NEW YORK – Although chronic respiratory diseases (CRDs) are the third leading cause of death globally, there remains a ‘mismatch’ between impact and action, said a group of global health leaders and experts on the sidelines of the 80th UN General Assembly.
“There is a mismatch between the disease [impact] from CRD and the action against it. CRD lags behind in awareness and attention, and so far, we don’t have any specific targets,” said Barbara Hoffmann, Chair of the European Respiratory Society (ERS) Advocacy Council, at the event Wednesday, Lung Health Matters – Accelerating Progress towards UN NCD targets.”
The high-level side event, sponsored by the Permanent Mission of Malaysia and the Government of Romania, focused on the enormous societal costs of CRDs and their main risk factors, and actions that can be taken to prioritize lung health and preventative measures, through political commitment, resource mobilization, and greater integration of lung health issues into environmental policies.
Some of the most common CRDs are chronic obstructive pulmonary disease (COPD), asthma, occupational lung diseases and pulmonary hypertension.
“Lung health is absolutely essential to personal well being. It’s essential for our economies and for our ability to thrive as societies,” said Hoffmann. In the WHO European Region, which includes some 53 nations extending from the British Isles to Central Asia and Russia, CRDs are the sixth leading cause of death.
Unveiling the Political Declaration on NCDs
The event came on the eve of the Fourth UN High-Level Meeting on Noncommunicable Diseases (NCDs), where the United States blocked the consensus approval of a new Political Declaration for the Prevention and Control of NCDs, despite overwhelming approval by almost all other UN member states. The declaration will now be brought for a vote in the UN General Assembly in October. See related story:
BREAKING: UN Declaration on Noncommunicable Diseases Fails to Win Approval After US Foils Consensus
Taking the long view, the lung health experts who gathered also noted the ‘missed opportunities’ within the declaration, especially in regards to respiratory health and air pollution.
“While there are things to celebrate in the declaration, there’s also actually quite a lot of missed opportunities in that document. It’s not as strong as it could be, or it should be, around the challenges that air pollution presents to health and in particular, particular to respiratory health,” said Sean Maguire, Executive Director of Strategic Partnerships of the Clean Air Fund.
In particular, Maguire called out the absence in the declaration of any reference to fossil fuels as a leading air pollution source. Nearly one-half of all deaths from COPD and 19% of deaths from lung cancer are attributable to air pollution exposures, according to the latest Global Burden of Disease data from the Seattle-based Institute of Health Metrics and Evaluation.
“Burning fossil fuels is really at the heart of what causes so much air pollution. So unless we’re honest about the challenges, we’re not going to succeed. We’re not going to meet our SDG targets, and we’re not going to reduce the health work of air pollution.”
Lack of Defined Targets for CRDs Despite Being Preventable and Manageable
In addition, unlike other major NCDs, CRDs lack robust global targets, both in the new political declaration as well as in WHO global action plans, which are essential to supporting country prioritization, measuring progress, and benchmarking. This includes the recent landmark resolution, “Promoting and prioritizing an integrated lung health approach,” which was formally adopted at the 78th World Health Assembly this past May.
The lack of defined targets for CRDs also means that governments may not assign it sufficient priority in national health planning.
In comparison, there are five global diabetes targets, three global targets on hypertension control, targets for reducing the burden of several types of cancers and three targets tackling HIV/AIDS, through increased access to prevention, diagnostics, and treatment.
“These CRDs are largely preventable and manageable, yet no specific targets have been formulated, and the action to prevent and match them remains weak,” she says, citing a recently released WHO European Region report on CRDs, co-developed with the Respiratory Society.
The report recommends that countries consider adoption of national-level targets for COPD and asthma to ensure advocacy, implementation and progress monitoring at country, regional, and global level.
“There is a need for setting targets and for starting disease surveillance, and we need further actions, national plans, awareness raising and education. CRD is largely preventable and manageable, and we know how to do it, and can do something about it,” said Hoffmann.
Bringing Lung Health to the Forefront in Malaysia
Malaysia is one such country that has been making concerted effort in the fight for better lung health, both locally and globally.
“Lung health must be a shared priority,” said Muhammed Radzi Jamaludin, the representative of Malaysia and Ambassador to Cuba, in his opening remarks.
He highlighted the recent WHA resolution, “Promoting and prioritizing an integrated lung health approach,” which was co-sponsored by Malaysia, together with 15 other WHO member states, which calls for a comprehensive and forward-looking agenda to strengthen prevention, early diagnosis, treatment and control of lung diseases.
Malaysia has also launched the roadmap for the Lung Health Initiative 2025 – 2030, a holistic plan that covers various aspects of lung health, from prevention to treatment, and including palliative care and research. Other efforts to address lung health issues in the country also included nationwide awareness campaigns, stricter tobacco and vaping regulations, multi-sectoral collaboration to improve air quality, workplace safety, and enhancing screening/early detection.
Jamaludin called on governments for even stronger commitments in order to accelerate progress and achieve UN NCD targets.
“By firmly placing lung health within the global NCD and sustainable development agenda, we can reduce premature mortality, improve population health and build healthier and more resilient societies.”
Stronger Governance for Multi-sectoral Action
Nick Banatvala, Head of the Secretariat for the UN Interagency Task Force on the Prevention and Control of Noncommunicable Diseases, also emphasized the need for lung health to be articulated at a national level, especially in development strategies, where multi-sectoral plans can be made.
“[Lung health] now needs to be well articulated in national health and development strategies. I’m always pushing for development strategies, because that’s where I think we have a big opportunity, because so much of what we’re discussing requires action across a number of different sectors.”
However, this is easier said than done, and as it ‘becomes notoriously difficult to get action’ once other sectors are involved, says Banatvala, using the example of tobacco industry interference.
The solution lies in stronger governance, he argues.
“We need to take this political declaration back not to the Minister of Health, because they’ve heard it, but to parliamentarians and say, these are your communities. These are your people. You should be elected or fail to be elected, dependent on whether or not you are sorting out tobacco and air and health services and universal health coverage.”
Investing in civil society and patient advocacy
Patients, those impacted by CRDs themselves, also need to become more involved in advocacy and policy debates in order to integrate lung health better into the NCD agenda, the experts agreed.
“Some of the best investment is investing in civil society organizations, in grassroots who can make their voice known, to try and get the voice of the patients,” Banatvala said.
Kjeld Hansen, Chair of the European Lung Foundation, spoke about his experiences working and advocating for patients with asthma and other CRDs as a person who himself has lived experience with lung disease. “I understood at that point that if I meet the right people with the right solutions, anything is actually possible,” he said.
“Civil society actors will come together with the government to help set priorities on different issues. And once you hear it from your constituency, then it’s much harder to strike down the message afterwards. So I would say, bring them into the process.”
Now the Real Work Begins
While final UN approval of the political declaration will now be delayed for a few more weeks, it’s important to focus on the next stages in the process, ”when the resl will begin,” said José Luis Castro, WHO Director-General Special Envoy for Chronic Respiratory Diseases.
“What matters now is implementation and advocacy at the national level, turning global commitments into cleaner air, into early diagnosis, into stronger primary care, into treatments for patients, for 650 million people affected by [CRDs].”
Patients impacted by CRDs must be at the heart of this work, “if we are to keep the momentum to ensure that patients see the change,” he emphasized.
“Let us measure our progress not by the declarations adopted, but by the lives that will be extended and the dignity restored to patients everywhere.”
Image Credits: National Cancer Institute/Unsplash, Raisa Santos, Our World in Data, IHME.
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