The Oxford Health Alliance | www.oxha.org

On 18 April 2008, the Secretariat for non-communicable diseases in WHO Geneva published the most recent draft (WHO A61/8) of its Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases (click here >>). The finalised version will be presented to the Sixty-first World Health Assembly when it convenes from 19 to 24 May in Geneva.

OxHA welcomes this report, and the long-awaited renewed focus of the WHO on NCDs. We hope that the necessary funding and capacity-building for this under-recognised cause of disability and mortality will follow, and we are ready to contribute to partnerships to forward this agenda. OxHA’s Grand Challenges in Chronic Non-Communicable Diseases (click here >>), the Community Interventions for Health initiative (click here >>) and the recent Sydney Resolution (click here >>) are important tools.

We wonder, however, if the time has come to drop the unhelpful term ‘NCD’. In this time of rapid globalisation, most diseases have become ‘communicable’, and a disease such as HIV/AIDS is becoming a chronic care issue. A better distinction might be acute diseases /chronic diseases with high and low mortality.

We have, however, noticed several new and reassuring recommendations and statements, upon which we would like to comment.

Several recommended high-levels changes now stand out clearly: the new focus on a restricted number of risks and diseases (that have been the focus of OxHA’s work for some years); the reference to the Global Strategy for Diet and Physical Activity and the FCTC as providing agreed ways forward; and the well-documented links to the MDGs/poverty alleviation and the role of social and economic factors. Chronic disease prevention is clearly positioned as a development issue. Furthermore, there is a strong focus on the need to involve and maintain all partners in a dialogue about finding solutions.

There is, however, one serious omission: health promotion in the workplace. Governments and others need to be alerted to this – OxHA hopes that they will understand that this is an area in which they have a chance to show leadership and reach large proportions of the population. Also omitted is a sufficient focus on gender/ethnic specificities – mentioned only briefly in paragraph 18. We would also have liked to see mention of the ways in which new technologies – the internet, mobile telephones, etc. – can be used to share best-practice and to connect and educate communities and individuals.
And some specifics:

• Paragraph 10 highlights the need for resources and for a readjustment of planned support. Although we have seen new money coming into play, most of it has come from private sources (for example, Bloomberg Philanthropies, and PepsiCo Foundation’s support of the OxHA Community Interventions for Health initiative, and lastly the Ovations/NHLBI Chronic Disease Initiative). We would like to see governments, the World Bank and WHO put serious funding into this area. We would also expect some of the huge private foundations, who have been in denial for a long time now, to wake up to and start funding in this area. The research funding is still dominated by suggestions to do traditional bio-medical research and, although this is still important, more funding needs to go into understanding how we can implement existing knowledge in realistic and sustainable way. We need research on implementations (ROI – like return on investment). If we fail to focus on how communities can facilitate the necessary changes in behaviours and how to make structural changes acceptable, we will never succeed.
• Paragraph 13 highlights the link between NCDs and global social and economic development.  As noted in this paragraph, there is very strong motivation to link chronic diseases and the Millennium Development Goals. In our view there is no good reason for omitting chronic diseases from the MDGs. The fight against AIDS/TB /malaria is important but will never succeed without well-functioning national health system – and these three communicable problems are ‘only’ 20% of the global health burden.
• Paragraph 16(d) links work on chronic diseases to the Commission on Social Determinants of Health – a vital area to address if chronic diseases and their risk factors are to be successfully tackled.
• Paragraph 17(c) provides a basis for public-private partnerships that needs support and specific ideas. The Pan American Health Organisation is already setting up such a Forum, and OxHA provides a space for such discussions and could play an important role in this space. The need for public-private partnerships is further stressed in paragraph 31.
• Paragraph 19 focuses on the need to link all major risks in a common framework. This makes sense for measurement where a unified approach is helpful – but a more flexible approach is needed for implementation, where there will be a need for a diversity of approaches tailored to specific risks and local circumstances.
• Paragraph 24 lists the steps needed to reduce the prevalence of poor diet and lack of physical activity. The language is broad and is inclusive of partnership approaches.
• Paragraph 25(b) provide an opening to support from the Secretariat for intervention programmes such as OxHA’s Community Interventions for Health initiative.