GENEVA – Just six countries in the world are on track to meet global targets to reduce non-communicable diseases (NCDs), particularly cardiovascular disease (CVD), cancer, chronic respiratory diseases and diabetes.  At the World Health Assembly (WHA) this week, every country – rich and poor – lamented their struggles to contain rising NCDs, which now cause three-quarters of global deaths.

Progress has been made since the last UN High-Level Meeting on NCDs seven years ago, sector leaders said at a sideline meeting organised by the NCD Alliance and the World Heart Federation on Thursday. But with current global NCD targets set to expire in 16 months when the next UN High-Level Meeting on NCDs will be held in New York, the world is “badly off track,” said Dr Bruce Aylward, World Health Organization (WHO) Assistant Director-General on Universal Health Coverage.

Bente Mikkelsen, WHO’s NCD Director, said it is “purely immoral” that only half the estimated 1.3 billion people who have hypertension were aware of their condition, although the diagnosis is simple. Undiagnosed hypertension is a major cause of strokes. While some 42 million people die from NCDs each year, many deaths could be averted with early detection and treatment.

“Four and a half billion people don’t have access to basic services, and two billion people are suffering financial hardship when they try to access life-saving services. This is a catastrophe,” said Aylward. “We can’t solve the NCD problem without financial protection. The poor in our societies need to be able to access medicines and services they need for free and that is a responsibility of governments.”

Expanded definition of NCDs 

In just seven years, the global NCD agenda has seen significant expansion, said Katie Dain, CEO of the NCD Alliance. The definition now firmly includes mental health and neurological conditions, and air pollution is recognized as a key risk factor. WHO’s Mikkelsen added that the links between climate change and NCDs are also now recognized.

Governments are starting to see addressing NCDs as an investment rather than purely an expenditure, with growing country-level leadership and involvement of people living with NCDs, Dain noted.

Rwandan Health Minister Sabin Nsanzimana said his country recently equipped 58,000 community health workers with blood pressure machines, a “very easy and cheap means of diagnostic screening.” Rwanda’s mortality rate began shifting from infectious diseases to NCDs around 2015, prompting the creation of an evidence-based, culturally sensitive NCD plan.

Nsanzimana noted that some lifestyle challenges are rooted in past community practices, making it difficult to encourage people to cut certain foods and drinks that are “strongly rooted in culture and society.”

“You tell people too much milk isn’t healthy, while mothers and grandmothers always said milk is everything,” he explained. Nsanzimana warned countries that not managing NCDs early leads to “complicated treatment” for issues like cardiac arrest and renal failure.

Building community trust

New Zealand’s Ashley Bloomfield, co-chair of the Working Group on International Health Regulation amendments, also emphasized the importance of building community trust. “We’ve had tremendous success in tobacco control. Our adult daily smoking rate is now under 7%. In the early 2000s, over a third of our indigenous Maori girls aged 14 smoked daily. It’s now 3%,” he said.

Bloomfield added that effective communication to build public trust was a key lesson learned during the pandemic, citing New Zealand’s successful COVID response that minimized deaths and prevented health system overload by “keeping the virus out until we had high vaccination rates.”

“Fundamental to that was building public trust, so people understood the why,” said Bloomfield. “Effective communication to build trust in the population … helped to minimise deaths and prevented our health system from being overwhelmed.” 

Karen Sealey, executive director of the Trinidad and Tobago NCD Alliance, said her group of 13 organizations successfully lobbied for years to establish a health ministry NCD unit. The alliance is now so well trusted that it assisted with the ministry’s pandemic vaccination drive.

Community involvement in health

“Next year’s NCD High-Level Meeting needs to represent a massive step change, with a significant focus on ground-level action and implementation, where the biggest gap is,” Dain said.

Community health system involvement is a timely topic, as the WHA adopted a “social participation” resolution this week.

The resolution urges member states to “implement, strengthen and sustain regular and meaningful social participation in health-related decisions across the system as appropriate, taking into consideration national context and priorities,” and suggests “facilitating capacity strengthening for civil society to enable diverse, equitable, transparent and inclusive social participation.”

Conservative countries targeted this resolution for its use of “gender-responsive,” as reported by Health Policy Watch. In the final resolution, this term was replaced by “gender equality”.