A warning and an opportunity: The WHO Independent High-Level Commission on non-communicable disease

It poses a stark warning that the Sustainable Development Goal for NCDs—to reduce premature deaths from NCDs by a third by 2030 and promote mental health—will not be met at the current rate of progress.

The WHO Independent High-Level Commission on NCDs was established by WHO Director-General, Dr. Tedros Adhanom Ghebreyesus, in October 2017. It gathers the best available evidence, including major input from The Lancet Taskforce on NCDs and economics, which published earlier this year and is a partner of the WHO's Independent High-Level Commission on NCDs.

The report of the WHO Commission was timed to coincide with the inter-governmental negotiations underway in New York in the run up to the third UN High-Level Meeting on NCDs, scheduled for September 2018. In the lead up to this, The Lancet family of journals is also publishing several major initiatives to put the best evidence at the heart of policies to reduce the global burden of NCDs.

The WHO Independent High-Level Commission on NCDs prioritises both the main NCDs (cardiovascular diseases, cancers, respiratory diseases, and diabetes) and their risk factors (tobacco use, harmful alcohol consumption, unhealthy diet and physical inactivity), as well as mental health, and air pollution as a risk factor for NCDs.

The authors acknowledge that there are obstacles to implementing proven interventions for NCDs in many countries. The Commission was also unable to reach a consensus on taxation on sugar-sweetened beverages and the accountability of the private sector.

The report proposes six recommendations, including:

• Recommendation 1: Increased political leadership and responsibility—Action on NCDs requires an upgrade in political leadership, and Heads of State and Governments must take the lead.
• Recommendation 2: Prioritisation and scaling up—Governments should identify and implement a specific set of priorities within the overall NCD and mental health agenda.
• Recommendation 3: Embed and expand NCDs within health systems and universal healthcare (UHC) - Synergies should be identified in existing chronic care platforms.
• Recommendation 4: Collaborate and regulate—Governments should increase effective regulation and appropriate engagement with the private sector and civil society using a whole of society approach.
• Recommendation 5: Improve financing—Implementing new means to invest in programmes to reverse the tide of NCDs—a new multi-donor fund, increased lending by international financial institutions for NCDs, an investors forum, and higher contributions to multilateral institutions, such as WHO, to ensure programme delivery.
• Recommendation 6: Improve accountability—Accountability must be strengthened to ensure that the promises and commitments of Governments and the private sector are delivered. This includes through initiatives such as The Lancet Countdown 2030 for NCDs.

Writing in the Commission, the authors say: "The challenge is not only to gain political support, but also to guarantee implementation, whether through legislation, norms and standards setting, or investment. We need to keep arguing for NCDs and mental health to have greater priority, but countries must also take responsibility for delivery on agreed outputs and outcomes, as stated in endorsed documents. There is no excuse for inaction, as we have evidence-based solutions."