HMG7120 Global Challenge - Non-Communicable Disease Assignment - Victoria University, Australia

Topic - Policy Review

Task - Review the evolution of global policy on Non-Communicable Disease (NCD) prevention and control from a public health perspective over the past 10 years.

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Solution 1 - Review of global policy on Non-Communicable Disease (NCD) prevention and control

Development of non-communicable diseases' effect on humankind around the globe

"But almost eight months thence, it has been established - non-communicable diseases are becoming the top killers of humankind, closely followed by substance abuse and psychological disorders" (GANESAN, 2019); the international challenge over non-communicable ailments is high, with forty million deaths each year, involving around 15 million deaths in people younger than 70 years. As per the current WHO report, non-communicable diseases have the capacity to kill around 41 million individual every year and account for around 71% of all deaths internationally (GANESAN, 2019). For instance, cardiovascular diseases are nearly 18 times the deaths resulted by HIV or AIDS. Chronic obstructive pulmonary diseases accounted for 3 million lives in 2016, while lung cancer only resulted around 1.7 million deaths. As per the WHO factsheet, in truncated- and medium-income nations around the world, NCDs claimed for 78% all deaths; yet only 1% of international health subsidy goes to protecting these ailments. On the other hand, the expenses of not taking any action against these diseases is vast that not only in diagnosis and treatments expenses but also in premature deaths.

Calculations indicate that financial loss from early deaths due to the NCDs diseases would be over 30 trillion dollars in the upcoming 20 years, which is equal to half of the international gross domestic product in 2010.

Evidence that underpins the NCD policy agenda

An Noncommunicable diseases policy agenda, specifically if entranced with the nation-wide health policy can safeguard strategic consistency and ease teamwork, and co-ordinated multisectoral actions of related departments external to the health industry. Balancing fitness care strategies required to offer the fundamentals for early discovery as well as treatments of risks and diseases, rather through a "primary health-care approach" that could safeguard equality. Counselling offered by the health workers frequently acts a significant role in educating individuals, families, communities and motivate too change behaviours (Mendis, 2010). Additionally, behavioural change often needs conductive and helpful surroundings in which strategies make healthy choices effective and reasonable. Policies included in NCD, which support tobacco control, physical activities, healthy eating and prevention of damaging application of alcohol act the core role in NCD deterrence and control. It requires multi stakeholder efforts.

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The multisectoral strategies have been efficiently functional to "settings of everyday life" in emerging and developed nations. Though strategy situation to prevent the wellbeing of people is mainly the business of Ministries of Health, factually this has often been non-governmental and other professional public groups that have had to persuade ministries into actions. For instance, in 1962, the first called was organized by the Royal College of Physicians for effective rules to protect and minimize the pervasiveness of smoking (Mendis, 2010). Their effective support policies donated to the prior preparation and application of tobacco prevention strategies in the United Kingdom. Currently, international and national non-governmental companies have fronted encouragement movements, which have developed government actions to govern salt in processed foods.

Lessons learnt in addressing NCDs over the last 10 years

As pet the NCD report in 2010, deaths are predicted to develop by 1% internationally between 2010 to 2020. The greatest developments will be in Eastern Mediterranean, South-East Asia, Africa, where they would develop by over 20 per cent. The foremost reasons of noncommunicable disease deaths in 2008 were: cardiovascular diseases, respiratory diseases, cancers and diabetes that resulted around 1.3 million deaths (who.int, 2010). Most of the noncommunicable diseases are effectively linked up with and casually associated with four main behaviours, which are tobacco use, unhealthy diet, ingesting of alcohol and physical inactivity.

The global report of 2014 is developed based on nine voluntary international targets. The first target is based on minimizing the overall mortality rate around 25%. 10% relative reduction on alcohol consumption and 10% relative reduction on the occurrence of ineffective physical activity are the second and third target respectively. 30% decrease in the mean population of salt intake, 30% reduction on the tobacco usage of aged 15 (who.int, 2014). Reduction of rising rates of diabetes, obesity, high blood pressure around 25%. 50% availability of drug treatment and therapy for preventing heart attacks and around 80% availability of fundamental treatment and basic skills for diagnosis.

