Preliminary Steps in Moscow
May 7, 2011
J. Stephen Morrison, Director, Global Health Policy Center
& Suzanne Brundage, Program Manager and Research Assistant, Global Health Policy Center
As the world fixated last Friday on the royal wedding between Prince William and Kate Middleton, a major milestone in the global effort to fight non-communicable diseases was coming to a close in Moscow. From April 27 – 29, World Health Organization’s (WHO) Director-General Margaret Chan, Russian Prime Minister Vladimir Putin, 90 Ministers of Health, and 300 representatives from diverse civil society groups gathered for two important meetings. On April 27 the WHO Global Forum on Addressing the Challenge of Non Communicable Diseases (NCDs) assembled diverse civil society actors – ranging from churches to patient groups to medical societies – to solicit views on the multiple measures needed to address the rising epidemic of chronic disease. The first ever Global Ministerial Conference on Healthy Lifestyles and NCDs, held from April 28 – 29, strived for a declaration that would inform and advance preparations for the September 2011 UN High Level Meeting on the Prevention and Control of NCDs, which many hope will be a historic turning point similar to the 2011 UN General Assembly Special Session that propelled forward global attention on HIV/AIDS. At both meetings discussions centered on the NCDs’ ‘4x4,’ the four main chronic diseases – cancer, cardiovascular disease, chronic respiratory disease and diabetes - and their four main risk factors -- tobacco use, unhealthy diet, physical inactivity, and harmful use of alcohol. There was also some consideration of mental health disorders.
The United States sent an impressive delegation. Secretary of Health and Human Services Kathleen Sebelius led the U.S. team, accompanied by CDC Director Thomas Frieden, advisors from HHS, USAID, and CDC, and four representatives from non-governmental organizations affiliated with the NCD Alliance.
Earlier this week, CSIS hosted a public debrief by six participants in the Moscow events. From the official U.S. delegation, we were joined by Rosie Henson, Senior Advisor to the Assistant Secretary of Health; Yolanda Richardson, representing the Campaign for Tobacco-Free Kids; and Paul Holmes of USAID. Others speakers who were in Moscow included James Hospedales of PAHO; Loyce Pace-Bass of Livestrong, and Laurent Huber Executive Director of the Framework Convention Alliance. Video of the event can be found here; audio can be found here. There are also interviews with Rosie Henson and Yolanda Richardson from this event.
* Highlight video: The Moscow Ministerial Conference on Healthy Lifestyles and NCDs: Outcomes and Next Steps*
The Moscow meetings certainly made progress in spotlighting the gravity of the epidemic and the steps necessary for preventing, controlling, and responding to NCDs. WHO Director General Margaret Chan, leveraged her personal leadership and WHO’s assets in preparing the meeting and through her forceful opening and closing statements. The meetings were successful in raising political awareness of the urgent need for a multi-sectoral approach to addressing NCDs, particularly in low and middle-income countries where NCDs pose a “devastating financial impact”. The Moscow Declaration puts into focus the “extraordinary challenges” many countries face in trying to deal with the growing burden of disease while explicitly acknowledging that many cost-effective interventions, including “measures to control tobacco use, reduce salt intake and reduce the harmful use of alcohol,” already exist and could have profound impacts if brought to scale.
Of the Moscow Declaration’s 23 “commitments to action”, some are particularly noteworthy. It calls for governments to commit to developing multi-sectoral policies that promote healthy environments; prioritizing NCD prevention efforts; engaging civil society and the private sector; accelerating implementation of the Framework Convention on Tobacco Control; encouraging ratification of the FCTC in other countries; and scaling up evidence-based interventions. At the global level, the declaration calls for the WHO to develop a monitoring framework for NCDs and to explore means for providing low and middle-income countries with access to essential medicines. The importance of taking into account women and vulnerable populations also received brief mention. Nonetheless, significant questions remain about how to carry forward the Conference’s momentum and achieve concrete commitments at the September UN High Level Meeting. Five critical questions remain:
- Is it possible to mobilize global interest in NCDs? In an age of austerity and deep concerns over national budgets, when resources are scarce and donors are not inclined to add a new global health and development priority to an agenda that is arguably crowded, and where existing commitments are already difficult to sustain, can we mobilize people to take up this cause? While it is true that significant gains can be made in NCD prevention through political will and inexpensive means (i.e. strong policies and regulations), modest financial resources will be needed to implement a truly comprehensive NCD agenda. In low income countries, especially, equitable access to treatment and care programs, full implementation of the FCTC, and scaling up effective prevention programs will require additional resources.
- How is business – especially in the food, beverage and pharma sectors - to be brought meaningfully to the table? Surely concrete solutions to rising NCDs can only be achieved through effective cooperation by the private sector, but how can we bring these particular actors constructively into the equation? While there were several discussions in Moscow devoted to the role of the private sector – there was rhetorical commitments to public private partnerships, and Margaret Chan’s and Secretary Sebelius’ pragmatic appeals to work with business were welcome – private sector participation was modest, and a wariness between business and global health communities persists. Much work remains.
- Thus far, there is no consensus on targets. Without concrete goals in the 4x4, it will be difficult to hold governments and others to account, and for the NCD movement to gain traction and credibility. Discussions on targets will continue in the run-up to the September High Level Meeting.
- High-level leadership is still missing. The September meeting’s odds of success will be significantly enhanced if a powerful and accountable prominent figure is designated to lead preparations in New York. No such person exists today. Another measure of success will be the participation of heads of state: that remains an open question.
- It is not yet clear whether the NCD Alliance will transform into a durable social movement. Such a movement will be vital for both political reasons and for putting into place real operational plans for instituting multi-sectoral approaches.