PHM-Exch> [PHM] a bit of history (8)

[Claudio Schuftan]

 WHO Consultations on a monitoring framework and targets for the prevention
and control of non-communicable diseases

Latest WHO -meeting covering noncommunicable diseases: EB130 *January 2012*
- agenda item 6.1: Prevention and control of non-communicable
diseases. Click here
<http://www.ghwatch.org/sites/www.ghwatch.org/files/WHO%20EB%20130-MMI%20PHM%20statement%20on%20NCDs.pdf>
for the *statement made by PHM *or read below.


Background: The challenge of non-communicable diseases

Non-communicable diseases (NCDs), principally cardiovascular diseases,
diabetes, cancers, and chronic respiratory diseases, are the leading causes
of death globally, killing more people each year than all other causes
combined. NCDs caused an estimated 35 million deaths in 2005. This figure
represents 60% of all deaths globally, with 80% of deaths due to
non-communicable diseases occurring in low- and middle-income countries.
About one fourth of global NCD-related deaths take place before the age of
60.

The combined burden of these diseases is rising fastest among lower-income
countries, populations and communities, where they impose large, avoidable
costs in human, social and economic terms. Patients and their families are
pushed into poverty because of catastrophic health expenditures and
countries are  spending a large part of their health budget on chronic
conditions. A recent Harvard University study
<http://www3.weforum.org/docs/WEF_Harvard_HE_GlobalEconomicBurdenNonCommunicableDiseases_2011.pdf>
estimates
that over the next 20 years, non-communicable diseases will cost the global
economy more than $30 trillion, representing 48 per cent of the global GDP
in 2010.

Total deaths from non-communicable diseases are projected to increase by a
further 17% over the next 10 years. The rapidly increasing burden of these
diseases is affecting poor and disadvantaged populations
disproportionately, contributing to widening health gaps between and within
countries. Despite their rapid growth and inequitable distribution, much of
the human and social impact caused each year by NCD-related deaths could be
averted through well-understood, cost-effective and feasible interventions.

The four ‘major’ NCDs - cardiovascular diseases, chronic respiratory
diseases, diabetes and cancer - are caused to a large extent, by four
behavioural risk factors that are pervasive aspects of economic transition,
rapid urbanization and 21st-century lifestyles: tobacco use, unhealthy
diet, insufficient physical activity and the harmful use of alcohol. The
greatest effects of these risk factors fall increasingly on low- and
middle-income countries, and on poorer people within all
countries, mirroring the underlying socioeconomic determinants. Among these
populations, a vicious cycle may ensue: poverty exposes people to
behavioural risk factors for NCDs and, in turn, the resulting NCDs may
become an important driver to the downward spiral that leads families
towards poverty. As a result, unless the NCD epidemic is aggressively
confronted in the most heavily affected countries and communities, the
mounting impact of NCDs will continue and the global goal of reducing
poverty will be undermined.

As the magnitude of the NCD epidemic continues to accelerate, the pressing
need for stronger and more focused international and country responses is
increasingly recognized by Member States. Since the WHO Secretariat
presented its Global Strategy for the Prevention and Control of
Non-communicable Diseases
<http://apps.who.int/gb/archive/pdf_files/WHA53/ea14.pdf>to the World
Health Assembly in 2000, many resolutions on the topic were adopted and
many meetings held, most recently the High-level Meeting of the United
Nations General Assembly on the Prevention and Control of Non-communicable
Diseases <http://www.ghwatch.org/node/633>. We have prepared a presentation
<http://www.ghwatch.org/sites/www.ghwatch.org/files/NCDs_HistoryInternationalPolicyDeclarations.pdf>
which provides an overview of all the relevant resolutions, documents and
political declarations. It also summarizes the aspects of relevance for
members of the PHM, focusing on what has been said on the social
determinants of health, access to medicines, integration, sustainable
financing and accountability.

However, despite abundant evidence of their negative impact, policy-makers
still fail to regard NCDs as a global or national health priority.
Incomplete understanding and persistent misconceptions continue to impede
action. Although the majority of NCD-related deaths, particularly premature
deaths, occur in lowand middle-income countries, a perception persists that
NCDs afflict mainly the wealthy. Other barriers include the point of view
of NCDs as problems solely resulting from harmful individual behaviours and
lifestyle choices, often linked to victim ‘blaming’. The influence of
socioeconomic circumstances on risk and vulnerability to NCDs and the
impact of health-damaging policies are not always fully understood; they
are often underestimated by some policy-makers, especially in non-health
sectors, who may not fully appreciate the essential influence of public
policies related to tobacco, nutrition, physical inactivity and the harmful
use of alcohol on reducing behaviours and risk factors that lead to NCDs.
Effective interventions, such as tobacco control measures and salt
reduction, are not implemented on a wide scale because of inadequate
political commitment, insufficient engagement of non-health sectors, lack
of resources, vested interests of critical constituencies, and limited
engagement of key stakeholders.