Technical notes on the UN result document on NCDs was modified in 2017 to make sure alignment with the modified set of WHO 'best-buys' and other polices for the regulation of "noncommunicable disease" that were recognized by World Health Assembly in May 2017. These indicators involve developing time-bound targets to control NCD deaths, increasing all of government strategies to underline NCDs; applying core tobacco demand control measures and increasing health systems with the help of primary health care initiatives and global health reporting (World Health Organization, 2018).

The "third set of Country Profiles in 2018" offers an apprise on every member state, outlining core information on NCD mortality, risks, nation-wide systems capability to reduce and control noncommunicable diseases and presence of nation-wide goals based on the international nursing platform. These outlines help the member states to keep an eye on development to reaching the nine global goals, to be achieved by 2025 (Nugent et al., 2018).

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Key issues that need to be addressed

As the global community has recognized efforts to combat against the international burden of communicable ailments, a developing burden of NCDs has also increased relatively unnotified in the emerging countries. Currently, this challenge of NCDs in the emerging world exceeds that in high-income nations. The possibility of dying from any of the main noncommunicable diseases between the ages 30 to 70 ranges from a 10% in developed world to 60% in emerging countries (who.int, 2019). This is calculated that up to two-thirds of premature deaths from noncommunicable diseases ate connected to exposure to risks identified in the policy and up to half of all thus deaths are connected to ineffective systems, which do not response efficiently to health care needs of individuals with NCDs. For instance, as per African Union in 2013, exorbitant expenses of noncommunicable diseases are reinforcing around 100 million of individuals in the country into poverty annually. This differential control of NCDs in and around populations in emerging countries includes one of the main tasks for growth in the 21st century that underlines both financial and social developments.

Additionally, in emerging countries, treatments for cardiovascular diseases, diabetes, cancer can easily drain household resources, forcing families into impoverishment. The NCDs worsen social inequality as most of the payments for health care in emerging countries are private and these expenses weigh more potentially on those least capable to afford them, developing their risks of impoverishment (who.int, 2019). This chronic nature of noncommunicable diseases, and the probable development in prevalence, suggest that the financial influence might increase cumulatively over various years and have dramatic financial impacts.

Key global actors and leadership in NCD policy

WHO has developed the "NCD global action plan", which offers options for the stoppage and controlling of the noncommunicable diseases for member states, for global partners and secretariats and the private sector (Diem et al., 2016). This plan has six different objectives related to reduction and prevention of NCDs. On the other hand, heads of state and government as well as ministers from across the globe currently committed to new and relevant actions to minimize suffering and death from the NCDs, primarily lung and heart diseases, diabetes and cancers, the leading killers. The pledge follows contract by world leaders to minimize "premature" deaths from NCDs by one-third by 2030 as part of the UN's programme for sustainable development (Who.int, 2019). Recently, noncommunicable diseases kill around 40 million annually that is more than any other causes of death. The Montevideo Roadmap recognizes a series of difficulties that are listed below;

• Uneven and ineffective development to reduce premature deaths from NCDs
• Impact of the private industry on governments to prioritize trading over public health objectives
• Lack of effective level political leadership to make sure that health promotion as well as NCDs protection and control are a part of all the areas of government policies (Who.int, 2019).

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Key milestones in policy formulation and implementation

In July 2014, in the "second United Nations High-level Meeting on noncommunicable diseases", ministers, had jointly committed to arrange four immediate domestic actions. These actions are listed below;

• By 2015, consideration situation of national NCD targets for 2025
• By 2015, consideration will be given on increasing national multisectoral strategies and plans to attain the national targets by 2025.
• By 2016, reduction of risk factors for noncommunicable diseases, building on guidance will be set out in the WHO international NCD action plan (World Health Organization, 2017).
• By 2016, health systems will be strengthened to adhere NCDs through people oriented main healthcare and global health treatment, create guidance stated in WHO global NCD action plan.

The WHO NCD mapping toolkit

The objective of this toolkit is to help policy creators and programme management in increasing implementing and examining national multisectoral NCD plans. This covers the core steps form situation analysis, stakeholder involvement, and setting national NCD objectives to apply, monitor and evaluate, involving practical templates and instances (Juma et al., 2018).

Principles and Approaches used in NCD policy

The key principles and methods used in the NCD policy are listed below;

• Supporting and empowering individual living with noncommunicable diseases to offer an effective self-care and perched for developed services.
• Investment in integrating the noncommunicable diseases into present development platforms. On the other hand, do nor neglect true expenses and efforts (Greene et al., 2016).
• Engaging in wide range of front-line employees to master care.
• Developing and building conditions to process the assets of the public sector's and private sector's capability and management.

