COMMONWEALTH MINISTERS

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1 COMMONWEALTH MINISTERS Reference Book 2012 Extract from the Commonwealth Ministers Reference Book featuring Britannia Industries Limited The enclosed is an extract from the Commonwealth Ministers Reference Book 2012, published by Henley Media Group in association with the Commonwealth Secretariat

2 India has over 60 million people living with diabetes. Flickr/nandadevieast The diabetes challenge Professor Jean Claude Mbanya, President of the International Diabetes Federation, calls for governments to translate political commitments into action. The global diabetes and related non-communicable disease (NCD) epidemic has finally reached global prominence. The voice of civil society has been joined by that of the private sector, governments and the UN in calling for immediate action in the face of one of the major health and development challenges of the twenty first century. The World Economic Forum rated NCDs as one of the greatest risks to the global economy, and the UN Secretary-General Ban Ki-moon has called the NCD epidemic a public health emergency in slow motion and a threat to development. Most importantly, the UN s 193 member states convened in September 2011 to adopt the landmark Political Declaration on NCD Prevention and Control. With diabetes and NCDs firmly on national and global agendas, we are entering a new era in which ignorance and inertia is replaced by awareness and urgency. A turning point for diabetes and NCDs The Commonwealth family, home to one-third of the world s population, has been a key driver of political momentum. Some of the planet s largest and smallest, richest and poorest countries make up the Commonwealth, but they all share common concerns over the growing diabetes and NCD epidemic. International Diabetes Federation (IDF) estimates that adult diabetes prevalence reaches 20 per cent in small Pacific island states such as Nauru and Tuvalu, and at the same time the largest member of the Commonwealth family, India, has over 60 million people living with diabetes (Diabetes Atlas, 2011). All ministers from all sectors must take a leadership role in implementing the Political Declaration. Collectively NCDs are the leading cause of death in the member states of the Commonwealth, causing 47 per cent of 19.5 million deaths (reported in 2011). As well as exacting a heavy toll on the health of Commonwealth populations, these diseases are crippling government budgets, vulnerable health systems and households. In low and middle-income 250 l Commonwealth Ministers Reference Book 2012

3 countries (LMCs) the majority of people with diabetes are under 60 years of age, an increasing trend which is striking household breadwinners, damaging productivity and increasing absenteeism. It was for these reasons that Commonwealth countries led the move for the UN Summit, and it is these messages that are now ingrained in a UN Declaration that all governments have signed up to (UN A/66/L.1). The causes of diabetes and NCDs are diverse and complex, driven by global patterns of urbanisation, globalisation and economic development, and their impact is felt by all of society. For this reason no single actor or sector can solve the diabetes epidemic alone. Rather, all sectors must be engaged and mobilised if we are to achieve a deepseated and sustained shift in the way we live, work and play and truly create an equitable health-promoting environment for current and future generations. The stewardship of the Commonwealth will be critical in this new era. Commonwealth Health Ministers are leading the world. But going forward, all ministers from all sectors must take a leadership role in implementing the Political Declaration. Commitments by 2012 Partnerships. The other short-term commitment requiring immediate action is for the UN Secretary- General to develop options to strengthen multisectoral action at the global level through effective partnership. Perhaps more than any other health issue, diabetes and NCDs require partnerships than span every sector public, private and not-for-profit. It is critical that multisectoral action is enacted horizontally across UN agencies, or government departments. There is already evidence of this, the most significant being the First Meeting of UN Funds, Programmes and Agencies on the Implementation of the Political Declaration, on 8 December But horizontal multisectoral action needs to be complimented by vertical multisectoral action between UN, governments, NGOs and the private sector. For this reason, IDF and the NCD Alliance have consistently called for the establishment of a Global NCD Partnership, housed within the UN, to co-ordinate follow-up action. Strengthening national responses In parallel with these global processes in 2012, the Declaration outlines a set of equally important and urgent national commitments on prevention and treatment. Governments have clearly taken leadership Health and Welfare Of the 22 commitments outlined in the Political Declaration, three are to be completed by the end of 2012 and require immediate attention by governments. Every government in the world will be required to report against the indicators and targets. Targets and monitoring. In consultation with governments, the World Health Organization (WHO) has been mandated to establish a set of voluntary global NCD targets, and a comprehensive global monitoring framework to measure progress. This will be a significant step forward for the global NCD response. Every government in the world will be required to report against the indicators and targets. In the case of HIV/AIDS, bold, specific and measurable targets and timetables were a key factor in driving progress and elevating HIV/AIDS to a global cross-sectoral issue. It is imperative we take this opportunity to do the same for NCDs. Civil society and governments must work together to define a set of targets that represent our shared vision for success for 2025, taking into account national priorities and capacity. Prevention is the cornerstone The Declaration states that prevention must be the cornerstone of the global response to NCDs, and certainly the case for prevention is compelling. WHO estimates that 80 per cent of type 2 diabetes can be prevented or significantly delayed. With simple cost-effective interventions we can avoid the tragedy and cost of diabetes that in so many cases impact upon government health budgets as renal failure or limb amputations. A successful approach hinges on the recognition that diabetes and NCDs are not a result of an individual s action, but are symptomatic of wider societal and environmental factors. The levers for change lie in the hands of governments, and can be affected through instruments that they control legislation, regulation and taxation. Equally, progress hinges on governments adopting policies across sectors as broad as health, education, energy, agriculture, sports, transport, urban planning, environment, labour, and finance. Multisectoral action is always challenging, and will require interdepartmental committees and partnerships that engage non-health actors and stakeholders. Commonwealth Ministers Reference Book 2012 l 251

