Policy Review: Global Policy on Non-Communicable Diseases (NCDs)

This policy review provides insights on the global policy on non-communicable diseases (NCDs). It discusses the impact of NCDs, key issues that need to be addressed, major global actors and leadership in NCD policy, milestone in policy formulation and implementation, approaches used, NCDs in Sustainable Development Goals (SDGs), and recommendations for the way forward.

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GLOBAL POLICY ON NON-COMMUNICABLE DISEASES(NCDs)
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Introduction
Non-Communicable diseases (NCDs) usually take a lot of duration of time to heal,
difficult to treat and always as a result of a combination of various determinants of health
including behavioral factors, genetic, environmental and physiological characteristics(WHO,
2018). The main categories of NCDs globally include, cancer, cardiovascular diseases, chronic
respiratory, and diabetes diseases. In major cases, NCDs affects people from developing
nationswhere about 32 million of deaths occurs(WHO, 2018). According to WHO 2018, NCDs
kills about 71% of all deaths worldwide which is equivalent to 41 million people every year. In
every year, about 15, millions of people die from NCDs between 30 to 69 years. Most of those
premature deaths caused by NCDs are usually from developing nations accounting for around
85%(World Health Organisation, 2015).
Around 17.9 million deaths are due to cardiovascular diseases, followed by 9 million
from cancer, 3.9 million from respiratory diseases and 1.6 million from diabetes each
year(WHO, 2018). There four major NCDs accounts for about 80% of all NCDs deaths every
year. Major determinants of health that leads to NCDs include physical inactivity, tobacco use,
unhealthy diets and harmful use of alcohol(Tackling NCDs: the capacity of countries to respond,
no date). Major responses to these diseases include health promotion activities, screening,
detection and finally treatment including the palliative care(WHO, 2018).In order to combat this
global challenge, WHO is working with members of the United Nations to create health policies
in order to reach attainable targets. This includes working with political leaders and governments
in promoting and monitoring worldwide actions against NCD in relation with work of other
agencies(World Health Organization, 2016). This policy review intends to demonstrate evidence
that promotes the NCD policy agenda, what we have learned in addressing NCDs over the last

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10 years, major issues that need to be addressed, global actors and leadership in policy, milestone
in policy formulation and implementation, approaches used, NCD in Sustainable Development
Goals(SDGs), global targets, national and global policies roles, monitoring and coordination
mechanisms, NCDs policy key documents , challenges, and provide recommendation for the way
forward.
Evidence that Promotes the NCDs Policy Agenda
According to WHO report 2018, NCDs are responsible for around 41 million deaths
across the globe which is equivalent to 71% of all deaths. NCDs have been incorporated by
SDGs goal 3 aiming to reduce premature mortality by about 34% by 2030. In developing nations
alone, it is estimated that about seven trillion united states dollars will be lost due to NCDs
between the year 2011 to 2025(WHO, 2015c). Around 96% of the most studies investigating the
macroeconomic productivity impacts of NCDs in high-income countries show that the
productivity of a country is affected by various factors. These include disability-adjusted life
years, change and reduction in hours worked, labor market participation, presenteeism,
absenteeism, return to work and medical or sick leave(WHO, 2015c). This is due to the fact that
these major NCDs have large negative impacts on the nations’ productivity. For instance, lower
employment and absenteeism due to coronally heart disease in Australia lead to loss of 13.2
billion each year. On the other hand, the United States usually lost 5.5 billion annually due to
total mortality and productivity loss from breast cancer. In addition, NCDs creates financial
burdens to vast of affected households. This includes an increase in levels of poverty as
insurance covers limited medical support, lack of basic needs due to the use of out pocket money
for hospital bills and increases dependency ratio. Overall, 2% to 158% of all out of the pocket
bills are spend by various families across the globe due to NCDs(WHO, 2015c). Due to the

