Click here for May report on the NCD Alliance
Click here for August report on the summit's Political Declaration
Click here for WN editorial on the summit
Click here for WN commentary on the summit by Philip James
Click here for WN comments on what next after the summit
Click here for Association letter to UN secretary-general

The science on obesity and serious diseases is solid. But the most powerful nations are hesitating. It looks like the message is not getting across at the top

The news team reports: Progress towards the UN summit on prevention and control of non-communicable diseases has stalled. It is now practically certain that the outcome of what is technically a 'high-level meeting', taking place at UN headquarters in New York on 19-20 September, will fall far short of the hopes and initial expectations of all concerned with public health. But in a letter to UN secretary-general Ban Ki-moon (pdf available here) the Association states that a modest outcome, and a general Declaration of commitment, should be seen as a first stage and a preliminary success, and not as a failure.

Commenting, Association president Barrie Margetts says: 'Expectations have been unrealistic. The process is not yet mature. We have been hoping for too much too soon. Also, it is too easy to put all the blame on ideological and commercial forces. These are blocking progress, for sure, and need to be overcome, and this needs to be stated. But also, the forces standing for improved public health, including real reductions in rates of obesity and other chronic diseases, are weak – and that, among others, means us'. He adds: 'If the summit turns out to be a fiasco, this needs to be acknowledged. The main message, which we need to take on board now, is that we need to regroup so as to be more persuasive and more effective. This must engage us, as professionals and citizens, and learn from the environmental movement'.

'This never could have been the final round' says Association Council member Philip James, a senior WHO advisor since the 1980s, and chair of the study group responsible for the first ever UN report on Diet, Nutrition and the Prevention of Chronic Diseases. 'At the moment, the food manufacturers and processors are thinking short-term, and they imagine that better health means less wealth for them. So they are hostile. What's needed now and immediately after the summit, is development of fuller analyses. These will show that the food industry as a whole can prosper while also promoting long-term global health. Key leaders of industry need to see this, and its implications. Courage and imagination will be needed, and of course there will be losers as well as winners, which is the nature of fair competition. This does not apply to the alcohol industry, any more than it does to the tobacco industry. But what we need now, is to envision food systems whose products are beneficial to health and to society and the environment, as well as to speculators and shareholders'.

The accusations

The accusations levelled against the summit process are fierce. A commentary in the British Medical Journal (pdf available here) states: 'Years of planning may be set to unravel. With only weeks to go before the summit, years of negotiations seem to be stalling. Discussions have stopped on the document that forms the spine of the summit, and charities are concerned that governments are trying to wriggle out of commitments'. An accompanying commentary by David Stuckler and others (pdf available here) summarises some of the shocking and awesome forces lined up against public goods and public health.

The Lancet (pdf available here) states: 'What looked like an opportunity to rewrite the world's agenda for global health is now turning into a fiasco, one in which corporations are successfully applying pressure to governments to block any attempt to produce an outcomes document with teeth. The European Union, for example, wishes to delete a paragraph saying that resources devoted to NCDs are not commensurate with the magnitude of the problem. The G77 group of nations wishes to retain that truthful statement of fact... On targets, the G77 wants WHO to establish global goals by the end of 2012. The US fiercely opposes this recommendation, preferring instead only voluntary targets. Major tobacco manufacturing nations, including Japan, the EU, and the US, oppose any language on tobacco taxation... For all their fine words about commitments to global health, the capitulation of EU nations and the US government to the tobacco, food, and drinks industries reveals their true allegiances – not to those at risk of chronic diseases, but to businesses growing fat on the early deaths of their consumers'.

The NCD Alliance, stating that it represents over 2,000 professional associations and civil society organisations, has written a militant letter to UN secretary-general Ban Ki-moon. The letter is signed by the four Alliance chiefs: Sidney Smith of the World Heart Federation, Eduardo Cazap of the Union for International Cancer Control, SB Squire of the International Union Against Tuberculosis and Lung Disease, and Jean-Claude Mbanya of the International Diabetes Federation.

