Accountability on NCDs: The missing link between commitment and action

Non-communicable diseases (NCDs) are indiscriminate killers – they can attack any individual regardless of their race, nationality or economic standing – but 86% of premature deaths due to NCDs occur in low- and middle-income countries (LMICs) and poorer and marginalised groups in all countries are disproportionately affected. Without urgent policy action, the global burden of NCDs is expected to increase by 17% by 2025, with most of this burden falling on LMICs. The World Health Organization (WHO) has demonstrated, however, that if cost-effective policy actions were implemented to tackle NCDs, nine million lives could be saved by 2025.

Finally recognising NCDs as a health issue of critical importance – as well as a development issue, a security issue and a human rights issue – governments added NCDs to national and global health and development agendas at the first United Nations High-Level Meeting (UN HLM) on NCDs in 2011. Health Ministers subsequently adopted the Global Action Plan for the Prevention and Control of NCDs 2013-2020, with its overarching goal to reduce the number of premature deaths from NCDs by 25% by 2025. 

The Global Action Plan aims to achieve its objective through nine global targets, focusing on four major diseases (cardiovascular diseases, cancer, diabetes and chronic respiratory diseases) and four risk factors (alcohol, insufficient physical activity, unhealthy diet, tobacco use). Other commitments to address NCDs and the risk factors driving them have been made at subsequent UN meetings of Heads of State in 2014 and 2018. Since 2018, mental health has been added to the NCDs requiring urgent global action and air pollution has been recognized as a fifth major global risk factor.

In September 2015, the United Nations General Assembly formally adopted the universal 2030 Agenda for Sustainable Development, along with a set of 17 Sustainable Development Goals (SDGs). SDG 3.4 addresses NCDs specifically, with the aim to reduce premature mortality from NCDs by one third by 2030. In addition to the High-Level Meetings on NCDs, NCDs were well reflected in the 2019 HLM on Universal Health Coverage (UHC). More recently, WHO drafted the Global Strategy for the Elimination of Cervical Cancer, to mobilise the international health community and ensure that future generations of women do not die from this largely preventable cancer. 

Thanks to plans and commitments like these, the world now has a truly global agenda for the prevention and control of NCDs, with shared responsibilities for all countries based on concrete targets. But progress remains unacceptably slow and many promises that have been made have yet to translate into tangible action and results. More than half of the world’s countries are likely to miss the targets for SDG 3.4, with only 35 countries for women and 30 countries for men that are on track to achieve the goal. And so lives continue to be lost to often preventable or treatable diseases. Shockingly, NCD mortality has stagnated or increased since 2010 in 15 for women countries and in 24 countries for men, meaning that people are dying younger.

How to translate commitments into actions and results

Until this vast gap between commitments made and action taken is closed, the world will continue to suffer disability and death from NCDs. One of the most crucial elements in bridging this gap is effective accountability, defined as a cyclical process of monitoring (data collection), review (analysis) and action (advocacy and dissemination of messages). In other words, looking at what decision-makers have promised to do alongside what they have actually done and achieved. This might include national, regional or local governments, public institutions, international agencies, or private sector entities. 

Effective accountability also analyses actions taken, to learn more about what works, what doesn’t and why. Beyond raising awareness and putting pressure on governments, sharing this information can help countries everywhere to find what works best in their specific context, in order to advance faster and more effectively. WHO and the UN have accountability mechanisms for NCDs in place and these can be strengthened by independent, civil society-led actions, especially at the national level. There are also different tools available to help organisations carry them out effectively. 

One way to take action is to produce Civil Society Status Reports, which are a form of civil society monitoring, with the aim of understanding national or regional responses to NCDs and assessing them from a civil society perspective. The information that is gathered can then be used to make NCDs an election issue, drive advocacy and inform policy-making within governments and decisions within other organisations.

The NCD Alliance Accountability Toolkit can also be used to guide an assessment of national or regional progress in achieving NCD-related goals and targets. The toolkit provides a Benchmarking Tool, with a practical outline for how to assess the NCD response in a specific country or region. 

As part of the effort to increase and align NCD civil society’s accountability actions, the NCD Alliance has also dedicated the Global Week for Action 2020, taking place this year from September 7-13, to the theme of accountability. It calls on everyone to get involved in holding governments, industries and other stakeholders accountable for their commitments through actions of all sizes. The Week gathers its strength and momentum through the collective efforts of the NCD civil society movement and offers many suggestions for taking accountability action.

Civil society plays a key role in holding governments and other stakeholders accountable – and together we are stronger. We must collaborate and align our efforts towards making sure that commitments become results, that promises to turn the tide on the NCD epidemic become reality in all countries. The message coming from around the world is loud and clear – we have had enough of preventable death and suffering. The time is now to see NCD promises become progress.