Non-communicable diseases (NCDs), mainly cardiovascular diseases, cancers, diabetes, obesity and chronic respiratory diseases, represent a leading threat to human health and human development in today’s world. These five NCD factors are the world’s leading causes of death and kill an estimated 35 million people each year - 60% of all deaths globally – with 80% in low and middle income countries. WHO estimates that total deaths from non-communicable diseases will increase by a further 17% over the next 10 years.NCDs are related to the interaction of various genetic, environmental and especially lifestyle factors, including smoking, alcohol abuse, unhealthy diets and physical inactivity. NCDs are often prevalent in disadvantaged socio-economic populations and areas and represent a major obstacle to the economic development of many countries. (See WMA's Social Determinants of Health). WHO predicts the greatest increase in incidence of NCDs in the African region, with a 27% rise, and the Eastern Mediterranean region with 25% rise. The highest absolute number of deaths will occur in the Western Pacific and South-East Asia regions.
WMA Advocacy activities in NCDs
In order to address these matters, WHO developed a Global Startegy on NCDs acting only on 4 diseases- cardiovascular diseases, cancers, diabetes, obesity and chronic respiratory diseases . With the focus mainly on these 4 diseases, WMA fear that governments will concentrate only on improvements in these areas, detracting from other significant needs of other major NCD threats, such as mental disorders, musculoskeletal diseases, oral diseases and accidents. The effect of this vertical or 'silo' approach will be to deprive other important areas of health care of necessary resources.
Furthermore, the burden of disease from NCDs is often multiple and chronic, and the illness and suffering of the individual numerous - only a combined, primary care based, collaborative and whole-person view can succeed.
We advocate for a complete approach that links individual risk factors with social and economic determinants of health, conditions in which people are born, grow, live, work and age, and the influences of society. From the outset, member states must address NCDs with SDHs and communicable diseases - and not in isolation
By addressing health systems strengthening and effective preventative measures for disease in general, healthcare in general would improve, thus improving treatment of both communicable and non-communicable diseases simultaneously.
It is for these reasons that the WMA has outlined the following key messages regarding the handling of the NCD epidemic. The WMA encourages:
• adoption of a holistic approach based on common risk factors. This approach, incidentally, would be equally applicable to communicable diseases.
• avoidance of restricting focus to a limited number of diseases, and to include other areas, such as mental health, arthritis, and oral health.
• a focus on equitable access to health care as a human right so as to address the dramatic disparities within and between countries.
• physicians and policy-maker to pay due attention to the link between noncommunicable diseases and the social determinants of health, with a particular focus on the broader factors that influence behaviour and associated health risks. These include the conditions in which people are born, grow, live, work and age, as well as societal influences.
• the strengthening of health care systems through a comprehensive approach that places emphasis on primary health care and integrates prevention, specialised treatment, and rehabilitation.
WHPA Health Improvement Card
People are increasingly exposed to a multiplicity of environmental and social influences, which frequently leads them to adopt unhealthy lifestyles/ behaviours that result in a higher risk of NCDs and poor health.
The WHPA Health Improvement Card is a simple, universal educational tool, which will allow everyone to assess and record their lifestyle/behavioural and biometric risk factors. These risk factors include unhealthy diet, physical inactivity, tobacco use and the harmful use of alcohol. The Health Improvement card enables individuals and their health professional to take a proactive approach to prevent NCDs and associated disability by identifying simple ways in which these habits could be mitigated. There are also four biometric measures that can be recorded in the card. These include body mass index, cholesterol, fasting blood glucose, and blood pressures. These measures could be tracked in a simple manner that allows the patient to see their progress in a simple and encouraging manner. This empowerment gives the individual the incentive to independently make the daily, necessary changes to improve their quality of life and still get the necessary support of their physicians to accomplish it.
The Health Improvement Card also contains two background documents with further information for health professionals and their patients, as well as the general public.
The Health Improvement Card is also viewed as an advocacy tool that might foster socially accountable health systems. By emphasizing the influence that individuals can have in their current and future health status, some of the strain would be alleviated from the overuse of treatment for preventable chronic disease.
UN Summits on NCD and SDH
The United Nations has been urged by the World Medical Association to change its strategy towards non communicable diseases by widening its activities to include other preventable diseases.
In a speech at the UN's High Level summit on NCDs in New York in September 2011, the WMA President Dr. Wonchat Subhachaturas said he had concerns about the present narrow disease-orientated approach to non communicable diseases being adopted by the UN.
Furthermore, the burden of disease from NCDs is often multiple and chronic, and the illness and suffering of the individual numerous - only a combined, primary care based, collaborative and whole-person view combining NCD and SDH can succeed.
The way forward is to emphasize access to effective health care as a human right. Defining health success as a mere statistical challenge deprives individuals of the health care they are entitled to. We are deeply concerned that the current discussion, especially disease targets, reduces health care to very limited technical provisions. This approach forgets the very important, person-centred care and people-centred public health care approaches. These are vital to all and currently absent from far too many health systems.
The World Medical Association has welcomed the global agreement on social determinants at the United Nations Conference in Rio de Janeiro in October 2011. WMA advocates for a complete approach that links NCDs with social and economic determinants of health, conditions in which people are born, grow, live, work and age, and the influences of society.
Fit For School Project
In 2009, the WMA amended its Declaration of Ottawa to foster the protection of children. With the Fit for School' project WMA has an implementation activity to increase the health status of children. The German Development Aid Agency GIZ together with the South East Asian Ministers of Education Organisation (SEAMEO) and WMA are developing the ‘fit for school course', which aims to promote and facilitate effective school health programmes worldwide through building of conceptual, implementation, and management capacity with governments, international organisations and NGOs in low- and middle-income countries.
The course is developed in a comprehensive yet modular way allowing for adaptation to different target audiences and country settings. It will cover a broad range of topics related to effective school health programmes, from concept development to implementation, from child health to evidence-based interventions, and from day-to-day management to evaluation and monitoring with a strong practical approach. The course content is applicable to different international settings. The course is based on the Fit for School model, which was internationally awarded by World Bank, UNDP and WHO. The first course was held in the Philippines in April 2011.
WMA Current Policy & Action
- Statement on Physicians and Public Health
- Statement on Health Promotion
- Statement on the Physician's Role in Obesity
- Statement on Health Hazards of Tobacco Products
- Statement on Reducing the Global Impact of Alcohol on Health and Society
- The WMA Statement on Alcohol and Road Safety
- WMA report on Fit For School Project 2011