Near-elimination of tobacco consumption worldwide by 2040 was proposed as the No. 1 priority for this fall’s United Nations High-Level Meeting on Non-Communicable Disease in a joint statement on April 6 from two stakeholder coalitions.
Dietary salt reduction, improved diet and physical activity, reduction in hazardous alcohol intake, and universal access to essential drugs and technologies were also listed as top global NCD priorities by the Lancet NCD Action Group, an informal collaboration of academics, practitioners, and civil society organizations, and the NCD Alliance, comprising four international nongovernmental organizations (Union for International Cancer Control, International Union Against Tuberculosis and Lung Disease, International Diabetes Federation, and World Heart Federation).
The UN High-Level Meeting (UN HLM) on NCDs in September 2011 is expected to focus the world’s attention on NCDs in the same way that a similar meeting did for HIV/AIDS in 2001, which concluded that dealing with the disease was central to the world development agenda. The rising global epidemic of NCDs is now responsible for two-thirds of all deaths worldwide and has become a major barrier to development, according to Dr. Robert Beaglehole of the University of Aukland, New Zealand, and 43 coauthors representing the two umbrella groups (Lancet 2011 [doi:10.1016/S0140-6736(11)60393-0])
"The UN HLM is a turning point in the way we approach global health issues, and it will place NCDs on the development agenda. The global community has to take this opportunity and sustain the momentum to achieve the goal of avoiding premature NCD deaths and disability, thus improving global health in the years to come," the authors wrote.
The five priorities were chosen because there is good evidence for each regarding their substantial impact on health and cost effectiveness, the low cost of implementation, and financial feasibility for scale-up. Specifically, the authors proposed goals of reducing worldwide tobacco consumption to less than 5% by the year 2040 and salt consumption to less than 5g (2,000 mg sodium) per person per day by 2025. "We propose a goal to achieve a world essentially free from tobacco by 2040," they said.
Tobacco reduction would be accomplished via full implementation of the 2003 World Health Organization Framework Convention on Tobacco Control, which calls for reducing demand for tobacco via methods such as raising tobacco taxes, legislation of health warnings, and smoking prohibitions. Salt reduction would be accomplished via mass-media campaigns and voluntary reformulation of food products by industry.
Using those methods, the yearly cost to implement tobacco control and salt reduction would be about 20 cents per person per year in countries such as India and China, with the total package of priority interventions priced at about $9 billion per year, the authors said.
Keys to progress include leadership at the highest levels of government, a focus on prevention, treatment, international cooperation, monitoring, reporting and accountability, they said.
"An ideal outcome of the UN HLM will be a sustained commitment to a set of feasible actions and interventions for which specific and timed targets and indicators can be developed, and progress can be readily measured."
The NCD Alliance has also issued a proposed outcomes document for the UN High-Level meeting.
Dr. Beaglehole declared that he has no disclosures. Two of the authors declared financial relationships with pharmaceutical companies, and two others received grants from charities including the Wellcome Trust. One of the authors, Richard Horton, is editor of the Lancet. The others declared that they have no disclosures.