The 71st Session of the World Health Assembly (WHA71) took place in Geneva last week from 21-26 May. Member States discussed many agenda items including women and children's health, mHealth, physical activity and preparations for the UN High-Level Meetings on Tuberculosis and NCDs. WHA71 also featured numerous side events, with over 25 NCD-related events scheduled throughout the week.
Many Member States and speakers at side events highlighted the importance of fiscal policies on unhealthy commodities as proven public health measures to curb the growing burden of NCDs. They also stressed the need to strengthen health systems with a focus on primary health care, and to exercise caution when embarking on multisectoral and multistakeholder partnerships.
Below find our summary of relevant agenda items and the full text of statements made by the NCD Alliance and partners, as well as a recap of some of our WHA71 side events.
11.7 Preparation for the third UN High-Level Meeting on NCDs - A71/14, A71/14 Add.1
Member States underscored the need for a whole of society approach, with engagement of sectors including the health workforce, communities, and non-State actors. Numerous interventions included a call for investments to be made now to address NCDs, and some countries emphasised their particular support for public awareness campaigns.
Malaysia noted that policy coherence between economic and trade and healthy environmental remains a challenge. Denmark flagged the importance of UHC to be embraced as an approach to achieve SDG 3, and of addressing NCDs in humanitarian settings. Portugal committed to becoming a trans-fat free country. Russia expressed a hope that the UN HLM will enable identification of “new global mechanisms to accelerate progress in tackling NCDs through political, regulatory, technical decisions for all stakeholders and all sectors in order to improve health of current and future generations of our planet”.
Of particular concern, and in contrast to an intervention by Mexico, Italy stated that policies must be based on “scientific measurements” and “proven effectiveness”, but disputed the value of fiscal policies on food and ingredients for health, despite the inclusion of taxation of sugar sweetened beverages in WHO’s recommended package of interventions for NCD prevention and control, following rigorous cost-effectiveness analysis. Discussions culminated in the adoption of a resolution calling for participation by Heads of Government and Heads of State at the UN HLM. Read our statement here.
11.1 Draft General Programme of Work - A71/14
Several Member States in the EURO and EMRO regions made direct reference to NCDs in their statements on the GPW agenda item. Qatar urged WHO to “step up measures” to overcome obstacles in NCD prevention and control. Pakistan highlighted the need for “predictable resources” for NCDs and mental health, alongside health emergencies, while the Netherlands noted NCDs and AMR to be particular priorities.
Finland emphasised how a high burden of NCDs and infectious outbreaks pose a threat to the sustainability of whole health systems. Not related specifically to NCDs, the UK noted that the investment case to accompany the GPW13 requested by the EB was not yet available.
Tedros referred to the GPW13 as a “living document” and expressed openness to hearing requests for elaboration on the new country model and concerns over the indicators, and proclaimed that “it is our partnership that will translate the plan into action”. Member States adopted resolution WHA71.1, approving the GPW13, and requesting the WHO DG to provide a report to the 75th WHA to inform potential extension to 2025 of the GPW13 in order to align with the wider UN planning cycle. Read our statement here.
11.4 Health, environment and climate change - A71/10, A71/10 Add.1, A71/11
Many Member States underscored the need for particular action to protect vulnerable populations. Bulgaria noted that “climate change affects everything and there is a need to promote actions that benefit everyone"; and that the costs of action on climate change far outweigh the cost of action. Norway reiterated calls for action beyond the health sector, while Sri Lanka spoke of the need to promote co-benefit outcomes, complemented by calls by the Dominican Republic and the Bahamas for a multisectoral approach.
The US noted the need for more data cautioned against policies “without strong evidence base”, a theme which was concerningly also mentioned in Member State statements on fiscal policies for NCDs and the promotion of breastfeeding in infants. The WHO Secretariat remarked that it will be necessary to find ways to uncouple economic growth from environmental degradation, and also confirmed that there has been increased collaboration between the Public Health and Environment (PHE) and Noncommunicable Diseases and Mental Health (NMH) clusters. Member States noted the three reports that had been prepared for this agenda item. Read our statement here.
