27 September 2018
Third High-Level Meeting on Non-Communicable Diseases, AM & PM Meetings

Approving Draft Declaration, World Leaders in General Assembly Pledge Increasing Multi-Stakeholder, Multisectoral Response to Tackle Non-Communicable Diseases

World leaders in the General Assembly today vowed to scale up efforts to prevent and control non‑communicable diseases, approving a draft political declaration during a high‑level meeting that commits them to providing greater policy coherence through a whole‑of‑Government approach.

Held under the theme, “Scaling up multi‑stakeholder and multisectoral responses for the prevention and control of non‑communicable diseases in the context of the 2030 Agenda for Sustainable Development”, the meeting featured two panel discussions and a plenary debate.  It is the Assembly’s third meeting on the issue since its landmark 2011 summit and 2014 review, with the draft declaration to be sent to the Assembly plenary for adoption at a later date.

By its terms, Heads of State and Government reaffirmed their political commitment to accelerate implementation of the 2011 Political Declaration and the outcome of the 2014 high‑level review, “which continue to inspire our action and catalyse our efforts” to prevent and control non‑communicable diseases.  They vowed to take ambitious multisectoral national responses, integrating action on prevention and control with promotion of mental health and well‑being.

Other efforts focused on scaling up efforts to reduce tobacco use, harmful alcohol use, unhealthy diets and physical inactivity, notably through cost‑effective, evidence‑based interventions to halt obesity.  A national investment case should be developed, they stated, to raise awareness about the national public health burden caused by non‑communicable diseases and health inequities, with information on the success of such policies shared with global and regional partners.

Importantly, health systems should be strengthened — and reoriented — towards the achievement of universal health coverage and improvement of health outcomes, while greater access to affordable, safe, effective and quality medicines and diagnostics should be promoted.  Leaders requested the Secretary‑General to submit a progress report by the end of 2024 in preparation for a high‑level review in 2025.

Hailing the draft as “ambitious and balanced”, Assembly President María Fernanda Espinosa Garcés (Ecuador) said 15 million people between the ages of 30 and 70 will die in 2018 because of non‑communicable diseases — 80 per cent of them in developing countries.  The poorest will likely suffer most from illnesses such as cancer, diabetes and cardiovascular disease, which more broadly lead to annual gross domestic product (GDP) losses of up to 6 per cent.

Deputy Secretary‑General Amina J. Mohammed said fighting non‑communicable diseases requires a new way of thinking about prevention.  She advocated holistic primary health care and systems able to ensure comprehensive coverage.  Efforts must be part of a larger ecosystem that supports physical and mental well‑being and promotes clean air and clean cities.  “I call on you, as leaders, to fulfil the commitments you have already made,” she said.

With that in mind, Tedros Adhanom Ghebreyesus, Director General, World Health Organization (WHO), said Governments are “dangerously off course” in efforts to reduce such premature deaths by one third over the next 12 years, as outlined in 2030 Agenda target 3.4.  He drew attention to WHO “best buys” — interventions that include a tobacco tax, restrictions on alcohol advertising and cervical cancer vaccinations for girls — which can save 10 million lives by 2025.  He pressed leaders to commit to them over the next 3 to 5 years.

Recalling her speech at the Assembly’s first high‑level meeting on non‑communicable diseases, Dina Mired (Jordan) said progress has been too slow.  She advocated taxing the industries “that break us”, such as sugar, salt, alcohol and tobacco, stressing that investing $1.27 in prevention today will yield $7 of annual return in 2030, totalling $350 billion.

For that, said Tabaré Vásquez, President of Uruguay and Co‑Chair of the WHO Independent High‑Level Commission on Non‑Communicable Diseases, universal health coverage is needed.  “If we fail in this struggle, what will tomorrow’s society be?” he asked.

