“NCDs in the Post-2015 Era: Delivering Action, Accountability and Results” Side event at UNGA on Review of Progress with NCDs, hosted by the NCD Alliance
Remarks of Dr. James Hospedales, Executive Director, Caribbean Public Health Agency on: Perspective of CARICOM LMICs and SIDS
Mdm Chair, Hon. Ministers, Ambassadors and Permanent Representatives to the UN, Sir George, members of the NCD Alliance.
I’m pleased to bring perspectives on NCDs in the post-2015 agenda, particularly as it concerns LMICs and SIDS, looking at the challenges and opportunities for operationalising inter sectoral cooperation.
In making these remarks I shall sometimes look back in order to look ahead, a technique often used by Richard Branson of Virgin Atlantic.
First let me say that NCDs represent symptoms of the failure of our development paradigms in this world, which focus unduly on economic growth, and insufficiently on health/social and environmental aspects of sustainable development. A more balanced approach is needed.
Secondly LMICs and SIDS are bearing the brunt of this situation, given small size and low capacity. Our countries are particularly vulnerable to global shocks, natural or man-made, and the corollaries of that, such as the very high dependence on imported food, which is contributing to obesogenic environments. That makes trade policy very important for us.
The CARICOM statement of yesterday, read by Minister Blokland of Suriname, outlined this prospective clearly. Thus, we would have been much happier had there been an explicit statement such as “Trade and Foreign Affairs negotiations should include explicit consideration of how obesogenic environments may be reduced and prevention and control of NCDs be better addressed”. In that regard, the outcome document of the UNGA review of progress with NCDs is lacking, together with the weakness in the accountability architecture specified.
But CARICOM countries, LMICs and SIDS regard health and NCDs in the post-2015 agenda as a priority and a cross-cutting development issue. Thus we are pleased to see the explicit recognition of NCDs as a development challenge in the outcome document, with recommendations for inclusion in the post-2015 agenda.
Regarding accountability, we do a better job in CARICOM with an Annual NCD scorecard that tracks the achievement of 26 indicators in 19 countries since the CARICOM Heads of Government NCD Summit of 2007. That annual monitoring has shown progress in some areas and weaknesses in others, such as measures related to improving diet and nutrition, e.g., mandatory food labelling, trans fat-free food supply, mandatory physical activity in schools, utilisation of trade agreements. This reflects the limited legislative capacity in the small states of CARICOM to give expression to the political will of the Port-of-Spain declaration.
Thus, we signed an agreement yesterday with the International Development Law Organisation (IDLO) to commence an initiative to stimulate legislative change and build legislative capacity to create supportive environments for the prevention and control of NCD. We also agreed with the Pan American Health Organisation to work together on this initiative. Strengthened policy and legislative measures will definitely be needed to address NCDs in the post-2015 agenda.
In making the rest of these remarks, I shall frame them in the scholarship of Prof John Kirton, Head of the G8 and G 20 Research Unit at University of Toronto, and a member of the CARPHA Technical Advisory Committee.
His work shows that a number of key catalysts are needed to ensure implementation of and results from the political commitments made in the UNHLM on NCDs of 2011 and will be needed pursuant to the current outcome document of the UNGA review. These compliance catalysts include:
- the critical role of civil society -- and thus its fitting that the NCD Alliance is organising this session
- the accountability architecture for the initiative
- insertion of the issue into other high-level agendas
- having champions for the cause
Let’s consider the role of civil society for a moment, engagement of whom has been a key catalyst from Prof Kirton’s work in HIV/AIDS, in environment, in malaria et cetera. Let’s begin by looking back. Some 3000 years ago a man called Nehemiah was attempting to rebuild the walls of Jerusalem. It is instructive to read the tactics that he employed to secure relief from the rich who were oppressing the poor. First he named them and shamed them, then he made an agreement with them with specific objectives, such as we have in the outcome document, then he got the priests to witness the agreement, and then he created “a great assembly of the people" to put pressure on the rich people, to give relief to the poor so they could do the job of reconstruction.
