The World Health Organization has released a new policy brief entitled “Responding to noncommunicable diseases during and beyond the COVID-19 pandemic”. The brand new document compiles examples of actions being taken by selected members of the United Nations Inter-Agency Task Force on the Prevention and Control of Non-communicable Diseases, making a strong case for action on alcohol, including alcohol taxation and mainstreaming alcohol policy considerations into multiple policy areas beyond health, such as labor, finance and economy.
The United Nations Inter-Agency Task Force on the Prevention and Control of Non-communicable Diseases (UNIATF) coordinates the activities of relevant UN organizations and other inter-governmental organizations to support governments to meet high-level commitments to respond to NCD epidemics worldwide. The UNIATF is hosted at the World Health Organization (WHO) in Geneva and has 42 members, among them the ILO, UNDP, UNICEF, UN Women, the World Bank and the WTO.
The brand new policy brief provides examples of NCD*-relevant actions being taken by agencies, funds and programmes to support countries in the COVID-19 response and recovery.
The brief provides actions that hold opportunities to increase, build upon and further apply these actions to NCDs should be pursued, including for building back better. Agencies, funds and programmes should ensure that their support for NCDs is aligned with the United Nations comprehensive response to COVID-19.
The NCDs burden and COVID-19
Global human development – a combined measure of health, education and income – is projected to reverse for the first time in 30 years.”The United Nations Inter-Agency Task Force on the Prevention and Control of Non-communicable Diseases (UNIATF), policy brief “Responding to noncommunicable diseases during and beyond the COVID-19 pandemic”, page 1
Before COVID-19, the world was already off track to achieve many of the targets in the United Nation’s Sustainable Development Goals (SDGs), including that to reduce premature mortality from NCDs. The pandemic is making achievement of the SDGs even more challenging. COVID-19 is expected to trigger the greatest global recession since the Second World War, huge losses of jobs and income, food crisesand mass impoverishment. Global human development – a combined measure of health, education and income – is projected to reverse for the first time in 30 years.
As NCDs worsen the pandemic and its wide-ranging impacts, they must be considered a major issue in the response, recovery and building back better to restore and drive progress in achieving the SDGs. The 2030 Agenda for Sustainable Development Agenda and the pledge to leave no one behind must continue to be the overarching approach for integrated action on NCDs.
Emerging evidence demonstrates the ways in which COVID-19 and NCDs interact:
- NCDs and their metabolic, behavioural and environmental risk factors are associated with greater susceptibility to COVID-19 infection and increased risks of severe disease and death from COVID-19.
- The pandemic has severely disrupted diagnostic, treatment, rehabilitation and palliation services for people living with NCDs.
- The pandemic and measures taken in response (e.g. lockdowns) are, for some people, increasing certain behavioural risk factors for NCDs, such as physical inactivity, an unhealthy diet and alcohol use.
- In some settings, domestic violence has increased during COVID-19, sometimes exacerbated by alcohol.
- Pressure on health services is likely to increase in the long term once they are restored and because of possible increases in cardiovascular and respiratory complications among COVID-19 survivors.
- The public and political attention paid to the pandemic has, in some places, resulted in difficulty in maintaining population preventive interventions for tobacco use, alcohol use, unhealthy diet and physical inactivity.
Further information on the links between COVID-19 and NCDs is available in the complementary paper, State of the evidence on COVID-19 and NCDs: a rapid review.
Despite the rapid progress made in addressing NCDs in the first decade of the 21st century, the momentum has dwindled since 2010, with annual reductions in age-standardized rates of premature mortality slowing for the main NCDs. Of 10 sets of indicators, used by WHO in 2020 to review progress in reducing NCDs in 194 countries, none were being fully met by all Member States, and only 3 of the 10 were fully met by a majority (52–57%) of Member States. The current rate of reduction is insufficient to meet SDG target 3.4 (reduce premature mortality from NCDs by one third) by 2030.
In 2017, the United Nations Secretary-General summarized the lack of progress in responding to NCDs:
- Action to realize the commitments made in 2011 and 2014 is inadequate.
- Current level of progress is insufficient to meet target 3.4 of SDGs on NCDs.
- The world has yet to fulfil its promise of implementing measures to reduce the risk of dying prematurely from NCDs through prevention and treatment.
- Initiatives to improve access to good-quality essential health-care services and to safe, effective, good-quality and affordable essential medicines and vaccines for the prevention and control of NCDs have not been scaled up in the majority of developing countries.
- Political commitments have often not been translated into concrete action.
- Serious constraints driven by economic and trade promotion interests are impeding the implementation by many Governments of some of the “best buys” and other recommended interventions for the prevention and control of NCDs, including the taxation of tobacco, alcohol and sugar-sweetened beverages and policies to reduce the impact on children of the marketing of foods and non-alcoholic beverages high in saturated fats, trans-fatty acids, free sugars or salt.
- There is a visible gap in respect of each country’s policy space and leadership to establish and implement policies for the prevention and control of NCDs.
- Despite the modest financing requirements and the cost-effectiveness of interventions, funding for national programmes from domestic resources and international finance is still grossly insufficient in developing countries. The level of official development assistance to catalyse additional resource mobilization from other sources has remained close to zero since 2011.
In 2018, the Political Declaration of the United Nations General Assembly on the Prevention and Control of NCDs acknowledged that:
- The burden of NCDs continues to rise disproportionately in developing countries.
- Action to realize the commitments made for the prevention and control of NCDs in inadequate. The level of progress and investment to date is insufficient to meet target 3.4 of the SDGs.