During a morning panel on strengthening health systems and the financing of prevention and control measures, Michael Bloomberg, WHO Global Ambassador for Non‑Communicable Diseases and Founder of Bloomberg Philanthropies, said that since 2007, his foundation had spent nearly $1 billion to set up WHO policies to combat tobacco use.  South Africa’s passage of a tax on sugary drinks and Chile’s ban on junk food ads aimed at children are other victories by cities that are “leading the way”.

The afternoon panel explored how Governments can engage the private sector and civil society more effectively in meeting Sustainable Development Goal 3.4, with delegates offering national success stories.  Keynote speaker Natalia Kanem, Executive Director of the United Nations Population Fund (UNFPA), highlighted the Agency’s involvement in the Joint Global Programme on Cervical Cancer Prevention and Control, which aims to end that disease by 2050.  It is devising national guidelines, screenings and treatment registries, as well as carrying out “prevent, screen and treat” programmes that include HPV vaccination.

Opening Remarks

MARÍA FERNANDA ESPINOSA GARCÉS (Ecuador), President of the General Assembly, said today’s meeting will be held under the theme, “Scaling up multi‑stakeholder and multisectoral responses for the prevention and control of non‑communicable diseases in the context of the 2030 Agenda for Sustainable Development”.

The meeting then approved a draft political declaration by acclamation, which it will transmit to the Assembly’s plenary for adoption at a later date.

Calling the draft “ambitious and balanced”, Ms. Espinosa said 15 million people between the ages of 30 and 70 will die this year because of non‑communicable diseases — 80 per cent of them in developing countries.  Not only is it more likely the poorest will suffer from illnesses such as cancer, diabetes and cardiovascular disease, she said non‑communicable diseases lead to annual gross domestic product (GDP) losses of up to 6 per cent.  “Non‑communicable diseases have become our greatest challenge to health,” she said, requiring action at all levels to manage corporate interests and overcome entrenched practices.  Success also requires sustained political will and financing.  Recalling that the Assembly’s first high‑level meeting was held in 2011, placing non‑communicable diseases on the multilateral agenda, she said the Sustainable Development Goals committed Governments to reduce by one third premature deaths due to non‑communicable diseases through prevention and treatment.  “We need immediate, urgent and swift action,” she said, pressing the private sector to scale up efforts to achieve the Agenda’s target 3.4.  “We must now walk the talk.”

AMINA J. MOHAMMED, Deputy Secretary‑General of the United Nations, said non‑communicable diseases are responsible for 70 per cent of deaths globally.  In a globalized world marked by longer life expectancy and growing urbanization, non‑communicable disease incidence is on the rise.  Each year, they are responsible for millions of premature deaths, robbing people of their ability to earn a living and fuelling a cycle of poverty.  The associated costs are enormous — for individuals as well as national health budgets and systems.  Noting that air pollution causes one quarter of adult deaths and is responsible for 30 per cent of deaths due to lung cancer, she stressed that “we must urgently grapple with the effects of carbon emissions” on health.  Moreover, 1 in 4 people will experience a mental health episode this year, and 800,000 will die from suicide.  One in 5 adolescents experience a mental health disorder in any given year.  Women and the poor are the most affected.  Alcohol and drug abuse require greater attention.

Noting that 810 million people are undernourished at a time when obesity is skyrocketing, including among children, she said success in fighting non‑communicable diseases requires bold commitment, increased investment, policies, programmes and partnerships, as well as a new way of thinking about prevention.  She advocated holistic primary health care and systems able to ensure comprehensive health coverage.  Efforts must be part of a larger ecosystem that supports physical and mental well-being, working beyond the health sector to promote clean air and clean cities.  “I call on you, as leaders, to fulfil the commitments you have already made,” she said, and to integrate non‑communicable diseases into broader efforts to achieve the Sustainable Development Goals.