Reducing exposure to the risk factors for NCDs and their determinants is
also not enough. Improved health care, early detection and timely treatment
is another necessary aspect of reducing the impact of NCDs. However,
appropriate care for people with NCDs is lacking in many settings, and
access to essential technologies and medicines is limited, particularly in
low- and middle-income countries and populations. Health systems need to be
further strengthened to deliver an effective, realistic and affordable
package of interventions and services for people with NCDs.

We need to change the way policy-makers perceive NCDs and their risk
factors, and how they then act. Concrete and sustained action is essential
to prevent exposure to NCD risk factors, address social determinants of
disease and strengthen health systems so that they provide appropriate and
timely treatment and care for those with established disease.

Sources:
WHO Global Status Report on Non-communicable Diseases
WHO 2008-2013 Action Plan on the Global Strategy for the Prevention and
Control of Non-communicable Diseases

*PHM analysis of the international response to NCDs*

*"The policies that promote unhealthy lifestyles throughout entire
populations are made in domains beyond the direct control of health. For
many decades, public health has stressed the need for collaboration with
other sectors, especially for prevention. For a very long time, these were
friendly sectors, almost sister sectors, like education, the environment,
water supply, sanitation, and a secure and safe food supply. Today, many of
the threats to health that contribute to noncommunicable diseases come from
corporations that are big, rich and powerful, driven by commercial
interests, and far less friendly to health*"


Dr Margaret Chan, Director General of WHO [1]

The most important message concerning non-communicable diseases is that the
factors that shape the NCD epidemic lie outside the reach of health policy
so that most health gains in terms of prevention will be made by
influencing policies in domains such as trade, food and pharmaceutical
production, agriculture, urban development, and taxation policies[2].
Addressing NCDs thus requires a Health in All Policies approach to enhance
accountability for health in other sectors; an approach that can further
promote health equity and more inclusive and productive societies [3].

The global response is hugely disappointing in this regard. While the
importance of the social, economical, political and environmental
determinants of health and the need for multisectoral action is recognized
in every document you can find, global action is geared towards
interventions to change individual health behaviours and multisectoral
action is understood as establishing partnerships with industry. The
current global response framework, the 2008-2013 Action Plan for the Global
Strategy Global Strategy for the Prevention and Control of Non-communicable
Diseases [4] focuses on 'four diseases and four risk factors'; and has
eliminated action on the social determinants of health in its objectives
(1). Within the international community, NCDs are still too much viewed as
problems solely resulting from harmful individual behaviours and lifestyle
choices, often linked to victim-blaming, and the influence of socioeconomic
circumstances on risk and vulnerability to NCDs and the impact of
health-damaging policies are underestimated [2].

*The 'four diseases and four risk factors'-framework fails to address the
causes of NCDs*. The strategy of identifying risks and expecting
individuals to change their behaviour to minimize their exposure has proved
inadequate. Genuine choice and an ability to modify risks depend on living
conditions and access to resources [5]. This point was stressed by Princess
Dina(Union for International Cancer Control) in her opening speech at the
UN High-Level Meeting on NCDs in September 2011:* "lifestyle changes, as
they are called, give the impression that it is a matter of choice or
preference. But when unhealthy foods are more affordable than healthy ones,
when tobacco, which kills, is so easily accessible, and when facilities or
space for exercise are non-existent, it becomes not a lifestyle choice but
a life sentence" *[6].

The Action Plan does not recognize the varying contributions of the
identified risk factors to the global NCD burden and will thus not be able
to respond to the different needs of people around the world, especially
the most vulnerable ones. Looking at tobacco use as the risk factor for
chronic obstructive pulmonary disease (COPD), it is crucial to realize that
the causes for COPD have opposite patterns according to the geographic
areas. In high- and middle-income countries tobacco smoke is the biggest
risk factor, meanwhile in low-income countries exposure to indoor air
pollution, such as the use of biomass fuels for cooking and heating, causes
the COPD burden (...) *The most poor women in the world do not get COPD
from smoking, but from bad living conditions* [7]. Averting these deaths
will not be done by tobacco control, but by ensuring access to clean fuel,
housing strategies etc. Such a social determinants approach further has a
greater potential return on NCD prevalence, health and social equity [8].

