UN commitment to tackling NCDs: ‘Landmark step’ or 'lacking ambition'?
The United Nations held its third high-level meeting on the prevention and containment of noncommunicable diseases last week (27 September). The group passed a political resolution reaffirming the pledge made under Sustainable Development Goal (SDG) 3.4, to reduce mortality from NCDs by one-third by 2030.
Under the resolution, Member States recognised that “action to realise the commitments made for the prevention and control of non-communicable diseases is inadequate and that the level of progress and investment to date is insufficient”.
Heads of state and government committed to 13 new steps to tackle NCDs including cancers, heart and lung diseases, stroke, obesity and diabetes, as well as backing efforts to promote mental health.
“World leaders have taken a set of landmark steps to beat NCDs,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. “These add up to a historic opportunity to promote health, save lives, and grow economies.”
According to the text of the resolution, signatories agreed to implement an unspecified set of “cost-effective, affordable and evidence-based interventions and good practices” to tackle NCDs.
Data from campaign group World Obesity show the global annual medical cost of treating obesity-related diseases, including heart disease, diabetes, liver disease and various forms of cancer, is expected to reach US$1.2trn (€1.04trn) per year by 2025.
If current trends are not reversed, the costs of treating these diseases are expected to reach $555bn in the USA, $34.4bn in Brazil, $30.6bn in the UK and $50.2bn in Germany by 2025.
Specific actions are to be determined on a country-by-country basis. The document notes that “policy, legislative and regulatory measures” could include fiscal measures “as appropriate”.
Signatories also committed to implementing a series of WHO-recommended policies, such as halting the rise of childhood obesity and initiating public education and awareness campaigns to promote healthier lifestyles.
The WHO also called on food manufacturers to take action. The organisation wants food makers to reformulate products to reduce salt, free sugars and saturated and industrially produced trans fats. The health organisation also backed the use of nutrition labelling on packaged food and restricting the marketing of unhealthy foods and beverages to children.
‘The political declaration lacks ambition’
On the sidelines of the UN General Assembly meeting, the WHO launched its third NCDs Country Profiles report. While the report found the risk of premature death from one of the four main NCDs had declined to 18% in 2016 – a relative reduction of 5% from 2010 levels – it also concluded that the rate of progress is “unlikely” to meet SGD 3.4.
Given the need to accelerate progress in order to reduce premature deaths related to NCDs by one-third over the next 12 years, health campaigners suggested that the UN political declaration could have gone further.
In a joint statement, the European Chronic Disease Alliance (ECDA) and the European Public Health Alliance (EPHA) acknowledged the high-level meeting “marks a further step in global efforts”.
However, they continued, “the political declaration lacks ambition” in particular due to the muted consideration of fiscal measures such as junk food taxes. “We deplore the absence of any reference to taxes and other fiscal measures, which are evidence based, effective means to address behavioural risk factors as well as the commercial and market determinants of health – which are recognised in the declaration.
“The declaration does not contain time-bound commitments from countries to deliver measurable advances, including national NCD plans, and to monitor results.”
ECDA and EPHA said that they “strongly encourage” the European Commission to push forward on expected legislative measure on trans fats.
Food sector sees 'no quick fix'
Welcoming the UN declaration, the International Food & Beverage Alliance (IFBA) highlighted the progress that the food sector is making in areas such as reformulation.
The organisation represents leading global food and non-alcoholic beverage companies, including Coca-Cola Co., Danone, General Mills, Kellogg’s, Mars, Mondelez International and Nestle.
According to IFBA Secretary General Rocco Renaldi, the body’s members have been working together for “more than ten years” to combat NCDs. “Today, more than 45% of members’ products are considered better-for-you products and trans fat has been eliminated from more than 98% of global portfolios.”
Speaking to FoodNavigator, Renaldi conceded that changes “do take time” and stressed that the food industry faces a number of barriers. “Food companies face a number of challenges in improving global nutrition, including scientific, technical and sourcing limitations, consumers’ consumption habits and behaviours and regulatory frameworks which stifle rather than incentivize innovation. There is no quick fix to these challenges.”
On the possible introduction of fiscal measures and other possible regulations, Renaldi stressed that the food industry does not oppose regulation “as such”.
However, he continued: “We are focused on outcomes. There are many examples of regulations that companies support, but there are differing views as to the effectiveness of fiscal measures on diet and health outcomes. For example, the McKinsey Global Institute analysis of worldwide interventions to address obesity found that the highest-impact intervention areas are portion control and product reformulation, while taxation delivers among the lowest impact.
“Interventions must be supported by strong scientific evidence of what works and why. It comes down to what type of regulation is appropriate, proportionate, workable and what its multi-faceted impacts will be.”
UK sugar tax and reformulation
Projections from the UK Treasury show that soft drink manufacturers moved to reformulate their products ahead of the introduction of a soft drinks levy, which came into force this April.
The sugar tax of soft drinks stands at 18p or 24p per litre, depending on how much extra sugar a product contains.
When it was announced in 2016, the Treasury expected the measure to raise tax revenues of about £500m per annum. A year later, the government's expected tax income was lowered to £385m annually. According to the latest estimates from the Treasury, the anticipated figure had been reduced to £275m.
Renaldi dismissed the suggestion that the introduction of sugar taxes might add haste to industry efforts to reformulate.
“IFBA companies have been introducing new and innovative ways to help consumers around the world eat healthy, balanced diets for many years. They have led the way in voluntary efforts to improve the nutrition of their foods and beverages by reducing sugar, salt and fat, offering smaller portions and increasing ingredients considered beneficial for good health. These efforts began not in response to impending legislation, but as part of their commitment to provide consumers with an ever-expanding range of foods and beverages with improved nutrition,” he insisted.
‘It will take a collective effort’
The UN political resolution stressed the need for collaboration across the public and private sector.
Member States pledged to “establish or strengthen national multi-stakeholder dialogue mechanisms” for the implementation of “national multi-sectoral action plans” for the prevention and control of NCDs.
The IFBA stressed that this collective and collaborative approach was vital to reducing NCDs globally.
“It will take a collective effort from all stakeholders if we are to win the fight against chronic diseases…. Experience has shown that collaborations between the public and private sectors that harness the unique skills and core strengths of each sector produce a collective impact far greater than the efforts of any single stakeholder and are, in fact, the only way to tackle complex global issues where the challenge is simply too great to be met by one sector alone,” Renaldi stated.
“Our industry has a unique and critical role to play in combatting diet-related NCDs and has pledged to take action in areas recognized by the UN and WHO as crucial to improving global health - product formulation and innovation, nutrition information, responsible marketing and the promotion of healthy lifestyles. For members of IFBA, good health is good business and we are committed to improving global nutrition and ensuring that our businesses empower consumers to eat balanced diets and live healthier lives.”