TEDROS ADHANOM GHEBREYESUS, Director‑General, World Health Organization (WHO), said non‑communicable diseases and conditions are a living reality for millions of people, causing needless suffering, expense and death, including “for people in this room, in our families and for the people you represent”.  Recalling that among the 2030 Agenda’s 169 targets, Governments committed to reduce premature mortality due to non‑communicable diseases by one third by 2030, he warned that “we are dangerously off course”, with less than half of countries able to meet that target.  However, Governments could change course in fighting non‑communicable diseases, which kill 41 million people prematurely each year.  “We could prevent nearly 10 million deaths by 2025,” he said, drawing attention to the WHO “best buys” — 16 practical interventions that are cost‑effective and feasible for all countries, including low‑ and middle‑income nations, and include recommendations for a tobacco tax, restrictions on alcohol advertising and vaccinations for girls against cervical cancer.  Endorsed at the WHO World Health Assembly in 2017, they could save 10 million lives by 2025, as well as prevent 17 million strokes and heart attacks by 2030.  They can be a powerful economic tool, he said, estimating that with their implementation they can generate $350 billion in economic growth in the poorest countries by 2030.  Every dollar invested will yield a return of at least $7.  “They’re like a tool box:  They only work if you get them out of the boxes and use them,” he said, proposing the formation of a coalition to catalyse bold decisions on non‑communicable diseases.  He pressed political leaders to commit to 3 to 5 years of efforts to implement the “best buys” and to drive progress towards the Agenda’s target 3.4.  “With political commitment, anything is possible,” he said, rallying participants to mobilize domestic investment and ensure universal coverage.

TABARÉ VÁZQUEZ, President of Uruguay, Co‑Chair of the World Health Organization Independent High‑Level Commission on Non‑Communicable Diseases, recalled the recommendations made at the 2017 Global Conference on Non‑Communicable Diseases, held in Montevideo, stressing that reducing premature deaths due to non‑communicable diseases by one third by 2030 “is incumbent on all of us”.  He stressed the need for key stakeholders, especially civil society and the private sector, to participate in the struggle.  Recalling that the tobacco industry is the only one that kills its own consumers, he said tackling non‑communicable diseases requires the highest political commitment, notably by Heads of State and Government who are responsible for policies that defend health and life.  Such actions should be applied based on each nation’s public health needs and consider the cost-effectiveness of interventions.  Universal health coverage is needed.  “If we fail in this struggle, what will tomorrow’s society be?” he asked.

DINA MIRED (Jordan), recalling her previous speech at the first high‑level meeting on non‑communicable diseases, said that since that time, progress has been too slow.  Noting that more than half of all countries are not on track to meet Sustainable Development Goal 3.4, she added that non‑communicable diseases are not just a health issue, but a development issue.  It is clear, she said, that investing $1.27 now on the prevention of non‑communicable diseases will yield a return of $7 per year in 2030, totalling $350 billion.  Pointing to the development of evidence‑based tools and guidance documents, initiatives such as the Global Initiative for Cancer Registry Development and the Resolve initiative, she commended the work of WHO in the last seven years for giving the international community a suite of “best buys” in efficient and cost‑effective action on non‑communicable disease prevention, treatment and care.

“We deleted the box of ‘we don’t know what to do’, we erased the ‘no money argument’ and we nullified the notion of the impossible,” she said.  And yet 15 million people are still dying prematurely every year.  The international community is well on track towards an unhealthy future, unless it delivers on its promises.  Sometimes it seems, she added, it is easier to fund weapons to wage war that destroys human lives than it is to financially support the wholesome actions that will save them.  Having witnessed this inequity first‑hand as the President‑elect of the Union for International Cancer Control, she emphasized “we cannot wish these diseases away”.

What accelerated their deadliness, she added, is the fragmented and indecisive approach of the international community.  It is necessary to put non‑communicable diseases as the number one item on the agenda of not just the health minister, but the whole cabinet.  Calling on the international community to implement the evidence‑based “best buys”, she added that vaccinations must be made available in all countries to limit the development of cancers, particularly cervical cancer.  “Let us tax the industries that break us,” such as sugar, salt, alcohol and tobacco, she stressed, highlighting the importance of legislating against industries that are intent on profiting at the expense of human health.