4 and ownership of the NCD epidemic by agreeing to promote, establish or support and strengthen multisectoral national NCD policies and plans by National diabetes or NCD plans are crucial to co-ordinate and harmonise national responses, and should be considered within a broader national NCD action framework comprising one agreed plan, one national NCD co-ordinating authority with a broadbased multisectoral mandate, and one agreed countrylevel monitoring and evaluation system. The UNAIDS Three Ones principle has been widely adopted by many countries, and should be considered as a good model for the basis of the NCD response. Within the Commonwealth there are many good practice examples of national plans, with member states such as India and Malaysia launching new plans around the Summit. It will be important to use these examples to support poorer countries in the Commonwealth, and mobilise North-South and South-South support as agreed in the Commonwealth Road Map for NCDs. Accessible medicines. The first of these is increasing accessibility, affordability and availability of lifesaving medicines to people with diabetes and NCDs. Governments made this commitment at the Summit, but as many Commonwealth nations are well aware, we have a long way to go before we see universal access in every country. IDF estimates that 100 million people with diabetes lack access to the medicines, technologies and quality care they so desperately need and the majority live in LMCs. This is despite insulin, discovered more than 90 years ago, being cheap and off-patent. The shared goal must be universal access and we have the means by which to achieve it. Investing in diabetes and NCDs now will prevent huge healthcare costs in the future. Long-term needs can only be addressed by integrating diabetes and NCDs so that health services respond to the whole person and are not organised by diseases. The Declaration also sets out a blueprint for action to strengthen health systems for diabetes and NCDs, placing strong emphasis on the primary healthcare level. Many LMCs have vulnerable health systems capacity, and many are oriented around vertical programmes that deal with acute illness. The long-term needs of people with diabetes and NCDs can only be addressed by reorienting existing organisational and financial healthcare arrangements, and integrating diabetes and NCDs so that health services respond to the whole person and are not organised by diseases. The Commonwealth Health Ministers meeting in May 2012, focusing on the interlinkages between NCDs and communicable diseases, provides a unique opportunity to advance an integrated and holistic approach to health. The unfinished agenda While the Political Declaration was a major step forward, there are many pieces of the diabetes agenda that are unfinished and require immediate political action to progress. Development frameworks. Another area for action is the integration of diabetes and NCDs into national and global development frameworks. With the end date of the MDGs coming ever closer, it is crucial that LMCs in the Commonwealth family state their health priorities in the intergovernmental consultations leading up the MDG High-Level Review in The Political Declaration reaffirmed diabetes and NCDs as a threat to social and economic development, and committed governments to include diabetes and NCDs in the upcoming dialogue on the post-2015 development framework. We have always given our full support to the MDGs, but the absence of diabetes and NCDs has distorted resource allocation and health systems at the national level. As far back as 2009, Commonwealth Heads of Government were calling for the integration of NCD indicators into the core MDG monitoring and evaluation system. We must take this opportunity to shape a global development that truly reflects the health needs and priorities of LMCs, and drives sustainable and equitable development. Financing. Finally, there remains the unresolved issue of global financing for diabetes and NCDs. The Political Declaration states that resources are not commensurate with the magnitude of the problem. But what was missing at the Summit was a collective pledge to commit resources. At a time when resources are scarce, increased investment 252 l Commonwealth Ministers Reference Book 2012