An extract of the letter, a pdf of which is available here, says: 'Member State negotiations on the draft Political Declaration for the High-Level Meeting stalled on 5 August and resume on 1 September. We understand that the current draft contains no overarching goal and no clear decision to establish the means through which commitments can be followed up and coordinated at a global level. It merely "requests the Secretary- General" to provide options by the end of next year for further consideration… It is reported that sound proposals for the draft Declaration to include time-bound commitments and targets are being systematically deleted, diluted and downgraded. In place of the promised "action-oriented outcomes", it seems there might be only vague intentions to "consider" and "work towards". This is simply unacceptable'.

The letter then points to the fact that the draft Declaration contains no times or numbers by which progress can be assessed, as do the Millennium Development Goals, and says: 'Member States must grasp the opportunity of the High Level Meeting and agree to:

1. An overarching goal to reduce preventable deaths from NCDs: 25% by 2025.
2. A set of specific, evidence-based targets and global indicators.
3. A clear timeline for tackling the epidemic of the four major NCDs.
4. A high-level collaborative initiative of government and UN agencies with civil society to stimulate and assess progress'.

And finally: 'Civil society will not accept a failure to act now. NCD Alliance members and supporters around the world are conveying these concerns to their Heads of State and Government this week'.

So what now?

Technically, the meeting in New York is not a 'summit', which implies a commitment from heads of state and prime ministers to attend. A 'high-level meeting' implies that member state delegations are usually led by ministers. One consequence of the NCD Alliance open letter is that some heads of state and prime ministers who would otherwise have attended, will cancel. Busy and important people prefer to engage in successes. It seems likely that the most powerful delegations will be headed by ministers responsible not for health, but for trade, or for home or foreign affairs, as is often the case with WHO and FAO meetings. So ironically, in going public with warnings of failure, the NCD Alliance has increased the chances of the New York meeting being identified as a failure.

Association publications secretary Geoffrey Cannon has examined a number of the successive documents drafted in preparation for the New York meeting. He comments: 'The NCD Alliance is right to say that there are no numbers in the current draft of the Political Declaration' (pdf of the version of 15 July available here)' and that the US and EC are among those member states opposed to numbers. The Alliance is also right in effect to say that without numbers specifying target years and quantifying success in disease prevention and control, policies are just words that cannot be translated into effective actions. But there never were numbers in the preliminary Moscow Declaration of April (pdf available here) nor ever since, apart from a brief appearance of the well-established number for salt reduction'.

Barrie Margetts concludes: 'In all the circumstances, and after discussion involving review of opinions expressed on our website, we believe that the best that ever could have been expected as an outcome of the New York meeting, is a statement of general principles and commitments. The present draft specifies the need to tackle major NCDs as a whole. This is progress. The draft also identifies the social, economic and environmental determining factors of health and disease, as well as biological and behavioural factors. This is a success, not least for the Association and its members, who have advocated for this 'big picture' approach. Perhaps above all, and most basic, the draft makes it clear that non-communicable diseases are preventable and can be controlled. These are not trivial gains.

'There are also some good reasons to regroup and rethink. There are a number of crucial issues not properly addressed so far, one of which is how to control and prevent undernutrition and deficiencies at the same time as obesity and other chronic diseases. Governments of impoverished countries don't have the resources or often the inclination to try to control NCDs in isolation'.

He continues: 'We invite readers to examine our letter to secretary-general Ban Ki-moon. The fact that we have to face, is that the UN and member states are not yet ready to commit to a Declaration with quantified targets, like the Millennium Development Goals. Perhaps this is just as well. Numbers need to be realistic and need to take regional and national circumstances into account. No government is going to accept and act on numbers "imposed" by the UN unless these are carefully derived from good evidence.

'The solution now is in part in our hands, together with those of the governments of the most committed member states. These need to come together with the most committed civil society organisations, with support from WHO and other relevant UN agencies and other actors, including industry sectors and leaders committed to better health. They can then address the general principles that no doubt will be agreed in New York and make them operational, region by region and country by country. This in turn can make an unanswerable case at global level. Will the community of nations ever be ready at global level? They better be'.