Abstract
This paper assesses progress in the development of a global framework for responding to non-communicable diseases, as reflected in the policies and initiatives of the World Health Organization (WHO), World Bank and the UN: the institutions most capable of shaping a coherent global policy. Responding to the global burden of chronic disease requires a strategic assessment of the global processes that are likely to be most effective in generating commitment to policy change at country level, and in influencing industry behaviour. WHO has adopted a legal process with tobacco (the WHO Framework Convention on Tobacco Control), but a non-legal, advocacy-based approach with diet and physical activity (the Global Strategy on Diet, Physical Activity and Health).The paper assesses the merits of the Millennium Development Goals (MDGs) and the FCTC as distinct global processes for advancing health development, before considering what lessons might be learned for enhancing the implementation of the Global Strategy on Diet. While global partnerships, economic incentives, and international legal instruments could each contribute to a more effective global response to chronic diseases, the paper makes a special case for the development of international legal standards in select areas of diet and nutrition, as a strategy for ensuring that the health of future generations does not become dependent on corporate charity and voluntary commitments. A broader frame of reference for lifestyle-related chronic diseases is needed: one that draws together WHO's work in tobacco, nutrition and physical activity, and that envisages selective use of international legal obligations, non-binding recommendations, advocacy and policy advice as tools of choice for promoting different elements of the strategy.
Highlights
Since 1970, life expectancy at birth has improved steadily, rising 7, 8 and 9 years, respectively, within high, middle and low income countries to reach 79, 70 and 58 years, as measured from data for the period 2000–2005 [1]
According to World Health Organisation (WHO) estimates, noncommunicable diseases accounted for nearly 59% of the 57 million people who died in 2002 [3]
This paper argues that global and national partnerships, economic incentives, and international legal instruments could each contribute to a more effective global response to chronic diseases
Summary
Since 1970, life expectancy at birth has improved steadily, rising 7, 8 and 9 years, respectively, within high, middle and low income countries to reach 79, 70 and 58 years, as measured from data for the period 2000–2005 [1]. The FCTC has improved the visibility of tobacco as the world's leading cause of preventable disease, but obesity, diet and physical activity are yet to achieve priority status, despite growing policy interest in obesity in developed countries. The Millennium Development Goals (MDGs) and the Framework Convention on Tobacco Control (FCTC) reflect two different processes for advancing global health policies. The FCTC process lacks the "shared ownership" of global policy goals that characterizes the UN/ WHO/World Bank response to the MDGs. The mutually reinforcing influences made possible through partnerships could significantly assist an agency such as WHO, which has limited resources of its own, and whose political influence is centred on Health Ministries. The development of legal standards in key areas could strengthen a wider strategy on non-communicable diseases comprising legal and policy elements, with careful use of partnerships and economic incentives
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