New global guidelines to prevent and reduce non-communicable diseases (NCDs), such as cancer, heart disease, diabetes, mental health conditions, and lung disease, were adopted by the 76th Session of the World Health Assembly (WHA76). Many member states expressed themselves on the issue of NCDs, their risk factors – including alcohol – and the need for proven solutions.
Interventions offered include pro-health taxes and bans on advertising for tobacco and alcohol, reformulation policies for healthier food and drinks, and the promotion and support of optimal breastfeeding practices.
The new list also includes secondary prevention for rheumatic fever, acute and long-term management of asthma and chronic obstructive pulmonary disease as well as several cancer control interventions related to cervical, breast, colorectal, liver and childhood cancer, and the comprehensive treatment of cancer for those living with HIV.
The updated best buys come with a whole menu of policy options and cost-effective interventions that will help governments prioritise investments according to their specific country context,” said Dr Bente Mikkelsen, Director NCD Department, World Health Organization, according to a WHO press release.
Investing in evidence-based policies is an investment in a healthy future.”
Dr Bente Mikkelsen, Director NCD Department, World Health Organization
NCDs are responsible for three-quarters of global deaths.
Latest scientific evidence to improve NCDs prevention and control
The latest revision of the NCDs Best Buys was updated to reflect WHO’s recommendations and guidance. The new guidelines reflect latest scientific evidence on impact of NCDs risk factors and the benefits of policy solutions.
The guidelines update the World Health Organization’s (WHO) “Best Buys” published in 2017 and focus on the four key risk factors for NCDs – tobacco, alcohol, unhealthy diet and physical inactivity – and the four main associated diseases – cardiovascular disease, diabetes, cancer and chronic respiratory disease.
Each revision is based on new WHO normative and standard-setting products, new evidence and data to expand and update the interventions.
The updated list highlights that NCD prevention and control – including alcohol policy – is a remarkable bargain that can save millions of lives and add millions of healthy life-years.
In 2017, we had a total of 88 interventions, and 39 of them had cost-effectiveness estimates,” Dr Mikkelsen said, according to Health Policy Watch.
We now have 90 interventions, and 58 interventions with cost-effectiveness estimates. And also very importantly, in 2017, we only looked at [evidence from] 20 countries, and today we have 62 countries grouped in all three income categories.”
Dr Bente Mikkelsen, Director NCD Department, World Health Organization
Twenty-eight interventions are considered to be the most cost-effective and feasible for implementation in comparison to 16 recommended in 2017.
These interventions can help support countries to achieve the Sustainable Development Goal of reducing by one third, premature mortality from NCDs through prevention and treatment and the promotion of mental health and well-being worldwide by 2030.
They also provide an opportunity to accelerate national action to prevent and control NCDs to reduce suffering and prevent deaths and pave the way for political commitment at the fourth High-level Meeting of the United Nations General Assembly on the Prevention and Control of NCDs in 2025.
The World Health Assembly resolution mandates that the intervention list be continuously updated, when data are available.
Huge Support for NCDs Best Buys
Many member states expressed widespread support for the WHO’s updated policy options and interventions to prevent and control NCDs – referred to as “Best Buys”.
Member states and civil society were asked by the WHO Secretariat to address universal health coverage (UHC) and non-communicable diseases (NCDs) at the World Health Assembly jointly and the list of speakers was very long. This indicated again the centrality of these issues for countries and civil society.
There was near-universal support for primary health services to be the backbone of UHC, with disease prevention as the other key pillar – particularly to prevent NCDs.
- Sweden, on behalf of the European Union expressed concern that no country was on track to meet its NCDs targets. They emphasized that actions needed to be accelerated. Due to the social, economic, and environmental impact of NCDs a holistic approach was required.
- Eswatini, on behalf of the African region expressed a special interest in obesity control.
- Jordan, on behalf of the Eastern Mediterranean region congratulated on the inclusion of primary care into the NCDs agenda, and especially welcomed the updated menu of best buys to prevent and reduce NCDs. Jordan called for the Best Buys to be given priority.
- Republic of Korea, on behalf of the Western Pacific region expressed concern that the burden of NCDs continues to rise and populations are aging. They ask for priority to be given to Primary Health Care.
- Bulgaria underlined that NCDs prevention is a way to achieve the Sustainable Development Goals (SDGs). They also highlighted the role of civil society and the private sector to achieve progress in NCDs prevention and control.
