Keynote address - Commonwealth Health Ministers Meeting 2011

Ministers of Health;

His Excellency Mr Kamalesh Sharma, Secretary General of the Commonwealth Secretariat;

Mr Ransford Smith, Deputy Secretary General of the Commonwealth Secretariat;

Dr Ala Alwan, Assistant Director-General, Non-communicable Diseases and Mental Health, World Health Organization;

Ladies and Gentlemen

Let me tell you a story. It was 30 years ago. I was a young doctor at the Central Hospital in Yaoundé, my home town in Cameroon. I was treating a very unusual case. This case was so rare that all the medical students at the hospital were rushed in to take a look. I remember the medical students ceaseless questioning about the condition, while studiously scribbling down notes. 30 years ago in Cameroon, that unusual and alarming condition was a heart attack.

Today, cardiovascular disease, along with cancer, chronic respiratory disease and diabetes, are the most common killers. And Cameroon is not an isolated case. This pattern is being repeated the world over. Every day, in every single country, we are seeing the same diseases striking people down in their most productive years. The tragedy is that this is happening more and more in the countries that can least cope with the terrible burden of disease, disability and death imposed on them by Non-Communicable Diseases.

The NCD epidemic is a mass killer. It is causing 36 million deaths every year, equivalent to two in every three deaths worldwide.

One third of deaths from NCDs are premature, occurring before the age of 60, blighting families and economies. The vast majority are preventable or can be delayed.

Four in every five people living with NCDs live in low and middle income countries.

And projections forecasting the next twenty years show that the NCD epidemic has only just begun. Described by Ban Ki-moon as a “public health emergency in slow motion”, NCDs are expected to swell to an unthinkable scale within a generation. In diabetes alone, global prevalence will escalate from 300 million in 2010 to 500 million by 2030. To put that in context, globally the number of people living with diabetes will be greater than the current population of North America.

This acceleration in NCDs is largely a crisis of our own creation. Urbanization, globalization and economic development in emerging economies are increasing exposure to the four shared risk factors - unhealthy diets, physical inactivity, tobacco use and harmful use of alcohol. These four risk factors cause two thirds of all new cases of NCDs. Tobacco use alone accounts for one in six of all deaths resulting from NCDs, and yet one billion people smoke or chew tobacco every day. Levels of obesity are leaping upwards, more than doubling since 1980. More than 1.5 billion adults are overweight, and 43 million children under the age of five are overweight.

No country – rich or poor – is immune. No country has these diseases under control. Without action, progress we have made on health to date will be washed away by a tidal wave of largely preventable diseases.

NCDs are not just a huge health issue, unchecked they will threaten our global security. Vulnerable health budgets will be further stretched by the impact, economies flattened as workers in their most productive years develop these diseases. It is for these reasons the World Economic Forum has ranked NCDs above climate change and alongside the global financial crisis in terms of the global threat they pose.

Today I stand in front of an expert audience, including around 50 health ministers who are all too familiar with this landscape. The Commonwealth is a diverse family - its two billion people live in the smallest island states and the largest nations, and everywhere NCDs are rife. Take Nauru, a Pacific island and the smallest independent republic in the world. This tiny nation has the highest diabetes prevalence in the world, with an astonishing 31% of the adult population affected by diabetes. And then take the largest member of the Commonwealth family, India. With over 50 million people with diabetes, this great emerging nation has the second highest number of people with diabetes in the world. Ladies and gentleman, NCDs do not discriminate and these diseases know no boundaries – small or large, rich or poor, men or women.

I last attended the Commonwealth Health- Ministers Meeting in 2006 when IDF was leading a global campaign for a UN Resolution on diabetes. At that time, diabetes and the related NCDs did not feature on the global health agenda. There was little recognition or understanding by governments, international organisations, civil society or the general public of the ‘NCD label’ that was devastating the developing world. While infectious diseases commanded the attention of policy makers and the funds of donors, NCDs were studiously relegated to the shadows, while gathering speed and undermining development progress.

In five years we have come far. And we pay credit to the Commonwealth for the leadership you have shown. The support of key Commonwealth countries, particularly Bangladesh, made the landmark UN Resolution 61/225 on Diabetes a reality. The UN Resolution was an important chapter in the NCD history books, recognising diabetes as a chronic, debilitating and costly disease that required urgent coordinated action. It was an early sign of global commitment to tackle all NCDs as a priority.

Together, we have made significant strides in exploding the myths that surround NCDs and critically, we have begun to unpack this political predicament. For NCDs undoubtedly are just that. We should ask ourselves why is it politically unacceptable for a child to die under 5 from pneumonia, or a woman to die from HIV/AIDS, TB or malaria but politically acceptable for a woman to die prematurely from a heart attack or cancer, or a man to die prematurely from diabetes or stroke. Something is badly wrong with our thinking on global health priorities. But your meeting in 2007, the CARICOM regional Heads of Government Summit on NCDs in 2007, and Commonwealth Heads of Government meeting in Port of Spain in 2009 all built the necessary political momentum to move NCDs from advocacy to action. At every step of the NCD journey, this global movement of governments has been led by Commonwealth champions such as the UN Special Envoy for HIV/AIDS in the Caribbean Sir George Alleyne and Guyanese Health Minister Dr Leslie Ramsammy. I applaud your determination and vision.

