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The UN Summit and beyond: A new era for diabetes
diabetes research and clinical practice 94 (2011) 163–165
Contents available at Sciverse ScienceDirect
Diabetes Research and Clinical Practice journ al h ome pa ge : www .elsevier.co m/lo cate/diabres
International Diabetes Federation
The UN Summit and beyond: A new era for diabetes
Ann Keeling, CEO, International Diabetes Federation. It has been a long journey to elevate diabetes and NCDs onto the global stage, but finally our determination and efforts have paid off. World leaders gathered in New York on 19–20th September for the first ever UN high-level Summit on noncommunicable diseases (NCDs) and agreed a political declaration that has changed the global health agenda forever. As one of the earliest voices calling for a UN Summit, the International Diabetes Federation has worked tirelessly from the global to national level to ensure strong outcomes for the millions of people with diabetes worldwide. This editorial reflects on the impact of the Summit, the implications of the outcomes for the global diabetes community, and priorities for the post-Summit world.
1.
Impact of the UN Summit
The decision to hold the Summit and the preparations leading up to it changed the global health landscape. It focused attention on diabetes and NCDs like never before-people who did not know the issues do now, people who did not know the numbers have been shocked to learn them and discussions have been held all over the world on NCDs among NGOs, governments, international organisations and the private sector. The United Nations official process for the Summit included WHO Regional Consultations on NCDs, many resulting in official Declarations which highlighted the priorities of governments in diverse regions and offered insights into differences between governments and political
blocs for the Political Declaration negotiations. The WHO led a number of multi-sectoral consultations, co-hosted the First Global Ministerial Conference on NCDs in the Russian Federation and the UN convened a Civil Society Hearing in June at UN Headquarters which provided further opportunities for government decision makers to familiarise themselves with NCD evidence and issues and hear the priorities of civil society. Alongside the increase in dialogue on NCDs, the Summit process also led to a strengthening of the evidence base through the publication of reports and research studies on NCDs. The World Health Organization’s Global Status Report on NCDs, the UN Secretary General’s Report on NCDs, and the complementary World Economic Forum’s Cost of Inaction Study and WHO’s Cost of Action Report have all provided much needed data and insight into these under-prioritised diseases. IDF and the NCD Alliance have also produced a number of policy briefs aimed at policy makers to raise awareness on specific topics such as women and NCDs, essential medicines and technologies, tobacco control, physical activity and nutrition, and NCDs as a human rights issue. Another significant marker of Summit preparations was the strengthening of alliances and partnerships to tackle the global NCD epidemic. IDF and its sister federations in the NCD Alliance created an NCD civil society movement in record time, working together across diseases for a common cause. This civil society movement is here to stay and will be integral to continuing momentum and monitoring commitments postSummit. Influential relationships were built with Governments, the private sector and NGOs working in inter-related development issues such as maternal and newborn child health (MNCH), HIV/AIDS and TB. IDF and NCD Alliance partners produced two influential articles on NCD priorities and solutions with the NCD working group of the influential medical journal, The Lancet. Exchange of best practice and innovative solutions in diabetes and NCD prevention and control have been promoted via these new alliances.
2.
Outcomes of the UN Summit
Summit preparations have undoubtedly built momentum for diabetes and NCDs. But Summit outcomes will determine
164
diabetes research and clinical practice 94 (2011) 163–165
future action. The Political Declaration that was signed by Heads of State and Government at the UN Summit was a hardfought battle. Governments failed to reach consensus on many important issues during the summer negotiations, and ended up stalling the process mid-way because of this. But a consensus has been reached and while not everything we asked for, the Political Declaration is undoubtedly a major milestone in the history of diabetes and NCDs. It builds on UN Resolution 61/225 on Diabetes in demonstrating that world leaders have recognised the magnitude and impact of the diabetes and NCD problem, and the urgent need for action. While the commitments in some key areas are not as strong as they could be, and many lack teeth without targets and timetables, the Declaration will accelerate international progress on diabetes and NCDs and provides a framework for saving millions of people from preventable death and disability. Importantly for people with diabetes, the Declaration commits governments to increasing access to affordable, safe, effective and quality-assured medicines and technologies. It achieves a balance of commitments on medicines and improving diagnostic services, which are equally important for people with diabetes. The dependency of delivery of care on a well-functioning health system is also well recognised in the Declaration, containing commitments