As I look around this UNGA review, where is the great assembly? Why aren’t there 25,000 people affected by NCDs outside? In the Caribbean in 2011, led by the Healthy Caribbean Coalition, almost 1,000,000 text signatures of support were received in the Get the Message campaign. This led to the Caribbean having the highest level of representation at the level of head of state in the UNHLM. I challenge the NCD Alliance to work with the HCC to raise 1 billion text signatures of support and create a global demonstration so that leaders get the message that NCDs are preventable cause of people suffering, and preventable impediments to economic growth.
Second, let’s look at the issue of insertion into other high-level agendas to keep NCD on the political agenda. Let’s begin by looking back again. And here I draw your attention to advice in Philippians 2:4, “Seek not only after your own interests but also to the interests of others“. I believe this approach is needed so that we reframe our arguments and balance our advocacy for NCDs with an understanding of the interests of the forums in which we hope to insert our message. Lest you think this is too old-fashioned, fast forward to the present and scholarly work of Roger Fisher’s interest-based negotiation which advises exactly the same thing as summarised in publications like “Getting to Yes", and “Getting past No".
What are some of these other high-level agendas into which we might wish to insert NCDs? They might relate to climate change, economic resilience, poverty reduction, human rights, or improving profitability and competitiveness in the private sector or reducing costs to business.
And so what might this reframing look like given some of the major high-level agendas in the world today?
Following this line of reasoning, the NCD cause in the post-2015 agenda might thus be better served along the following lines. Request a meeting with the finance minister on the subject of “Removing Preventable Impediments to Economic Growth". That’s more likely to secure an audience than NCDs per se. What about “Mitigating Climate Change by increasing alternative transportation like biking and walking and rapid mass transport for triple bottom-line returns to the economy, energy security, and health/NCDs?" This puts the interest of many development partners today upfront, and the interest of the NCD cause is met through increasing physical activity, a critical risk factor for NCD. How about “Poverty reduction through attention to preventable NCDs"? How about a message to the private sector like, “Improving profitability, quality and reducing costs to business by prevention of NCDs”?
I believe that to deliver action and results in the post-2015 agenda for the prevention and control of NCDs, these are some of the approaches that the NCD movement will need in the post-2015 agenda, and not only to take a narrow health or disease approach but to look at the interests of others and frame our interests along those lines.
I learned a lesson like this some 15 years ago when attempting to advocate with the Caribbean hotel Association for attention to preventable problems like diarrhoeal disease in the tourism industry. Over a year I attended board meetings of the Caribbean hotel Association comprised of over 100 mostly male, mostly millionaires. I was making little progress gaining their attention, quite the opposite, in fact. Until the financial controller of the Caribbean tourism organisation took me aside and said, “James, you can’t talk to the fellas like that; you have to frame your issue in the things that interest them, which is primarily making money". So in my next presentation at the inter-American travel Congress on this subject, my title slide said, “Improving Profitability through attention to health, safety and environment in the hotel industry". 95% of my talk content was the same as before, but reframing the argument got their attention and eventually we signed an agreement and got support from a development partner to work on the problem to improve the quality and competitiveness of the industry, through improving health and safety and environmental conditions.
I was also asked to comment on country ownership in the Caribbean countries. This certainly is occurring but sovereignty can sometimes be misleading: for example, what do we do about transnational advertising of junk food to children who are not rational economic decision-makers?
Having said that, programs like the Chronic Disease Action Programme of Trinidad and Tobago, or the National Health Fund of Jamaica, or Barbuda’s is national drug program make available free medications for people with NCDs. A recent evaluation of the decline of cardiovascular mortality in Trinidad and Tobago attributed most of the decline to the scale up of secondary prevention through the CDAP program. Throughout the Caribbean NCD services have been integrated into primary health care. A good example is the “one-stop shop for chronic disease" in Suriname.
We still have a long way to go especially with multisectoral action, but as I indicated earlier we will be pursuing adjustments to trade policy in the region, within the bounds of WTO, and we will pursue legislation to create more supportive environments for NCD prevention.
I thank you.
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