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Selecionado pela AMICOR Maria Inês Reinert Azambuja
Why is the global health community failing to respond effectively to the rising burden of non-communicable diseases (NCDs)? The answer can be summed up in one word—fear. Fear of a species-threatening pandemic. A pervasive fear that has displaced all other health concerns. Anxiety among political elites is causing a recalibration of priorities among global health leaders. In his first speech to staff in Geneva this month, WHO's new Director-General, Tedros Adhanom Ghebreyesus, named four urgent issues: health emergencies; universal health coverage; women's, children's, and adolescents’ health; and climate change. NCDs, the cause of 71% of the world's deaths, were absent from his list. In an address to G20 leaders just a few days later, Tedros underlined the importance of “pandemics, health emergencies, and weak health systems”. He was silent again on the 39·8 million deaths annually from NCDs. In his speech to health ministers at this year's World Health Assembly, he did call NCDs “a perfect storm”. By contrast, his predecessor, Margaret Chan, in a valedictory summing up of her decade as Director-General, observed that the growing importance of NCDs was “the trend that most profoundly reshaped the mindset of public health”. She was correct. But her diagnosis seems not to be shared by her successor.
The 2011 Political Declaration on the Prevention and Control of NCDs urged presidents and prime ministers to take chronic diseases much more seriously. A plethora of strategies, action plans, and status reports before and since have emphasised the importance of NCDs as a cause of premature mortality. Today, NCDs are embedded in the Sustainable Development Goals (SDG 3.4). Civil society mobilisation has benefited from a rejuvenated NCD Alliance. The knowledge base for policy action has never been better. Global awareness is high. And there is even a political mechanism to exploit—a third High-Level Meeting on NCDs to be held in September, 2018. Yet even those who led efforts to secure a Political Declaration admit that progress has been inadequate and disappointingly slow. Countries are struggling. There is little money available. Health systems are still too weak to deliver quality services. Nobody has been able to articulate how NCDs fit into the call for universal health coverage. An advocacy strategy based on four diseases and four risk factors seems increasingly out of touch with the realities in poor countries. Many political leaders believe that NCDs are just too big and too complex a challenge. And so they are paralysed. We need a different approach.
Recently, I listened to a senior adviser to the Global Fund set out the lessons to be learned from the Fund's success in winning the confidence of donors to invest billions of dollars in AIDS, tuberculosis, and malaria. First, translate your evidence into clear and simple political (not technical) messages. Second, articulate why you need money—what exactly will you spend it on and what will be the results of that investment? Third, break down your broad global demands into tangible country-specific needs. And finally, connect your case to the big political picture—give it meaning. For NCDs, the issue is one of framing. For the Political Declaration, that frame was the adverse effects of NCDs on development. It is an argument that has survived into the SDG era. But it is not enough. Given the deep fears and anxieties of political leaders, those seeking greater action on NCDs should consider the frame of global health security. The argument is compelling. The overall objective? Global health security. How? Individual health security. The means? Universal health coverage. The place of NCDs? There can be no security without making NCDs fundamental to the vision for universal health coverage. There are several additional lessons to consider. Learn from the AIDS movement. Access to medicines for NCDs should be a decisive matter of human rights. Talk the language of heads of state—investing in the prevention and treatment of NCDs is good for economic growth. Link the case against NCDs to major social movements, such as climate action and the resultant health cobenefits. Build new alliances, especially with the child and adolescent health community. Strengthen accountability. Take communication more seriously. Be human. Be specific. Be vivid. Because if a radical course correction is not made within the next 12 months, the global goal of controlling some of the biggest killers in the world today will not be achieved.