PIH delivers message on equitable NCD care at UN Interactive Briefing

Author: Amy McLaughlin, NCD Synergies
July 6, 2018

On Thursday, July 5th 2018, the NCD Synergies team joined hundreds of civil society advocates at the United Nations Interactive Hearing on the prevention and control of NCDs in New York. The UN hearing provided non-state actors an opportunity to formally participate in the lead up to the third UN High-Level Meeting on NCDs on September 27th 2018. The hearing featured four panels representing a diverse set of speakers across focus areas and geographies and an opportunity for participants to provide statements and questions from the floor throughout the day.

Dr. Agnes Binagwaho, leading PIH’s University of Global Health Equity (UGHE) and a global Lancet NCDI Poverty commissioner, and Dr. Mary Nyamongo, co-chair of the Kenya NCDI Poverty Commission were both featured panelists, speaking on topics around “Promotion of multisectoral partnerships” and “Political leadership and accountability.” Katie Dain of the NCD Alliance and a global NCDI Poverty commissioner also provided comments on behalf of the NCD Alliance and NCD civil society more broadly, featuring key messages that a number of civil society advocates, including PIH and HMS, have provided input into throughout June 2018.

PIH was invited to provide an intervention in the late morning session of the hearing, which our Program Manager Maia Olsen delivered on behalf of NCD Synergies and the Program on NCDs and Social Change at Harvard Medical School.

Text of the full statement below:

Chairperson and distinguished delegates –

Aaron Emmel / American Academy of Pediatrics
Maia Olsen, Program Manager for NCD Synergies, provides an intervention on behalf of PIH, referencing her own experiences as someone living with NCDs and the need for the global community to accelerate progress in addressing inequities in access to care for NCDs and mental health, especially among the world’s poorest and hardest to reach. 

Partners In Health, supported by Harvard Medical School, stands alongside our many colleagues advocating for NCDs as an essential part of UHC and the 2030 sustainable development agenda. We must also lead with a rights based approach, recognizing the global scale of the NCD, injury, and mental health burden and in particular, the needs of the world’s poorest and most vulnerable.

As a childhood cancer survivor [Hodgkin’s lymphoma] and person living with a severe and chronic immune disorder, I am acutely aware of the challenges people living with NCDs face in any setting. At the same time, my ability to access timely and effective care is in many ways a result of where I live and my socioeconomic status. Illness, death, and disability from NCDIs can be an economic catastrophe for the poor and near poor in low- and middle-income countries, and conditions of poverty increase risk for many NCDIs, while preventing patients from accessing quality care.

We must significantly accelerate progress in addressing these inequities. As we look towards the HLM in September, we ask member states to consider the following recommendations for the political declaration –

  1. Preserve language promoting a life course approach to NCDIs, inclusive of the millions of children and young adults who do not currently fall within WHO’s definition of premature mortality from NCDs. We also ask for greater attention to gender equity, in order to better account for the gendered dimensions of the NCD burden.

  2. Expand the document’s framing to include NCDI conditions and risk factors beyond the “4×4”. Much of the excess NCD burden among the poor can be explained by infectious and environmental risks and lack of treatment.

  3. UHC and the SDGs will not be achieved unless we preserve and strengthen the focus on the equitable delivery of integrated NCDI care and prevention, emphasizing scale-up of interventions informed by country-led priority setting and reflective of the local disease burden. There are proven strategies that work, even in the poorest settings, and training and retention of health workers is paramount to capacity building at all levels of the health system.

  4. Recognize that lowest-income countries do not have the resources to adequately address NCDIs. We must commit to catalytic donor support, innovative financing mechanisms, and increased technical assistance in order to address these gaps, and better position governments to progressively increase their share of health spending for NCDIs.

  5. Ensure strong data and accountability mechanisms, disaggregated by age, gender, geography, and socioeconomic status in order to better address the NCDI burden inclusive of all populations.

Most importantly, we must more meaningfully include the voices of people living with NCDs, injuries, and mental illness, their families, caregivers, and local implementers, in every step of the policy process, particularly those in settings of extreme poverty who are often hardest to reach.

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Unfortunately, there was not enough time for our team to include important points around the full spectrum of conditions that are not covered within current global frameworks such as acute kidney disease, epilepsy, and sickle cell disease (to name only a few), conditions which should be prioritized given how severely disabling or lethal these can be at young ages. We had also hoped to underscore the importance of investing in surgery, a critical component of service delivery for many NCDs and injuries.

Many other organizations were not provided the opportunity to speak at all, despite having prepared comments for the hearing – including groups representing cross-cutting issues around palliative care, access to medicines, and building data and research capacity, as well as patient advocacy groups from low- and middle-income countries.

The WHO Global Coordinating Mechanism will be providing written versions of statements submitted to the hearing for member states and non-state actors to review later this month. Formal negotiations on the UN HLM draft political declaration will resume on July 18th 2018.