to promote universal coverage in national health systems and training and retention of health workers among others. From the diabetes prevention perspective, the Declaration includes commitments to promote healthy diets and increase physical activity through urban planning, active transport and work-site healthy lifestyle programmes. While no targets have been agreed, governments have still taken a step forward and committed to reducing salt, sugar, and saturated fats, and eliminating industrially produced trans-fats in foods. There is a strong focus on reducing childhood obesity and restrictions on the marketing to children of foods high in fats, sugar and salt have been agreed. Furthermore, the Declaration promotes a life course approach to prevention and the inclusion of NCDs in reproductive, maternal and newborn child health programmes due to the link between maternal under-nutrition and increased risk of the infant developing diabetes later in life. The two major weaknesses of the Declaration are the lack of time-bound targets to help create a shared political vision for the future, and the failure to agree a high-level multisectoral partnership to drive follow-up action. Both of these decisions have been postponed until 2012. Governments will agree to a comprehensive global monitoring framework for NCDs and a set of voluntary global targets and indicators in 2012 and in the same year will define the partnership. Delaying these critical decisions weakens them as they will not be signed off by Heads of Government and State at the Summit itself. However, if this longer decision-making process provides the opportunity for all sectors, particularly civil society, to contribute to the thinking and results in strong outcomes, it will be an acceptable second best. A third weakness, although not surprising considering the current global economic recession, is concrete commitments on resources. While the Declaration recognises that resources devoted to dealing with NCDs are not commensurate with the
magnitude of the problem, it only requests Member States to investigate options for potential sources of funding. Encouragingly however, it does specify bilateral and multilateral channels, which to date have been limited for diabetes and NCDs, as well as innovative long-term financing approaches and taxation policies. In terms of follow-up, Member States have agreed to hold a comprehensive review and assessment in 2014. This review will provide an opportunity to track commitments made in the present Declaration and assess progress on the global targets and indicators that Member States should deliver on in 2012. It will also provide an opportunity to ensure that diabetes and NCDs are integrated with other health priorities in future internationally-agreed development goals when the current Millennium Development Goals end in 2015.
3.
No magic bullets
IDF called for a UN Summit to kick-start change, which it has achieved. But one Summit will not solve all the problems in diabetes and NCDs. There are no magic bullets for this epidemic. It will take decades to turn this global catastrophe around, and it is important to recognise the need for this longterm vision. Now that commitments have been made, it is up to governments to implement them and this will require sustained leadership and political will. To support governments and inspire leadership over the next decade, IDF has launched the first ever Global Diabetes Plan 2012–2021. Developed by world experts, the Plan presents the costeffective solutions and a framework of action to guide governments, healthcare providers, and civil society in the short to medium term. The Global Diabetes Plan completes the delivery of a range of impressive IDF documents on diabetes in the lead up to the Summit, including the Call to Action on Diabetes, the International Charter of Rights and Responsibilities of People with Diabetes, and a Guide to National Diabetes Programmes. As a federation of 220 member associations in 160 countries, IDF is ready to support and lend expertise and guidance to governments in the post-Summit world. Translating commitments into action will also require a new level of partnership. Beyond the Summit IDF envisages ‘Triple P Partnerships’ involving public and private sectors and the people. The HIV/AIDS movement has shown how important and effective the involvement of people living with HIV has been to the global response. The NCD movement still has work to do to ensure people with diabetes and NCDs are involved at all levels, from global policy to services design on the ground. Only then will we see effective partnerships and real change for people with diabetes. People with diabetes and NCDs also need to be centre stage to shift political momentum down to the grass roots level. Just as the HIV/AIDS movement has done so effectively, we need people with these diseases to stand up and demand their right to health and the right to universal access to medicines. Accidents of geography still determine whether people with diabetes live or die. Children are dying from type 1 diabetes in low-income countries, yet insulin was discovered 90 years ago and children with type 1 in high-income countries can live long and healthy lives. This is a violation of human rights, yet a
diabetes research and clinical practice 94 (2011) 163–165
sense of outrage is still missing from the diabetes and NCD movement. In the post-Summit world, IDF will continue to nurture a movement that is based on rights and that has people with diabetes at the heart.
4.
