Johanna Ralston, CEO, World Heart Federation
When Member States met during September’s United Nations High Level Summit on Non-Comunicable Diseases (NCDs), one of the clear outcomes in the Political Declaration was their agreement to develop global targets to reduce the burden of NCDs by the end of 2012. Last week, the World Health Organization (WHO) Executive Board met here in Geneva and the commitments to targets and timeframes appeared in danger, as calls for more time and more targets threatened to undermine what Member States have committed to in the Political Declaration and further delay implementation with new deadlines for the creation of targets proposed for 2013 instead of 2012. Fortunately, leadership by key actors involved in negotiations and powerful statements by the NCD Alliance, other civil society organizations, and certain member countries, ensured that we will see those targets “completed” this year. Notably, Member States have agreed to “submit a substantive progress report on the development of a framework, including a set of indicators and targets, to the sixty-fifth World Health Assembly (May 2012) for consideration,” with “completion” committed to by the end of the year.
As the saying goes, “what gets measured gets done” and the discussions at the WHO Executive Board have brought us one step closer to being able to monitor and track progress made on NCDs. However, it is clear that controversy concerning how many and which targets will be presented at the World Health Assembly has not yet been resolved. The complexities include lack of a complete picture of available data and underlying surveillance systems that would be key in setting baseline measures against which to achieve targets. As well as limited and uncertain resources at a time when the major global organizations, including WHO and the Global Fund, are undergoing severe resource constraints and reform processes; and only an emerging recognition that achieving the commitments laid out in the Political Declaration and being debated in the targets process will require a different framework for policy, funding and partnership, what has been called a “new policy narrative.”
For the NCD and health community, this is the time to come together and build solidarity around which targets are needed to successfully reduce the global burden of cardiovascular disease and other NCDs. It is imperative that work on the global monitoring framework for NCDs is completed by the end of 2012, as agreed upon by member states at the WHO Executive Board last week. However, all of us will need to work together to ensure that the timeline laid out by last week’s resolution on NCDs is actually fulfilled.
The most critical goal included within the WHO proposed set of targets is one that has been championed by the NCD Alliance, that is to decrease the overall mortality from NCDs by 25% by the year 2025, using the mortality in 2010 as a baseline (and recognizing possible advantages in extending that goal to 2030 to align with development goals). In order to do this, all the major risk factors of NCDs must be addressed – including physical inactivity, which is noticeably missing from the current set of targets proposed by the WHO. There has been a push from many within the NGO community for the creation of a target for the reduction of physical inactivity, however some Member States feel that it does not sufficiently satisfy the WHO requirements regarding what should constitute a global target. A sticking point is an accurate indicator for physical activity. In other words, what measurement could governments use that would allow them to effectively monitor and track changes in physical activity levels? PAHO and GAPA have suggested legitimate and defensible indicators, as have many of our colleagues who submitted comments to the NCD Alliance prior to the Executive Board meeting, including the segmentation of targets based on age. The need for consistent data presents a legitimate challenge, yet to allow the targets process to continue without addressing physical activity seems a far greater problem.
Please weigh in: should physical activity be addressed in the global targets?
For more information
See the list of proposed WHO targets listed as table 2 in the following discussion paper
Download the statement made by the NCD Alliance at the Executive Board
Download the complete text of the WHO Executive Board Resolution on NCDs
Access full documentation from the 130th Session of the WHO Executive Board