Panel I

The General Assembly held a high‑level panel on “Strengthening health systems and financing for the prevention and control of non‑communicable diseases, on each country’s path towards achieving universal health coverage, including through sharing evidence‑based best practices, scientific knowledge and lessons learned”.  Co‑chaired by Edgar Chagwa Lungu, President of Zambia, and Timothy Harris, Prime Minister of Saint Kitts and Nevis, it featured presentations by:  Sania Nishtar, Founding President of the non‑governmental organization Heartfile; Zoleka Mandela, Global Ambassador, Child Health Initiative; and Yoshitake Yokokura, President, World Medical Association.  Michael Bloomberg, World Health Organization Global Ambassador for Non‑Communicable Diseases, Founder of Bloomberg Philanthropies, delivered a keynote address.

Mr. HARRIS, welcoming delegates and speakers to the discussion, outlined three questions for the panellists to focus on.  First, he asked, how can Heads of State and Government ensure that national universal health coverage packages include non‑communicable disease and mental health services?  Stressing the importance of specific examples from countries that have done this successfully, he said it is also necessary to consider the steps Heads of State and Government can take to ensure that non‑communicable disease prevention and control are firmly embedded in primary health care.  Another important question was to think through the options available for international financing for non‑communicable disease prevention, and it is also vital to hear the lessons learned from countries that have developed and implemented fiscal policies to finance that, he stressed.

Mr. BLOOMBERG, delivering a keynote address, said that while there are few issues more critical than the growing problem of non‑communicable diseases, for the most part global policies have not shifted in response.  Noting that two thirds of all deaths are caused by those diseases, he lamented that only 2 per cent of international health funding goes towards preventing those.  Further, they contribute to poverty and cause declines in productivity.  “This is something we can do something about,” he said, noting that it is not necessary to choose between fighting non‑communicable diseases and communicable diseases.  Many of the biggest causes of non‑communicable diseases, he added, such as junk food and tobacco, have powerful interests behind them, and it is important to take them on.  His foundation worked with many countries, he noted, adding that tobacco use is the number one agent of preventable death.

He said that his foundation has spent almost $1 billion since 2007 to set up WHO policies aimed at combating that.  Today more than 120 countries have these policies in place, though the tobacco industry has fought back at every turn.  Noting other victories such as South Africa recently passing its own national tax on sugary drinks, and Chile banning junk food ads aimed at children, he said that “cities are leading the way”.  What worked in one city often worked in others, he said, noting his foundation’s new initiative, Partnership for Healthy Cities.  Once policies work at the city level, national Governments become more willing to adopt them, he noted.

Mr. LUNGU said that non‑communicable diseases have the potential to explode into an outbreak in Zambia unless they are curtailed.  Currently they accounted for 1 out of every 4 deaths in the country.  Zambia has developed an ambitious plan to counter that and he personally leads a social movement to encourage healthy lifestyles.  This included introducing legislation to protect people against tobacco use and harmful use of alcohol.  Noting his country’s progress in reducing the burden of infectious diseases as well as maternal and child mortality rates, he said, “however, there is no point in saving people from HIV/AIDS, tuberculosis or malaria only for them to die from preventable non‑communicable diseases.”  Zambia is a firm believer in partnership, he added, and is currently receiving support from WHO and the United Nations Development Programme (UNDP) and is pursuing a multisectoral approach that encompasses traditional, civic, faith‑based and civil society stakeholders.

