Addressing Noncommunicable Diseases to Deliver for Good

In less than three months, governments of the world will come to New York for the UN General Assembly High-Level Week and for a landmark event– the UN High-Level Meeting on Noncommunicable Diseases (UN HLM on NCDs). This will be the third time governments meet to discuss NCDs at the highest political level. Together, Heads of State and Government will review progress against addressing the burden of NCDs and make new, bold commitments to accelerate action in the form of a Political Declaration.

So why does this matter to the women and children’s health community? And how can you be involved to ensure a successful UN HLM on NCDs that also drives progress for the reproductive, maternal, newborn, child and adolescent health (RMNCAH) community?

Firstly, it matters because NCDs – namely cancer, diabetes, cardiovascular disease, chronic respiratory disease, and mental and neurological conditions – represent nothing less than a global health and development emergency. Collectively, these diseases cause more deaths and disability than any other worldwide, hitting developing countries the hardest and fastest, crippling health systems, and draining national economies at an alarming rate. Economies are being depleted by the direct and indirect costs of NCDs. Annual GDP losses range from 3.5% – 5.9%, and the amount these diseases will have cost developing countries alone between 2011 and 2025 will be $7 trillion dollars, equivalent to the combined GDP of France, Spain and Germany last year. Although for far too long these diseases were marginalized and forgotten by the global health and development community, they are finally now included as a priority in the Sustainable Development Goals and by WHO. Despite this, progress to date has been slow, and at the current trajectory, the world will not realize its goal of reducing by 1/3 premature mortality due to NCDs by 2030.

Secondly, NCDs are a major threat to women and children’s health and development across their life course. They are an important maternal and reproductive health issue, a threat to child and adolescent health and wellbeing, and a major contributor to poor health in old age for women. Cardiovascular disease causes 8.6 million deaths among women annually; globally, every two minutes a woman dies of cervical cancer; by 2045, the number of women ages 20-79 living with diabetes is projected to increase to 308 million from 204 million in 2017. These diseases collectively are the leading cause of death and disability among women and girls, contributing to two out of every three deaths. NCDs impact upon women’s health and development across the lifecycle, causing morbidity and mortality, compromising their socio-cultural status in communities, and women and girls, especially those in low- and middle-income countries (LMICs), often face a triple burden of disease due to communicable and noncommunicable diseases, and reproductive health issues. When it comes to mental health conditions, women and girls are more likely to suffer from depression and Post Traumatic Stress Disorder, which have long-lasting effects on physical and mental health.

The impact of these diseases in women is profound and goes beyond their own health; NCDs affect the health and life chances of the next generation too. A combination of epidemiology studies in human populations and a better understanding of the epigenetic process now indicates that diabetes and other NCDs may be triggered by events in the womb. Being born to a malnourished mother increases the chances of the infant suffering under-nutrition, late physical and cognitive development, and NCDs such as diabetes and cardiovascular disease in adulthood.

Women and girls experience exposure to the main risk factors for NCDs – tobacco use, harmful use of alcohol, poor diet, physical inactivity, and indoor and ambient pollution – differently than men and boys, often as a result of stigma and cultural and societal norms.

NCDs have vastly different consequences for women and their families in LMICs than for those living in high resource settings. In settings constrained by poverty, cultural and societal norms, limited health infrastructure, and human-resource capacity, women are far less likely to access timely, adequate, or affordable diagnosis and care. As a result, many NCDs are often detected at a late stage, increasing the likelihood of largely preventable, premature death. And, women of all ages must battle underlying determinants, including illiteracy and low socio-economic and political status, which limit their ability to inform and protect themselves against NCDs.

The strong links between gender and the risk of developing an NCD in life necessitate an integrated approach to health and physical and mental well-being.

The Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030) recognized the need to integrate NCDs into the RMNCAH response, including a target on addressing NCDs as an essential component of the Survive pillar.

Thirdly, not only are there multiple links between NCDs and RMNCAH, but there are also significant opportunities to leverage solutions that deliver results across the board. At the heart of the 2030 Agenda is the belief that the SDGs are ‘integrated and indivisible,’ and without a coordinated and coherent approach, we will not achieve our shared goals of sustainable human development. We must break down siloes between health issues and empower and enable women and girls to access quality, affordable health information and services that are people-centred. Successful integration of NCDs and RMNCAH services include screening all pregnant women for diabetes – nearly 80 per cent of women in LMICs have at least one antenatal visit, providing a crucial opportunity for delivering integrated services. Dr Tedros, WHO Director-General, announced a flagship initiative to eliminate cervical cancer by provision of the HPV vaccine, early screening, and treatment. Providing safe spaces for women and girls to exercise helps address physical inactivity, and eliminating all forms of malnutrition, including under and overnutrition, have intergenerational benefits that result in healthier and happier populations.

The case is clear – we need to build greater synergies between the NCD and RMNCAH communities.

The NCD Alliance and Women Deliver have been working together to build those bridges and strengthen joint action, but much more needs to be done. The UN HLM on NCDs is a prime opportunity to advance this shared agenda and secure political commitments from Heads of State and Government for integrated services that embody a lifecourse approach to health. In order to help achieve, here are three actions we would like to see the RMNCAH community take forward in support of the UN HLM on NCDs:

1. Call on Heads of State and Government to attend the UN HLM on NCDs and to commit to political leadership to drive an integrated NCD response;
2. Call for gender-responsive approaches to NCDs, recognizing that gender plays an important role in the drivers, determinants, access to health services and care-giving elements of NCDs;
3. Promote the meaningful involvement of young people, people living with NCDs, in the NCD response and in the lead up to the UN HLM on NCDs.

This year’s UN HLM on NCDs is the first time governments will review progress on NCD-related targets within the context of the Sustainable Development Goals and the 2030 Agenda for Sustainable Development. It is an opportunity for Heads of State and Government to commit to political action at the highest level to deliver an integrated, lifecourse approach that goes beyond disease siloes and treats people as a whole, and not as a disease. And, it is an opportunity for health and women’s rights communities and advocates to come together and call for strong commitments that place the health and well-being of women and girls at the core of the agenda. Now is the time for women’s health and rights advocates to be vocal in the NCD movement, for the two are closely intertwined.

Visit enoughncds.com to get involved in the UN High-Level Meeting on NCDs campaign to help call on governments to commit to ambitious political action that delivers on the integrated nature of the 2030 Agenda and results in improved health and physical and mental well-being for women and girls of all ages around the world.