There is an urgent need to devote more attention to the *structural*
determinants of health, such as international trade and financial policies.
In his article on international trade and NCDs, Labonté points out that
trade, despite bringing potential health benefits through economic growth,
is one of the major driving factors of a growing chronic disease burden
[9]. Current attention towards the role of globalization and trade in the
spread of risk factors for chronic diseases however is geared towards
interventions to change health behaviours and on voluntary corporate
responsibility. Labonté stresses the need for a more concerted approach to
regulate trade-related risk factors and thus more engagement between health
and trade policy sectors within and between nations. He noted that an
explicit recognition of the role of trade policies in the spread of
non-communicable disease risk factors should be a minimum outcome of the
September 2011 Summit, with a commitment to ensure that future trade
treaties do not increase such risks. Unfortunately this did not happen.

The negligence of the importance of the socioeconomic determinants of
health in shaping the NCD epidemic is further reflected in how the
discourse has shifted from a 'vicious cycle' between poverty and NCDs in
the Global Strategy to a* 'tunnel vision'; on the negative economical
impact of NCDs*. The most prominent message now is that NCDs are
threatening macroeconomic development [10]. This narrowing of the focus was
aggravated in a way by attempts to put NCDs on the development-agenda of
the General Assembly, a success story culminating in the High-Level Meeting
in September 2011. Unfortunately, this has led to a mere focus on how NCDs
lead to poverty, with almost no attention to the ways in which poverty
contributes to NCDs (2).

In the current NCD discourse, health is regarded simply as an input to
economic growth, a means to an end; and a personal responsibility rather
than a public good. *"The victim-blaming strategy fails to have a positive
vision of health and its contribution to society"* [11]. As described by
McMichael and Beaglehole, there are constant tensions between the goals of
different policy sectors: "tension persists between the philosophy of
neoliberalism, emphasizing self-interest of marked-based economies, and the
philosophy of social justice that sees collective responsibility and
benefit as the prime social goal" [12]. They rightfully concluded that "the
practice of public health, with its underlying community and population
perspective, sits more comfortably with the latter philosophy". Health has
intrinsic value and is a basic human right, and should therefore be an end
of political and societal activity in itself [13]. It is a trans-national
public good and should be an overarching goal in all policies [11].
However, it does not seem that states are ready to take the necessary
actions on international trade regimes as this is completely left out of
the declaration of the HLM.

*What should be stressed in the case of health determinants and NCDs is a
virtuous cycle and not a vicious one*. In the Action Plan the four main
risk factors are considered together to "highlight potential synergies in
prevention and control", but a social determinants approach would bring
about much more important synergies; not just amongst the different risk
factors, but between NCDs and other global challenges. The aim needs to be
to "implement policies that serve broader societal goals, such as improving
wellbeing and development, which also contribute to tackling
non-communicable diseases" [5]. A virtuous circle is possible whereby
improvements in health and its determinants feedback into each other,
providing mutual benefits [13]. The example of providing women with clean
stoves for cooking to prevent COPD points out one of the most important
synergies: *mitigating climate change*. WHO recently reviewed the IPCC
mitigation strategies in its Health in the Green Economy Initiative and
concluded that "the best climate solutions address key social determinants
of health and inequalities" [15]. These "best climate solutions" would also
help reducing the burden of NCDs, by their so-called "health co-benefits"
[16]. A report released in 2010 by the Health & Environment Alliance states
that a 10% increase in the EU greenhouse gas emissions targets by 2020
(from 20% to 30%) would lead to savings of €10.5 billion to €30.5 billion
per year, mostly by reducing cardiovascular disease, cancer, asthma and
other respiratory or cardiac conditions [17]; exactly the conditions on
which the Action Plan focuses.

*Synergies can also be found in the control of the four 'major NCDs' *and
all the remaining conditions people can suffer from, especially those that
take a chronic course. During consultations in preparation of the UN
High-Level Meeting, NGOs have repeatedly pointed out the unclear boundaries
between communicable and non-communicable diseases and have stressed that
we should draw lessons from the HIV/AIDS epidemic and move away from the
vertical disease approach. Separate global health initiatives or funding
mechanisms for vertical non-communicable disease-specific programmes are
unlikely to work. Efforts in one disease area can be used to strengthen the
overall health system, thereby improving care for other conditions as well
[18]. In their in their Political Declaration coming out of the UN HLM,
Heads of State have "noted with concern the possible linkages between
non-communicable diseases and some communicable diseases, such as HIV/AIDS,
and call to integrate, as appropriate, responses for HIV/AIDS and
non-communicable diseases" [19].