Ms. NISHTAR said universal coverage is the twenty‑first century world health contract, stressing:  “We need systems to deliver quality.”  In 2025 a woman in an African village with high blood pressure and diabetes will largely manage her conditions from her smart phone.  Her digital tattoo will work as a digital lab, uploading information to her health cloud thanks to blockchain.  She is able to access medicines through Amazon and have her insulin delivered to her home by a drone.  Each of these solutions exists today in isolation, but efforts are underway to knit them together, with institutions drawing on big data to implement behaviour change and make efforts more chronic‑care centric.  A focus on prevention and early intervention is needed.  Viewed alongside such changes in developing countries as leapfrogging straight from 2G to 4G to 5G, the future of health can be about the future of non‑communicable diseases and mental health.  The global community must address ethical patient safety, notably by setting adequate standards.  Noting that the wellness industry is among the world’s fastest growing, a 7.3 trillion market, she said non‑communicable diseases underpin most health‑care innovations, from gene editing to immunotherapy.  It is not pure business, but rather, must be grounded in the principles of human rights, equity evidence and empathy, catering to the world’s poorest billion living in humanitarian crisis.  While catalytic funding is demanded, the mainstay must be domestic public financing.  She concluded by stressing that no single breakthrough is likely to catalyse systems change.  Science and evidence are vital to success, as is activating a wide range of policy levers — from soft to hard.

Ms. MANDELA said a voice must be given to the voiceless and those who are suffering must be allowed to share their stories.  Sharing her experience, she said she was diagnosed with breast cancer in 2012 at the age of 32.  She underwent a bilateral mastectomy and, like the few privileged, received the best care in South Africa, which was especially important in the many days of despair.  Early detection and access to treatment saved her life.  “I am alive today because I was lucky and I am privileged,” she said.  Most others are faced with the reality of poor consequences.  Without such access, they have no chance of survival.  Millions in Africa, and in developing countries, lack the same access to a health system that is reliable and efficient.  Many are denied their right to have their health protected.  Meanwhile, societies are creating new health issues, with toxic air poisoning children’s lungs and urban environments often too dangerous for them to explore the world.  Recounting that her daughter had been killed by a drunk driver, she said that increased road traffic means that millions of children breathe polluted air.  Basic policies are not put in place, implemented or enforced.  It is shocking that in the twenty‑first century, Governments fail at providing safe and healthy journeys for children on their way to school.  She wondered why leaders across have not followed the work of Mr. Bloomberg, stressing:  “We need others like him to follow.”  She urged leaders to listen and act.  “We have had enough of inaction, enough of neglect and enough of failure”, she said, issuing a personal plea, as a mother and cancer survivor, to “please step forward, for our children, for our health and for our lives”.

Mr. YOKOKURA, highlighting Japan’s achievement in pushing healthy life expectancy to the world’s highest level in health care, noted that population ageing is rapidly progressing in many countries around the world.  It is impossible for specialized medical institutions alone to respond to the complex needs of patients with dementia and their families.  Stressing the importance of “building a friendly town for people with dementia”, he said that involves training primary care physicians in dementia support, training dementia coordinators and dementia support teams and raising awareness among elementary and junior high school students.  Further, he said, disease prevention must start early in life.  Turning to obesity, he highlighted the seriousness of that problem, especially in young people who are the generation expected to support the elderly.  Japan has implemented policies such as the school doctor programme and food education to tackle that.  Governments tend to hesitate to build and maintain strong health‑care systems because it is expensive, but, he stressed, it is not just expenditure, but an investment.

In the ensuing discussion, the representative of Trinidad and Tobago noted recent achievements in the health sector in his country, pointing out that the country has reached its Sustainable Development Goals target for reducing maternal and infant mortality rates.  Other successes included a public‑private partnership with pharmacies and the banning of sugar‑sweetened beverages in primary and secondary schools.  An important component of any health‑care plan is the availability of trained human resources, he said, noting that his country is however, losing its senior experienced personnel, especially nurses, through active recruitment by institutions in developed countries.  He urged developed countries to collaborate with the Caribbean Community (CARICOM) countries to reduce this brain drain.

The representative of Brunei Darussalam stressed the importance of ensuring sustainable funding and adequate human resource capacity for tackling non‑communicable diseases.  Underscoring the importance of universal health coverage, he noted that in his country, the promotion of health is a priority at the ministerial level.  The country also implemented a “health ambassadors” programme, involving grassroots leaders to champion health promotion at the community level and introduced a sugar and salt tax in 2017.