A new era for diabetes
The UN Summit on NCDs and the Political Declaration that was agreed marks the beginning of a new era for diabetes. It was inconceivable two years ago that diabetes and other NCDs would have achieved the prominence they have today without the catalyst of the Summit. Diabetes and NCDs are now on the
165
global agenda and they will not slip back into obscurity. With courage, leadership and a long-term vision, a new future is possible for people with diabetes and NCDs. IDF is proud to have been at the forefront of this important milestone in the history of diabetes, and we will continue to mobilise and monitor progress for the millions of people with diabetes worldwide. Ann Keeling CEO, International Diabetes Federation, 166 Chausse´e de La Hulpe, Brussels B-1170, Belgium 0168-8227/$ – see front matter doi:10.1016/j.diabres.2011.09.014
Contents available at Sciverse ScienceDirect
Diabetes Research and Clinical Practice journ al h ome pa ge : www .elsevier.co m/lo cate/diabres
International Diabetes Federation
The UN Summit and beyond: A new era for diabetes
Ann Keeling, CEO, International Diabetes Federation. It has been a long journey to elevate diabetes and NCDs onto the global stage, but finally our determination and efforts have paid off. World leaders gathered in New York on 19–20th September for the first ever UN high-level Summit on noncommunicable diseases (NCDs) and agreed a political declaration that has changed the global health agenda forever. As one of the earliest voices calling for a UN Summit, the International Diabetes Federation has worked tirelessly from the global to national level to ensure strong outcomes for the millions of people with diabetes worldwide. This editorial reflects on the impact of the Summit, the implications of the outcomes for the global diabetes community, and priorities for the post-Summit world.
1.
Impact of the UN Summit
The decision to hold the Summit and the preparations leading up to it changed the global health landscape. It focused attention on diabetes and NCDs like never before-people who did not know the issues do now, people who did not know the numbers have been shocked to learn them and discussions have been held all over the world on NCDs among NGOs, governments, international organisations and the private sector. The United Nations official process for the Summit included WHO Regional Consultations on NCDs, many resulting in official Declarations which highlighted the priorities of governments in diverse regions and offered insights into differences between governments and political
blocs for the Political Declaration negotiations. The WHO led a number of multi-sectoral consultations, co-hosted the First Global Ministerial Conference on NCDs in the Russian Federation and the UN convened a Civil Society Hearing in June at UN Headquarters which provided further opportunities for government decision makers to familiarise themselves with NCD evidence and issues and hear the priorities of civil society. Alongside the increase in dialogue on NCDs, the Summit process also led to a strengthening of the evidence base through the publication of reports and research studies on NCDs. The World Health Organization’s Global Status Report on NCDs, the UN Secretary General’s Report on NCDs, and the complementary World Economic Forum’s Cost of Inaction Study and WHO’s Cost of Action Report have all provided much needed data and insight into these under-prioritised diseases. IDF and the NCD Alliance have also produced a number of policy briefs aimed at policy makers to raise awareness on specific topics such as women and NCDs, essential medicines and technologies, tobacco control, physical activity and nutrition, and NCDs as a human rights issue. Another significant marker of Summit preparations was the strengthening of alliances and partnerships to tackle the global NCD epidemic. IDF and its sister federations in the NCD Alliance created an NCD civil society movement in record time, working together across diseases for a common cause. This civil society movement is here to stay and will be integral to continuing momentum and monitoring commitments postSummit. Influential relationships were built with Governments, the private sector and NGOs working in inter-related development issues such as maternal and newborn child health (MNCH), HIV/AIDS and TB. IDF and NCD Alliance partners produced two influential articles on NCD priorities and solutions with the NCD working group of the influential medical journal, The Lancet. Exchange of best practice and innovative solutions in diabetes and NCD prevention and control have been promoted via these new alliances.
2.
Outcomes of the UN Summit
Summit preparations have undoubtedly built momentum for diabetes and NCDs. But Summit outcomes will determine
164
diabetes research and clinical practice 94 (2011) 163–165
future action. The Political Declaration that was signed by Heads of State and Government at the UN Summit was a hardfought battle. Governments failed to reach consensus on many important issues during the summer negotiations, and ended up stalling the process mid-way because of this. But a consensus has been reached and while not everything we asked for, the Political Declaration is undoubtedly a major milestone in the history of diabetes and NCDs. It builds on UN Resolution 61/225 on Diabetes in demonstrating that world leaders have recognised the magnitude and impact of the diabetes and NCD problem, and the urgent need for action. While the commitments in some key areas are not as strong as they could be, and many lack teeth without targets and timetables, the Declaration will accelerate international progress on diabetes and NCDs and provides a framework for saving millions of people from preventable death and disability. Importantly for people with diabetes, the Declaration commits governments to increasing access to affordable, safe, effective and quality-assured medicines and technologies. It achieves a balance of commitments on medicines and improving diagnostic services, which are equally important for people with diabetes. The dependency of delivery of care on a well-functioning health system is also well recognised in the Declaration, containing commitments to promote universal coverage in national health systems and training and retention