It is striking to see that WHO itself has pointed out the arbitrary
delineation between communicable and non-communicable diseases when it
comes to treatment. In its 2002 Innovative Care for Chronic Conditions
(ICCC) Framework, the term *chronic conditions* is used, which is said to
encompass but to expand beyond the traditional 'NCDs' to include several
communicable diseases such as TB and HIV/AIDS, as well as long-term mental
disorders and ongoing physical/structural impairments [20]. WHO explains:
"when communicable diseases become chronic problems, the delineation
between non-communicable and communicable diseases becomes artificial and
unwieldy". It is emphasized throughout the framework that all these
conditions place similar demands on patients, families and the health care
system and that there are similar and comparable management strategies
effective in addressing them. This means that the global response should
not be about the control of non-communicable diseases, but about*
strengthening health systems to provide quality care for chronic conditions*.
It has been argued that primary health care, because of its
patient-centeredness and community-based approach, is best positioned to
address the challenges of chronic disease prevention and management [21].

Another key issue in the treatment of chronic conditions is *access to
essential medicines and social security* to prevent patients and families
to be pushed into poverty. At the UN HLM States decided to "promote access
to affordable, safe, effective and quality medicines and diagnostics and
other technologies, including through the full use of trade-related aspects
of intellectual property rights (TRIPS) flexibilities" [19]. While
emphasizing the need for access to essential medicines, we also want to
urge for caution because of clear interests of pharmaceutical companies in
this issue. We do not need another 'me too' medication to treat high-blood
pressure. Focusing too much on biomedical management diverts attention and
resources away from other essential aspects of chronic disease care such as
education, self-management and developing a health workforce [22]. We
therefore urge to include the *rational use of medicines* in the current
policy framework.

The issue of conflict of interest of the pharma industry points out
the *necessity
to have a reflection on the 'partnership'-paradigm* that is so central in
the NCD discourse. NGOs, CSOs, industry and academia have been joined
together under the umbrella term 'stakeholders' and have been invited to
join the global debate, without any clarity on their different roles or
safeguards against conflict of interest [23-26]. The Action Plan explicitly
calls for the involvement of the private sector as one of the international
'partners'. Industry is seen as part of the solution and has declared its
commitment to playing a full part in Civil Society's response to NCDs at
the Moscow Conference [27]. *We strongly believe that this proposed
'partnership'-approach is entirely the wrong strategy.* There are numerous
examples of the powerful sway that the tobacco, alcohol, and food
industries have over international governments and how this impedes
effective health policy [23]. Evidence suggests that these corporate social
responsibility strategies are intended to facilitate access to government,
co-opt nongovernmental organizations to corporate agendas, build trust
among the public and political elite and promote untested, voluntary
solutions over binding regulation [26]. While the tobacco industry is not
allowed at the negotiation table because of an "intrinsic conflict of
interest", the Global Alcohol Producers Group (GAP-G) was a civil-society
representative at the UN HLM. Predictably, given existing evidence on
efforts by the alcohol industry to prevent effective public health
policies, they pushed for voluntary rather than regulatory approaches [26].

The political declaration contains no references to international
legislation surrounding the marketing and taxation of alcohol, but instead
urges measures favoured by industry such as partnership working, community
actions, and health promotion [23]. These kind of soft actions had been
previously promoted by the World Economic Forum - also sitting at the table
at the HLM - stating that "the food and beverage industries have a crucial
role to play in selling healthier alternatives", using the example of
PepsiCo's announcement to stop selling high-sugar drinks in primary and
secondary schools worldwide; and that "contemporary marketing and behavior
influencing methods are undervalued in public health and should be fully
incorporated into prevention programmes"[28]. It is noteworthy that
evidence suggests that educational interventions are the least effective
means of reducing alcohol-related harm, and that alcohol industry-funded
educational programmes are ineffective and potentially counter-productive,
like their counterparts funded by the tobacco industry [26]. Another
interesting fact is that PepsiCo promptly decided to spend 30% more on
advertising when the CEO was facing doubts from investors and industry
insiders, who were concerned that her push into healthier brands had
distracted the company from some core products [29]. Nevertheless, PepsiCo
had secured the prime side-event slot at the UN meeting: a breakfast event
from 8-10 am on the morning of the summit [23].

