PHM-Exch> [PHM NEWS] Progress on NCDs lags: WHO must address the drivers, overcome the barriers

[Claudio Schuftan]

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From: <dlegge at phmovement.org>
Date: Fri, Jan 19, 2024 at 1:58 PM

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Progress on NCDs lags: WHO must address the drivers, overcome the barriers

At its forthcoming Executive Board meeting WHO will confront the reality
that progress on NCDs is either way off track or that the disease burden is
worsening (reported in detail in EB154/7
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=983a5a7297&e=5f3cea0f3e>
).

WHO has not been sitting on its hands. EB154/7
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=e8aecd3b3d&e=5f3cea0f3e>
reports on a wide range of conferences and consultations, resolutions and
reports, strategies, work plans and frameworks, and the adoption of
technical guidance documents.

However, EB154/7
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=95e8db06c3&e=5f3cea0f3e>
does not adequately address the reasons for the limited progress, even a
decade after the world had accepted NCDs as a major public health issue.
Neither does it inquire deeply into the obstacles blocking the achievement
of its many targets.

The three key challenges which need to be addressed are: health systems
strengthening and the integration of disease strategies into comprehensive
primary health care; intersectoral action at the domestic and international
levels; and social and economic inequality

Health systems strengthening is critical to achieving every one of WHO’s
NCD objectives. This boils down to resources (fiscal capacity and all the
related issues), to the organization of service delivery, and to human
resources policy.  Health system strengthening also needs to address the
values or ethics on which public services are organized and, as part of
this, to build a different set of incentives, free of market pressures
(including the pressure to focus solely on episodic sick care), in which
health care practitioners can work. A key to health systems strengthening
is to build the domestic political constituencies which care about
comprehensiveness, quality, efficiency, resource allocation, evaluation in
health care.

WHO’s focus on specific diseases and specific risk factors has encouraged a
vertical and selective approach to health system development which
contributes to the fragmentation of care. The challenge is to integrate the
specific interventions being promoted into comprehensive health care
services based on primary health care.
The intersectoral and international dimensions of NCDs control are
critical, including the regulation of ultra-processed foods, unhealthy
diets, tobacco, alcohol, air and water pollution, and occupational health.
WHO has produced a great deal of policy advice here but has not confronted
the task of building national constituencies which can insist on addressing
the social, commercial and environmental determinants of health.  Such
constituencies are needed to drive domestic intersectoral action as well as
foreign affairs engagement in the structures of global governance across
sectors.

Health care personnel can play a major role in advocacy for health systems
strengthening and for effective intersectoral/international action
particularly in systems where the cultural norms are about public service
rather than private profit. The dramatic upscaling of the CHWs workforce
which WHO calls for in EB154/7 would strengthen such advocacy.

The report before the Executive Board is almost silent on the issue of
social and economic inequity and its impacts on the causes, consequences
and response to NCDs. The focus on particular diseases and specific risk
factors has obscured the inequality dimension. This includes inequality in
terms of accessing decent healthcare but also social and economic
inequality and discrimination, which are associated with greater
vulnerability and a greater exposure to all the specific risk factors
described.  It is time to name the structural drivers of deepening
inequality; not just documenting their effects.

The full PHM Commentary on this agenda item explores these challenges in
more detail and sets out key actions to address them.



The full PHM commentary on this item
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=1ac190f0ff&e=5f3cea0f3e>
provides
a more detail and references.  See also Tracker links to previous
discussions of NCDs
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=926caa03bc&e=5f3cea0f3e>
.

The WHO Tracker and PHM item commentaries are produced as part of *WHO
Watch* which is a project of the People's Health Movement
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=94c32157a4&e=5f3cea0f3e>
in association with Medicus Mundi International
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=a0bac19bdc&e=5f3cea0f3e>,
Third World Network
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=7e61ac6dfb&e=5f3cea0f3e>
and a number of other civil society networks. WHO Watch contributes to
democratising global health governance, through new alliances, new
information flows and by broadening the policy discourse.

See the WHO Tracker page for this EB154 session (here
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=b42eed2419&e=5f3cea0f3e>).
See PHM’s integrated commentary
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=d9a9fa6190&e=5f3cea0f3e>
on the full agenda of EB154 (or read the flipbook version
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=815128c501&e=5f3cea0f3e>).
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