London School of Hygiene & Tropical Medicine

Non-communicable diseases (NCDs), mainly heart disease, stroke, diabetes, cancers, and chronic respiratory disease, are responsible for two out of every three deaths worldwide and the toll is rising.

A landmark global alliance between leading scientists and four of the world’s largest NGOs brings together evidence from a 5-year collaboration with almost 100 of the world’s best NCD experts and proposes a short-list of five priority interventions to tackle the increasing global crisis. Reducing tobacco and salt use, improving diets and physical activity, reducing hazardous alcohol intake, and achieving universal access to essential drugs and technologies have been chosen for their health effects, cost-effectiveness, low costs of implementation, and political and financial feasibility.

Just 5 months ahead of the UN High-Level Meeting (HLM) on NCDs, only the second of its kind to focus on a global disease issue and with the potential to stimulate action globally as well as nationally, The Lancet NCD Action Group and the NCD Alliance launch a clear set of commitments in The Lancet that they would like to see from the meeting.

The scientists include a number of London School of Hygiene and Tropical Medicine staff.

“The most important outcome of the UN HLM on NCDs will be sustained and strong high-level political support for a framework of specific commitments to tackle the NCD crisis as part of a costed national health plan”, explain the authors. The aim is to reduce NCD death rates by 2% per year which will avert an estimated 36 million deaths over 10 years.

Despite numerous national and international policies, strategies, and plans to tackle NCDs progress has been slow—partly, say the authors, because of the “pressing nature” of other global health issues.

In the lead up to the UN meeting, the authors call on heads of state and governments to commit to a coordinated set of feasible actions and interventions for which specific and timed targets and indicators can be developed, and against which progress can be measured.

The top priority must be to reduce tobacco use followed by lowering salt intake, say the authors. Key to the success of this intervention will be the accelerated implementation of the Framework Convention on Tobacco Control (FCTC) to achieve the proposed goal, “a world essentially free from tobacco by 2040”, where less than 5% of the population uses tobacco; achieving this goal would prevent at least 5.5 million premature deaths over 10 years.

By 2025, they would like to see salt intake reduced to less than 5 g per person. They point out that reducing global salt consumption by just 15% through mass-media campaigns and reformulation of processed foods and salt substitution could prevent an estimated 8.5 million deaths in just 10 years.

Importantly, the costs of these interventions will be small, say the authors. The yearly cost to implement tobacco control and salt reduction will be less than US 50 cents per person per year in countries like India and China. The total package of priority interventions will require a new global commitment of about $9 billion per year.

Key to the immediate delivery of these interventions is a set of priority actions—securing broad political leadership at the highest levels nationally and internationally, support for strengthening health systems (with a strong focus on primary care), building international cooperation and consensus for priority interventions (particularly primary prevention), and establishing independent monitoring systems and accountability mechanisms for assessing progress.