- The world has yet to fulfil its promise of implementing, at all levels, measures to reduce the risk of premature death and disability from NCDs.
The way forward: building back better
Addressing NCDs must be an integral part of the immediate COVID-19 response and recovery at global, regional, national and subnational levels as well as efforts to build back better to achieve the 2030 Agenda for Sustainable Development. There are significant opportunities for integrating NCD prevention and control into measures to address COVID-19 and its impacts, with a focus on reaching those furthest behind.
In the first instance, countries should:
- Rapidly assess essential services, including for NCDs, in the COVID-19 pandemic.
- Raise population awareness about the links between COVID-19 and NCDs and how disadvantaged and vulnerable people can protect themselves.
- Identify opportunities to reduce NCD risk factors at population level, with attention to vulnerable communities, including in humanitarian settings.
Building back better must also start now for NCDs. This includes:
- increasing funding for NCDs at all levels, commensurate with the social and economic burden of these diseases. Both domestic and international financing should be increased, in line with the Addis Ababa Action Agenda;
- addressing the social, economic, commercial and environmental determinants of NCDs and health, which includes implementing bold policy, legislative and regulatory measures, including fiscal measures, to minimize the impact of the main risk factors for NCDs and remove barriers to health services. “Health taxes” on harmful products such as tobacco products, alcoholic beverages, sugar-sweetened beverages and fossil fuels are SMART and cost-effective. They raise revenue, improve health and health equity, and avoid health and economic costs, all of which are necessary duringand beyond COVID-19. Removing subsidies for fossil fuels also benefits the environment;
- advancing universal health coverage, ensuring that benefit packages include NCDs and that people with NCDs are not exposed to financial hardship when receiving care. Countries should prioritize high-quality primary health care and population-wide prevention of NCDs.
Building human rights and gender equality into the NCD and COVID-19 responses, recovery and building back better:
- Optimize resource allocations for health; at a minimum, ensure sufficient allocations to respect, protect and fulfil the right to health for all.
- Ring-fence budgets to ensure the availability of essential health and other basic services.
- Ensure that the determinants of health are addressed as part of a fully costed strategy and plan of action to meet the core minimum obligations for fulfilling the right to health. These core minimum obligations include access to medicines, equitable access to health facilities, goods and services, without discrimination, and access to the minimum quantity of safe, nutritionally adequate food.
- Strengthen primary prevention to address the social, economic, commercial and environmental determinants of the causes of NCDs and their risk factors, including improving health literacy, creating enabling environments for health and implementing effective strategies to reduce tobacco use, alcohol use, unhealthy diets, physical inactivity and air pollution.
- Ensure that specific measures are in place to protect the health rights of marginalized and vulnerable populations and groups, even when resources are severely limited.
- Include women in decision-making, implementation and monitoring of NCD prevention and management to take into account their priorities and needs.
- Ensure that women health workers receive equal pay, hold leadership positions and can perform their duties without fear of violence.
- Engage women’s community organizations in response and recovery.
Examples of actions for parliamentarians to integrate responses to COVID-19 and NCDs
Strengthen NCD-related laws, policies and regulations, and their enforcement, to protect populations from NCDs during and beyond COVID-19. Subject to national laws and domestic context, parliaments should use the pandemic as an opportunity for rapid legislative action. New or updated laws should include:
- advancing taxes on products that are harmful to health, such as tobacco, alcohol, sugar-sweetened beverages and fossil fuels;
- regulating marketing:
- prohibit tobacco advertising, promotion and sponsorship;
- ban or comprehensively restrict marketing of alcoholic beverages; and
- comprehensively restrict marketing of and access to food products of infants and young children and of foods and non- alcoholic beverages to children;
- regulating online sales and home delivery of tobacco products and alcoholic beverages in order to enforce marketing laws and prevent sales to minors and intoxicated people;
- regulating the labelling of tobacco products, alcoholic beverages and foods and non-alcoholic beverages; and
- restricting or prohibiting lobbying by representatives of tobacco, alcohol and other companies that profit from health-harming products or processes.
Examples of actions beyond the health sector for an integrated response to COVID-19 and NCDs
Finance and economy
- Prioritize funding for health and health care;
- Increase investments in NCD prevention and control, recognizing that NCDs, like COVID-19, entail massive avoidable economic costs; and
- Advance health taxes on tobacco, alcohol, sugar-sweetened beverages and polluting fuels designed to improve health, unburden health systems and raise revenue.
- Ensure that health, social and economic protection, including income relief, is sensitive to workers living with NCDs and other groups especially vulnerable to COVID-19;
- Extend and scale up support for tobacco cessation and screening and brief interventions for alcohol problems at the workplace;
- Ensure that effective NCD care and social support are available for all workers and the unemployed; and
- Strengthen inclusion of NCDs in occupational safety and health management systems, and support broader actions on NCDs to ensure a healthy workforce during and beyond COVID-19.
In this policy brief “NCDs” refers to cardiovascular disease, diabetes, cancer and chronic respiratory disease, in line with WHO and United Nations resolutions and declarations. In the 2018 political declaration of the third high-level United Nations meeting on NCDs, the term was extended to include mental health. As a United Nations policy brief on mental health has been published, this paper addresses only the four diseases listed above and their risk factors (tobacco use, alcohol use, unhealthy diet, physical inactivity and air pollution).
Responding to non-communicable diseases during and beyond the COVID-19 pandemic. Geneva: World Health Organization and the United Nations Development Programme, 2020 (WHO/2019- nCoV/Non-communicable_diseases/Policy_brief/2020.1). Licence: CC BY-NC-SA 3.0 IGO.