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increase in economic burden and suffering of people, many countries have recognized NCDs as a
threat and come together to make health policies together with WHO in order to eradicate the
issue.
What the world have Learned in Addressing the NCDs over the Last 10
Years
Over the past decade, there are valuable lessons learned across the globe regarding the
control and prevention of NCDs. The first major lesson learned includes the role of community,
national and global leadership and coordination in fulfilling a broad-based and coordinated
national response(Katie Kowalski, 2015). NCDs response must start with the national leadership
of the country managed and country-owned programs and strategies(Torpey and Mastro, 2016).
The NCDs responses have led to the improvement of the key components of WHO Systems
Framework which include technologies,health funding, governance, health workforce, and health
data and medical products,(Katie Kowalski, 2015). In order to address NCDs, nations have come
to know that community-based programs can generally work. In addition, NCDs response can
leverage management mechanisms, planning, and infrastructure through governance,
multisectoral strategic planning, and implementation, enhance the role of civil society, and
community mobilization(Sturke et al., 2016).
Other than, the world has come to understand NCD control requires a need development
of the high level of multisectoral committees in the response to NCD that coordinate
management, resources allocation, and policy(Katie Kowalski, 2015). Coordination of this type
with the use of national strategies would lead to the integration of NCDs within other health
sectors and international targets(Sturke et al., 2016). According to Torpey and Mastro 2016,
many nations have come notice that in addition to working across the government and use of

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political leaders, there are valuable aspects in response to NCDs when the participation of civil
society and private sectors are involved. This includes incorporating the input of non-
government stakeholders as many as possible in setting priorities and allocating the available
limited resources(Torpey and Mastro, 2016). Both national and international organizations have
been at foremost of the NCDs response and would continue to be equally valuable partners if
better strategic plans are set(Torpey and Mastro, 2016). Community-based organizations, on the
other hand, can play a vital role in targeting people at risk and those who cannot access health
care services.
Major Issues that Need to be Addressed
The nation needs to choose NCDs interventions priorities strategically. In order to
achieve global targets, many nations need to set their plans in an organized manner in order to
prevent failure(NCD Alliance Strategic Plan FROM GLOBAL COMMITMENTS TO NATIONAL
AND REGIONAL ACTION ON NCD PREVENTION AND CONTROL, 2016). As a major step
forward, reducing primary NCD burdens requires all the leaders and heads of states to jointly
agree to set up major interventions against the determinants of health including excess use of
alcohol tobacco use, unhealthy dieting and physical activities (Gouda et al., 2015). In addition to
that, nations with the collaboration of WHO and other associated organizations need to identify
other local factors that may lead to NCDs. Other than that, NCDs monitoring priorities must go
hand in hand with the prioritized interventions. The interventions activities should be determined
by the monitoring activities(Gouda et al., 2015). Many nations do not have the abilities to collect
the necessary data required in order to fulfill the WHO NCDs recommended framework. In order
to ensure NCDs prevention and control requirements are at hand, governments should ensure
they have a collective way of setting dataset that demonstrates the need for certain strategies.

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This include the use of vital and reliable registration data that support continuous monitoring of
population at risk, cause-specific mortality, and associated determinants of health(Mendis, 2010).
Other than that, the country needs to understand challenges of implementation including what is
lacking or needed(Gouda et al., 2015). Other primary issues include how monitoring and
preventive strategies can be integrated into healthcare systems, implementation strategies and
how they will be monitored, and the commitment of political leaders and heads of state in
enforcement of laws and policies that underpin prevention of NCDs.
Major Global Actors and Leadership in NCD policy
WHO represents primary global participant in control and prevention of NCDs (WHO,
2015a). The WHO Secretariat, using the World Health Assembly drafted a global action plan
that was intended to prevent and control NCDs for the period 2013-2020. This plan was intended
to be used by all other major stakeholder and active actors in the prevention of NCDs in order to
eradicate suffering and promote economies of all nations(Horton, 2013). These actors include
Members of States, international financial institutions like the World Bank, relevant United
Nations system agencies, key international organizations and development banks, health
professionals, academia and health researchers, health experts, civil society and private
sectors(Reubi, Herrick and Brown, 2016). Major policymakers in the countries include the
governments and political leaders. WHO works with all the above stakeholders to make sure the
targeted action plans and strategies are implemented.
Key Milestone in Policy Formulation and Implementation
These key elements include building a roadmap, conducting a country analysis, preparing
the strategic plan and developing the matrix and finally developing the monitoring and
evaluation plan(WHO, 2015a). Building a roadmap in policy formulation and implementation