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UN meeting on NCDs

The NCD alliance as well as 300 supporting companies including PATH called the UN meeting on NCDs a lost opportunity. An open letter has been delivered showing criticism in the agreement, which governments signed on to and arranged for more accountability. Governments have wasted the chances of this high-level meeting to end the economic gaps for noncommunicable diseases with real communities for the health of their people (Lieberman, 2018). Leaders involved in the policy who disregard to make important investments in NCDs are failing their people and would be accountable for untold preventable suffering and loss of life. Aim of the political declaration for strengthening leadership and to control and reduce noncommunicable diseases, primarily, the cardiovascular disease, diabetes, cancers and others does not, however, involve either extra funding or an economic facility to assist generate it.

To be precise, "On the whole, [the declaration] is pretty unambitious and non-committal" (Lieberman, 2018). There are some significant gaps in the political declaration in which efficient policy should be. Expectations are there regarding clearer language on the success for fiscal measures and on taxation on tobacco and other unhealthy foods such as soda and sugar.

NCDs in the Sustainable Development Goals (SDGs)

Developing the health of people, involving preventing and supervisory NCDs, is integral to ensure improvement around the three main stances of financial development, social equality and environmental protection along with the aim of attaining sustainable development. Many UN declarations, policies and global agreements underline that governments understood the interconnections between NCDs, sustainable development and health (ncdalliance.org, 2019). The "2030 policy for sustainable development" has been adopted at the United Nations Conference on Sustainable Development in September 2015, underlines NCDs as one of the main difficulties for sustainable growth. Noncommunicable diseases were not underlined in the "Millennium development goals". As included in the Agenda, Heads of State and Government has committed to increase a national response to the entire application of this agenda, consisting of

• Reduction by one third mortality (premature) rate from NCDs
• Developing replies to minimize the dangerous usage of alcohol
• Reach global health coverage
• Develop the application of the WHO Framework Convention on Tobacco Control
• Supporting the evaluations and development of vaccines and drugs for NCDs, which chiefly influence emerging nations (ncdalliance.org, 2019).
• Offer access to effective important drugs and vaccines for NCDs

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Global Targets

There are nine separate targets include in the global target framework of NCDs. These targets are listed below;

• Around 25% reduction of the overall mortality from cancer, diabetes, cardiovascular diseases by 2025
• Reduction of alcohol consumption rate by 10% as appropriate in national context
• Developing physical activities and 10% reduction of the prevalence of insufficiency
• Mean population intake on salt will be reduced by 30%
• The reduction of recent tobacco consumption rates by 30%
• As per the national circumstances, minimization of blood sugar level and blood pressure level by 25% (World Health Organization, 2019).
• Prevent the development of obesity and diabetes
• Develop the workforce and provide training, counselling and medicine therapies to eligible people to 50%.
• Availability of technological measurements and treatments by 80% for the people.

The role of global versus national NCD policy and the importance of national policy

The primary part of global NCD is to tackle the rising threats of cancer, cardiovascular diseases, and chronic respiratory diseases among other diseases. It looks at the problems at a macro prospective and comes up with solutions. It monitors and regulates health related issues throughout the region. It helps the government to tackle the growing threats of the disease and provide solutions to the issues faced by the people. It studies the overall impact of disease on the population a specific group of population and helps them with the research on the possible cure. It helps the leaders of the country to create awareness regarding the impact and the disease itself (World Health Organization, 2019).

However, when it comes to the national NCD policy, it looks at the micro aspects of the disease and help the nation to deal with a daisies type. For example, polio, small pox, tuberculosis and many more are directly tackled by the national NCD policy. These policies are specific to a country based on the population and health quality. It follows the guide and principle that are led by the global NCD policies. There can be multiple national policy but there is only one global policy. Every national policy is based on the country from where it operates.

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Coordination and monitoring mechanisms

World health organization is directly responsible for the coordination and monitoring mechanism. According to McIntyre (2015), WHO need to ensure better coordination among the parties and must need to take these significant steps.