The representative of Ukraine highlighted her country’s robust primary health‑care services and education campaigns.  It is not only about forcing citizens to live healthy lives, but also helping them choose healthy changes in their lives, she said.  Ukraine is also cooperating with WHO experts and approved an action plan for tackling non‑communicable diseases, which includes banning tobacco and alcohol advertising.

Venezuela’s delegate said that the lifestyles of capitalist countries have important consequences for non‑communicable diseases.  The cost and availability of diagnosis and accessible treatment is another important issue, he said, especially when medicines are treated as goods.  As a victim of sanctions, his country has limited access to currency which has affected its health‑care systems.

The representative of Papua New Guinea said that communicable diseases remain a serious issue in the country even as it faced increasing prevalence of non‑communicable disease caused by lifestyle changes.  People are moving away from traditional healthy foods, replacing them with cheap, processed foods.  Sugary drinks are no substitute for coconut water, he said, expressing concern about cancer which is the leading non‑communicable disease in the country.

The representative of Brazil said that life expectancy in her country has increased by six years thanks to concerted health‑care efforts.  The public health system covers 85 per cent of her country’s population while the private system covers around 20 per cent, she noted, stressing the importance of tackling inequality in health‑care access.

The representative of Portugal said that the excessive consumption of sugar, fat and salt is widely contributing to health loss in his country.  The taxation of unhealthy foods has a huge role in preventing non‑communicable diseases, he said, adding that in Portugal, a two‑tier tax on sugary drinks has decreased the demand for those beverages, and also reduced their sugar content.

The representative of the United Nations System Standing Committee on Nutrition said that it is necessary to recognize the millions of young people who are living with or at risk of non‑communicable diseases, and include people of all ages when talking about their prevention.  Middle- and low‑income countries need greater support, she said, applauding those countries that established national targets.  Interventions must include adequate nutrition, vaccinations and promotion of healthy pregnancies.

A representative of the International Federation of Pharmaceutical Manufacturers stressed the importance of empowering individuals to make informed choices and expressed concern that the outcome document is insufficient in addressing multisectoral collaboration.  Equal access to high quality health care is critical, he said, adding that affordability is most effectively addressed through financing and reimbursement policies.

The representative of Kenya, noting that the global community is not on track to achieve the goals it set for the prevention of non‑communicable diseases, called on States to commit more domestic financing and harness the inputs and resources of the private sector.  A catalytic fund is necessary to mobilize the broader efforts, he said.

Mr. LUNGU, in closing remarks, said that the international community is united on the point that non‑communicable diseases are a major public threat.  It is time to stop tobacco abuse, irresponsible consumption of alcohol and physical inactivity, he said, adding, “let’s say bye‑bye to poor diets”.  Health is key to the socioeconomic sector and sustainable development can only happen in a healthy population, he stressed.

Also speaking in the discussion were representatives of Bangladesh, Nigeria, Uganda, Armenia, Brazil, Turkmenistan, Turkey, Morocco, Malaysia, Senegal, Mexico and Slovakia.

Panel II

In the afternoon, the General Assembly held a high‑level panel on “Opportunities and challenges in engaging Governments, civil society and the private sector at the global, regional and national levels to promote multisectoral partnerships for the prevention and control of non‑communicable diseases and the promotion of healthy lifestyles”.  Co‑Chaired by Christopher Tufton, Minister for Health of Jamaica, and Ginette Petitpas Taylor, Minister for Health of Canada, it featured presentations by:  Maria Helena Semedo, Deputy Director General, Food and Agriculture Organization (FAO); Trevor Hassell, President, Healthy Caribbean Coalition; and Gerda Verburg, Coordinator, Scaling‑Up Nutrition Movement.  Natalia Kanem, Executive Director, United Nations Population Fund (UNFPA), delivered a keynote address.

Mr. TUFTON started the meeting by showing a short dance video and leading delegates in a dance.