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involve engaging the governments and political leaders across the United Nations and other
stakeholders using the key WHO framework, strategies, and action plans depending on the
region and associated determinants of health of the country(Abdul Rahim et al., 2014). After
that, the governments agree with the framework and enforce laws, roles, tasks, and
responsibilities. Conducting the country analysis involve identifying the existing plans, case
studies and information on the extends of the NCDs and their risk factors available(WHO,
2015a). After that, the country makes the NCDs as major priorities or the business case of the
nation and access any conflicts of interests to promote smooth implementation. Preparing the
strategic plans and developing the results of the matrix involves various steps. These include
agreeing on the cooperative advantage of individual agencies and the United Nation system,
accessing where the regional and global momentum support the action plan, including the NCDs
in the result matrix linking with other programs like the Universal Health Care, and finally
grouping the results into categories(WHO, 2015a). Developing a monitoring and evaluation
process is meant to oversee and make implementations possible. This includes using the national
data for monitoring, response using the available tools and resources where possible and
checking the assumption and risks in the results matrix.
Principles and Approaches used in NCD policy
The principles and approaches used in NCDs policy include governance, health
financing, , policies, health systems infrastructure , surveillance, plans and strategies, health
promotion, and partnership and multisectoral collaboration(Abdul Rahim et al., 2014).
Governance includes the use of heads of state and political leader in determining the roadmap to
follow regarding control and prevention of chronic diseases. The major contributor for funding
the research and prevention measures include the governments. However, private sectors and

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international banks can also contribute to NCDs prevention strategies to enhance haste
implementations. Healthcare system infrastructure approach tends to recognize that NCDs are
public health problems and therefore should be incorporated as priority in the healthcare system
of a country(Abdul Rahim et al., 2014). Development of NCDs policies, plans and strategies are
part basic principles of NCDs prevention strategies as they enhance voluntary commitments of
nations and development of laws and regulation intended to work against risk factors of
NCDs(Abdul Rahim et al., 2014). Surveillance covers risk monitoring and health outcomes.
Proper health surveillance on NCDs increases chances of policy implementations thus reducing
the overall risks factors. Health promotion help in eradicating the risks factors and promote the
citizens to stick to the provided policies. This is usually achieved when governments create a
partnership with the other private sectors and civil society.
NCDs in Sustainable Development Goals
The year 2030 Agenda for Sustainable Development adopted in September 2015 by the
United Nation Summit recognize the NCDs as one if the major challenge that can hider
sustainable development (WHO,2019b). However, NCDs were not addressed in millennium
development goals. NCDs are part of the Sustainable Development Goals specifically goal 3 of
which as part of the agenda, Governments, and Head of State committed themselves to develop
national strategies in response to overall implementations of SDGs (WHO, 2018a). The SDG
state that the governments are supposed to work in reducing one third of premature mortality
rates from NCDs, achieve the universal health coverage, reduce harmful use of alcohol by use of
policies and action plans, implement the WHO Framework Convention on Tobacco Control,

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increase the access of affordable vaccines and medicines for NCDs and support the development
and research of vaccines and drugs for NCDs particularly in developing nations.
Global NCDs Targets
Governments have created and endorsed global targets aiming to reduce four major
NCDs by the year 2025 by 25%. The first target is intended to reduce 25% of all overall
mortality from cancer, respiratory diseases, diabetes, and cardiovascular diseases(WHO, 2017a).
The nations also intend to reduce the harmful use of alcohol and prevalence in physical activities
by 10% globally(WHO, 2017a). Tobacco intake and excess intake of salts are also targeted to
reduce by 30% by the year 2025. The global targets by the United Nations also include a 25%
reduction of hypertension, halts obesity and diabetes, and increase the percentage of people
eligible for counseling and drug therapy by 50%(WHO, 2017a). Other than that, the governments
are working to increase the availability of affordable basic technologies and crucial medicines
needed to treat NCDs in private and public facilities by 80%(WHO, 2017a).
The role of Global Versus the National Policy and the Importance of National Policy
The global NCDs policy is normally created by WHO through the Political Declaration.
This NCDs declaration policy reaffirms all political leaders and heads of state globally through
WHO to monitor and promote global actions against the NCDs(WHO, 2017b). The global policy
work with other international United Nations agencies, banks, and in consultation to countries
members. National policy is the specific country’s objectives, plans, and strategies in combating
NCDs as controlled by the government and political leaders. National health policy is important
as it ensures specific strategies and methods of monitoring targeting particular risk factors and
diseases are put into place and enforced by the law to eradicate NCDs.