• Make sure to allocate and mobilize all the necessary resources in order to attain the NCD- related targets. This is very much stated in the sustainability development goals by 2030.
• Make the utilization of effective and efficient domestic resources in order to implement national NCD responses. It includes proper and greater use of tax that are generated by Tobacco and other taxes that are related with health.
• Encourage and promote from the private sector to address the issues of NCD. Because they might have an effective and efficient effect on the large population.

Key documents on NCD policy

Starting from September 1st, 2018, the world health organization have started providing country specific health related data with the countries from all around the world. The countries that are having low or lower middle income are recently facing premature death from non-communicable diseases. A study in 2018 stated, an investment of $1.27 per year per person could ultimately help millions of people belonging from low and middle incoming country (Global-business-plan-ncds.info, 2019). This study also indicates that these countries can help generate around $350 a year from those saved people. The above tool builds on the data indicates how a single and individual country can help and save millions of lives while at the same time generating immense amount of money from them. The tools of WHO is made in such a way that it can help the country and an individual donor to identify the impact of their investments.

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Challenges in formation and implementation of NCD policies

The international policy considered that the fast rise of noncommunicable diseases that in 1998 was responsible for around 60% of the international deaths and around 43% of the international burden, outlines one of the main difficulties to international development in the 21st century. On the other hand, the treatment gaps and improper systems of social and healthcare, specifically in LMICS, jointly with human rights abandon, stigmatization and relegation along with social isolation of individuals with metal health disorders outline the main challenge in controlling the mental health challenge (Riley et al., 2016).

According to the Heads of State and Government's understanding that the international burden of NCDs combines one of the main encounters to socio-economic increasement in the 21st century and threatens the development of globally agreed increment goals. Lack of proper health care for the initial detention and care of curable cancers, life-saving cardiovascular interference, treatments of diabetes and other chronic diseases are one of the most important challenges, which health systems in the developing countries face and these often leads to disastrous costs and poverty influencing all the households.

Recommendations for the way forward

Possible recommendations are listed below;

• Governments and public agencies need to mobilising communities by implementing solutions for NCDs
• National actions plan needs to be modified and role of stakeholder network analysis needs to be done effectively to track the progress.
• The NCDs programmes could be developed by systematically recognizing application difficulties and translating them into methods and questions, which could be answered with the help of proper research.
• Financial analysis of interventions needs to be applied to reducing the effects of NCDs on developing countries that could encourage countries to develop investment.
• An entire systems approach, which integrates action on the social causes of health system could be applied for reducing the challenges of NCDs along with the integration of mental health agendas in NCDs plans.

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Solution 2 - HMG7120 Global Challenge: Non-Communicable Diseases

Underpinnings of the NCD policy agenda and lessons from past years

According to the World Health Organisation, the number of cases of non-communicable diseases has continued to grow on a global level, which has made its management an issue of mammoth proportions. The policies on NCD prevention and management are aimed at reducing the instances of premature mortality, while improving the quality of life for the people.

The resolution of WHA64.11 was adopted in 2011 for the prevention and control of non-communicable diseases, which aims to implement and follow-up on various plans with the assistance of the numerous United Nations agencies (World Health Organisation, 2012). Another resolution of EB130.37 was also adopted in 2012, which was intended at helping with a WHO action plan for the same.

Key issues to be addressed

The objective of the global action plan that aimed to prevent and control the instances of non-communicable diseases between 2013 to 2020 can be thus outlined as below -

• To raise the levels of priority related to the prevention and control of non-communicable diseases in global, national and regional agendas, and to agree on internationally sustainable goals by cooperating on a global level (World Health Organisation, 2012)
• To strengthen the capacity, governance, leadership, partnerships and initiatives for action on a national level for the prevention and control of communicable diseases.
• To bring about a reduction in the modifiable risk factors for non-communicable diseases, together with the social determinants that lie at its roots, for the creation an environment that promotes healthy living (World Health Organisation, 2012)
• To reinforce the health systems for addressing the prevention and control of non-communicable diseases and its causes, through primary healthcare aimed at the betterment of the people and to cover the health issues on a global level
• To assist in high-quality research for the purpose of developing methods for combatting the prevention and control of non-communicable diseases (World Health Organisation, 2012)
• To keep track of the trends in the occurrences of non-communicable diseases to monitor the progress in the attempts for prevention and control.

