In September, government leaders from around the world as well as representatives from civil society, the private sector and academia gathered at the United Nations in New York for the first-ever summit on the growing economic and human crisis posed by noncommunicable diseases (NCDs), especially in low- and middle-income countries. According to data from the World Health Organization (WHO), noncommunicable diseases—mainly cancers, cardiovascular diseases, diabetes, and chronic respiratory diseases—are the world’s biggest killers, accounting for over 60% of all deaths globally, chiefly from cancer—7.6 million people annually. That figure represents more deaths than from HIV/AIDS, malaria, and tuberculosis combined.
Looming Crisis
Unless interventions are put in place to alter this trend, warns WHO, mortality rates will rise by 17% over the next 10 years—with a projected increase of 24% in the poorest African countries. The World Economic Forum puts the cost in lost productivity and medical care over the next 2 decades at $47 trillion. To avert this looming crisis, member nations attending the UN General Assembly High-level Meeting on the Prevention and Control of Noncommunicable Diseases voted unanimously to adopt the Political Declaration, which calls for the establishment of specific steps by 2013 to reduce the incidence of noncommunicable diseases and their devastating consequences.
“A very welcome and positive observation of the meeting was that all member states, regardless of socioeconomic status, showed a unity in supporting the guidelines and fighting the threat of NCDs. The Political Declaration also sets out the need for allocating more resources to control cancer and other NCDs, as well as optimal use of existing resources,” said Tanja Cufer, MD, PhD, Chair of ASCO’s International Affairs Committee and Professor of Oncology at Medical Faculty, University of Ljubljana in Slovenia.
Proposed Measures
Some of the Declaration’s actions include:
- National policies to prevent and control noncommunicable diseases
- Information systems for health planning and management and the development of population-based national registries to track noncommunicable disease incidences
- International agreements and legal and regulatory measures to reduce an individual’s risk factors for noncommunicable diseases, including restrictions on tobacco and alcohol use and the promotion of healthier diets and physical exercise
- Improvements in access to palliative care and to affordable, safe, effective, and quality medicines and technology
- Greater priority to early detection, screening, and diagnosis of noncommunicable diseases, especially cancer screening programs for breast and cervical cancers
- Increased access to hepatitis B and human papillomavirus vaccines as part of national immunization programs to prevent infection-related cancers
ASCO immediately announced its support of the actions outlined in the Political Declaration. “For many years, ASCO has been aware of this growing issue [of noncommunicable diseases], particularly as it relates to cancer, and we are glad to see it recognized by our world leaders. The Political Declaration on NCDs is of enormous importance to the cancer community and organizations like ASCO in particular. We look forward to establishment of the Declaration targets and identifying opportunities to match our ongoing efforts against them,” said ASCO CEO Allen S. Lichter, MD, in a statement.
Important Starting Point
The Declaration is also being heralded by the Union for International Cancer Control (UICC) as an important step in the global recognition of the threat posed by skyrocketing cancer and other noncommunicable disease rates, even though the document lacks specific target goals, such as reducing avoidable deaths from noncommunicable diseases by 25% by 2025 (as called for by WHO) and a system for evaluating progress.
“From the point of view of putting cancer and other NCDs on the global political agenda, the Declaration is a very important starting point for future actions. The UN summit was a success because now all the countries in the world will be obliged to fulfill the recommendations in the document,” said Eduardo L. Cazap, MD, PhD, President of the UICC, Co-chair of the UN Civil Society Task Force, and an ASCO board member. In addition, the Declaration provides cancer organizations, such as ASCO and UICC, with additional ammunition to have the reduction of the incidence of cancer and other noncommunicable diseases added to the UN’s Millennium Development Goals, which range from lowering rates of extreme poverty to stopping the spread of HIV/AIDS by 2015.
“There will be a review of the [target areas] in the Millennium Development Goals in 2013. Adding cancer to the list of targeted goals is a very important step because not having cancer included is an obstacle to successfully reducing worldwide cancer incidence,” says Dr. Cazap. “For example, if a country is requesting support from the World Bank or other agencies, and the issue of cancer is not included in the Millennium Development Goals, it’s not a priority for international funding.”
Next Steps
Now that the Declaration has been approved, participating countries—especially developing countries—have the task of putting in place the infrastructure necessary to implement the agreed upon actions contained in the document. To be effective in reducing the number of noncommunicable diseases, all areas of government, not just the public health sector, will have to be involved, including the departments of agriculture, finance, education, and transportation, says Dr. Cazap.
Another important component for success is the development of a global accountability framework to measure the implementation of policies to prevent cancer and other noncommunicable diseases and monitor progress. The NCD Alliance, which includes the UICC, World Heart Federation, International Diabetes Federation, and International Union Against Tuberculosis and Lung Disease, has asked WHO to establish a monitoring, evaluation, and accountability system for presentation at a meeting of the World Health Assembly scheduled in 2013.
ASCO, too, has an important role to play in the process of reducing cancer deaths globally. “The power of ASCO is that its members are usually the best doctors in each country. So my message to our members, especially to our non-U.S. members, is that they must be part of this action and work together with government and the medical society of the country they live in and try to make these resolutions real and applicable. We now have an incredible tool to put pressure on a local level to achieve better cancer control in individual countries. And I think that is an important responsibility that comes with the power ASCO members have in countries around the world,” said Dr. Cazap. ■
Disclosure: Drs. Cazap, Cufer, and Lichter reported no potential conflicts of interest.
