Sania Nishtar’s Comments on the Round table on post 2015 at the International Conference on Nutrition, Rome, Italy November 19, 2014

Sania Nishtar 2Non-communicable disease is a collective name for four major diseases, CVD, diabetes, some cancers and chronic lung conditions

These 4 diseases, are linked by 4 lifestyle and four biological risks.

Diet is one of them

This afternoon, I would like to make 4 points about the relevance of NCDs to the global development agenda

First, I would like to point out that this is not a problem to be ignored

NCDs are the leading cause of death worldwide. They caused 38 million deaths in 2012, which is 68% of the world’s entire deaths that year. Most of these premature deaths are avoidable.  

Three quarters of all NCD deaths occur in the low and middle income countries where more than 250 million people also risk medical impoverishment or foregoing care when affected.

The cumulative economic losses due to NCDs between 2011 and 2025 are estimated to be around 7 trillion US$

Tacking NCDs is therefore now recognized as a necessary condition for sustainable development

Secondly, I would like to point out that after years of neglect, NCDs are finally likely to be included in the global development agenda

It is auspicious that world leaders committed to address NCDs in 2011 and that the UN-led global process following the political declaration has included NCDs as a target under health in its proposal for Sustainable Development Goals.

It is also favorable that we are starting from a well-prepared technical ground.

WHO has consolidated evidence in support of the NCD best buys, which are a set of cost-effective, high impact interventions, feasible for implementation in low resource settings.

This year the DG of WHO established the Commission on Ending Childhood Obesity and last year at the World Health Assembly, the Global NCD action plan was adopted. Its 6 objectives and 9 targets are aimed at achieving 25% relative reduction in premature mortality from NCDs by 2025. An accountability framework will ensure periodic reporting to the World Health Assembly.

This global progress is yet to be mirrored in countries; unfortunately, majority of the countries are off track in meeting global NCD targets.

But before analyzing country imperatives, I would like to reiterate, as my third point that both over and under-nutrition are relevant to NCDs as risks in what is referred to as the nutrition transition

Over nutrition takes a recognized toll with obesity being one of the 4 biological risk factors

But on the other hand, under-nutrition, especially in early age is also a risk for NCDs and along with subsequent obesity has a synergistic effect on adult NCDs.

Poorly nourished mothers deliver infants programmed before birth to develop risk of NCDs later in life.

The nutrition transition is well underway in settings where pervasive poverty and food insecurity coexist with rapid economic, demographic and health transitions…and where the adverse effect of urbanization, globalization and overconsumption are ushering in an epidemic of obesity and overweight, including in children.

This creates an imperative to shift from food security to nutrition security in the post 2015 setting

A healthy diet can contribute to achieving global NCD targets. Polices, which promote accessibility, affordability, and acceptance of plant-based diets and breast feeding and those that enable reduced intake of salt, sugar, animal fat and trans-fat and highly processed foods….more broadly, policies that support implementation of WHO’s Global strategy on diet and physical activity and the global strategy for infant and young child feeding could prevent millions of deaths.

These approaches to tackling NCDs straddle many policy arenas.

As a fourth point therefore, I would like to touch upon the complex inter-dependencies between diet, disease, sustainability and development.

On the one hand, diet is a leading risk factor for NCDs. On the other food production is a major driver of climate change and environmental degradation

Human and planetary health is deeply interlinked, which creates an opportunity for common solutions

Economic incentives in the food system can influence both the nutritional quality of food as well as the environmental footprint

Synergies can be exploited, …. e.g., between fishery sustainability and aquaculture and the NCD recommendations to increase in fish intake

Between recommendations supporting white meat and poultry farming, which is relatively more environmentally advantageous.

The post-2015 framework is a potentially favorable context to reshape nutrition and sustainability policy for more than 6 billion people on this planet

Governments have a leading role and responsibility to address malnutrition but these tasks cannot be undertaken by one government sector

As there are complex interactions and interdependencies in the public policy space

And that is where the challenge lies

We envisage governments to be a single entity, but they are in effect an archipelago of many agencies and ministries.

The whole-of-government approach and multi-sectorial action which are critical for nutrition policy become a challenge when agencies have a disincentive to collaborate.

We therefore need a shift in policymaking for nutrition as there is need to involve several government ministries and agencies in this effort.

Such a shift towards multi-sectorial collaboration would require intermediary agencies, instruments for asset allocation and mapping, incentives for collaboration, and metrics for whole of government performance assessment are needed.

Beyond that, inter-sectorial collaboration is also needed to harness the potential of civil society and to forge transparent partnerships with the private sector for policy implementation

Mainstreaming NCDs into country health planning also requires health systems reorientation, and more broadly health systems strengthening

Eblola has been a wake-up call

But our inattention to NCDs is unfolding a disaster many times over, except that it is happening in slow motion

There are complementarities between the public policy agendas of Universal health Coverage and NCDs, both of which are now in the post 2015 framework

We must regard these policy asks as measures to support a county’s human capital, which is a vital input towards the national process of development…….As I am sure you will all agree

I thank you



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