The threat and burden that non-communicable diseases have on a global scale is a major challenge in terms of public health that has the power to undermine the social as well as the economic development of any country. In order to mitigate these issues, a strong sense of leadership, together with urgent action, are needed, which would help decrease the gap and inequality that is prevalent between the numerous countries and within their populations.

In 2008, out of the 57 million deaths that occurred on a global scale, around 63 per cent were due to non-communicable diseases, most cardiovascular ailments, followed by cancer, respiratory diseases, and diabetes. These non-communicable diseases can sometimes arise due to many behavioural risk factors, such as lack of physical activity, tobacco use, alcohol abuse, and an unhealthy diet (World Health Organisation, 2012). Among these deaths, more than 80 per cent were from countries that constituted the low and middle-income bandwidths. The World Health Organisation (2012) has also predicted that the number of deaths due to non-communicable diseases will tend to increase to as high as 55 million by the year 2030, in case no tangible action is taken in these countries. Many preventive and curative interventions are already available for most non-communicable diseases, and these need to be implemented properly in a balanced manner if the instances are to be reduced, and this is very much possible as there is adequate scientific evidence to back it up.

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Principles and approaches

A preliminary action plan as outlined by the World Health Organisation provided the roadmap necessary for the policy operations related to the stakeholders, especially the member states, to take coherent and coordinated action at all of its levels, from local to global and to achieve a 25 per cent reduction in mortality of premature nature due to cancer, diabetes, cardiovascular issues and respiratory ailments. The risk factors as outlined above are also linked to the health systems and other determinants, such as the occupational factors, ageing, reproductive health and so on. Explained below are some of the key issues that need to be addressed when it comes to policies related to the prevention of non-communicable diseases -

• The tobacco free initiative: The death toll due to tobacco has been of epidemic proportions, which has led the World Health Organisation to take action against its usage. The aim of this initiative is to raise awareness and gain more control over tobacco products. The attempts had originally been started from 1998 itself, and was focused on attention on an international level, along with resources dedicated towards taking action for controlling the global epidemic due to tobacco (World Health Organisation, 2019). There are three major areas that are emphasised by this initiative - the tobacco control economics, information and surveillance systems, and national capacity building.

The tobacco control economics are aimed at the demonstration of the various control policies, especially with regard to tobacco taxation. They usually work with many countries to increase the tax systems for tobacco, and to carry out relevant research for developing manuals and tools that would enable the development of more policies. They also conduct surveys to get an understanding of tobacco taxation across countries.

The information systems team assists countries in terms of improving the data available on the surveillance of usage of tobacco, the exposure to the drug, and the subsequent health effects. On the other hand, the team for national capacity building provides the necessary assistance for the countries that need to improve their ability in terms of resisting the epidemic and also for reducing the tobacco demand (World Health Organisation, 2019). It functions in alignment with the World Health Organisation's Framework Convention on Tobacco Control.

• Health promotion: This team acts to promote health as well as health equity across the different sectors, and also for reducing risks, and for promoting a lifestyle that is overall healthy. Some of the key programmes that this team conducts are the School Health and the Oral Health (World Health Organisation, 2019). This is also integrated with non-communicable diseases prevention and control, and to achieve outcomes that are related to it on a population level by collaborating with the key stakeholders, both within and without the World Health Organisation.
• Population and surveillance-based prevention: These are the fundamentals for preventing deaths due to non-communicable diseases. It is focused on policies and programmes, along with environmental interventions that are targeted at the overall population rather than the individuals that are high-risk. Some of the areas that have been under focus in case of the World Health Organisation are the Physical Activity and Health, and the Global Strategy on Diet (World Health Organisation, 2019). These all include the instances of salt reduction, promotion of physical activity, marketing of food products to children, and also fiscal policies regarding the everyday diet.
• mHealth: In this case, mobile-based technologies are used for promoting changes in terms of behaviour, which are believed to be healthy. This is essentially a joint venture between the International Telecommunications Union and the World Health Organisation. It is aimed at providing advice as well as technical toolkits to those countries that have provisions for non-communicable diseases prevention and control programmes (World Health Organisation, 2019).

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Global actors and leadership in NCD policy

The awareness pertaining to non-communicable diseases is increasing, which has encouraged the NMH or the WHO non-communicable diseases and mental health cluster to respond to the new challenges that are being presented within the landscape. It supports countries worldwide in an attempt to help tackle the occurrences of non-communicable diseases, be it neurological, mental, malnutrition, mental, or through physical violence or injury (World Health Organisation, 2014). This cluster works typically as one of the leaders in the regional and national levels in many countries.

