Norway Launches First-Ever Strategy By Major International Donor To Combat Non-Communicable Diseases

Oslo – Norway has launched a milestone “Better Health, Better Life” strategy to combat deadly non-communicable (NCDs) diseases as part of its international development assistance. This makes Norway the first to develop a strategy for combating this large and growing global health threat, which currently receives only about 1% of international health assistance.

NCDs are the cause of some 70% of deaths worldwide – and are now a major, growing cause of illness and premature death in low- and middle-income countries.

‘Worldwide, 41 million people die each year as a result of respiratory disease, cancer, cardiovascular disease, diabetes, mental disorders and other non-communicable diseases. This cannot continue,” said Norwegian Minister of International Development Dag-Inge Ulstein.

“Therefore, Norway will triple its assistance to fight NCDs, allocating over 200 million NOK to these agendas for 2020. This is just the start, we will step up the funding towards 2024,” said Ulstein.

Norwegian Minister of International Development, Dag Inge Ulstein

Speaking at a launch of the strategy in the Norwegian capital at a “Gathering for The Future of Global Health,” the minister noted the “strong upward trend” in the number of deaths from non-communicable diseases in countries at the lowest income levels.

“Tobacco, air pollution, alcohol, unhealthy food, lack of physical activity…These silent killers cause 70 percent of all premature and unnecessary deaths worldwide – yet the fight against them receives only 1 percent of the international development funding that goes to health. 70 percent – One percent,” said Ulstein.

“That has to change – and that is why we are here today. In Africa, the deaths from non communicable diseases are projected to increase from around 35%  to over 50% of total deaths by 2030. We are going the wrong way.”

NCDs often develop into chronic conditions, and when they are not treated or managed early enough, the result can be catastrophically high costs for individuals as well as health systems, he observed.

“If you cannot go to work – or plow your fields – there will be one less bread-winner in the house – and one less co-fighter in our collective quest to win the 2030 race to meet the SDGs,” he said.

Norway Asks Other Donors To Step Forward on NCDS
Norwegian Minister of Health, Bent Høie. (Photo: Stine Jenssen).

In launching the strategy, Norwegian officials were clear that they hope other high income countries which provide billions of dollars in international development assistance will also step forward and follow their example.

“No country until today has presented a programme on how to use development aid as a tool … to address the NCD epidemic. This is what makes this day so special,” said Norway’s Minister of Health, Bent Høie who co-hosted the strategy launch.

Referring to Norway’s longtime record of promoting health in development aid, he said that “this strategy will take it a step further, I urge other countries to follow up and develop their own NCD strategies for development assistance.”

Historically donor aid from high income countries has been used almost exclusively on communicable diseases, he noted, referring to the billions of dollars spent every year on global health programmes to fight AIDs, TB, malaria, other neglected infectious diseases, as well as to promote immunization.

Historically those programmes “corresponded to the disease burden and the biggest challenges in global health,” he noted, but, “today, this has changed.

“The NCDs are claiming far more lives than communicable diseases with many people dying prematurely. With this change in the disease burden, we need to change our priorities accordingly.”

WHO’s Bente Mikkelsen talks about the need for collaboration between health, finance, urban development, agriculture, food and pharma sectors to reduce NCDs, at the launch of the Norway’s NCD Strategy.

While some NCD treatments can be extremely expensive, others are “relatively cheap, like getting medication to lower blood pressure. But in many low income countries, this is out of reach,” he added.

“The [Norwegian] strategy recognizes these challenges and underlines the need to provide treatment based on universal health coverage. Primary health care is the basis.”

He noted that the strategy builds upon the 16 WHO-recommended Best Buys for preventing and controlling NCDs, which include comparably simple and inexpensive measures such as reduced salt and sugar intake and increasing physical exercise. The Best Buys were agreed upon by UN Member States at last year’s Third High Level UN Meeting on NCDs.

“If these were implemented, over 8 million lives could be saved annually by 2030,” Høie said, adding that according to WHO estimates, that would also lead to a savings of $US 7 trillion in low- and middle-income countries over the next 15 years.

Three-Pronged Strategy 

The new strategy has three main points of focus: Strengthening primary health care services: Prevention of leading NCD risk factors like air pollution, tobacco and alcohol consumption and unhealthy diets; Better data management and health information systems.

