On 8 December, four days before Universal Health Coverage Day, high-level experts and people living with NCDs from around the world took part in an online event, “Integration of Noncommunicable Diseases into Universal Health Coverage in the Era of COVID-19”, hosted by the NCD Alliance. The overall aim was to outline global progress towards the integration of NCDs into UHC benefit packages, ensuring that global commitments transform into national action and outcomes.

The event included the perspective of was people living with NCDs from Rwanda and Sweden and was chaired by Dr Kaushik Ramaiya from the Tanzania NCD Alliance. Guest speakers included the Honourable Christopher Tufton, Minister of Health and Wellness, Jamaica; Dr Emmanuel Ankrah Odame, Director of Policy Planning Monitoring and Evaluation, Ghana; Dr Samira Asma, Assistant Director-General for Data, Analytics and Delivery, WHO; Dr Bente Mikkelsen, Director of the NCD Department, WHO; Prof Srinath Reddy, President of the Public Health Foundation of India; Prof Rob Moodie,Professor of Public Health, University of Melbourne and University of Malawi and Ms Estefania Palomino, Helmsley Charitable Trust.

Discussions assessed and reflected on the latest data on integration of NCDs into UHC at global level, including the key results from the NCDA’s 2020 Global Consultation with People Living with NCDs, and also took into consideration the impact and lessons learnt from the COVID-19 pandemic and its detrimental effects on health systems for people living with NCDs.

The two people living with NCDs – Ms Grace Gatera, living with a mental health condition and Ms Cajsa Lindberg, living with type 1 diabetes mellitus, brain cancer and endocrine conditions – shared their experiences with their respective health care systems. “Rwanda has done an incredible amount of work to make sure that [mental health] conditions and NCD conditions are integrated into universal health care,” said Ms Gatera, also recalling her life as a refugee, when she was unable to access the medications she needed to manage her condition due to limited availability and unaffordability.

The event also provided an opportunity to share some best practice examples of NCD integration into UHC policies from diverse countries and across low-, middle- and high-income contexts, which are now translating into sustainable, transformative and protective impact across the world. The Honourable Christopher Tufton shared some of his own country’s successes, noting that “Jamaica has made efforts and taken a multifaceted approach to improve prevention and care for people who are susceptible to or living with NCDs - the major cause of economic burden and mortality in Jamaica and the Caribbean.”

While there is no one size fits all approach to UHC or NCD integration, such examples hallmark the need for a whole-of-government, whole-of-society approach to health care that includes those with valuable lived experience into decision making processes. There are also various tried-and-tested actions that can be taken. For example, implementation of the WHO Best Buys for NCDs within UHC packages across low- and middle-income countries globally by 2030 could save up to 8.2 million lives and generate US$350 billion in economic output due to reduced health care costs and increased participation within the workforce.[1]

However, COVID-19 exposed the pre-existing cracks in our healthcare systems, also spotlighting the dangerous link between NCDs, communicable diseases and health emergencies, and reinforcing the need to address health issues in a more integrated manner. Prof Srinath Reddy commented, “Government departments tend to act in siloes. Civil society can join sectors and bring to life multisectoral coordination. We have seen this in diabetes and hypertension control, via civil society working on primary care in community settings.”

Furthermore, despite people living with NCDs being at higher risk of severe complications and death from COVID-19, 75% of countries reported disruptions in NCD care during the pandemic, according to WHO. As WHO’s Bente Mikkelson commented during the event, “Before the COVID-19 pandemic, 15 million NCD deaths under the age of 70 occurred every year.” This makes NCDs the number one cause of death in the world – a pre-existing pandemic that is largely ignored.

The urgency, scale and impact of NCDs on populations’ health and on economies poses unique challenges for the design and implementation of UHC, yet epitomises why UHC is needed in all countries. Instead of being seen as a dispensable luxury, NCD prevention and care must be seen as the bedrock of sustainable UHC.

As WHO’s Dr Samira Asma said, “If we are serious about realising Universal Health Coverage and health for all, staggering inequalities must be addressed from an NCD perspective. We have the opportunity now to reclaim the role health will play.”