The mission of the NMH is to improve the health conditions on a global scale by providing the much-needed leadership, for lessening the burden of non-communicable diseases. It also intends to improve the lives of the people who suffer from numerous disabilities (World Health Organisation, 2014). The objectives of this body can be simplified as below -

• Provision of timely and effective public health and epidemiological data for supporting action on public health that is based on evidence
• To help countries develop policies and approaches while involving all the government and non-governmental actors of the state
• Leading the development of plans and policies in support of public health on a global scale, for the development of broader and internationalised objectives
• Provision of technical aid to countries in need
• For raising the priority given to non-communicable diseases as per the national and international agendas
• Provision of timely and effective advice related to public health policies to various countries
• To encourage the coverage of universal health, while being accountable to the General Assembly at the United Nations.

The past ten years has been quite progressive as well as challenging for the NMH, as they have rethought the scope of development, and raised the necessary priorities related to non-communicable diseases. The Global NCD Action Plan of 2013-2020, as explained previously, targets at being a guideline for the prevention and control of non-communicable diseases. Similarly, the Comprehensive Mental Health Action Plan has been formulated for the governance and leadership of services that promote mental health and prevent mental disorders, including providing information, and preventing suicides (World Health Organisation, 2014).

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The NMH has also worked in many countries for supporting the promotion of good health, preventing disability and/or premature death from non-communicable diseases, and also for improving the general lives of the individuals who are living with disabilities. In 2014, an all-new global coordination mechanism related to the prevention and control of non-communicable diseases had been established, and this facilitates the stakeholder engagement, activity coordination and action across local, regional, national as well as international centres for contributing to the implementation of the 2013-2020 Action Plan (World Health Organisation, 2014). This mechanism also ensures that the efforts remain genuine and do not get duplicated, and also that the allocated resources are being used efficiently. They are also safeguarded from any kind of influence due to potential threats of conflicts of interest.

Key milestones

The most significant milestone for global non-communicable diseases has been that the probability of death from such an illness reduced considerably between 2000 and 2015 by almost 17 per cent. However, this rate is less than the intended rate (one-third) for reducing mortality rates due to non-communicable diseases by 2030 (World Health Organisation, 2014), but there is yet work to be done.

Sustainable development goals (SDGs) and global targets

The Sustainable Development Summit of 2015 at the United Nations committed several governments for developing their own responses on a national scale -

• The prevention as well as treatment of drug abuse, including narcotic substances abuse and alcohol abuse is to be further strengthened (Bettcher, 2018)
• Universal health coverage is to be achieved, which also includes financial risk protection, access to healthcare of good quality, access to safe and effective medication, and access to affordable and essential vaccinations for all
• To strengthen the implementation of the Tobacco Control Initiative by the World Health Organisation as applicable for the countries
• To support the research and development of medicines and vaccines for the communicable as well as the non-communicable diseases, especially for developing countries, and to increase the access to necessary medication, which is an extension of the right of those countries to utilise the appropriate provisions (Bettcher, 2018).

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Role of national and international policies

Both global and national policies are necessary for the control and prevention of non-communicable diseases, which ultimately helps protect the much-needed health of the populations. A single national policy is necessary for clarifying the purpose and vision, and it also enables to address the risk factors as well as the determinants that are shared by the various non-communicable diseases (Mendis and Fuster, 2009). It also acts as the framework for helping governments combine and balance out the public health strategies that are not only synergistic but also targeted towards the high-risk population groups. The strategies adopted are usually cost-effective and evidence-based, and national policies pertaining to non-communicable diseases can help provide the basis on which a strong legislation can be framed in relation to tobacco control, healthy diets, and physical activity (Mendis and Fuster, 2009). National policies also act as those vessels that facilitate the efficient as well as effective use of the available public funds for healthcare pertaining to non-communicable diseases, while striving to maintain equity. In other words, a single national policy related to non-communicable diseases is a lot more effective as compared to numerous policies regarding separate non-communicable diseases, especially in countries that are low and middle-income ones, as they tend to have a shortage of financial and human resources on a regular basis (Mendis and Fuster, 2009).