Other 'civil-society representatives' with a clear business interest
invited at the HLM were the International Federation of Pharmaceutical
Manufacturers and Associations (IFPMA), and the International Food and
Beverage Alliance (IFBA) [29]. A senior director of the WEF was also part
of the Civil Society Task Force set up by the President of the General
Assembly. In addition, GlaxoSmithKline, Sanofi-Aventis, and the Global
Alcohol Consumers Group were included within the official US delegation and
drinks companies Diageo and SABMiller were coming from the UK [23]. The
representatives of the food and beverage industry succeeded in deleting a
specific target of reducing population salt intake to less than 5g per
person per day from the draft political resolution [23].

*Instead of establishing partnerships with industry, the UN and WHO need to
put up firewalls between their policy making processes and the alcohol and
food companies whose products stoke chronic disease and the drug and
medical technology companies whose fortunes rise with every diagnosed case.*
In a Lancet article on conflict of interest at the UN HLM Lincoln et al
have urged for the adoption of the following recommendations in the
political declaration and follow-up actions to the high-level meeting on
NCDs [30]:

   - WHO should develop a code of conduct that sets out a clear ethical
   framework to identify and address conflicts of interest, eliminating those
   that are insurmountable and managing those regarded as acceptable after a
   thorough risk/benefit analysis. Article 5.3 of the WHO Framework Convention
   on Tobacco Control provides an example of a framework that safeguards
   public health policy from the influence of the tobacco industry.
   - This code of conduct and ethical framework should be used to guide any
   interactions with the private sector in NCD prevention and control at UN,
   regional, or national level and to differentiate clearly between no
   involvement in policy development and appropriate involvement in
   implementation that complies with existing regulations and the principles
   established in the code of conduct.
   - This code of conduct should be mandated at the international UN level,
   and adopted as good practice recommendation for action by member states.

The authors emphasized that, without such safeguards, policies and
recommendations will invariably be weakened to suit the interests of
powerful corporations, and this is exactly what happened. The Political
Declaration does not go any further than recognizing "the fundamental
conflict of interest between the tobacco industry and public health" [19].
Health was again undermined by prioritising the interests of the food and
beverage industries, as well as the pharmaceutical, technology, and
treatment companies, over the public good.

*Because of industry influence, the political declaration coming out of the
UN HLM lacks clear and measurable targets and relies only on voluntary
action*. Instead of the promised 'action-oriented outcome document' in
General Assembly resolution 65/238, there are only vague intentions "to
consider" and "work towards". This is one of the main shortcomings of the
political declaration since NGOs, CSOs and academia had repeatedly stressed
the urgent need to create of a small set of global goals, targets and
indicators for NCDs [31]. The lessons from HIV indicate that measureable
targets create accountability and spur action. Despite these messages from
civil society, the proposed overarching goal to cut preventable deaths from
NCDs by 25% by 2025 was not included because of opposition from the US,
Canada and the EU [32]. Instead, industry has succeeded in its call for
voluntary measures:* the declaration calls upon WHO to prepare
recommendations for a set of voluntary global targets for the prevention
and control of NCDs, before the end of 2012* [19]. National leaders have
embraced lame vendor-friendly voluntary solutions instead of effective
regulations governing advertising, product reformulation, package
labelling, government procurement, and VAT reforms [23]. The document is
infused with elusive and vague terms: "may" instead of "will" and
"encourage where appropriate" instead of "provide". This clearly is a great
failure of the High-Level Meeting. If voluntary measures are put in place,
who's going to monitor and who's really going to hold the various players,
governments, industry and civil society, to account?

This voluntariness is also reflected in the* lack of clear commitments to
increased financing* for NCD action. Member States at the HLM called for
the fulfillment of all official development assistance-related commitments
and declared to promote all possible means to identify and mobilize
adequate, predictable and sustained financial resources, and to consider
support for voluntary, cost-effective, innovative approaches for a long
term financing of non-communicable disease prevention and control. This
falls short of requests by civil society to include: (1) taxation on
tobacco and a levy on currency transactions, (2) the integration of NCDs in
overseas development assistance programmes, and (3) the inclusion of NCDs
in existing global funds and initiatives [31]. We are concerned that,
without clear commitments and mechanisms to increase funding for NCDs,
donors will shift resources from communicable programs to non-communicable
programs instead of adding them to the existing envelopes. The double
burden faced by countries should be recognized. As pointed out by Julio
Frenk at the Moscow Conference, global health is not a zero‐sum game [27].
As for the Solidarity Tobacco Levy (STL) proposed by the Task Force for
Innovative Financing for Health Systems and backed up by Bill Gates, we
caution that the goal of taxation should be to reduce consumption only,as
raised by the Indian delegation at the Moscow Conference [27]. The STL
would in a way send a message of legitimizing tobacco.

