World leaders convened in New York City on September 27 for the third United Nations High-Level Meeting on Noncommunicable Diseases (NCDs). The previous meetings were held in 2011 and 2014.
Major NCDs, including cancer, heart disease, lung disease and diabetes, are responsible for around 70 percent of global deaths—and in many cases these deaths are preventable. Looking at cancer alone, experts estimate that around 18 million people will be newly diagnosed and nearly 10 million people will die of cancer worldwide this year.
“Noncommunicable diseases kill 41 million people prematurely every year, many of them in the prime of life. But we could prevent nearly 10 million of those deaths by 2025.” - @DrTedros #BeatNCDs #UNGA pic.twitter.com/PQCrTJ8hrv— World Health Organization (WHO) (@WHO) September 27, 2018
Preventable causes including air pollution, unhealthy diet, obesity, and the use of tobacco, alcohol and drugs contribute to many NCDs. Air pollution causes a quarter of adult deaths from heart disease and stroke and 30 percent of cancer deaths, according to UN Secretary-General António Guterres.
“With an increasingly globalized world, longer life expectancy, a rapidly changing climate and increasing levels of urbanization, we are witnessing shifts—demographic and otherwise—that see the burden of noncommunicable diseases rising in all nations,” Guterres said in a statement. “These diseases rob people of the ability to earn a living and fuel a cycle of poverty that continues to impoverish families and communities. The costs of noncommunicable diseases are enormous—not only to the people affected, but also to national budgets, health systems and the global economy.”
Other NCDs can be prevented by medical interventions, for example human papillomavirus (HPV) vaccination and regular screening to prevent cervical cancer. Deaths due to cervical cancer fell dramatically after the introduction of routine Pap screening in the United States and Europe, but it is still a major cause of death for women in developing countries.
There’s some good news on the NCD front. The latest World Health Organization (WHO) NCD country profiles report shows that the risk of premature death from the major NCDs fell to 18 percent in 2016—a relative risk reduction of 5 percent since 2010. But big gaps in health services and access to medications and technologies to manage NCDs persist.
In advance of the meeting in March, WHO launched a new high-level commission, made up of heads of state, health ministers, leaders in health and development, and entrepreneurs, to propose “bold and innovative solutions to accelerate prevention and control of the leading killers on the planet.”
At Thursday’s meeting former New York City mayor Michael Bloomberg was reappointed as WHO’s global ambassador for NCDs and injuries.
Thank you, @DrTedros, for leading the @WHO’s charge to combat noncommunicable diseases. In the face of this epidemic, our work together will continue to encourage and support governments that are implementing proven, cost-effective measures to save lives. pic.twitter.com/04ACo1DjfI— Mike Bloomberg (@MikeBloomberg) September 27, 2018
But some advocates including Katie Dain, CEO of the NCD Alliance, called attention to the lack of participation by civil society organizations and affected individuals.
After all the fine words this week about the importance of civil society in #NCDs, not a single civil society rep was called upon 2 make an intervention from the floor at #HLM3 panel 1. Unacceptable. @ncdalliance— Katie Dain (@katiedain1) September 27, 2018
National and Global Efforts Needed
Coinciding with the meeting, Lancet Oncology published an analysis of national cancer control plans, conducted by the Union for International Cancer Control, the International Cancer Control Partnership and the World Health Organization. In 2017, the World Health Assembly passed a resolution on cancer control that called on governments develop national plans to guide cancer prevention and management. Today, around 80 percent of countries have operational plans.
Overall, there was stronger emphasis on cancer screening and prevention than on treatment and care—no doubt reflecting many countries’ limited health budgets.
Evaluation of 11 domains across #cancercontrol showed higher scores for #prevention and early #detection and #screening than for #treatment @WHO @uicc @myESMO @NCIGlobalHealth #UNHLM #HLM3 #NCDs #LancetNCDs https://t.co/1bHcAdDPIC pic.twitter.com/vZrVgyZgAw— The Lancet Oncology (@TheLancetOncol) September 27, 2018
A majority of countries included immunization against HPV and hepatitis B virus, which can cause liver cancer. Eight percent of national plans included breast cancer screening. Overall, 45 percent of plans included radiation therapy, but this fell to 30 percent for low-income countries. Just over half of the countries overall and 30 percent of low-income countries included guidelines for cancer treatment and the WHO List of Essential Medicines, while 27 percent of plans included cancer surgery. Nearly a third specified cancer pain management.
In July, the American Society of Clinical Oncology (ASCO) and the European Society for Medical Oncology (ESMO) issued a statement calling on government leaders and health ministers to reduce the burden of all NCDs including cancer.
ASCO and ESMO asked meeting participants to develop programs to encourage lifestyle changes such as smoking cessation, implement cost-effective primary prevention measures, assure early-stage diagnosis and high-quality, affordable treatment for all stages of cancer—including advanced and metastatic disease—and strengthening health systems to provide care for “the millions of patients who die prematurely” because they don’t have access to cancer treatment.
“Despite the progress we have made in treating cancer, millions of people still die prematurely from the disease because they do not have access to the necessary resources to receive high-quality care,” said ASCO chief medical officer Richard Schilsky, MD. “This is simply unacceptable and we are calling on all countries to take the steps necessary to prevent or reduce this needless suffering.”
“We are calling on all countries to take the steps necessary to prevent or reduce this needless suffering.” See our joint statement on today’s UN Meeting on non-communicable diseases, including #cancer: https://t.co/pDOdCXVCdV #beatNCDs @rschilsky @myESMO— ASCO (@ASCO) September 27, 2018
Participants at Thursday’s meeting committed to 13 new steps to tackle NCDs and promote mental health and well-being, according to a WHO press release.
These include legal and economic measures to protect people from tobacco, unhealthy foods and other harmful products—for example, by banning smoking, restricting alcohol advertising and taxing sugary drinks. The leaders committed to public education and awareness campaigns to promote healthier lifestyles, HPV vaccination, treatment of high blood pressure and diabetes, halting the rise of childhood obesity and reducing air pollution.
“Today, world leaders have taken a set of landmark steps to beat NCDs,” said WHO director general Tedros Adhanom Ghebreyesus, PhD. “These add up to a historic opportunity to promote health, save lives and grow economies.”