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Challenges

There are numerous challenges that are faced when it comes to the implementation of non-communicable diseases control and prevention policies. Some of these can be outlined as below -

• The exposure to the risk factors for the non-communicable diseases is increasing manifold due to the high levels of globalisation, and expansion of trade and unplanned population growth (World Health Organisation, 2010)
• The lower and middle-income countries lack the necessary resources that would be required for combatting the risks of non-communicable diseases, while people in developed nations could be otherwise well-protected by numerous interventions
• The political commitment for lending priority to the issue of non-communicable diseases on a general scale is inadequate, as the importance the governments tend to give is quite insufficient. This is further reflected in the poor amounts of funds allocated to the development agendas
• The inconsistency in terms of the seriousness pertaining to the treatment and dealing of non-communicable diseases is rather challenging, as the discussions with the high-level member states might be insufficient and irrelevant
• In many countries, the national policies for non-communicable diseases might have insufficient funds allocated to them
• Health financing in a sustainable manner is often threatened by the insufficient government expenditure in the low and middle-income nations, while in high-income countries, the systems are often inefficient and do not let the funds be utilised for health gains. This increases the expenditure that has to be spent for non-communicable diseases, thereby increasing the pressure on the families and individuals, which is further worsened due to the lack of insurance benefits (World Health Organisation, 2010)
• The monitoring and surveillance systems for mortality and morbidity are totally insufficient and inadequate, as many countries that have substantial amounts of deaths due to non-communicable diseases often do not report those cases (World Health Organisation, 2010). This is due to the lack of integration of the risk factor data into the national healthcare systems, thereby bringing about major issues in terms of programme assessment and intervention
• Many health systems often respond in an ineffective manner, especially when it comes to the needs of the people suffering from non-communicable diseases (World Health Organisation, 2010). This is mostly due to the lack of operational plans, a shortage of trained workforce, and poor technological advancement
• Evidence-based tools as well as guidelines pertaining to the cost-effectiveness of the interventions are also quite limited, not to mention the serious lack of allotment of funds and human resources for conducting research as well as implementation
• Governmental action for the control of advertising and sale of harmful substances such as tobacco and alcohol are either ineffective or not present in many countries, and this is also true in cases of nutrition profiling of the food (World Health Organisation, 2010)
• There is also a serious absence of national as well as international partnerships that would be strong enough to help build and collaborate the results and alliances of non-communicable diseases prevention
• Many governments as well as other bodies are not actively involved or sufficiently interested in the formulation of approaches or policies to non-communicable diseases control and prevention. In other cases, the entities might not be functional at all, while in some they could be completely ineffective.

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Recommendations

It is extremely important to address these challenges in terms of policy drafting and implementation in the case of non-communicable diseases. For instance, governments and other significant bodies need to be educated on the importance of preventing non-communicable diseases, especially given the fact that more than half the deaths in the world are actually due to such illnesses, which would otherwise be easily avoided or mitigated. International forums, the United Nations, and its functional bodies have the responsibility as well as the scope for recommending the formulation and implementation of such policies, as they would only help in the betterment of the people and reduce the overall investments necessary for healthcare purposes. Another recommendation for the government bodies would be to exercise strict control over the advertisement of tobacco and alcohol, especially through popular media such as television. This would help curb the marketing efforts of those companies, and also reduce the tendency of the buyers to engage in such purchases to a considerable extent.

The funds allocated for non-communicable diseases prevention and control should be dedicated only for that purpose, and care must be taken to ensure that the funding is being utilised properly. The approach should be such that the existing funds get utilised correctly, while the stakeholders, which is mostly the government bodies, should be encouraged to have a wholly separate budget for healthcare purposes, especially for non-communicable diseases, since they are quite easily presentable and can therefore help lower the premature mortality rates by a significant extent.

The rapid level of urbanisation is one arena that cannot be dealt with as effectively as needed. This is because people cannot be expected to give up mixing with others or travelling to other nations for their professional or personal pursuits. However, the stress and challenges faced due to the immense increase in the population can be controlled to some extent with the help of education and family planning measures, which can again be done only by the regional and national governments in the countries.

There also needs to be a consistency between the seriousness pertaining to non-communicable diseases, and the political commitment in this regard must also be encouraged. Governments need to be educated on the importance that the prevention of non-communicable diseases has on reducing the premature mortality rates, which can also help solve the issue of these policies being insufficiently funded.

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