Ms. TAYLOR said that the Political Declaration adopted at the first high‑level meeting in 2011 included important commitments to promoting meaningful engagement with civil society, the private sector and others.  In Canada, multisectoral approaches are the foundation of non‑communicable diseases prevention efforts.  Just as it takes a village to raise a child, it takes everyone working together to protect public health, she stressed.  Within Government, departments worked collaboratively and Government worked with civil society.  Inviting delegates to talk about partnerships in their own countries, she emphasized that the ideal partnership provides public value and makes independently variable data available in the public domain.

Mr. TUFTON said that non‑communicable diseases are a growing concern in Jamaica, where a recent study showed that 1 in 8 of the country’s citizens suffer from diabetes and 1 in 3 suffer from hypertension.  The four major non‑communicable diseases, namely cardiovascular, diabetes, cancer and chronic respiratory disease, account for 67 per cent of all deaths, he noted, asking “How can Governments, civil society, private sector, and people living with non‑communicable diseases be engaged in scaling up the implementation of WHO policies?”

Ms. KANEM, delivering a keynote address, said non‑communicable diseases have a significant impact on overall health, especially sexual and reproductive health.  Breast, cervix and prostate cancer are common.  The impacts of obesity, diabetes and hypertension on the health of infants and pregnant women also come into play, while parental smoking and drug abuse might affect fertility.  “Prevention is way better than cure, and this calls for a holistic approach,” she said, drawing attention to the Fund’s work with young people to lay the foundation for good health.  Efforts hinge on delivering the skills and information — about diet, exercise, avoidance of alcohol and tobacco — in modes that they understand, and importantly, accept.  This “life‑course approach” is part of what the non‑communicable disease movement has embraced.

As part of the United Nations Interagency Task Force on Non‑Communicable Diseases, UNFPA works to ensure country programmes emphasize sexual and reproductive rights, she said, citing other efforts to end cervical cancer by 2050 through involvement in the Joint Global Programme on Cervical Cancer Prevention and Control.  As the vaccines, screening treatment and palliative care exist to resign cervical cancer to the history books, she asked why half a million women are affected by a totally preventable disease.  UNFPA is developing national guidelines, screenings and treatment registries to address cervical cancer, including the social stigma around it.  UNFPA regional and country offices are carrying out “prevent, screen and treat” programmes that include HPV vaccination in adolescent health and reproductive health programmes, efforts that must be scaled up, as introduction of HPV into the discussion can be an entry point for reaching adolescents with contraception to avoid unintended pregnancies.

She said Sustainable Development Goal 3 (good health and well‑being) offers an overall framework for focusing attention, stressing “we need that focus”.  Commitments must be translated into action through donor support and domestic funding.  Recalling that Goal 17 (partnerships) offers a framework for partnership with civil society, the private sector and others, she said UNFPA partners in over 150 countries to help Governments create the policies and infrastructure needed to promote healthy lifestyles.  “Civil society mobilization has been very important,” she said, with their advocacy helping to identify community champions.  She encouraged companies to engage in ethical investment and corporate social responsibility as a way to augment synergistic efforts.  The provision of information and policy guidelines must be based on the best available evidence, she insisted, which is how UNFPA helps Governments scale up their non‑communicable disease responses.

MS. SEMEDO, stressing the importance of healthy diets, said “hunger is increasing”, with 821 million persons food insecure in 2017.  But what is surprising also is the level of obesity, she said, noting that it is especially a problem in Africa.  FAO is directly concerned with Sustainable Development Goal 2, which in turn affected other Goals.  If the international community does not improve its food systems, it cannot prevent non‑communicable diseases, she said, calling for improvements in agricultural policies.  Healthy food is becoming more and more expensive and even among the middle class, it is becoming difficult to eat a healthy diet.  Promoting sustainable food systems goes hand in hand with improving food security, which calls for far‑reaching policy changes in trade as well as concerted international action.  It is necessary to non‑incentivize sugary foods, she said, stressing the importance of private sector partnerships to achieve this.

