. And, as advocates of a broad and multi-stakeholder approach, the United States has strongly supported the expansive pool of contributors hailing from the NGO community, academia, and the private sector.

We have also cast the net broadly within our own government, recognizing that addressing the risk factors for NCDs requires a “whole-of-government” approach. From transportation to education, agriculture to finance, we need buy-in from a broad range of government entities if we are to succeed. This “health in all policies” approach allows us to use the fullest range of tools to promote healthy choices, adopt sound fiscal policies and regulations, and encourage voluntary or other measures for change.

Turning to the second of the “two UNs” I mentioned earlier, we seek to work broadly across the UN system’s specialized and technical agencies to ensure they are partners in the effort to address NCDs. While the UN’s political bodies bring together the world’s governments to set priorities and build political constituencies for action, the technical and specialized agencies undertake programs worldwide to achieve the goals set by the global community.

Among the UN’s specialized agencies, the linchpin for our multilateral response to NCDs is the World Health Organization. WHO actually straddles the “two UNs” – its Assembly serves to bring governments together to build political constituencies for action and set priorities, and its programmatic efforts work to achieve those priorities. WHO’s strategies on diet, nutrition, physical activity, alcohol, and tobacco, set the standard for countries to act upon.

Yet WHO has a wider health mandate than just NCDs, and there remains a gulf between resources available at WHO for infectious disease control and those for NCDs. NCDs have arisen as a priority for WHO member states only in the relatively recent past, and so the efforts to close the gap will take time.

Success also will take engaging beyond WHO, which is the UN’s flagship health agency but only one of several UN specialized bodies with a role to play on NCDs.

We work with the International Atomic Energy Agency (IAEA) on cancer control issues, as it develops greater access to radiation medicine and technology to enable developing countries – particularly in Africa -- to introduce, expand or improve their cancer care capacity and services. The IAEA Program of Action for Cancer Therapy, or PACT, seeks to integrate and align cancer prevention, surveillance, screening and early detection, treatment and palliative care activities and investments. Also, the work of the International Agency for Research on Cancer, or IARC, which is part of the WHO, has gained attention in light of the work by one of its expert committees on the potential link of cancer to mobile phone use, although it has been collecting worldwide data on cancer incidence and working on cancer causes for decades.

We also work with UNESCO, the UN Educational, Scientific, and Cultural Organization, on educational tools for combating NCDs. UNESCO has potential to do more in the area of school policy and curriculum development around NCD prevention.

We also believe that other UN agencies should continue to have increased engagement on NCDs, namely the International Labor Organization (ILO) on healthier workplaces and employees; the Food and Agriculture Organization (FAO) for improved nutrition outcomes and healthier diets through its work to increase the variety of locally-produced foods and improve micronutrient content in staple foods; the World Food Program which does local purchase to improve diets in school-feeding programs; and UNICEF, which focuses on improving health equity and outcomes for women and children. Clearly there are specific NCD challenges for women, and women are the key to healthier children and families.

In pursuing these strategies in the UN’s political bodies and through its technical and specialized agencies, as well as for national-level action, we are guided in our approach by six principles or areas of action.

First, as I noted earlier, we believe that responsibility for preventing and controlling NCDs extends within and beyond the health arena, and requires a “whole of government” approach that fosters collaboration with policy makers in the transportation, education, agriculture, energy, finance, and other sectors. We must pursue policies that promote health and healthy choices, and adopt fiscal policies, regulations and other cost-effective measures to reduce common risk factors. The range of stakeholders, including civil society, NGOs, industry, academia, and media, must meaningfully engage to help curb NCDs.

Second, given the scope of the problem and the budget constrained environment in which we operate, governments need to prioritize the high-impact, affordable strategies that work and that are available to target the most significant risk factors in NCDs, such as tobacco use, harmful alcohol use, poor diet and inadequate physical activity. Evidence-based interventions for prevention, early-detection and treatment should be prioritized to reduce premature death and preventable morbidity and disability from NCDs. To that end, greater implementation is needed of the WHO Framework Convention on Tobacco Control, and strategies including the 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases, and the WHO Global Strategy to Reduce the Harmful Use of Alcohol.

Third, is the need to promote innovation and adapt successful models. As the global burden of chronic disease evolves in tandem with changes in population density and development, there is a continuing need for research and new technologies to better understand the relationships between NCDs and existing health priorities such as TB and HIV/AIDS, and inform the implementation of effective clinical and public health interventions against NCDs. In particular, research to understand how best to tailor NCD prevention and control programs to diverse resource settings should be promoted. The global community will get the greatest value from limited resources by sharing our knowledge and experience of what has worked in different settings. For example, strategies to manage HIV/AIDS as a chronic disease in low resource settings can inform NCD efforts, and mobile health tools used to improve maternal and child health can be adapted to reduce NCD risk factors and improve quality of care.

Fourth, to be fully effective, NCD programs need greater scale and geographic spread to improve overall health and reduce health inequities. NCD efforts should support the creation of healthier communities by implementing broad, evidence-based prevention programs to reduce NCD rates and promote health equity. Health planning must move toward an effective multi-disease management approach appropriate to national contexts. Strengthening health systems and approaches that build on the community level are therefore important components of the global NCD response.

Fifth, we believe that accurate health information is essential to improve local, national and global capacity to respond to the NCD burden. WHO must be the organization to lead a global monitoring framework on NCDs, to provide key information needed to achieve global strategies already in place. We also must work to strengthen the responsiveness and capacities of national health systems to monitor, measure and evaluate progress made in reducing NCDs and their underlying risk factors.

Last but not least, we would like to see media cover the stories effectively worldwide to further the cause of NCDs. NCDs is sometimes called the stealth epidemic. We recognize that it is hard sometimes to get an exciting story out of such a major challenge, and that we need to get the word out in smaller bites. It is imperative that we do so. Because taking on NCDs ultimately will come down to individuals making healthy choices, all levels and types of media have an important role to play in helping inform individuals and consumers to make better choices.

In conclusion, the United Nations has a key role to play in addressing NCDs as a convener and driver of action. We hope that the September UNGA High Level meeting on NCDs, and the important preparatory process that has preceded it, will lead to global acknowledgement that NCDS are an increasingly urgent public health concern and a strain on global economies. Coming out of the September meeting, we also hope that we will see a global commitment to achieving effective, multi-sector responses in all countries, including in low- and middle-income countries. We look forward to working with many of you on this important effort in the months and years to come.

Thank you.