5 in NCDs will seem challenging for governments. However, investing in diabetes and NCDs now will prevent huge healthcare costs in the future. It will save money, lives and misery. Investing in NCDs will multiply into huge social and economic gains and improve health outcomes not only for the four main NCDs, but also for a wide range of infectious diseases and chronic conditions. Equally, the Summit did not result in a shift in resource allocation within the multilateral and bilateral aid agencies. The major bilateral donors, the World Bank and the IMF, remain reluctant to allocate resources for diabetes and NCDs. The extent of incoherence in global health funding is evident by the fact that NCDs represent 60 per cent of the global burden, yet they receive less than 3 per cent of the US$22 billion Official Development Assistance spent on health. It is now essential that country compliance with the UN Summit commitment is actively measured and monitored. We need to make the case for bilateral and multilateral donors to readjust funding priorities, and in the absence of these traditional funding mechanisms we need to explore non-traditional innovative financing mechanisms to fund NCDs. There are examples of countries in the Commonwealth that have successfully used revenues from raised taxation on tobacco and alcohol to finance health promotion and promote coverage in primary healthcare which can be learnt from and replicated around the world. The dawn of a new era It is in all of our interests to build on the political momentum generated by the UN Summit. The Political Declaration has defined a new future for the millions of people with diabetes and NCDs worldwide. It is now essential that all stakeholders are held accountable for the promises made in New York, and country compliance with the UN Summit commitment is actively measured and monitored. This will require a truly global effort involving governments, the private sector, civil society and the people living with these diseases. We must ensure that commitments made on paper now translate into concrete action on the ground in order to safeguard the health and well-being of current and future generations. It is quite clear what to do. With the right policies, commitment and investment, and relentless determination, we can and will make a difference. Contact Details Professor Jean Claude Mbanya is President of IDF. He is Professor of Medicine and Endocrinology at the Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon. He was instrumental in IDF-led Unite for Diabetes campaign, which led to passage of the UN Day Resolution on Diabetes in December Professor Mbanya s research mainly focuses on cultural diabetes-related factors, which are often unique to the African countries and communities he studies. He also serves on several WHO advisory groups, and has received many international research grants and awards. International Diabetes Federation (IDF) is a non-governmental organisation of over 200 member associations in more than 160 countries in official relations with the WHO, and is associated with the Department of Public Information of the UN. The mission of IDF is to advance diabetes care, prevention and a cure worldwide. IDF s strategic goals are to drive change at all levels, from local to global, to prevent diabetes and increase access to essential medicines; to develop and encourage best practice in diabetes policy, management and education; to advance diabetes treatment, prevention and cure through scientific research; and to advance and protect the rights of people with diabetes, and combat discrimination. International Diabetes Federation 166 Chaussee de La Hulpe B-1170 Brussels Belgium Tel: Fax: info@idf.org Website: Health and Welfare Commonwealth Ministers Reference Book 2012 l 253

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8 Extract from the Commonwealth Ministers Reference Book featuring Britannia Industries Limited