International Development CommitteeWritten evidence submitted by the National Heart Forum

Summary

Based in the UK, the NHF is an alliance of 60 organisations working to reduce the risk of avoidable non-communicable diseases (NCDs) including coronary heart disease, stroke, cancer and diabetes. We recommend the inclusion of NCDs in the post 2015 development framework for the following reasons:

NCDs are the leading global cause of death worldwide, accounting for 60% of global deaths. Of these, 80% occur in developing countries.1 This makes them a problem for both rich and poor countries alike.

They are estimated to cost the world economy $47 trillion over the next 20 years, representing 75% of global GDP and surpassing the cost of the global financial crisis.2

A large proportion of NCDs are preventable through tackling the risk factors of tobacco use, obesity and overweight, unhealthy diet, lack of physical activity, and excessive alcohol consumption.

Our recommendations on the future post 2015 framework are that it should:

(i)Be underpinned by universal human rights principles which are respected by all actors.

(ii)Address all dimensions of inequality both within and between low, middle and high income countries.

(iii)Protect global public goods, such as health.

(iv)Be global in scope, equally applicable to both rich and poor countries and guided by the principle of common but differentiated responsibility.

(v)Encompass the wider impact of global policies including those of international institutions such as the International Monetary Fund, as well as the policies of rich countries.

(vi)Include measures to assess and promote the practice of policy coherence for development through the development and use of tools such as global health impact assessments.

(vii)Include clear lines of responsibility as well as effective redress mechanisms to address failures.

(viii)In addition to goals and targets, include other measures relevant to particular issues such regulation and binding minimum standards for health-damaging products and activities.

(ix)Include financing mechanisms focused on strengthened domestic tax-based revenues and tackling illicit financial flows; as well as re-pricing of goods and services to internalise ecological and social costs.

(x)Include an outcome which requires all corporations to produce and grow in a sustainable manner in order to support sustainable development objectives.

(xi)Incorporate an ethical framework and code of conduct to guide engagement of actors, particularly the private sector, in order to safeguard against conflicts of interest.

(xii)Address the responsibilities and spill-over effects of the private sector though strong transparency and accountability mechanisms which incorporate measures for redress such as “name and shame”.

Full Response

Lessons learned from the adoption of the International Development Targets and the Millennium Development Goals: in particular how effective has the MDG process been to date

1. The adoption of International Development Targets through the MDG framework has been instrumental in shaping and influencing the development and global health priorities of the UK government and other key actors.

2. However, as non-communicable diseases were omitted from the framework, they haven’t featured as a development priority among donor governments and have now emerged as the leading cause of death and disability world-wide. We welcome both the recognition that NCDs are an emerging issue in developing countries, and the commitment to raising awareness of this issue among multilateral institutions at the global level in the UK government’s Health is Global Strategy.3

How should the “Sustainable Development Goals” be established following Rio +20 relate to the “Development Goals” being considered by the High-Level Panel?

3. We agree with Action for Global Health that in order to secure the level of political will necessary to deliver on any ambitious global commitments, it is essential that after the work of both the Open Working Group (SDGs) and that of the High-Level Panel (post-MDGs) are complete, we are left with one cohesive global development framework with strong buy-in from all actors. This is important not only to ensure the success of the framework but also because drawing a line between sustainability and development is an artificial division.

The coverage of future goals: should they be for developing countries only or should progress be monitored in all countries?

4. The future framework should be global in scope, equally applicable to both rich and poor countries and guided by the principle of common but differentiated responsibility whereby every country has obligations but they may differ to reflect the country context. Countries must be accountable to both their citizens and to the international community.

5. The framework should also encompass the wider impact of both global policies, such as those of the World Trade Organisation and International Monetary Fund as well as the policies of rich countries in areas such as trade, agriculture, tax and financial regulation. To support this, it should include measures to assess the practice of policy coherence for development at all levels within the goals and indicators of the future framework. We commend the UK government on its commit to develop a global health impact assessment tool which would facilitate policy coherence for global health across the UK government.302

6. The framework must include clear lines of responsibility among relevant institutions, as well as an effective redress mechanism which allows for affected people to be heard and have their case raised when their rights are being undermined by incoherent policies of actors including rich countries and the private sector.

The process: are the right voices being heard? What are the opportunities for and constraints to global consensus?

7. We agree with Beyond 2015 that the next global development framework should result from a Southern-led process that includes participatory dialogue with those directly affected by poverty and injustice. Only through the meaningful engagement of a broad range of stakeholders, including civil society and local communities, will the next framework be effective and have legitimacy.

Targets: was the MDG “target-based” approach a success? Should it be retained? How should progress be measured?

8. We recommend that the positive aspects of the current MDG framework including concrete, measureable and time-bound targets and indicators, should be retained and a broad approach to targets and indictors, including both qualitative and quantitative measures be adopted.

9. We also recommend that in addition to goals and targets, other measures relevant to particular issues are considered. In the area of non-communicable diseases, such measures might include regulation and binding minimum standards for unhealthy products (tobacco, alcohol, ultra-processed high fat, salt and sugar foods) and new mechanisms—such as a framework conventions on alcohol and obesity.

Financing global goals: are new mechanisms needed?

10. We support the recommendations made by the BOND Beyond 2015 UK group on improving development financing, particularly in relation to adopting a rights-based approach to fiscal policy which should include the following:

(a)Strengthen domestic revenues through effective taxation: we welcome the IDC’s recent recommendation to support developing countries in their revenue collection though strengthening national tax systems and administrations as well as tackling illicit financial flows arising from multinational companies’ tax evasion and fraud,4 and which amount to eight times the budget of Overseas Development Assistance. This will assist developing countries to sustainably raise much needed revenue to strengthen weak health systems and implement programmes which tackle the determinants of poor health which drive the rising burden of non-communicable diseases.

(b)Re-pricing of goods and services in order to internalise ecological and social costs and discourage undesirable behaviour. Unhealthy goods which drive NCDs, including tobacco, alcohol and ultra-processed foods which are high in fat, salt and sugar are prime candidates which could be addressed through taxes or surcharges, for example.

(c)Tax-based measures focused on enabling the poor to attain their right to health and wellbeing, for example, through the development of comprehensive social protection systems including free universal health and education and income support to ensure and enable food and nutrition security for all.

The role of the private sector and other non-state organisations

11. The development agenda needs to be clear on its primary public interest goals and objectives, and involve different actors accordingly. This will be particularly important for priorities which challenge private interests, such as those relating to the corporations involved in the production, marketing and selling of tobacco, alcohol and unhealthy food as major drivers of the rise in non-communicable diseases globally.

12. We recommend that the future framework:

(a)Incorporates an ethical framework and code of conduct to guide engagement of actors, particularly those from the private sector partners, in order to safeguard against conflicts of interest.

(b)Must address the responsibilities and spill-over effects of the private sector though strong transparency and accountability mechanisms, which incorporate measures for redress, such as “name and shame”.

(c)Include regulation for minimum standards for trans-national corporations on the health, social, environmental and other dimensions of development, accompanied by improved reporting on their impacts. An example in the area of non-communicable diseases is regulation in the area of marketing and promotion of tobacco, alcohol and high fat, salt and sugar products, particularly to children.

(d)Include an outcome which requires all corporations to produce and grow in a sustainable manner in order to support sustainable development objectives.

The content of future goals: what would be a good set of global goals? What continuity should there be with the MDGs, and how should the unfulfilled MDGs be taken forward?

13. We support the globally valid, guiding principles and policies which have been proposed by BOND Beyond 2015 UK:

(a)Human rights are universal and must be realised both at national and international levels and must be respected by all actors, including the private sector.

(b)All dimensions of inequality must be addressed within and between low, middle and high income countries.

(c)Global public goods, such as health, need global protection.

(d)All countries have to make their policies coherent for development globally. Rich countries have particular obligations towards poor countries. An example is in the area of agriculture subsidies and related policies which have contributed to food and nutrition insecurity, as well as a rise in diet-related non-communicable diseases. This has occurred through dumping of excess produce and cheap ultra-processed foods (which are high in fat, salt and sugar) on poor countries thereby undermining local food production and increasing reliance on world markets as well as susceptibility to volatile food prices.

October 2012