- Bhutan expressed concern about interference of health harmful companies against measures to tackle tobacco and alcohol harm and promote healthy diets. Bhutan welcomes youth participation in mental health issues and social determinants of health. They also emphasized the importance of policy options for NCDs prevention to be adapted to national characteristics and conditions.
- The Philippines addressed the problem of interference by health harmful companies. They support measures to address environmental risk factors for NCDs and the protection from commercial determinants.
- Namibia expressed concern that countries were far from achieving what they set out to do in terms of NCDs targets. For Namibia addressing food insecurity, sanitation, water, education, and health environments is key. They also focus on strengthening substance use rehabilitation programs in particular and improving health care staff capacity with regards to mental health issues in general.
- Denmark focused on mental health and emphasized the need to pay special and separate attention to mental health. They expressed concern that the mental mental topic was not adequately funded and was accompanied by stigma and discrimination.
- Thailand spoke about the importance of multi-sectorial collaboration with civil society and the private sector for NCDs prevention and control. They highlighted the importance of addressing the commercial determinants of health in this work. Thailand brought attention to the fact that alcohol is recognized as carcinogen. Therefore, they ask WHO to stop selling and offering alcohol in its facilities and events.
- Slovenia said that collaborative work between countries and with WHO was needed for NCDs prevention and control. A community-based approach was needed. Slovenia called for global solutions to counteract commercial determinants of health and to support civil society.
- Senegal spoke the importance of healthy diets for their people and expressed concern about obesity in the country. That’s why they emphasized the need to work on NCDs risk factors: tobacco and alcohol use, insufficient physical activity, and unhealthy diets.
- Canada expressed support, especially for addressing the gaps and challenges WHO outlined in the report. They also support more work to reduce stigma in mental health.
- Ghana expressed concern about the increase in catastrophic health spending. They underlined their commitment to further strengthen NCDs prevention and control activities.
- Zimbabwe mentioned the mental health investment case they recently developed with WHO support. They explain that the problem of substance use disorder continues to rise and that the country’s President is taking a whole-of-society approach, for example by convening a multi-disciplinary national committee on substance use issues.
- Spain said they would like to see a special focus on mental health in relation to the 2025 high level meeting on NCDs. They addressed the importance of improving the prevention and treatment of substance use disorder and highlighted the urgency of promoting physical activity and healthy environments as well reducing tobacco and alcohol use to mitigate their burden on the health system.
- Kenya spoke about the importance of primary health care to prevent health harm and to promote health, for example through strengthening community health services.
- Norway called for strategies to tackle NCDs to be “free from undue political and commercial influence”, something that NCD advocates lobbied for on the sidelines of the WHA76.
The alcohol policy best buys – positive news and missed opportunity
Movendi Internal has advocated for the inclusion of more alcohol policy solutions among the list of Best Buys, for instance alcohol age limit increase, opening hour reductions, and government-run alcohol retail monopolies.
While the alcohol policy Best Buys were reconfirmed. WHO did not expand the list of alcohol policy Best Buy solutions – even though countries like Lithuania show the impact of alcohol age limit increases.
Movendi International welcomed the scientific exercise of updating Appendix 3. And made a number of asks for the process:
- For the scientific process to also improve the alcohol policy language. The flawed concept of “harmful use of alcohol” should be replaced by more accurate terms. Strong evidence shows that there is no healthy or safe level of alcohol use.
- For the methodology of updating alcohol policy recommendations to be improved. More best practices from high-income should be included in the cost-effectiveness analysis. This matters because most countries are still off track to reach the global target of reducing per capita alcohol use by 10% until 2030.
Movendi International President Kristina Sperkova said about the adoption of the expanded NCDs Best Buys:
We congratulate WHO and member states for the adoption of the expanded set of high-impact policy solutions to prevent and reduce NCDs. Periodic updates based on rigorous science is important for WHO to fullfill its normative leadership role in providing the most impactful and effective solutions to the world’s biggest health problem.
We welcome the re-confirmation of the alcohol policy Best Buys. They are proven and yield a substantial return on investments for governments. And we see more and more best practices from countries implementing high-impact alcohol policy solutions.
On the other hand, this update is a missed opportunity to improve the alcohol policy best buys and to better support countries in using the most cost-effective interventions, such as age limit increases, opening hours reductions, and government-run alcohol retail monopolies.
Nevertheless, the three alcohol policy Best Buys that WHO recommends are the second most cost-effective and impactful set of solutions among all NCDs Best Buys. So we call on countries to accelerate implementation, for example through the SAFER initiative.”
Kristina Sperkova, International President, Movendi International
Civil society advocates for NCDs prevention and control said the Best Buys needed to be strengthened to prevent interference from health harmful industries selling products that harm people – tobacco, alcohol, ultra-processed foods, sugary drinks, and fossil fuel.
The industries that produce and market these products are more interested in profit than in healthy people and healthy communities,” said José Luis Castro, President and CEO of Vital Strategies, as per Health Policy Watch.
The Best Buys should be modified to include more explicit recommendations against corporate influence because corporate influence worldwide has been identified as the main reason why Best Buys’ implementation falls short.”
José Luis Castro, President and CEO, Vital Strategies
Sources
Health Policy Watch: “Huge Support for Universal Health Coverage and NCD Measures, But WHO Replenishment Fund is Rejected”
Health Policy Watch: “Stronger Global Roadmap to Tackle NCDs is Finally Passed“
Health Policy Watch: “As World Health Assembly Grapples with NCDs, What is the Plan to Stop These Killer Diseases?”
List of Expanded NCD Best Buys
Tobacco
- Increase excise taxes and prices on tobacco products
- Implement large graphic health warnings on all tobacco packages, accompanied by plain/standardized packaging
- Enact and enforce comprehensive bans on tobacco advertising, promotion and sponsorship
- Eliminate exposure to second-hand tobacco smoke in all indoor workplaces, public places, public transport
- Implement effective mass media campaigns that educate the public about the harms of smoking/tobacco use and secondhand smoke, and encourage behavior change
- Provision of cost-covered effective population-wide support (including brief advice, national toll-free quit line services and mCessation) for tobacco cessation to all tobacco users
Alcohol
- Increase excise taxes on alcoholic beverages
- Enact and enforce bans or comprehensive restrictions on exposure to alcohol advertising (across multiple types of media)
- Enact and enforce restrictions on the physical availaility of retailed alcohol (via reduced hours of sale)
Unhealthy Diet
- Reformulation policies for healthier food and beverage products (e.g. elimination of transfatty acids and/or reduction of saturated fats, free sugars and/or sodium)
- Front-of-pack labelling as part of comprehensive nutrition labelling policies for facilitating consumers’ understanding and choice of food for healthy diets
- Public food procurement and service policies for healthy diets (e.g. to reduce the intake of free sugars, sodium, unhealthy fats, and to increase the consumption of legumes, wholegrains, fruits and vegetables)
- Behaviour change communication and mass media campaign for healthy diets (e.g. to reduce the intake of energy, free sugars, sodium, unhealthy fats, and to increase the consumption of legumes, wholegrains, fruits and vegetables)
- Policies to protect children from the harmful impact of food marketing on diet
- Protection, promotion and support of optimal breastfeeding practices
Physical Inactivity
- Implement sustained, population wide, best practice communication campaigns to promote physical activity, with links to community-based programmes and environmental improvements to enable and support behaviour change
Cardiovascular Diseases
- Secondary prevention of rheumatic fever and rheumatic heart disease by developing a register of patients who receive regular prophylactic penicillin
Chronic Respiratory Diseases
- Acute treatment of asthma exacerbations with inhaled bronchodilators and oral steroids
- Acute treatment of COPD exacerbations with inhaled bronchodilators and oral steroids
- Long-term management of COPD with inhaled bronchodilator
Cancer
- Vaccination against human papillomavirus (1-2 doses) of 9–14 year old girls
- Cervical cancer: HPV DNA screening, starting at the age of 30 years with regular screening every 5 to 10 years (using a screen-and-treat approach or screen, triage and treat approach)
- Cervical cancer: early diagnosis programs linked with timely diagnostic work-up and comprehensive cancer treatment
- Breast cancer: early diagnosis programs linked with timely diagnostic work-up and comprehensive cancer treatment
- Colorectal cancer: early diagnosis programs linked with timely diagnostic work-up and comprehensive cancer treatment
- Prevention of liver cancer through hepatitis B immunization
- Childhood cancer: early diagnosis programs linked with timely diagnostic work-up and comprehensive cancer treatment, focusing on 6 index cancers of WHO Global Initiative for Childhood Cancer
- Early detection and comprehensive treatment of cancer for those living with HIV
