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Keywords: Political commitment (1 hits),

NCDs in the Rio+20 conference outcomes

The NCD Alliance, an international network of over 2000 organizations working on non-communicable diseases (NCDs) including cancer, cardiovascular disease, chronic respiratory diseases, and diabetes, believes the outcome document from the Rio+20 conference must contain a strong focus on health, specifically the threat to sustainable development and poverty eradication posed by the global NCD epidemic.

Rio +20 will be a critical opportunity to build on the efforts already underway to accelerate progress towards sustainable development and reduce poverty and inequality, which will ultimately contribute toward the prevention and control of NCDs worldwide.

Overall outcomes of the conference should be sustained Political commitment and willingness to adequately address and invest in NCD prevention and control on the local, national, regional, and international levels. The conference will also provide a platform for Member States and other stakeholders to follow up on the commitments made during the UN High-level Meeting (HLM) on the Prevention and Control of Noncommunicable Diseases, held on 19-20 September 2011 at UN Headquarters.

NCDs since the Johannesburg Declaration

The 2002 Earth Summit in Johannesburg, South Africa, putforth a comprehensive agenda for action on sustainable development. Paragraph 19 of the Johannesburg Declaration on Sustainable Development highlights a key area for further attention in the Rio+20 Outcome Document. It states:

?We reaffirm our pledge to place particular focus on, and give priority attention to, the fight against the worldwide conditions that pose severe threats to the sustainable development of our people, which include...endemic, communicable and chronic diseases, in particular HIV/AIDS, malaria and tuberculosis...?1

In the 10 years since the adoption of the Johannesburg Declaration, NCDs (referred to as chronic diseases in the declaration above)have emerged as one of the foremost development challenges of the 21st century. There is growing evidence that NCDs are impeding progress to achieving the UN Millennium Development Goals (MDGs).Effective prevention and control of NCDs requires that these diseases not be dealt with in isolationbut be fully integrated into all aspects of theglobal development agenda.

NCDs and the eradication of poverty

The linkages between NCDs and sustainable development, particularly as a means toward the eradication of poverty, are clear and require concrete actions on the part of all stakeholders.

Member States unanimously adopted a Political Declaration during the HLM recognizing NCDs as a global development priority and the?the vicious cycle whereby NCDs and their risk factors worsen poverty, while poverty contributes to rising rates of NCDs, posing a threat to public health and economic and social development.?

According to the World Health Organization, 100 million people are pushed into poverty annually because they have to pay directly for health services, which results in up to 5% of the population being forced into poverty in many countries.

In addition to the economic burden they place upon individuals, families, and communities, NCDs are already having devastating consequences on the global economy. A recent study by the World Economic Forum and Harvard University estimates that NCDs will cost the world economy $47 trillion over the next 20 years, representing 75 percent of annual global GDP and surpassing the cost of the current global financial crisis.

NCDs in the green economy

WHO?s Health in the Green Economy series, published in spring of 2011, highlights the relationship between sectors of the green economy and health and recommends solutions that both mitigate climate change and improve health conditions, particularly in low-income settings.5 The NCD Alliance urges Member States and other stakeholders to strongly consider these solutions in the discussions and outcomes of the Conference.

The NCD Alliance suggests the following priorities for consideration during the Rio+20 Conference:

Health systems integration: The NCD Alliance urges governments to integrate NCDs into existing health policies and health systems strengthening initiatives, refocusing health systems on prevention, health education, and chronic disease care. Strengthened health systems will also benefit other diseases and conditions, including HIV/AIDS and other infectious diseases. The Rio Declaration should reaffirm the commitment made by Heads of State in the Political Declaration issued at the HLM to ?promote, establish or support and strengthen, by 2013, as appropriate multi-sectoral national policies and plans for the prevention and control of non-communicable diseases? (para 45).

Development goals: The MDGs currently contain no goals or targets for NCDs. Yet, NCDs cause 60 % of all deaths globally (36 million) each year and four out five of these deaths occur in low- and middle-income countries. It is therefore critical that Member States include NCDs in discussions at the Conference and at the 2013 MDG Review Summit, and commit to including targets on NCDs in the follow up development framework when the current MDG goals expire in 2015.

Donor assistance: Less than 3% of official development assistance (ODA) on health is spent on NCDs.6The NCD Alliance requests all governments with major overseas aid programmes to low and middle income countries to end the policy ban on funding NCDs that most bilateral donors operate now. Bilateral donors countries must live by the commitments made in the Paris Declaration on Aid Effectiveness. The Rio Declaration should support the commitment in HLM Political Declaration to ?promote all possible means to identify and mobilize adequate, predictable and sustained financial resources and the necessary human and technical resources, and to consider support for voluntary, cost-effective, innovative approaches for a long-term financing of non-communicable disease prevention and control? (para 49).

Whole of Government engagement: NCD plans must involve the whole of government, not just the health sector. Action to prevent and control NCDs requires the active engagement of ministries of finance, foreign affairs, education, agriculture, and transportation, trade and others.

Adopt policies to prevent NCDs: Only governments have the power to regulate environments so that healthy food, smoke free places and physical activity are the norm and not the exception. The NCD Alliance expects governments to regulate unhealthy food content ? salt, trans-fats and sugar - and harmful use of alcohol through policies on price, availability and marketing. Governments must accelerate implementation of the Framework Convention on Tobacco Control (FCTC) and tax tobacco to the level recommended by the WHO to both reduce tobacco use and generate revenues that can be used for sustainable development.

Universal access to NCD medicines, technologies and care as a human right: Today, over 100 million people with NCDs are denied access to the basic medicines (including for pain relief), technologies, education and care they need to stay alive and stay healthy.7 Individuals and families in many contexts are being tipped into poverty by catastrophic expenditure on NCD care. NCDs are not new diseases and many can be treated effectively with off patent medicines. NCD prevention, and investment in early NCD diagnosis and treatment, is both morally right and sound economic strategy.

Follow Up Action on Non-communicable Diseases: Heads of State committed to a ?comprehensive review and assessment in 2014 of the progress achieved in the prevention and control of non-communicable disease? (para 65) in the HLM Political Declaration.

The Rio Declaration should recommend that this review culminate in a High-Level Meeting of the United Nations to ensure that prevention and control of NCDs are given adequate follow-up as a priority factor in achieving sustainable global development.