Introduction by Croakey: The Director-General of the World Health Organization (WHO) has been tasked with developing a global action plan for the health of Indigenous peoples, to be completed in time for presentation to the 79th World Health Assembly in 2026.
The landmark resolution to the 76th World Health Assembly (WHA), which has just concluded in Geneva, was co-proposed by Australia, together with several other countries.
Drowning prevention, out-of-pocket healthcare costs, the health implications of chemicals, waste and pollution, substandard and falsified medicines, a global health for peace initiative, and the importance of the behavioural sciences were among other matters addressed by the WHA (see more details of WHA outcomes here).
The WHA also expanded the list of “best buys” for tackling non-communicable diseases (NCDs), reports Lucy Westerman below, in an examination of progress towards the 2030 Agenda for Sustainable Development.
Lucy Westerman writes:
Australia is among 193 countries that endorsed the 2030 Agenda for Sustainable Development in 2015. The 2030 Agenda seeks to individually and collectively address domestic and international challenges of eradicating poverty, protecting the planet, and ensuring equality and prosperity for all by 2030.
Several Sustainable Development Goals (SDGs) and targets relate to health. So how is the world progressing with regards to chronic disease?
The World Health Organization‘s World Health Statistics track and report on health-related SDGs, including SDG 3. The 2023 edition describes the projected increase in non-communicable disease (NCD) mortality & morbidity as “daunting”, requiring a doubling down on multisectoral efforts to address NCDs, their underlying risk factors and treatment.
The report projects that while premature mortality from major NCDs is reducing, not only is the world off track to achieve the 2030 target to reduce premature mortality from major chronic diseases by one third by 2030 (SDG 3.4), but on current trends we would not even achieve the target by 2048.
Living longer but with more illness
Like the 2023 World Health Statistics, the Australian Institute of Health and Welfare (AIHW)‘s 2022 Burden of Disease Study similarly found that while Australians are living longer, “years lived in ill health are also increasing”.
The WHO report cautions: “It is imperative that we are prepared for the consequences of the epidemiological transition and demographic changes that will manifest in the next few decades.”
While WHO documents some global progress in reducing exposure to chronic disease risks include tobacco and alcohol, the report also notes that exposure to leading NCD risk factors including alcohol, air pollution and hypertension remain high, while obesity prevalence is rising.
These risk factors correspond with the same leading causes of disease burden in Australia, which are largely the focus of the National Preventive Health Strategy 2022-2030 and related strategies for obesity, tobacco and alcohol.
They are also relevant to the forthcoming National Health and Climate Strategy. Health risks arising from global heating include disruptions to food supplies, and pollutants in the air we breathe.
Reducing risk
WHO’s 2023 report draws attention to the need to address such underlying risks, referencing a newly updated menu of evidence-based cost-effective measures to do so, and the need to work both inside and outside the health sector to implement evidence-based measures which will reduce exposure to so much chronic disease risk.
“An indispensable way to prevent and control NCDs is to focus on lowering the associated risk factors… A comprehensive approach is needed to require all sectors – health, finance, transport, education, agriculture, trade and others – to work together towards a common goal,” says the report.
Indeed, the evidence keeps getting stronger that taking action to minimise exposure to risk and intervening early provides big returns on investment for countries that embrace them.
Colloquially referred to as the ‘Best Buys’ for NCDs, the 2023 update to ‘Appendix III’ of the Global Action Plan for Prevention and Control of NCDs has a menu of measures, which has evolved since 2013.
While retaining the same evidence-based recommendations from previous editions – such as excise taxation and marketing restrictions on tobacco and alcohol products, and community wide education and awareness campaigns for physical activity and healthy diet – the update expands on food reformulation opportunities, and front of pack labelling recommendations (for food, tobacco, alcohol).
It also elevates recommended policies to strengthen protecting children from unhealthy food marketing, and sugar sweetened beverage taxes to reduce sugary drinks consumption.
Australia has led the way on many of measures to prevent chronic disease, for example, ever-strengthening tobacco reforms continue to deliver benefits in the form of declining smoking prevalence.
However, untapped opportunities remain in other areas, such as better alcohol and unhealthy food labelling and marketing restrictions, and sugary drinks taxes, to name a few, which could change the game for Australians’ health.
The World Health Statistics report also reiterates the importance of chronic disease detection, screening, and treatment to reduce the burden of the conditions, with primary healthcare identified as central to early detection and timely treatment, in turn alleviating strain on wider health systems and improving people’s lives.
Addressing inequities
The WHO Director General’s 2023 World Health Statistics foreword refers to persistent inequalities within and between countries, and the elevated risks of illness and death from preventable conditions that certain populations face due to their experiences of health-harming determinants.
We see this within Australia, for example, chronic conditions contribute to nearly two-thirds of the disease burden among Aboriginal people and Torres Strait Islander people, and account for 70 percent of the life expectancy gap compared with non-Indigenous populations.
To advance efforts to address social determinants of health, and specifically health disparities experienced by Indigenous people, the World Health Assembly also approved a request from Member States, co-sponsored by Australia, for WHO to develop, by 2026, a Global Plan of Action for the Health of Indigenous Peoples, in consultation with Indigenous Peoples.
Further opportunities for multisectoral action on improving health have been identified in a new WHO report from the Council of the Economics of Health for All (as recently covered by Croakey), and supported by a global framework for integrating well-being into public health utilising a health promotion approach, also adopted at the 76th World Health Assembly.
These new global resources provide a reference point and support to assist countries to ensure that health and wellbeing are appropriately valued across economies, including the Australian Government’s efforts to develop a national framework to ‘measure what matters’.
They also provide a mechanism for WHO to support and monitor on Member State progress, including reporting through future governing bodies’ meetings on well-being and health promotion in 2024, 2026 and 2031.
Australia’s National Preventive Health Strategy (NPHS) 2021-2030 has ambitious goals aligned with Agenda 2030, including that “Australians will have at least an additional two years of life lived in full health by 2030” and at least three additional years of life lived in full health for those burdened unfairly by wider determinants of health particularly Australians in the two lowest SEIFA (Socio-Economic Indexes for Areas) quintiles, Australians living in regional and remote areas, and Aboriginal and Torres Strait Islander people.
During last September’s Global Week for Action on NCDs, ACDPA colleagues wrote for Croakey about the urgent need for funding for comprehensive implementation of the NPHS and related strategies, with preventive health investments accounting for less than two percent annual national health spending – far from the NPHS’ own goal for preventive health to receive five percent of total health expenditure across Commonwealth, state and territory governments by 2030.
As shown by ever-increasing global evidence, the return on investment from effective, evidence based low and no cost preventive health measures are considerable.
Increasing preventive health investment and accelerating implementation of the actions identified in the NPHS and related strategies, supported by ever-increasing global evidence and momentum, is necessary – for achieving both the vision we share of a healthier Australia, and the targets we share with 192 other countries in pursuit of a fairer and healthier world.
The clock to 2030 is ticking – there is no time to waste.
• Lucy Westerman is Executive Officer of the Australian Chronic Disease Prevention Alliance (ACDPA) which brings together Cancer Council Australia, Diabetes Australia, Heart Foundation, Kidney Health Australia, Stroke Foundation, and Lung Foundation Australia. Previously Lucy worked at the Victorian Health Promotion Foundation on Commercial Determinants of Health, prior to which she led prevention policy advocacy and campaigns at the global NCD Alliance. (Twitter: @lewest/@ACDPAlliance) www.acdpa.org.au
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