2018 High-Level Meeting on NCDs – what now?

On the 27th September Member States will adopt a Political Declaration that falls well short of our hopes and does not represent the turning point we needed in the global NCD response. It lacks much of what we need, and a lot of what we expected, including a direct reference to the WHO ‘Best buys’ and other recommended actions, and a clear commitment by Member States to cost-out national plans or a diary note to have a further HLM ahead of the 2025 deadline when the NCD global targets should be delivered.

This underscores that we are facing a major challenge. Despite having three High Level Meetings over the last 7 years, and placing cancer and the other NCDs in the SDGs, we still have not seen global commitments make dramatic change at a national level. Moreover, some countries appear to be back peddling on agreed “Best buys” and are undermining the decisions of their predecessors. This is unacceptable and should be called out. NCDs are the leading cause of mortality globally and cancer the second single leading cause. Updated data from our colleagues at IARC in GLOBOCAN 18 estimates that 18.1 million more people will be diagnosed with cancer this year and a further 9.6 million will lose their lives – another increase since the last set of figures in 2015. We regularly call for political champions to fight the good NCD fight, but what 2018 has taught us is that the appetite to tackle NCDs at a global level is waning and it is at national level where the action must now take place.

Recently, Richard Horton described cancer as the “Cinderella” of the NCD movement. In some respects, he is right to call that out because there are many whose natural instinct is to sideline cancer treatment and care because they consider it to be too expensive or complicated to address. But just as Cinderella’s prospects ultimately change, cancer’s prospects are also changing.. The truth is that cancer is a priority in almost all countries – how can governments ignore it? So the real challenge we face is how to channel that concern into action and the release of dollars needed to improve treatment and care. Some countries believe this too. Seventeen countries put their name to the 2017 World Health Assembly Cancer Resolution, making a public commitment that they will increase their investment in cancer control. To our delight this has been borne through in negotiations around the Political Declaration and broader conversations here in Geneva, New York and in capitals. We are seeing numerous countries stepping up to call for more action on treatment and care, build universal health coverage plans that respond to the needs of cancer patients, and invest in core cancer services as a development priority. A review of National Cancer Control Plans by the International Cancer Control Partnership shows that the number of cancer control plans being implemented is increasing year on year. There is progress.

We have also seen from the HLM preparatory process that the global NCD community has a strong voice, and that voice is amplified by the 1,100 cancer organisations who are members of UICC. Each of them works with their national government to address the growing burden of cancer we are all facing. It is seven years until the next global review of progress on NCDs and I hope that by then we will be able to report a significant change in the way cancer is addressed country by country.

"The voices of cancer patients, those living with a cancer diagnosis and the families of those affected by cancer around the world are coming together as we have never seen before. Their rallying call is to see investment in cancer treatment and care increase in the coming years. We cannot rely on cancer prevention alone – even countries that have successfully reduced tobacco use will still need to uplift their treatment facilities to respond to the growing number of people who will develop cancer."

So where do we move from here, given that the document in front of us on the 27th September takes us no further than the ones in 2011 and 2014? Is it possible to pursue global commitments when the mechanics of diplomacy includes countries that backtrack on previous agreements and choose to turn a blind eye to the plight of other countries, particularly low- and middle-income, suffering from the burden of cancer? I would suggest we start with what we do have. The 2017 World Health Assembly Cancer Resolution sets out a clear framework for action, while the commitments that pre-date it lay a strong foundation. Bringing these together, we see the next seven years as being full of opportunity, available to those countries prepared to make cancer a priority.

To help us get there UICC and its members have created a new global initiative called Treatment for All. The campaign pinpoints where we can get the ball moving, globally and nationally, to start changing things for cancer patients. Our community’s work is incredibly diverse, and so rather than duplicating the work of experts in the field, we are asking anyone with a stake in cancer control to look at the four pillars for action and identify if, how, and when they can support changing the treatment paradigm in their country.

We need national political champions and a groundswell of support from national actors to start implementing what we know works. Let’s view the next 7 years of barren global consensus building as a time to drive meaningful action at a national level. All countries can accelerate their response to cancer treatment and care and UICC and its members are ready to step up to support them in that ambition. Cinderella will marry the prince!