Noncommunicable Diseases
Authors: Shannon L. Marrero, David E. Bloom, Eli Y. Adashi
Journal: JAMA (2012)

IN SEPTEMBER 2011, THE UNITED NATIONS GENERAL ASsembly (UNGA) held—for the first time—a HighLevel Meeting on the Prevention and Control of Noncommunicable Diseases. In taking this unusual step, the UNGA, home to 193 member states and the principal decision-making organ of the United Nations (UN), has affirmed not only the global importance of the noncommunicable diseases (NCDs) but also the imperative of concerted remedial action. In this Viewpoint we discuss the outcomes of the high-level meeting (HLM) and the aftermath thereof and affirm that the heretofore unrecognized NCD epidemic has at last acquired a voice. However, the HLM, accompanied by a severe international economic downturn, exposed a new world order wherein erstwhile global health donors play a more limited role, aid recipients assume greater responsibility for developmental progress, and UN agencies increasingly integrate NCDs into their programmatic and budgetary constructs. The NCDs—cardiovascular disease, chronic respiratory disease, diabetes, and cancers—are the dominant public health challenge of the 21st century. Left unattended, NCDs compromise the Millennium Development Goals, thwart the eradication of poverty, and undercut economic growth. The attendant global loss of economic output over the next 2 decades has been estimated at more than US $30 trillion. United by common modifiable risk factors—tobacco use, unhealthy diet, physical inactivity, and the harmful use of alcohol—NCDs account for an estimated 63% of the global death toll. By 2030, it is estimated that NCDs may account for 52 million deaths worldwide, nearly 5 times the projected number of deaths from communicable diseases. Most (80%) NCD-related deaths, especially premature ( 60 years of age) deaths, occur in lowand middle-income countries. It is only the second time in history that the UNGA convened an HLM in response to a global health crisis. The first HLM, in 2000, primarily addressed the human immunodeficiency virus (HIV)/AIDS epidemic and was followed by an unprecedented global response. However, that is where the similarities likely end. First, NCDs do not have the moral urgency, the fear of contagion, and the social justice envelope associated with HIV/AIDS. Second, NCDs are not perceived as an imminent threat to global security necessitating the (unparalleled) engagement of the UN Security Council. Third, NCDs lack the grassroots attention and celebrity power inherent in the social movement mobilized by and for HIV/AIDS. Fourth, NCDs are coming to the fore at a time of profound global austerity that stands in stark contrast to the relative prosperity at the turn of the 20th century. Fifth, NCDs are encountering the leading edge of a maturing aid reform movement willing to conceptualize a world “beyond aid.” Crafted against this backdrop, the Political Declaration on the Prevention and Control of NCDs—the key tangible deliverable of the HLM—could hardly please everyone. To its supporters, the declaration offered affirmation, empowerment, coordination, and continuity. Examples of such provisions include that the consumption of tobacco and alcohol will be curtailed through national taxation and marketing restrictions; the use of saturated fats, trans fats, salt, and sugar will be constrained through regulation and negotiation; public campaigns will target the 4 modifiable risk factors (tobacco use, unhealthy diet, physical inactivity, harmful use of alcohol) and their attendant disease groups; the World Health Organization, the designated coordinator of the global response to the NCDs, will develop a comprehensive global monitoring framework; and the UN Secretary General will consider relevant partnerships, monitor the realization of HLM commitments, and report on progress in the prevention and control of NCDs. To its detractors, the declaration fell short in its failure to deliver sweeping global mandates. Broadly anticipated binding and time-delimited targets gave way to voluntary, to-be-developed goals. Widely advocated incorporation of the NCDs into future Millennium Development Goals frameworks was left out. Private-public partnerships repeatedly proposed for the NCDs were deemed optional and subject to future consideration. Commonly suggested endorsements of NCD-friendly regulatory policies, patent laws, or