This year marks the first UN High-Level Meeting on ending tuberculosis (TB), which will take place one day prior to the UN HLM on NCDs, on Wednesday 26 September. Members of the World Health Assembly expressed their support for the report and called for accelerated action to address TB and multidrug resistant TB. In their statements, Member States highlighted the need for a multisectoral response to TB that leaves no-one behind. The Assembly approved the draft resolution and the draft multisectoral accountability framework that will be presented to Member States at the HLM on TB in September, and called for Heads of State and Government to attend the UN HLM on TB. Read our statement here.
12.2 Physical activity for health - A71/18
In May 2017, at the 70th World Health Assembly, Thailand led calls for the development by WHO of an Action Plan for Physical Activity. With 12 months of extensive consultation with government, civil society, non-state actors, private sector, research and academic community (into which NCD Alliance and network contributed), the first Global Action Plan on Physical Activity 2018-2030 More Active People for a Healthier World was endorsed by WHA on the 24th of May.
Pivoting around a target (also embedded in the 13th GPW) of a relative reduction in physical inactivity of 15% by 2030, the Action Plan pursues 4 objectives: Active Environments, Active People, Active Systems and Active Society, through 20 action areas with specific policies and recommendations for different stakeholders.
The Action Plan was welcomed enthusiastically by Member States, who noted the potential for it to make progress across the SDGs. More Active People for a Healthier World will be launched in Portugal on Monday 4 June 2018, will be available together with supporting materials from the WHO website from June 4 2018. Read our statement here.
12.3 Global Strategy for Women’s, Children’s and Adolescents’ Health - A71/19
As part of the review of the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030), the World Health Assembly is invited to focus on a specific aspect of the strategy each year. This year, the focus was on early childhood development and also provided a review of implementation of policies and the current situation on issues such as sexual and reproductive health and interpersonal violence.
The United States stated that sexual and reproductive health does not include abortion, and the US does not recognize it as a human right; this was echoed by several other countries as well, including Niger. Other countries, such as Norway, stated that access to safe abortion is an essential component of women’s and girls’ health.
Many Member States applauded the focus on addressing cervical cancer, and Denmark stated that “vaccinations shouldn’t be a privilege.” There was a focus on the need for prevention and the importance of proper nutrition, especially during the first 1,000 days of development, and for strong health systems that focus on prevention and provide affordable, safe treatment to those that require it. The Assembly noted the report and will review a report on midwifery next year. Read our statement here.
12.4 mHealth - A71/20
Marking the widespread recognition of the contribution of digital health interventions to public health, India delivered the first Member State intervention stating it was “happy to move from a digital health revolution to a digital health movement”.
Member States noted the value of digital health programmes, including mHealth, to bolster health systems, many of which are overburdened, to enable widespread access to healthcare even in remote populations, and the potential for daily support for people living with chronic conditions including NCDs. Support was expressed for the joint WHO-ITU led initiative “Be He@lthy, Be Mobile”.
The Assembly adopted a resolution, urging Member States to consider how digital technologies could be integrated into existing health systems infrastructures; and to develop legislation and data protection policies around issues such as data access, sharing, consent, security privacy. The Resolution also requested the WHO DG to provide technical assistance and normative guidance to Member States for scaling up the implementation of digital health; and to develop a repository on regulations, evidence related to improvements and unintended effects regarding health promotion, disease prevention, and access to health services. Read our statement here.
This item initially focused on the presentation of 2 biennial reports, Maternal, infant and young child nutrition: Comprehensive implementation plan on maternal, infant and young child nutrition: biennial report and Safeguarding against possible conflicts of interest in nutrition programmes, however in days preceding WHA, it came to light that 13 Member States (and others not listed as sponsoring Member States) had been developing and submitted a consensus Draft Resolution on Infant and Young Child Feeding (22 May) reinforcing the importance of protecting and promoting breastfeeding, particularly referencing guidance and recommending legal mechanisms to do this.