Mr. HASSELL, emphasizing the important role of civil society in responding to the threat of non‑communicable diseases, highlighted the work of the Healthy Caribbean Coalition and said that regional and national alliances are mobilizing civil society in various countries.  But despite those successes, challenges remain, he said, noting the need for sustainable independent financing for civil society organizations.  Many such organizations are technically underresourced and function in silos.  Another ongoing challenge is how best to manage relationships with the private sector, especially big food and beverage and big alcohol.  Should they be avoided or engaged, he asked, noting significant differences of opinion on this in all countries, but especially in the small countries of the Caribbean where the private sector is a leading national partner leading to a conflict of interest.  Suggesting a partnership in which the private sector plays an important role in implementation but not in policy development, he said that climate change, education and human resource development are related issues.

Ms. VERBURG said that non‑communicable diseases are more than just a health issue.  Stressing the importance of breastfeeding, she said that the first 1,000 days of a baby are crucial.  Global thinking must be supplemented by “country acting”, she said, calling for collaborations between the minister of health and the ministers of agriculture, education and women’s affairs.  All of them need to come together to build a coherent plan to tackle non‑communicable diseases, she stressed.  Turning to the role of civil society organizations, she said the United Nations must encourage a critical dialogue with them.  In addition to the big companies, there are many small and medium‑sized companies also involved in food production and it is important not to lock them out.  Big companies are part of the problem and the international community will succeed only by making them part of the solution.  Corporate social responsibility is not enough anymore, she stressed, adding that healthy foods must become affordable to people with small wallets.

In the ensuing discussion, the representative of Mexico called for active participation by multilateral agencies, federal and local agencies, academic institutions and the private sector in combating non‑communicable diseases.  Sharing best practices from Mexico’s experience, she added that electronic data on health and sanitation is helpful in making better decisions.

The representative of the Netherlands said that “the days are gone when the tobacco industry had a seat the table”.  Involving all stakeholders is not always a good approach, he cautioned, and Governments must remain in the lead and stay vigilant.

The representative of Singapore said that the people of his country love food and the Government is encouraging healthy eating by working with restaurants and the food industry to make healthy food more accessible.  The introduction of a healthy ingredients development scheme has also helped and the Government is influencing consumer preferences by offering grants to food vendors to develop healthy meals.

Portugal’s representative said that his Government has developed an integrated strategy for the promotion of healthy eating, involving seven different ministries.  The strategy aims at promoting innovation and entrepreneurship.

A representative of the International Food and Beverage Alliance said that the companies in the group are committed to improving the nutritional quality of their products and increasing the number of healthy options, while actively supporting WHO.  “Nutrition is today on boardroom agendas,” he said, acknowledging that more needs to be done.

Members of various civil society organizations, including the Non‑Communicable Diseases Alliance and the Young Professionals Chronic Disease Network also spoke today calling on Governments to put people first, from policymaking to programme planning.

A representative of the United Nations Framework Convention on Tobacco Control said that it is essential that any interventions under the Convention must depend on the broadest range of stakeholders while excluding the tobacco industry because of the inherent conflict between public health and that industry.  The know‑how gathered in the 13 years since the Convention came into force are integral to any non‑communicable disease prevention efforts, he said.

Ms. TAYLOR, delivering closing remarks, thanking the panel and lauding the initiatives that the delegates spoke of, said that multisectoral partnerships are both a solution to reducing non‑communicable diseases and a way to collectively achieve the Sustainable Development Goals.  Reducing those diseases is not easy, but it is achievable with creativity and cooperation, she said.

Also speaking in the discussion were the representatives of Barbados, United States, Ukraine, Malta, Italy, Monaco, China and Czechia.

The President of the Inter‑Parliamentary Union (IPU) and an official from the United Nations Office of the High Representative for the Least Developed Countries, Landlocked Developing Countries and Small Island Developing also spoke today.

For information media. Not an official record.