Non-communicable diseases: 2015 to 2025

In 2012, the World Health Assembly endorsed an important new health goal: to reduce avoidable mortality from non-communicable diseases (NCDs) by 25% by 2025 (the 25 by 25 goal). Although a valuable step forward, quickly building on the UN General Assembly’s 2011 political declaration on the prevention and control of NCDs, the obstacles to achieving this goal are great and largely undiscussed, thanks to their deep political sensitivity. It remains a truth today that, despite global rhetoric and resolutions, chronic NCDs remain the least recognised group of conditions that threaten the future of human health and wellbeing. There is almost a taboo about substantively engaging with this most pressing of health predicaments. At a highly successful meeting to discuss the future of maternal health, held in January, 2013, in Arusha, Tanzania, one doctor from Zimbabwe pointed out that although it was completely correct to place the highest possible priority on health outcomes for women during pregnancy and childbirth, she was horrifi ed at the neglect still shown towards other causes of women’s ill-health— eg, hypertension, stroke, cancer, and asthma. She saw women daily in primary care clinics with these conditions, yet she also saw no serious commitment by donors or countries to create programmes to address these diseases and their risk factors. In her opening address to this same conference, the Minister of Health for Rwanda, Agnes Binagwaho, noted that cervical cancer now kills more women in the world than pregnancy and childbirth. Last year, The Lancet published work from 27 sub-Saharan African countries showing that maternal obesity had become a signifi cant risk for early neonatal death. So where are the global conferences on NCDs, the research meetings, the task forces, the grand challenges initiated by funders and foundations? They don’t exist. We, the global health community, understand that chronic diseases are a present danger to the health of our societies. Yet we are unable to translate that understanding into real political action. We cannot quite bring ourselves to put heart disease, stroke, cancer, chronic respiratory disease, diabetes, or mental illhealth, together with their associated risk factors, on an equal footing with childhood pneumonia and diarrhoea, preventable maternal death, or epidemics of AIDS, tuberculosis, and malaria. The disconnect between the reality of people’s lives in countries and the concerns of professional and political leaders has rarely been greater. The Lancet Series on NCDs is the fourth phase of our work to encourage decision makers to take NCDs more seriously. That eff ort began in 2005, when, in collaboration with WHO, we made the case for chronic diseases as a neglected priority in global health. In 2007, we returned with work showing that scaling up population-level (tobacco control and salt reduction) and individual-level (medicines) interventions could readily avert millions of preventable deaths. In 2010, we reframed that evidence in a development rather than a purely health context, making the political and economic case for giving greater attention to NCDs. We also added diet, physical activity, and health system strengthening to the growing list of interventions to control this most diverse of epidemics. With our latest Series, we have sought to adapt the core messages of The Lancet NCD Action Group, this time around the post-Millennium Development Goal notion of sustainable development. We also try to build on past work by focusing on country actions (rather than merely global political or multilateral agency responses), inequalities, the harmful eff ects of the food and drink industries, access to essential medicines, and improving the responsiveness of health systems. Our objective, together with earlier and related Lancet Series on obesity and physical inactivity, is to present the case for including NCDs as part of the post-2015 framework being developed now and over the next 2 years by governments and the UN system. That framework includes systems Published Online February 12, 2013 http://dx.doi.org/10.1016/ S0140-6736(13)60100-2