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Ala Alwan ¹

The World Health Organization’s (WHO) 194 Member States met during the last week of May 2013 to discuss an important list of agenda items during the 66th World Health Assembly (WHA). The Assembly concluded with agreement on a range of new public health measures and strategic recommendations to improve global health. In all, 24 resolutions and 5 decisions were adopted by the nearly 2000 delegates representing Member States.

The WHA is the principal governing body of the World Health Organization (WHO), comprising representatives of the governments of all Member States of WHO. The WHA sets the policies of the Organization through resolutions, appoints the Director-General every five years, oversees financial policies, and deliberates on and approves the biennial programme budget. The WHA is the foremost annual global meeting addressing the public health agenda and is attended not only by the delegates from Member States but also by other stakeholders and partners operating in the area of global health, making it the most important event in the global health calendar.

With a dense agenda, numerous side meetings and a wide range of health issues to be discussed there was much to be done. The Assembly passed resolutions on disability, neglected tropical diseases, universal health coverage, ehealth, health in the post-2015 agenda, implementing the recommendations of the UN Commission on Life-Saving Commodities for Women and Children and on the recommendations of the Consultative Expert Working Group on Research and Development, as well as action plans for noncommunicable diseases (NCDs), mental health and blindness.

The delegates adopted the General Programme of Work (GPW) which outlines the high-level strategic vision for the work of WHO over the next six years. The GPW responds to the demographic, socioeconomic, political, and environmental changes in the 21st century that will significantly influence the health agenda at the country, regional and international levels. Many parts of the world are experiencing socioeconomic and epidemiological transitions with a major impact on public health and a pressing need to readjust priorities and strategies. The document explains how the Organization will meet the requirements of a changing world and contribute to the achievement of health outcomes and impacts.

One of the key challenges of the 21st century that receives priority in the GPW is noncommunicable diseases (NCDs). These health problems, mainly cardiovascular disease, diabetes, cancers and chronic lung diseases, are responsible for about two thirds of all deaths worldwide. While popular belief presumes that NCDs afflict mostly high-income populations, the evidence tells a very different story. Nearly 80% of NCD deaths occur in low- and middle-income countries and NCDs are the most frequent causes of death in all regions of the world, except the African Region. Also, mortality and morbidity data reveal the growing and disproportionate impact of the epidemic in lower-resource settings and NCDs kill at a younger age in low- and middle-income countries.

The challenge is global and it requires a global response. This year’s WHA endorsed an action plan for the prevention and control of NCDs which comprises a comprehensive set of actions for Member States, WHO and other international partners. When performed collectively, these actions will set the world on a new course to achieve nine globally agreed targets for NCDs, including a reduction in premature mortality from NCDs by 25% in 2025. The action plan also contains a monitoring framework with 25 indicators to track risk factors and determinants, and outcomes (morbidity and cause-specific mortality) and assess progress countries will make in implementing national policies and programmes and in strengthening their health systems. The global plan provides policy options and cost-effective interventions which will allow all countries to make considerable progress towards achieving the nine targets by 2025.

The WHA resolution on NCDs requests WHO to develop draft terms of reference for a global coordination mechanism through a consultative process culminating in a formal meeting of Member States in November 2013. WHO was also tasked to provide technical support to Member States and to develop a limited set of action plan indicators to inform on the progress made with the implementation of the action plan in 2016, 2018 and 2021.

Having unanimously endorsed the global action plan and the set of global targets and indicators, Member States will now have to scale up action. This particularly applies to the countries of the Eastern Mediterranean Region. The NCD epidemic already extends far beyond the current capacity of many countries of the Region to cope with, which is why morbidity, disability and premature mortality are rising disproportionately. According to the global action plan, the WHA resolution and the recommendations of the political declaration passed by Heads of States and Government during the 65th session of the United Nations General Assembly in 2011, countries will have to establish and strengthen national multisectoral plans, implement proven measures to reduce risk factors and improve health care for people with NCDs. In doing so, countries of the Eastern Mediterranean Region will be guided by the framework for action endorsed by the 59th session of the WHO Regional Committee, held in Cairo, in October 2012 (http://applications.emro.who.int/docs/RC_Resolutions_2012_2_14692_EN.pdf). Ministers of Health and their delegations will be discussing the progress made in implementing the strategic interventions in the framework as well as the implementation of the global action plan agreed at the WHA within the context of our Region at the Sixtieth Session of the Regional Committee for the Eastern Mediterranean which will be held in Tunis in October this year.

WHO will continue to seek ways to improve how it supports countries of the Region in tackling the NCD challenge. Unless serious and collective action is taken, the burden in this Region will reach levels that are beyond the capacity of all stakeholders to manage.

¹Regional Director, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt.