Measuring progress on NCDs: one goal and five targets.

Heads of states and governments made commitments to the prevention and control of non-communicable diseases (NCDs) in the Political Declaration from the UN High-level Meeting on NCDs in September, 2011. A key commitment in the Political Declaration calls upon WHO to develop a comprehensive global monitoring framework to assess progress in the implementation of national strategies and plans for the four main NCDs: cardiovascular diseases (CVD), diabetes, cancer, and chronic respiratory diseases. Central to the monitoring framework is the selection of goals and targets for NCDs. WHO member states have agreed on an NCD target of a 25% reduction by 2025 in the probability of dying from the four main NCDs for people aged 30–70 years. We refer to this target as the overarching NCD goal (“25 by 25”). The latest WHO proposals include ten targets to reach this goal. Although these targets address important areas of NCD prevention, the choice and hierarchy of the ten targets is based on their level of support by member states. There is strong support from member states for targets on raised blood pressure, tobacco smoking, salt intake, and physical inactivity. Targets deemed as “requiring further development” relate to obesity, fat intake, alcohol consumption, raised total cholesterol, the availability of essential generic NCD medicines and basic technologies to treat major NCDs, and drug therapy to prevent heart attacks and strokes. Member states will discuss these proposed targets at a consultation in November, 2012, and the monitoring framework will be fi nalised at the World Health Assembly in May, 2013. In our view, the key criteria for choosing any target should be that it has a strong scientifi c basis, is sensitive to change, and that achieving it will have a major impact on the global NCD mortality goal. Other criteria include empirical evidence that the target is achievable with cost-eff ective interventions that are feasible for scaling up, and that baseline data and robust methods for assessing progress are available. Unlike WHO, we propose that implementation of interventions should initially be limited to only a small number of priority targets to ensure that existing resources are used most effi ciently, with additional targets added as country experience and success builds. In proposing targets, we underline technical considerations over political consensus. Further, to promote equity, the targets must be reported in relation to measures of socioeconomic status, for example, education, and gender. Based on earlier work undertaken with WHO, we propose fi ve priority targets to meet the NCD mortality goal by 2025, with 2010 as the baseline (fi gure). The priority targets include two of the main risk factors for NCDs—tobacco use and salt reduction (as the key dietary target)—and one treatment target. Physical inactivity and alcohol reduction have been included because they are the other two main risk factors for NCDs highlighted in the Political Declaration. Tobacco control is the key NCD target and is relevant for the prevention of a wide range of NCDs. The current global prevalence of tobacco smoking is about 23%, with major variations by country and gender. We propose a 40% relative reduction in prevalence of tobacco use, including smokeless tobacco, by 2025; this target would achieve a global adult smoking prevalence of about 14%. The required rate of change has already been reached in several countries, including middle-income countries such as Uruguay. Achievement of this target requires accelerated implementation of all elements of the WHO Framework Convention on Tobacco Control. Some countries have committed to being tobacco free by 2025. An even longer-term global goal is for a tobacco free world by 2040, with a prevalence of adult tobacco use of less than 5%. The key dietary target is a reduction in population levels of salt consumption to reduce population blood