In addition to behind the scenes efforts to have the Resolution not submitted in the first place, withdrawn and not supported at all, the US took official steps to contest the Resolution by proposing an alternative, weaker decision point. This led to the establishment of a drafting group on the Resolution, which convened for 2 days of negotiations. The final Resolution on Infant and Young Child Feeding (26 May), was agreed near closing of the WHA late on Friday 25th May and sponsored by 18 Member States. It was adopted on Saturday 26th May, and while still supporting and seeking to promote breastfeeding, is a pared back version of its former-self with references to supporting implementation of the WHO Code of Marketing for Infant Formula (The Code) and WHO Guidance on Ending the Inappropriate Promotion of Foods for Infants and Young Children weakened or removed entirely.
While the adopted resolution is positive for protecting and promoting breastfeeding, and will require report back on implementation in 2020, the process of undermining, negotiation and weakening of a Resolution intended to protect children’s and mothers’ health is concerningly reminiscent of Appendix III and Commission on Ending Childhood Obesity (ECHO) Report Implementation Plan negotiations in 2017. Read our statement here.
12.8 Rheumatic fever and rheumatic heart disease - A71/25
Following discussions at EB 141 in May 2017, the WHA adopted a resolution calling for Member States to address the socio-economic determinants of RHD, to improve access to timely healthcare and technologies; for the international community to place RHD at the heart of the prevention and control agenda; and for the WHO DG to report on the extent of the burden and nature of RHD and to submit a report of progress to the 74th World Health Assembly.
This year’s WHA boasted a record number of NCD-related side events, with at least 27 taking place over the course of five days. NCDA’s main event ENOUGH. Making 2018 the year for action and impact on NCDs, took place on Monday evening.
Attended by around 300 people, the event comprised an opening address by Dr Svetlana Axelrod, followed by two panels focusing on the WHO Independent High-level Commission on NCDs, and priority outcomes for September’s UN High-Level Meeting. In her opening remarks, Dr Axelrod spoke of how, as global citizens, we can no longer tolerate such slow rates of progress on NCDs, and how Member States must participate in the discussion about NCDs at the highest level.
The first panel, which featured eminent speakers including Dr Michelle Bachelet, Former President of Chile, Dr Adolfo Rubinstein, Minister of Health of Argentina, and Dr Sania Nishtar, Co-Chair of the Commission, discussed matters including fiscal policies, engagement with the industry, catalytic funding, and the commercial determinants of health, and how these priorities have been reflected in the work of the Commission.
The second panel, which included interventions from Dr Christopher Tufton, Minister of Health of Jamaica and Dr Agnes Binagwaho, Vice Chancellor of the University of Global Health Equity, Rwanda focused in on some key success factors for a new era of the NCD response - from creative and even ‘glitzy’ public awareness campaigns such as ‘Jamaica Moves’ and the need for champions to spearhead progress, to the need for a person centred, right- based approach that includes mental health and is rooted in achieving UHC.
But perhaps the most memorable intervention of the evening was by panellist Ms Kwanele Asante, Chair of the Ministerial Advisory Committee on Cancer Prevention and Control within South Africa’s Department of Health, who spoke of her own experience living with multiple NCDs and seeking treatment, and being treated for tuberculosis as a child. She called for an end to the rhetoric of “investing in people” and empty political promises and to follow the example of the HIV/AIDS movement, with “no decision about us, without us.” She closed with the expression of a wish “to know that other people have a fair chance at good health.”
The Side Event was recorded and is available through NCD Alliance's Facebook page.
Other events throughout the week which NCDA was proud to co-host included a roundtable event on integrated care at which a new report was launched, entitled “Shaping the health systems of the future: case studies and recommendations for integrated NCD care.” NCDA was also involved in events on digital health and diabetes in pregnancy, with many other inspiring events being hosted by the NCD community throughout the entire week, including several focused on ensuring the youth voice is a central component of the NCD response.