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Coordination and Monitoring Mechanism
Coordination of global targets of NCDs is done by WHO through the Global
Coordinating mechanism Framework as agreed in the Political Declaration of 2011(WHO,
2015b). The scope of WHO is to enhance the coordination of activities in the countries and
multisectoral engagement in order to promote the implementation of global targets goals of
NCDs by 2025(WHO, 2019a). Governments are supposed to coordinate all activities regarding
control and prevention of NCDs in their own countries using the proposed policies. Monitoring
of NCDs is usually done through the use of the WHO STEPwise conceptual framework
tool(WHO, 2019b). This tool is divided into three levels in which in each level have various
subdivisions including core, expanded and optional divisions. Step one contain all minimum
measures that a country should obtain(‘WHO | NCD Global Monitoring Framework’, 2018). In
addition to those, social economic data, alcohol use, tobacco use, physical exercises, and
nutritional status are included. Step two includes physical measurements including weight,
height, blood pressure and waist circumference whereas step three is the biomechanical
measurements(‘WHO | NCD Global Monitoring Framework’, 2018). All those monitoring are
then reported to the national levels and also to WHO to check if the policies implemented are
working.
Key Documents on NCD policy
There are key documents that tackle and direct the NCDs policy toward the eradication of
diseases such as cardiovascular diseases, cancer, respiratory diseases and diabetes as developed
by WHO and the United Nations. These include, Sustainable Development Goals (SDGs),
Global action plan for the implementation and control of NCDs 2013-2020, WHO Framework
Convention on Tobacco Control, Global Strategy on Diet, Physical Activity and Health, Global

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strategy to reduce harmful use of alcohol, set of recommendation on marketing of foods and
nonalcoholic beverages to children and WHO coordination and monitoring framework for
NCDs.
Challenges information and Coordination of NCDs Policies
The first biggest challenge impeding NCDs policy is the political commitments among
the policymakers and other associated stakeholders(Alwan, 2017). The experience from the last
decade indicates that, despite the fact that many nations have declared to tackle NCDs, such
commitments have not been transferred to effective actions. According to WHO, in 2015, only
two countries globally scored 14 out of 18 in the WHO NCD progress monitor. Other than that,
only 41% of all nations had a multisectoral national strategy, 34% had operational strategies, and
only like 3% to 9% of nations in any region had implemented policies to eradicate saturated fats
in trans-fat by 2015(Alwan, 2017). Other major challenges include lack of enough finance in
WHO, the UN agencies and the World Bank, poor of civil society and professional organization
engagement, lack of support from international agencies, poor or unmet need for technical
assistance to provide countries with multisectoral and bilateral and domestic channels(Alwan,
2017). In addition to that, some nations have the inadequate capacity and weak health systems in
public health, inadequate funds for national NCD interventions and programs, and limited
progress in engaging in health and private sectors.
Recommendations
 Increase countries commitments regarding the implementations of NCDs strategic plans.
This include increase in both political and leadership commitments and creating policies
that can be easily be used or those that are applicable in order to make sure global targets
are achieved.

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 Increase budgeting and finance of NCDs programs and interventions to make sure there
is enough funding of such activities like research, health promotion strategies,
surveillance, and monitoring.
 Involvement of other private and non-health sectors or use of multisectoral approach to
make sure there is enough participation in both national and international NCDs
programs.

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