Reducing premature deaths from NCDs by 45% − a bold vision discussed by NCD programme directors in Moscow
More than 100 international experts on noncommunicable diseases (NCDs) convened in Moscow, Russian Federation, on 8–9 June 2017. Together they discussed the feasibility of the WHO European Region exceeding the global target and reducing premature mortality from NCDs by 45% by 2030.
The experts presented and discussed progress and opportunities in tackling cardiovascular diseases, cancer, diabetes and chronic respiratory diseases through addressing their main risk factors. The Russian Minister of Health and the representative of the State Duma also reiterated the Russian Federation’s dedication in this area.
The Russian Government has invested strongly in reducing mortality from NCDs. At the national level it prioritized tackling NCDs within domestic policies, and at the international level it funds the WHO European Office for the Prevention and Control of NCDs (the NCD Office) in Moscow. The NCD Office strengthens WHO’s capacity to lead NCD prevention and control in the Region, and positions the Russian Federation as a leader in global health.
In his video address to participants, Sir George Alleyne, Director Emeritus of the Pan American Health Organization, noted, “Your Region is a leader in the world in terms of reduction of premature mortality, and the achievements of your Region is one of the reasons for my optimism. Over the course of the years you have demonstrated it is possible to achieve a reduction in premature mortality.”
The opening presentations illustrated how Europe is leading other continents in reducing the risk of dying prematurely from NCDs. However, major inequities persist in the Region both between women and men and geographically. For example, the risk of men from eastern European countries dying from an avoidable NCD far outweighs the risk for men of the same age from western European countries. Most of these deaths are from strokes and heart attacks, which present an area for major gains through public health actions.
Implementing policies that make a difference
Several presentations pointed to the experience of the last two decades, which shows that a dramatic reduction of tobacco use and alcohol consumption is possible with strong political will. This supports the aspiration to reduce premature mortality by more than 33%. Doing so will require governments to implement policies proven to be effective, such as tobacco and alcohol taxation, blood pressure measurement and hypertension treatment.
Dr Jürgen Rehm, Director of the Institute for Mental Health Policy Research at the Canadian Centre for Addiction and Mental Health, used Finland as an example of the effect of taxation. Taxation on alcohol was lowered when the country became a member of the European Union, and death rates markedly went up. This primarily affected people in lower social classes. When taxes were increased again, the death rate went down.
Similarly, Turkey has one of highest tobacco taxation rates (83%) and has seen a substantial decrease in consumption. At the same time, it has significantly increased taxation revenue (281%).
Furthermore, taxation can delay or deter the initiation of drinking and tobacco use. This underscores the cost–effectiveness of an increase in excise taxes, and supports the recent decision at the World Health Assembly in Geneva, Switzerland, to endorse taxation as a best buy for preventing NCDs.
Cardiovascular health and NCDs
Another presentation underlined the promotion of cardiovascular health as a key to decreasing premature mortality. Current efforts by nongovernmental organizations and Member States include raising awareness of stroke and high blood pressure, and encouraging better diets by implementing nutrient profiling, introducing front-of-pack labelling of foods, and raising awareness of the role that nutrition and reduced salt intake play in cardiovascular health.
Experts also pointed to the treatment of hypertension as a major contributor to reducing cardiovascular deaths. Largely taking place at the country level, it would benefit from a unified and multidisciplinary approach.
Health systems’ contribution to tackling NCDs
A series of presentations and discussions highlighted the importance of physicians playing a larger role in promoting healthy lifestyles and in adopting a patient-oriented approach of self-management.
Further contributions from health systems include assuring access to medicines, training clinicians and supporting community initiatives. This necessitates a multisectoral effort to establish structured, integrated care. It involves acknowledging the important role of patient organizations, applying effective approaches to other risk factors and considering complementary policies that can be applied together.
Partnerships, innovation and information
Experts emphasized the formidable challenge posed by industry – the tobacco industry in particular, but also the food industry, which seeks credibility through establishing public health partnerships. They put forward the key message that it is problematic to partner with an industry whose products undermine public health, and when company profit is valued above public interest.
Speakers offered Israel’s experience in using electronic medical records and upgrading information systems as an example of how information can determine effectiveness. They noted that information can help direct scarce resources to maximize impact and move health systems towards personalized treatment and care, thus reducing overtreatment and overdiagnosis.
Presentations also established the rationale for acting at the population level to prevent and treat NCDs. Experts urged countries to assess whether a policy has an impact on a population by looking at the data in a natural environment. This involves conducting so-called natural experiments, such as monitoring the health effect of introducing a sugar tax in one city by comparing it to a neighbouring city with no sugar tax.
Major scope for accelerating achievement
Throughout the meeting, countries described challenges and shared successes at the national level. They covered areas such as childhood obesity, tobacco legislation, creating urban environments conducive to physical activity, front-of-pack food labelling, measuring blood pressure and introducing the STEPwise approach to surveillance (STEPS) survey.
They agreed that more needs to be done to implement the best buys in the Region, including taxation of alcohol and tobacco. Furthermore, knowledge from existing taxation and price policies can be applied to other areas such as foods.
Despite being uneven, the progress made so far and the opportunities for advances through innovations and new technologies confirm that the Region can go far beyond the SDG target for reducing premature mortality. If well implemented across the Region, the interventions reviewed at the meeting could make a 45% reduction in premature deaths by 2030 possible.