of health workers among others. From the diabetes prevention perspective, the Declaration includes commitments to promote healthy diets and increase physical activity through urban planning, active transport and work-site healthy lifestyle programmes. While no targets have been agreed, governments have still taken a step forward and committed to reducing salt, sugar, and saturated fats, and eliminating industrially produced trans-fats in foods. There is a strong focus on reducing childhood obesity and restrictions on the marketing to children of foods high in fats, sugar and salt have been agreed. Furthermore, the Declaration promotes a life course approach to prevention and the inclusion of NCDs in reproductive, maternal and newborn child health programmes due to the link between maternal under-nutrition and increased risk of the infant developing diabetes later in life. The two major weaknesses of the Declaration are the lack of time-bound targets to help create a shared political vision for the future, and the failure to agree a high-level multisectoral partnership to drive follow-up action. Both of these decisions have been postponed until 2012. Governments will agree to a comprehensive global monitoring framework for NCDs and a set of voluntary global targets and indicators in 2012 and in the same year will define the partnership. Delaying these critical decisions weakens them as they will not be signed off by Heads of Government and State at the Summit itself. However, if this longer decision-making process provides the opportunity for all sectors, particularly civil society, to contribute to the thinking and results in strong outcomes, it will be an acceptable second best. A third weakness, although not surprising considering the current global economic recession, is concrete commitments on resources. While the Declaration recognises that resources devoted to dealing with NCDs are not commensurate with the
magnitude of the problem, it only requests Member States to investigate options for potential sources of funding. Encouragingly however, it does specify bilateral and multilateral channels, which to date have been limited for diabetes and NCDs, as well as innovative long-term financing approaches and taxation policies. In terms of follow-up, Member States have agreed to hold a comprehensive review and assessment in 2014. This review will provide an opportunity to track commitments made in the present Declaration and assess progress on the global targets and indicators that Member States should deliver on in 2012. It will also provide an opportunity to ensure that diabetes and NCDs are integrated with other health priorities in future internationally-agreed development goals when the current Millennium Development Goals end in 2015.
3.
No magic bullets
IDF called for a UN Summit to kick-start change, which it has achieved. But one Summit will not solve all the problems in diabetes and NCDs. There are no magic bullets for this epidemic. It will take decades to turn this global catastrophe around, and it is important to recognise the need for this longterm vision. Now that commitments have been made, it is up to governments to implement them and this will require sustained leadership and political will. To support governments and inspire leadership over the next decade, IDF has launched the first ever Global Diabetes Plan 2012–2021. Developed by world experts, the Plan presents the costeffective solutions and a framework of action to guide governments, healthcare providers, and civil society in the short to medium term. The Global Diabetes Plan completes the delivery of a range of impressive IDF documents on diabetes in the lead up to the Summit, including the Call to Action on Diabetes, the International Charter of Rights and Responsibilities of People with Diabetes, and a Guide to National Diabetes Programmes. As a federation of 220 member associations in 160 countries, IDF is ready to support and lend expertise and guidance to governments in the post-Summit world. Translating commitments into action will also require a new level of partnership. Beyond the Summit IDF envisages ‘Triple P Partnerships’ involving public and private sectors and the people. The HIV/AIDS movement has shown how important and effective the involvement of people living with HIV has been to the global response. The NCD movement still has work to do to ensure people with diabetes and NCDs are involved at all levels, from global policy to services design on the ground. Only then will we see effective partnerships and real change for people with diabetes. People with diabetes and NCDs also need to be centre stage to shift political momentum down to the grass roots level. Just as the HIV/AIDS movement has done so effectively, we need people with these diseases to stand up and demand their right to health and the right to universal access to medicines. Accidents of geography still determine whether people with diabetes live or die. Children are dying from type 1 diabetes in low-income countries, yet insulin was discovered 90 years ago and children with type 1 in high-income countries can live long and healthy lives. This is a violation of human rights, yet a
diabetes research and clinical practice 94 (2011) 163–165
sense of outrage is still missing from the diabetes and NCD movement. In the post-Summit world, IDF will continue to nurture a movement that is based on rights and that has people with diabetes at the heart.
4.
A new era for diabetes
The UN Summit on NCDs and the Political Declaration that was agreed marks the beginning of a new era for diabetes. It was inconceivable two years ago that diabetes and other NCDs would have achieved the prominence they have today without the catalyst of the Summit. Diabetes and NCDs are now on the
165
global agenda and they will not slip back into obscurity. With courage, leadership and a long-term vision, a new future is possible for people with diabetes and NCDs. IDF is proud to have been at the forefront of this important milestone in the history of diabetes, and we will continue to mobilise and monitor progress for the millions of people with diabetes worldwide. Ann Keeling CEO, International Diabetes Federation, 166 Chausse´e de La Hulpe, Brussels B-1170, Belgium 0168-8227/$ – see front matter doi:10.1016/j.diabres.2011.09.014