Non-communicable diseases: most nations way off meeting targets, says WHO

Nearly 16 million people die prematurely, before the age of 70, every year due to non-communicable diseases (NCDs), even though an investment of just US $ 13 per person per year can save their lives. Urgent government action is needed to meet global targets to reduce the burden of NCDs that range from heart and lung diseases, stroke, cancer and diabetes, according to a new World Health Organization (WHO) report.

The report states that of the 38 million lives lost to NCDs in 2012, 16 million (42 per cent) were premature and avoidable – up from 14.6 million in 2000. The report provides the most current estimates on NCD mortality (2012) and risk factors in 194 countries.

“In 2015, every country needs to set national targets and implement cost-effective actions. If they do not, millions of lives will continue to be lost too soon,” said WHO Director-General Margaret Chan, who on Monday launched the Global status report on noncommunicable diseases 2014.

Recommended actions for governments

Nearly five years into the global effort to reduce premature deaths from NCDs by 25 per cent by 2025, the report gives recommendations about actions by governments. Premature NCD deaths can be significantly reduced through government policies which reduce tobacco use, harmful use of alcohol, unhealthy diets and physical inactivity, and delivering universal health care. Almost three quarters of all NCD deaths (28 million), and 82 per cent of the 16 million premature deaths, occur in low- and middle-income countries.

WHO’s nine voluntary global targets are enshrined in the Global action plan for NCDs 2013-2020 (see ‘Nine NCD targets’).

High impact interventions

The report released on Monday provides examples of most cost-effective and high-impact interventions by various nations.

• Turkey was the first country to implement all the “best-buy” measures for tobacco reduction. In 2012, the country increased the size of health-warning labels to cover 65 per cent of the total surface area of each tobacco product. Tobacco taxes now make up 80 per cent of the total retail price, and there is currently a total ban on tobacco advertising, promotion and sponsorship nationwide. As a result, the country saw a 13.4 per cent relative decline in smoking rates from 2008 to 2012.
• Hungary passed a law to tax food and drink components with a high risk for health, such as sugar, salt and caffeine. A year later, 40 per cent of manufacturers changed their product formula to reduce the taxable ingredients, sales decreased 27 per cent and people consumed 25-35 per cent fewer products.
• Argentina, Brazil, Chile, Canada, Mexico and the US have promoted salt reduction in packaged foods and bread. Argentina has already achieved a 25 per cent reduction in the salt content of bread.
• In Brazil, the NCD mortality rate is dropping 1.8 per cent per year, due to, in part, expansion of primary health care.

The report notes that most of the countries are off the course to meet the 2025 targets. While 167 countries have operational NCD units in the ministry of health, progress on other indicators has been slow, especially in low- and middle-income countries (see ‘Progress report of countries’).

Economic burden of NCDs

From 2011-2025, cumulative economic losses due to NCDs without any intervention in low- and middle-income countries is estimated at US$ 7 trillion. WHO estimates the cost of reducing the global NCD burden is US$ 11.2 billion a year, an annual investment of US$ 1-3 per capita.

The first UN General Assembly high-level meeting on NCDs took place in 2011 and resulted in the adoption of a political declaration that put the prevention and control of NCDs high on the development agenda. The second high-level meeting took place in 2014, when countries committed to setting national NCD targets in 2015. In 2018, the UN General Assembly will convene a third high-level meeting to take stock of progress of countries in attaining the voluntary global targets by 2025.

Progress report of countries

Progress report on targets for 2025 as of December 2013:

• 70 countries had at least one operational national NCD plan in line with the Global NCD action plan
• 56 countries had a plan to reduce physical inactivity
• 60 countries had national plans to reduce unhealthy diets
• 69 countries had a plan to reduce the burden of tobacco use
• 66 countries had a plan to reduce the harmful use of alcohol
• 42 countries had monitoring systems to report on the nine global targets

Nine global NCD targets

Target 1
A 25 per cent relative reduction in risk of premature mortality from CVDs, cancer, diabetes, chronic respiratory diseases

Target 2
At least 10 per cent relative reduction in the harmful use of alcohol, as appropriate, within the national context

Target 3
A 10 per cent relative reduction in prevalence of insufficient physical activity

Target 4
A 30 per cent relative reduction in mean population intake of salt/sodium

Target 5
A 30 per cent relative reduction in prevalence of current tobacco use in persons aged 15+ years

Target 6
A 25 per cent relative reduction in the prevalence of raised blood pressure or contain the prevalence of raised blood pressure, according to national circumstances

Target 7
Halt the rise in diabetes and obesity

Target 8
At least 50 per cent of eligible people receive drug therapy and counselling (including glycaemic control) to prevent heart attacks and strokes

Target 9
An 80 per cent availability of the affordable basic technologies and essential medicines, including generics, required to treat major NCDs in both public and private facilities

Noncommunicable diseases: Country profiles 2014

Non-communicable disease and development: future pathways

Contribution of six risk factors to achieving the 25×25 non-communicable disease mortality reduction target: a modelling study