An official website of the United States government

Ambassador King Delivers Opening Statement on NCD Global Monitoring Framework
November 5, 2012

Ambassador Betty E. King
Americas Regional Opening Statement on NCD Global Monitoring Framework

World Health Organization
November 5, 2012

On behalf of the 35 Member States of the Americas Region, I am pleased to present this opening statement today and express our optimism that this meeting will finalize a package of voluntary global targets and indicators along with a global monitoring framework that will strengthen and focus our collective action to prevent and control non-communicable diseases.  This meeting is the culmination of a process that began even before the adoption of the Political Declaration on NCDs last year and we wish to highlight its inclusive, consultative and informed dimensions, where we think the Secretariat and the chair have exceeded expectations.

Having said this, we also believe that in this final meeting to agree the global monitoring framework, targets and indicators, we must emphasize the need to take into account the measurability, feasibility and achievability of the indicators and associated targets.  We believe that this will most probably require, not only limiting the number of targets, but also specifically strengthening interventions in Health Systems capacity, as well as support for Data collection and reporting, accountability and predictable financing and ultimately Country Ownership in order to guarantee achievability and sustainability at country level.

In this sense, we acknowledge and stress the aspirational dimension of the voluntary global targets put forth during this process and underline the opportunity to further adapt the set of targets and indicators based on national situations, building on the guidance at global level provided by WHO and its Member States.

We believe a Global Monitoring Framework will provide significant value for public health, and that it will promote action, accountability and communication and provide a focus for resource mobilization efforts.  The Americas region strongly endorses WHA 65’s decision to adopt the “25 by 25” premature mortality reduction target and views this as a solid starting point for our work this week.

While there is a diversity of views in the region on the larger set of indicators proposed in the current WHO paper, generally speaking we support the need for a set of indicators that is as comprehensive and flexible as possible, covering the spectrum of NCDs prevention to treatment and care.  Indeed, at our recent regional committee meeting it was clear that once the global level framework is in place, PAHO plans to look at adaptation for regional and potentially sub-regional levels, considering additional actions to complement the global framework.

Concerning the overall framework, the Americas region strongly supports inclusion of obesity in the document. Overweight and obesity rates are a major problem, and are especially on the rise in low and middle income countries. Obesity has been recognized as a major risk factor linked to diabetes, cardiovascular diseases and cancer.  We understand that it is linked to complex social, cultural and economic issues and that including it in the framework could be perceived as ambitious, but we believe that it is critical to tackle this problem directly.

Returning to global targets, individual Member States may have specific amendments to propose or questions to pose, but our region supported a number of targets from the current revised WHO discussion paper at its recent regional committee meeting. In our view, the final package of targets should include 1) the 30% relative reduction in prevalence of current tobacco smoking, 2) 10% relative reduction in prevalence of insufficient physical activity, and 3) the proposed target on salt/sodium intake.  The region also expressed the view that the proposed target of 25% relative reduction in prevalence of raised blood pressure merits further consideration.

The Americas region also strongly supports the inclusion of a target to reduce the harmful use of alcohol, as the alcohol-related risk factor we have committed to address in the UN Political Declaration and the recent WHA decision.  We do not find the WHO-proposed target of 10% relative reduction in overall alcohol consumption to be a good global measurement for harmful use.  We are seeking instead a target that is closely related to and coordinated with the interventions in the WHO Global Strategy for the Reduction of the Harmful Use of Alcohol.  We look forward to the discussion on this element of the framework.

We believe there should be a target aimed at measuring the health systems response and look forward to the discussion this week in finding the best way to track this important element in the response to NCDs.  We are appreciative of the Secretariat’s work in developing the zero draft of the 2013-2020 Action Plan on NCDs and last week’s discussions because we believe this document should be viewed alongside the Global Monitoring Framework as two parts of a single, integrated approach.

When considering the Exposure Targets, and more specifically targets relating to the main risk factors, the Americas region believes these must be focused on changing life styles from an early age in order to have the desired impact on public health and, therefore, they necessarily must include interventions targeting Children and Adolescents.  Recognizing there are serious data gaps, this will be an area where linkages between the GMF and GAP need to be strengthened.

We would also like to underline the Intersectoral Dependence of many of these targets. In other words, the achievability of many of the proposed targets is dependent on sectors other than the Health Sector and, therefore, underscores the need to develop and strengthen a “whole-of-government and whole-of-society” approach, as put forth in the “Note by the SG transmitting the report of the WHO Director-General on options for strengthening and facilitating multisectoral action for the prevention and control of NCDs through effective partnership”

We consider that the Action Plan should be a tool to promote success in achieving the targets and monitoring the indicators we will adopt this week as well as other important areas of NCD prevention, treatment and care which may not be fully captured in the indicators.  This means recognizing the need to strengthen country capacity, particularly given that most indicators are likely to rely on surveys.  A focus on capacity building is central to implementing the evidence-based approaches that will be successful in reducing the NCDs burden, and underscores the link between NCDs and development that has rightly been made in an increasing number of fora.  In this respect, improving access to essential medicines and health technologies is critical to address the need of patients currently suffering from NCDs.

In terms of the global monitoring framework, we believe that the targets and indicators to be adopted should be duly reflected in the development of the Action Plan.  We will want to use the meeting this week to further strengthen and clarify how the Action Plan will tackle the social determinants of health, particularly around the package of targets and indicators we adopt, in recognition of how critical social determinants are to effective prevention and control of NCDs.

In closing I would like to emphasize that individual Member States may and likely will augment this opening statement with further views of their own on national priorities.  However, we wanted to show as well through the relatively rare occasion of a regional statement, how much convergence there is among us in this process and highlight that for colleagues.

Finally, Mr. Chair, let me say how pleased the Americas region is that you are leading us this week.  We expect our region to be very active and even challenging at times, but we are confident that with our fellow Member States we will succeed in meeting the challenge posed by our leaders in the Political Declaration last year.