As political voices have grown, so a strong civil society movement has also emerged. Two years ago the four major NCD federations, the International Diabetes Federation, the Union for International Cancer Control, the International Union Against TB and Lung Disease, and the World Heart Federation came together as the NCD Alliance. The NCD Alliance with its 900 member associations in more than 170 countries has unrivalled experience and legitimacy to speak to governments and policymakers on NCDs. The NCD Alliance has since been joined by another 350 NGOs, including those representing health professionals and policy think tanks, and is playing a leading role in galvanizing action at a global and local level.

In many poorly resourced communities, the member associations of IDF and our sister federations provide the only health and support services available to people with NCDs. We are saving and prolonging millions of lives. I hope you will see us in civil society as vital partners with your governments on this journey.

And now we have arrived at a milestone year. A year ago on 13 May 2010, UN member states led by the Caribbean Community countries voted unanimously to hold a UN high-level Summit on NCDs in September 2011. 130 countries co-sponsored the resolution, including 29 Commonwealth Member States. This widespread geographical support for the Summit is significant - it confirms the political backing of world leaders for action on this issue. At last we are knocking on an open political door.

It will be this political platform that will determine the future of NCDs. This September’s Summit will bring together Heads of State and government representatives with NGOs and public health experts from across the globe to discuss the enormity of the problem and the necessary action required to turn around the global NCD epidemic. Far from being just a talking shop, this Summit is an unrivalled opportunity to get world leaders around a table to agree on measurable commitments and an action plan that engages all sectors and stakeholders. To underline the rarity and importance of such an event, it is worth remembering that this is only the second time that the UN has held a high-level meeting on a health related issue. Many in this room will remember the first, in 2001, on HIV/AIDS. A decade on we intend to translate this opportunity for NCDs into the turning point it proved to be for HIV/AIDS.

With the Summit rapidly approaching, we must now focus on the big questions: What will success look like? What is achievable in terms of deliverables? And what metrics will we need to judge success after September? As WHO Director General Margaret Chan recently said at the Global Ministerial Conference on NCDs in Moscow, ‘Without global goals, this is not going to fly – what gets measured gets done.”

As NGO federations, we have canvassed our 900 member associations at national level and built a set of recommendations that our constituents want to see included in the UN Summit Outcomes Document. The NCD Alliance’s Proposed Outcomes Document, which you have in front of you, contains 34 carefully considered goals and targets that represent our vision of success. Together they provide the joined-up approach so vital to the complex, multi-faceted challenge we face.

I would like to use the remainder of my time to drawn upon our Proposed Outcomes Document and impress upon you five priority areas for action at the UN Summit.

First, one of the most important outcomes of September must be leadership and partnerships at all levels. Only with the four pillars of leadership – the UN, governments, civil society and the private sector - will we translate the opportunity of the Summit into real change for the millions of people living with NCDs. We need to join forces in a ‘Stop NCDs Partnership’ as the TB community did so successfully a decade ago, to bring strategic consistency to the various actors in the NCD response as well as continue to effectively raise the profile of NCDs onto the global health agenda.

And within each pillar of leadership, cross-sectoral coordination must be the cornerstone. The UN needs to inspire leadership across the whole UN system, pooling the brainpower and resources of all its agencies and bodies. Governments must turn commitments into action at national level. And there is a key role for the private sector, creating innovative solutions and taking concrete action for the common good, but also because it is sound business sense.

We are calling on governments to put national NCD Action Frameworks in place encompassing sectors as broad as agriculture, trade, food production, education, and urban development. As health ministers you must lead, but Heads of State and Government must ensure that NCDs are addressed across the whole of government.

Secondly, we must use the opportunity of the Summit to focus on NCD prevention since, as I said in my introduction, the vast majority of NCDs can be prevented or delayed. With simple cost-effective interventions we can avoid the tragedy and cost of diabetes that in so many cases impact upon your health budget as renal failure or limb amputations. A successful approach hinges on the recognition that NCDs are not a result of an individual’s action, but are symptomatic of wider societal and environmental factors. The levers for change in the enabling environment lie in the hands of governments and can be affected through the instruments that they control – legislation, regulation and taxation. We have some public health instruments already in our hands, such as the Framework Convention on Tobacco Control, and we can look to NCD champion countries for good practice in legislation, regulation and fiscal measures to reduce the consumption of tobacco, alcohol and reduce the salt, trans-fat and sugar content in processed foods.