Strengthening Primary Healthcare Services as part of Universal Health Coverage.

Many NCD interventions, can be delivered effectively and affordably at primary health care level, with greater benefits to patients and savings for health systems.   Examples are checks for hypertension, diabetes, prevention of cervical cancer with HPV vaccination, as well as capacity for prevention and early diagnosis and treatment of mental health disorders in primary health services.  Norway will support the strengthening health services so that primary health care services are well-equipped to support NCD prevention, early diagnosis and treatment, as well as ensuring everyone has access to health services, subsidized in part, by the public authorities.

A woman gets her blood pressure measured to test for hypertension.
Preventing and reducing risks through intersectoral action, including regulation, taxation and other measures.

Norway will help to prevent non-communicable disease through development cooperation that contributes to healthy and sustainably produced food, a healthy environment with clean air and the consumption of clean energy, opportunities for physical activity, access to high-quality education and stronger tobacco and alcohol regulations. Emphasis shall be given to social sustainability and reducing health differences from childhood to old age.

In this context, Norway will also support countries requesting assistance to improve taxation and regulation of products that are harmful to health,  through its Tax for Development Programme (Skatt for utvikling). Such measures can be used to effectively discourage consumption of health-harmful products such as tobacco, alcohol, sugary drinks, saturated and trans fats, and encourage healthier alternatives.  Similarly, pollution taxes and regulations can encourage shifts to clean energy and transport, reducing health-harmful air pollution. These are all among the key risk factors contributing to NCDs, including cancer, hypertension and heart disease as well as obesity-related disease such as diabetes.

Unhealthy, unregulated street foods are commonly sold in low- and middle- income countries.
Strengthening data management, digitalization and other health information needs.  

The strategy also calls for assisting countries in developing better health information systems, to  improve access to health data critical to facilitating early stage NCD diagnosis, treatment; supporting NCD-related health norms and standards, as well as efforts to improve access to medical equipment and medication, particularly  in areas hit by crises and conflict.

Norway’s officials say that the strategy will support the SDG 3 goals of Universal Health Coverage (SDG 3.8) and reducing premature deaths from NCDs by one-third by 2030 (SDG 3.4), as well as the commitments reached at the Third UN High Level Meeting on NCDs  in 2018 as well as the recent UN High Level Meeting on Universal Health Coverage,” Høie added.

The strategy also supports other SDG 3 targets for reducing deaths and illness from hazardous chemicals and air pollution, as well as preventing and treating harmful use of alcohol.

Strategy Launched At Oslo “Gathering for Global Health” Event

Norway has become “the first in the world to launch a strategy to include non-communicable diseases in its international development policy,” said WHO’s Director General Dr Tedros Adhanom Ghebreyesus in a videotaped message broadcast at the strategy “Gathering for Global Health” launch in Oslo on Friday.

Tore Godal

“Non-communicable diseases are the leading killers of our time. As is so often the case, the world’s poorest bear the heaviest burden,” the WHO Director-General added. “The risks of dying between the ages of 30 and 70 from a heart attack, stroke, diabetes, cancer or asthma are 4 times higher in most countries of Africa than in Norway.”

“You have anchored this strategy in the political declaration on NCDs and Universal Health Coverage, which were adopted this year and last year at the UN General Assembly.”

“And you have built it on the WHO Global Action Plans on NCDs and Mental Health and the WHO Best Buys. I appreciate the central role in the strategy of primary health care, both in preventing and managing NCDs.”

“Thank you for your leadership in this important area.  WHO is delighted to accept your invitation to be a co-sponsor of this strategy. Together we can ensure more people get the health services that they need for NCDs and for all their health needs.”

The launch event included Dr Tore Godal, as a guest of honor, celebrating Godal’s lifelong service to global health on behalf of the Norwegian government and the global community.

Godal, a special advisory on global health at the Norwegian Ministry of Foreign Affairs, compared today’s NCDs challenge to the battle against tobacco, which mobilized the global health community several decades ago and is still ongoing today. Like the fight against tobacco, we need a multi-pronged strategy including legal action, awareness and taxation to achieve meaningful progress,” he said.

 

A video describing the challenge of NCDs in low income countries here:

Image Credits: Twitter: @NorwayMFA, Stine Loe Jenssen, E Fletcher/HP-Watch, Twitter: @NorwayMFA.

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