comments on the first draft report of the who independent high-level commission on non-communicable diseases - Foundation for a Smoke-Free World

comments on the first draft report of the who independent high-level commission on non-communicable diseases

Millions of people worldwide are affected by Non-Communicable Diseases (which include heart disease, lung diseases, mental illnesses, cancer, and diabetes), the burden of which is heaviest in high-income countries but is increasing in low- and middle-income countries. This burden becomes more visible as populations age and other causes of death and disease decline. The burden of NCDs is worsened by globalization of risk factors. The WHO Independent High-Level Commission on NCDs issued a draft first report on May 1st, 2018 on recommendations to Heads of State and Governments to implement policies to accelerate progress towards Sustainable Development Goals (SDGs) on the prevention and treatment of NCDs. The draft report policies call for the promotion of mental health and well-being. The actions proposed in the draft report are not sufficient to meet the NCDs-related SDGs.

The Foundation submitted comments to the Commissioners addressing NCDs, in which it made the following suggestions to accelerate the progress towards meeting SDGs.

  1. Better and more current data is available and should be used.
    • Use data from the Institute for Health Metrics and Evaluation (IHME) diseases and major risk factors that shed light on the decline in mortality rates for many NCDs, but also show that some NCDs are on the rise.
  2. More of the same will not achieve better results.
    1. Countries lacking regulatory and enforcement capabilities cannot effectively implement interventions defined as cost-effective in advanced industrialized countries.
    2. Current policies that apply to multinational food production in leading developing countries are not easily applicable to address small, local and informal companies.
  3. Multiple chronic conditions are a reality for many patients, especially over 50 years of age.
    1. Integrate primary health care (PHC) services for adults to assess the global impact of the burden and risks of chronic conditions that affect one in three adults worldwide.
    2. Standardize the definition and reporting system for multimorbidity, and for addressing the research gaps such as how to best prevent the development of multimorbidity and maximize the treatment of patients with multimorbidity; and how to organize healthcare systems to manage patients with multimorbidity.
    3. Call for PHC services to address lifelong NCDs as a contributor to healthy aging, particularly in patients over 50 years of age. A combined personalized and cross-sector partnership approach towards healthier aging may prove beneficial to the society, rather than see increased global life expectancy as a burden.
  4. Behavioral economics have yet to be fully applied to NCDs prevention and control.
    1. Address the hyperbolic discounting issue which underlies future health being affected due to the postponement of healthy actions that may be taken today – behavioral economic insights using incentives and choice architecture can effectively prevent NCDs.
    2. Adopt a human-centric health ecosystem (HCHE) approach that cooperatively connects public and private sector stakeholders to improve global well-being by reducing risks that cause or worsen NCDs and by providing efficient and effective care for NCD patients.
    3. Apply harm reduction approaches to all complex behaviors that underpin NCD risks and outcomes. Harm reduction approaches could be implemented to address the complex behavioral issue of smoking that results in the development of NCDs. Indeed, while harm reduction is stated in Article 1 of the WHO Framework Convention on Tobacco Control (FCTC), it has yet to be implemented. This links back to HCHE, which is most effective when stakeholders prioritize the individual by recognizing and responding to the behavioral percepts that influence the individual’s behavior.
    4. Implement strategies that encourage healthy behavior such as smoking cessation, healthy eating and physical activity in an integrated manner.
  5. Learn from experiences with “Shared Value” as implemented by diverse corporate sectors.
    • The Shared Value approach provides a framework to engage all companies in a private-public partnership to transform their portfolios towards a common goal such as the SDGs and healthier options. A framework for a successful business model ensures that health is both a driver and a product of economic success.
  6. New funding mechanisms for NCDs are needed to build on those proposed by the Trust Fund for NCDs and Mental Health and a Global Solidarity Tobacco and Alcohol Contribution.
    1. Define how much funding is needed and to what purpose. As the total health spending is increasing globally, development assistance for health continues to decline, and further cuts to this development (for instance to meet humanitarian crises needs) may slow the progress towards SDGs.
    2. Prioritize investment and use of healthcare resources, macroeconomics, and health agenda more efficiently. Better investment in health to ameliorate people’s health is a critical measure of the success of the recommended policies.
    3. Increase investments by governments in NCDs and mental health (MH) to match external funds.
    4. Increase taxes on cigarettes, of which a proportion must be earmarked for NCDs and MH, as this earmarking receives public support.
  7. Focus advances in collaborative research, science, and technology targeted to specific NCD challenges.
    1. Seek support from groups like the Global Alliance for Chronic Diseases to identify gaps in research and technology and support the current advances in the fields of NCD prevention and control in an affordable manner to low- and middle-income countries. Examples to address NCD challenges are:
      1. Polypills for common NCDs and MH
      2. Advanced diagnostics for MH conditions
      3. Substantially more effective smoking cessation interventions and better evidence of the safety of reduced risk products for smokers.
    2. Seek funding from public bodies, corporations, and foundations to address NCDs research gaps and strengthen the science to build a much-needed pipeline of expertise in developing countries.

Last but not least, one must consider the promotion of health through the work place. The incidence of poor MH outcomes, elevated healthcare expenditures, and lost productivity have been linked to low adherence to physical inactivity, poor diet harmful use of alcohol, and tobacco use. Companies are urged to maintain a smoke-free space and may be encouraged to provide medical benefits including preventive services such as tobacco cessation.

WHO Independent High-level Commission on NCDs:

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