We used to focus heavily on over-nutrition and obesity when addressing NCD prevention, but increasingly evidence shows that NCDs like diabetes are also fuelled by poor maternal health and nutrition. There are strong links between maternal malnourishment, the offspring’s birth weight and the child’s consequent propensity to early insulin resistance. This is particularly important in countries like India and throughout much of sub Saharan Africa where high levels of under-nutrition co-exist with rapid changes in nutrition in young adulthood. This puts a whole new spin on NCD prevention. It highlights the need to focus on the two faces of NCD prevention – over-nutrition, and under-nutrition and poverty. It means we must remove any blame for NCDs from the shoulders of the individual, and it gives policy makers yet another reason to invest in women’s health and nutrition, and safeguard the health of future generations.

We fully support and congratulate the Commonwealth’s 2011 theme of Women as Agents of Change. To quote Michelle Bachelet, the new head of UN Women, “women’s strength, women’s industry, women’s wisdom are humankind’s greatest untapped resource”. Our recent NCD Alliance publication on Women and NCDs highlighted the importance of women as resilient and influential partners in the fight against NCDs and broader sustainable development, both at a household and community level. A mother with greater control over money will allocate more to healthy food, education and healthcare for her family – all key elements for NCD prevention.

Thirdly, alongside prevention, early diagnosis, treatment and care of NCDs are vital elements of the NCD response. Universal access to affordable and high-quality essential medicines and technologies remains a distant reality in many countries, and millions of people worldwide with NCDs do not have access to lifesaving essential medicines. Insulin has existed for 90 years yet children with type 1 diabetes in some parts of Africa have a life expectancy of less than a year due to the lack of availability of the drug that their lives depend on. In most industrialised nations, a person with type 1 diabetes can expect to live a long full life. It is criminal that an accident of geography should arbitrarily govern who can access these essential medicines, determining who will live and who will die.

We must have proper resourcing for essential medicines, supported by a well-functioning and equitable health system. Two years ago, my predecessor met a man with diabetes in Cambodia who told him “I wish I had AIDS and not diabetes”. If he had AIDS he could have been treated for free in a modern health facility. But since he had diabetes, no affordable healthcare was available, and the cost of treatment was bankrupting his family.

We do not want to repeat this grotesquely distorted situation for NCDs. As Ban Ki-moon said, “success will come when we focus our attention and resources on people, not their illnesses; on health, not disease”. This approach does not imply a zero-sum gain. Money we spend on NCDs should not be diverted away from other health issues, it should be money spent to drive a different type of health system that prioritises prevention, patient education and treats the whole person, whatever their disease. These changes to health systems would benefit patients with all diseases and conditions including AIDS, tuberculosis, and maternal and child health.

Fourthly, international cooperation is vital, and with this comes the question of funding that governments are asking now. At a time when resources are scarce, increased investment in NCDs will seem a challenging option for governments. However, investing in NCDs now will prevent huge healthcare costs in the future. It will save money, lives and misery. Investing in NCDs will multiply into huge social and economic gains and improve health outcomes not only for the four main NCDs, but also for a wide range of infectious diseases and chronic conditions.

Investment must come from both domestic and overseas sources for low- and middle-income countries. International partners will play a special part in supporting further action on NCDs in low income countries by aligning these diseases with other priority development programmes, particularly the Millennium Development Goals. NCDs have so many interconnections with the MDGs that they are part of the MDG agenda, not a competitor. Diabetes, for example, drives 15% of new TB cases in India every year. The evidence shows that unmanaged NCDs will hinder achievement of the MDGs. It makes sense therefore to integrate NCDs into development assistance programmes and encourage innovative financing mechanisms and better procurement policies that will deliver better health.

Ladies and gentleman, this September is a first step to a global solution. There is life after the summit in September, which is why my fifth and final priority for action is to work together to monitor progress, and ensure accountability. We are recommending a high-level commission on accountability to include governments, donors, multilateral institutions, civil society and the private sector in an ongoing partnership to drive and monitor implementation.

And to reflect the long term nature of NCDs, we are calling for a UN Decade of Action on NCDs. It took us just one generation to get to this crisis point for NCDs. It is going to take us significantly longer to get past it. To focus attention on activities and policies that create long-term sustainable change, and encourage time horizons outside normal political cycles, a UN Decade of Action will maintain the international spotlight required to fight this complex challenge.

I want to conclude by repeating one thing: Every country everywhere has a role to play in the fight against NCDs. We cannot wait for additional resources to come on stream. Every country can do something right now to stop this epidemic spreading.

We urge the Commonwealth to continue to exploit your comparative advantage in NCDs. The countries in this room represent the leaders of the NCD movement, and can use the opportunity of the High-level summit in September to play a key role not only in forging commitments, but ensuring that after the summit, the fight against NCDs moves from rhetoric to action. The Commonwealth will want to particularly ensure that your most vulnerable states and regions, particularly small island states, are supported in the NCD response.

We have the evidence, cost-effective solutions, and with the Summit we have the political opportunity. We need the Commonwealth to lead the way on ensuring that the NCD Summit makes strong and visionary decisions that will secure our common future.

In five years’ time, let us meet again and say that we seized this opportunity with both hands and opted for action to safeguard the health and prosperity of our children and future generations.

The people in this room have led the fight so far – do not fail us now. We in civil society stand ready to support you.

Thank you