The NCD Alliance and World Heart Federation: Global Support for Country Implementation Johanna Ralston July 21, 2011

Four by Four (or Five?) Modifiable causative risk factors Tobacco use Unhealthy diets Physical inactivity Harmful use of alcohol Non-communicable Diseases Heart disease and stroke Diabetes Cancer Chronic lung disease Mental Health?? ?

“From… “The World Health Organization needs to help sick people, not be a nanny. Dr Chan must cure the agency's addiction to noisy campaigns against obesity, smoking and other non-infectious ailments… Many of these afflictions arise from personal choice, and are not contagious”- The Economist, 2006 To “It is not that there is not enough data, not enough information and not enough knowledge as a basis for addressing the prevention and control of NCD. The problem has been how to raise the issue to a high enough level in the political agenda and maintain it there, as without that there will be no material progress.” Sir George Alleyne, 2011 Changing a Mindset From

The NCD Alliance Four NGO federations with 900 associations in 170 countries Founded in 2009 to address common risk factors and common issue of under-recognition on global health and development agendas Common Interest Group of 350 additional members 24 and counting country based NCDAs and two regional alliances Common voice for NCDs

13th May 2010, LANDMARK ACHIEVEMENT: UN General Assembly Resolution on NCDs CARICOM, civil society and the NCD Alliance campaigned for a United Nations (UN) Summit on NCDs, this included our member organizations On 13th May 2010, the UN voted unanimously for the passage of resolution 64/265, ‘Prevention and control of non-communicable diseases.’ Modalities resolution to define length and content of meeting Civil society task force and civil society interactive hearing on June 16

"The summit in September in New York is our chance to broker an international commitment that puts NCDs high on the development agenda, where they belong" Mr Ban Ki-Moon, UN Secretary-General, World Economic Forum, 27 January 2011 "The summit in September in New York is our chance to broker an international commitment that puts NCDs high on the development agenda, where they belong" Mr Ban Ki-Moon, UN Secretary-General, World Economic Forum, 27 January 2011

Progress to Date

Preparatory Process: WHO Regional Consultations

The NCD Alliance’s vision for success

Lancet NCD Action Group and NCDA: NCDs and Development Source: Beaglehole R, Bonita R, Horton R, et al for The Lancet NCD Action Group and the NCD Alliance. Priority actions for the NCD crisis. Lancet 2011; 377:

PREVENTION Accelerate implementation of Framework Convention on Tobacco Control (FCTC) Reduce dietary salt, sugar, saturated and trans-fats and harmful use of alcohol Implement strategies to encourage physical activity TREATMENT Strengthen health systems through integration of NCD prevention and treatment Increase access to affordable, quality- assured essential medicines and technologies to prevent and treat cancer, cardiovascular disease, chronic respiratory disease and diabetes, including vaccines and palliative care. LEADERSHIP and international cooperation Establish an NCDs Partnership, linked to WHO, to coordinate follow up action with member states, other UN and multilateral agencies, foundations, NGOs and private sector Commit to a whole-of-government response through costed national plans for NCD prevention and treatment Promote synergies between programmes for NCD and other global health priorities Raise the priority of NCDs on the global health and development agendas and increase funding for their prevention and treatment, and invest in these proposed low-cost priority actions: MONITORING, REPORTING AND ACCOUNTABILITY Establish a high level Accountability Commission on NCDs with cross sector representation to monitor Summit commitments

This Week NCDA is especially keen to promote the overarching goal of reducing NCD deaths: a 25% reduction by 2025 Honour commitment to Paris Declaration The G77 are calling for increased resources through domestic, bilateral and multilateral channels. Norway is proposing language on tobacco taxation as an underused source of governmental revenue in many countries. Please call on the EU and other donor countries such as Canada and US to stop opposing this language. Please ask your government to support the G77’s proposal to hold a follow-up High-Level Meeting on NCDs in 2014 to ensure commitments are followed through and progress is measured.

ZERO DRAFT UPDATES Weakening of language around donor commitments, accountability, targets, taxes, essential medicines and technologies Supoprt G77 call for increased resources through domestic, bilateral and multilateral channels and Norwegian language on tobacco tax. Stronger push on external media given that negotiation talks ended on August 5 without key agreements having been reached.

September and Beyond

Key Post Summit Themes Integration: into existing health systems Advocacy: to ensure outcomes document and post- Summit commitments are made and met Capacity: at country level, strengthening member organizations Whole of Society: engaging multiple sectors and stakeholders

NCDA Post Summit Priorities 1.Build Evidence Operations Research Demonstration Projects 2.Programmes at country level Risk Factors Mapping and Coordination 3.Strengthen country capacity NCD Alliances NCD planning 4. Political Advocay MDG successor goals in 2013 Monitor outcomes document

Nigeria  Example of a country that has developed an Alliance without external support but with advisory supports from two main core partners, IDF and the African Heart Network/World Heart Federation, with additional links through WHO AFRO  MoH has in principle accepted NCDA suggestions to Zero draft and has formed a Technical Working Group (TWG) on UN summit.  TWG will be charged with convening an expanded National Stakeholders Meeting on NCDs prior to the UNS that will articulate the Nigerian position  TWG will have 20 members: 6 FMoH directors, reps of 4 MDAs, 2 from NCD Alliance plus tobacco and government NCDs. Dr. Kingsley Akinroye and Ms Bola Ojo of AHN attended the UN Civil Society hearing and are reporting to TWG on this  Successful advocacy including several op-eds in the Guardian by Dr. Akinroye have resulted in likely attendance of President at HLM  TWG will look at post Summit implementation of outcomes

India  Highest burden of NCDs but less likely to advocate for development assistance  “We have funding. What we need is technical assistance in task shifting and management as well as integrating NCDs into existing health systems.”  Improved public health and primary health-care systems are essential for the implementation of cost-effective interventions.  Taxation of tobacco and alcohol  Integration of national programmes across NCD diseases and with national health agendas.

“It is not the strongest of the species … nor the most intelligent that survives. It is the one that is the most adaptable to change.” Charles Darwin