*Next steps*

In the final paragraphs of the HLM political declaration, Heads of State
call upon WHO to build on continuing efforts to develop before the end of
2012, a *comprehensive global monitoring framework*, including a set of
indicators, capable of application across regional and country settings,
including through multisectoral approaches, to monitor trends and to assess
progress made in the implementation of national strategies and plans on
non-communicable diseases. They further request the SG, in close
collaboration with WHO and Member States, to submit to the General
Assembly, at its sixty-seventh session, *options for strengthening and
facilitating multisectoral action* for the prevention and control of
non-communicable diseases* through effective partnership* and to present to
the General Assembly at the sixty-eighth session a *report on the progress*
achieved in realizing the commitments made in the declaration, including on
the progress of multisectoral action, and the impact on the achievement of
the internationally agreed development goals, including the Millennium
Development Goals, in preparation for a comprehensive review and assessment
in 2014 of the progress achieved in the prevention and control of
non-communicable diseases.

We urge for the development of a framework to guide countries in adopting a
Health in All Policies-approach, addressing the social determinants of
health and looking for synergies with other global health and development
challenges. We encourage the involvement of *public-interest* civil society
organizations but do not support the push for public-private partnerships.
We urge WHO to develop a code of conduct that sets out a clear ethical
framework to identify and address conflicts of interest, eliminating those
that are insurmountable and managing those regarded as acceptable after a
thorough risk/benefit analysis to be used to guide any interactions with
the private sector in NCD prevention and control at UN, regional, or
national level. This code of conduct should be mandated at the
international UN level [30]. Finally, we urge for a replacement of the
voluntary targets by clear goals to ensure accountability.

As argued by Rasanathan and Krech in their excellent article on the social
determinants of health and NCDs, commitment towards a global agenda for
non-communicable diseases is only a partial solution. As the 2015 deadline
draws near, coordinated global action, keeping equity foremost, is needed
on the unfinished Millennium Development Goals agenda, climate change,
social protection and non-communicable diseases. This requires a social
determinants approach at global level, with aligned strategies,
implementation and monitoring. [5]

*Notes *

(1) The Global Strategy puts forward three goals, the second of which is to
"reducde the level of exposure and populations to the common risk factors
for non-communicable diseases (...) and their determinants". The 3th
objective of the Action Plan, which is the translation of the 2nd goal of
the Global Strategy, however, does not make any reference to the underlying
determinants of what is called an unhealthy lifestyle. In addition, actions
on the social determinants of health are not included in the range of
actions proposed for Member States under Objective 3 in the Action Plan. It
is striking that the socioeconomic determinants of NCDs get so much
attention throughout the document but are left out under the objective
where specific action to address them could be proposed. We are left with
the promotion of more attention towards the determinants, and more research
and monitoring.

(2) To illustrate this, it is interesting to look at what became of the
following activity planned by the Secretariat in the 2008-2013Action Plan
under objective 1: "draw up a document in support of policy coherence,
pointing out connections between the findings of the Commission on Social
Determinants of Health and the prevention and control of non-communicable
diseases; and take forward the work on social determinants of health as it
relates to non-communicable diseases". In the report that will be presented
now at the 130th EB in January, the following activity is the
implementation of what the Secretariat had promised to do: "the evidence
linking non-communicable diseases with socioeconomic development, poverty
and the health-related Millennium Development Goals was reviewed. A summary
of the findings was included in WHO's Global status report on
non-communicable diseases 2010".
Note that while the initial idea was to depart from the social determinants
of health and look at their implication for prevention and control of NCDs,
it became narrowed down to how NCDs link to socioeconomic development,
poverty and the MDGs. Moreover, no separate document in support of policy
coherence was prepared. Instead the findings got scattered out in a 176
page document (the Global Status Report), which will most likely not reach
policy makers from different government departments and thus remain dead
letter.
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