By Dr Liu Yunguo, WHO representative for Cambodia, and Nick Beresford, country director for the United Nations Development Programme, written on behalf of the United Nations Interagency Task Force on the Prevention and Control of Non-Communicable Diseases.
The past century witnessed a global revolution in the control of communicable diseases. This was accomplished by improved access to clean water and sanitation, and by applying new scientific knowledge to population-based public health strategies and services, such as universal vaccine coverage to protect children against diseases such as measles and polio. In the 21st century, the unprecedented rise of noncommunicable diseases (NCD), particularly diabetes, cardiovascular disease, cancer and chronic respiratory disease, pose a new and urgent threat that may overwhelm these gains.
There is clear evidence that the burden of NCDs in Cambodia is increasing. In 2014, these diseases caused more than half (52 percent) of all deaths in Cambodia, up from 46 percent in 2011. Nearly one in every five NCD deaths are people under age 70.
These chronic diseases are imposing an ever greater burden on countries coping with the rising cost of treatment, and on families through loss of income due to NCD-related disabilities and health care costs. Poor people face the greatest hardship. There is growing recognition that failing to control NCDs will threaten the attainment of national health targets and development goals.
There is no single policy or intervention that can ensure success in meeting the Sustainable Development Goal target of reducing premature mortality from NCDs by 2030. Most premature deaths are associated with unhealthy lifestyle choices.
The main avoidable risk factors for NCDs are poor diet, physical inactivity and harmful use of alcohol and tobacco. Despite progress in implementing stronger tobacco control legislation, nearly one-third of adult Cambodian men still use tobacco. Data from Cambodia’s socio-economic surveys show a worrying trend of increasing alcohol consumption. Although much is known about effective strategies and policies that can make a difference, implementation and enforcement of these measures requires a whole-of-government and society approach.
To support these efforts and generate global support and resources for NCD prevention and control, then-United Nations Secretary-General Ban Ki-moon established the United Nations Interagency Task Force on the Prevention and Control of Non-communicable Diseases (UNIATF) in 2013, with the goal of helping countries mobilise health and nonhealth sectors of government to address the growing burden of NCDs through effective strategies.
The UNIATF is helping countries mobilise sectors within and, importantly, beyond health to address NCDs, by promoting a whole-of-government approach. It coordinates the activities of fellow UN organisations, civil society players and other multilateral bodies to support national governments in implementing the high-level commitments of the 2011 UN Political Declaration on NCDs, the Outcome Document of the 2014 High-level Meeting on NCDs and the 2030 Agenda for Sustainable Development and its related Sustainable Development Goals.
This task force will be in Cambodia from today through Friday to undertake a joint programming mission in collaboration with several United Nations agencies that are supporting efforts to strengthen multisectoral response to NCDs. The Cambodia government has already shown commitment to this effort through the adoption of a new Tobacco Control Law and sub-decrees that protect people from second-hand tobacco smoke and include pictorial health warnings on tobacco packaging, as well as restriction of point-of-sale promotion of tobacco products.
The Ministry of Economy and Finance is also working closely with WHO and the Ministry of Health to increase taxation on tobacco products. Similarly, supply and demand reduction measures are needed to reduce harm from alcohol. The government has also demonstrated commitment through the development of a draft national multisectoral action plan for the prevention and control of NCDs, a clear framework for multisectoral action in several areas, which includes specific roles for various ministries.
As the disease burden continues to shift from communicable to noncommunicable diseases in many developing countries, there is also an urgent need to reorient health systems to prepare for this profound change. Sustainable Development Goal 3.8 sets the target to achieve universal health coverage, including financial risk protection, access to quality essential health care services and access to quality, safe, effective and affordable essential medicines and vaccines for all, by 2030.
These services need to include early detection and preventive health services for NCDs, presently unavailable to many, especially for rural Cambodians. While it is the health sector’s role to ensure these services are in place, political support is crucial for allocation of much needed resources.
The newly elected Director-General of WHO Tedros Adhanom Ghebreyesus has made universal health coverage a top priority. This will require greater effort from the WHO to catalyse proactive engagement and advocacy with global, regional and national political structures and leaders, including heads of state and national parliaments.
With all this in mind, the UNIATF and UN agencies in Cambodia are committed to strengthening Cambodia’s capacity to prevent and control NCDs and ensure a healthy and a sustainable future.