102016 draft shanghai declaration on health promotion ncd ......the ncd alliance is led by: 3...
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TheNCDAllianceisledby:
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NCDAllianceResponse:ZeroDraftShanghaiDeclarationonHealthPromotion
October2016
TheNCDAlliancewelcomesthisopportunitytocommentontheDraftShanghaiDeclarationonHealth
Promotion(theDeclaration).Thirtyyearslater,theprogressionoftheShanghaiDeclarationonHealth
PromotiontoexpanduponthefoundationsoftheOttawaCharteristimelyandnecessary.Wecommend
WHOforinitiatingthisprocessinadvanceofthe9thGlobalConferenceonHealthPromotioninShanghai.
NoncommunicableDiseases,HealthPromotion&SustainableHumanDevelopment
Wecommendtheintegrationofsustainabledevelopmentsymbolizedbythe5Ps-People,Planet,
Prosperity,PartnershipsandPeace,intheHealthPromotionagenda.Thislinkageasanimportantentrypoint
forgreatermultisectoralengagementandcollaborationtoprioritizepolicieswhichhaveco-benefitsfor
healthandplanet.Wearepleasedtoseecivilsocietyhighlightedaskeyactorsinsupportinggovernmentsto
implementhealthpromotionpolicies,andtherecognitionofhealthasapoliticalchoice.
TheDeclarationappropriatelyemphasizesthatpromotinghealthandwellbeingforallandbyallasessential
toequitableandsustainablehumandevelopment.Healthpromotionisalsoanecessaryelementto
effectivelytacklenoncommunicablediseases(NCDs),responsibleforthegreatestburdenofdiseaseglobally,
andlargelypreventable.TheroleofhealthpromotioninreducingtheburdenofNCDsliesnotonlyin
prevention;effectiveimplementationofcomprehensive,well-resourcedhealthpromotionstrategiesshould
includeimprovinghealthliteracytosupportmanagementandmitigationofNCDs,leadingsystemschangeto
equitablyimprovehealth,andaddressingthesocialdeterminantsofhealththatperpetuatepoorhealthand
exacerbateNCDs.ThisDeclarationisanimportanttoolinreinforcingtherangeofsocial,environmentaland
economicconditionsthataffectNCDprevalence,andgovernments’centralrolesinshapingtheseconditions.
Politicalengagementinhealthpromotionprinciplesofprotecting,preservingandmaintaininghealth
equitablyacrosssocietiesisimperativetoreducingtheprevalenceofpreventableNCDs,premature
mortalityfromNCDs,andlived-burdenofNCDs.
TheDeclarationnotestheneedforcarefulcollaboration,asnoonestrategyorsectorwillbesufficientto
addresstheepidemicofNCDs.ActiononNCDsandhealthcanhaveimportanteffectsacrosssustainable
developmentprioritiesandviceversa.However,theDeclarationneglectstoemphasizethespecificneedto
addressNCDpreventionasanurgenthumandevelopmentpriority.
WhiletheAgenda2030forSustainableDevelopmentanditsSDGsareimportant,andusefulframingforthis
document,itisimportanttorecognizespecificglobalcommitmentsalreadymadebyGovernmentsand
referencedintheSDGs,suchastheglobal25x25NCDmortalityreductiontargetwhichhasinformedSDG
3.4.ThenineglobalNCDtargetsandtheevidence-basedpolicyoptionsoutlinedintheWHOGlobalActionPlanforthePreventionandControlofNCDs2013-2020shouldreceivegreaterattentioninthedocument.
TheNCDAllianceacknowledgestheprioritizationofgoodgovernanceinthecontextofhealthpromotionin
theDeclaration.WegreatlyappreciatethatthedocumentcallsattentiontothethirdUnitedNationsGeneral
AssemblyHigh-levelMeetingonNCDsin2018.TheMeetingprovidesanopportunityforhealthpromotion
agenciestohighlightactionsandprogressthattheyhavetakenalready.Healthpromotioniscriticaltothe
achievementofa25%reductioninprematuredeathsfromNCDs;Duetotheimpactofglobalizationof
marketingandtrade,particularlyinthecontextofindustrialriskfactorsofNCDs,nowisthetimetonotonly
articulatetheneedtoputNCDpreventionandhealthimprovementfrontandcenterinhealthpromoting
policiesandinvestment,butalsoactonthecommitmentstodoso.
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GeneralComments
OurcommentsbelowdrawtogethertheperspectivesofdifferentstakeholdersfromtheNCDAlliance
networkwiththeobjectiveofstrengtheningfutureiterationsoftheDeclarationtobepresentedtotheWHOGlobalConferenceonHealthPromotioninNovember2016.
i) ‘HealthInAll’terminology:ThetermHealthInAll(HiA)appearstohavereplacedmorewidely
usedHealthinAllPolicies(HiAP).Thiscouldbeduetoanassumedunderstandingthat‘Healthin
All’referstoHealthinAllPolicies.Ifthisisanofficialshiftinlanguagefromthatarticulatedin
the2013HealthinAllPolicies:FrameworkforCountryActionadoptedatthelastWHOGlobal
ConferenceonHealthPromotioninHelsinki,toensurebroadinterpretationitmaybe
worthwhileprovidingcontextfortheterminologychange.Forexample,fromtheWHOwebsite:
‘Healthpromotionrequirespolicymakersacrossallgovernmentdepartmentstomakehealthacentrallineofgovernmentpolicy.Thismeanstheymustfactorhealthimplicationsintoallthedecisionstheytake,andprioritizepoliciesthatpreventpeoplefrombecomingillandprotectthemfrominjuries.’
ii) Referencetointernationalinstrumentsforhealthaccountability:Weenvisagethatthe
commitmentshighlightedwithintheDeclarationwillhelptoinformapotentialstrategyor
actionplanonhealthpromotionasproposedbytheDeclarationinParagraph29,todrive
momentumtowardsachieving2030goalsandtargets.ThisDeclarationonHealthPromotionis
aninstrumentwhichcanalsoreiterateexistingglobalcommitmentsrelevanttohealth
promotion,particularlytheGlobalNCDMonitoringFramework.
SpecificSectionsoftheDeclaration
Paragraph6:Theachievementsandpotentialofhealthpromotionasacomponentofeffectivedisease
preventionisworthyofrecognition.HoweveritisimportanttoalsonotethattheburdenofNCDscontinues
togrow,suggestingalackofsystematicapplicationofhealthpromotionprinciplesacrossNCDriskfactors.
Forexample,inspiteofhealthpromotionefforts,nocountryhasyetreverseditsobesityepidemic;alcohol
use,physicalinactivity,andtobaccousecontinuetobeprominentcontributorstoNCDs.Withtheserisk
factorscontinuingtoconstrainhumandevelopmentacrosstheglobalsustainabledevelopmentagenda,itis
crucialthathealthpromotionissystematicallyintegratedasacomponentofabroadsuiteofeffectivepolicy
interventions.
Paragraph9(a):TheacknowledgementoftheprominenceofNCDs,mentalandneurologicaldisorders,
environmentaldiseases,andmalnutritioninallitsformsasmanifestationsofinequalityofdevelopmentis
welcome.Wedo,howeverrecommendthatthissectionbestrengthenedbyemphasizingthatNCDsarea
symptomoffailureofthedominantdevelopmentparadigm,andthatthisneedstochangetoprioritize
sustainablehumandevelopment.
Malnutritioninallitsformsisanevolvingtermnotyetwidelyacknowledgedasencompassingtheunique
challengesofdietrelatedNCDsandobesity.Itwouldbeusefultoexpanduponthistermswithspecificityto
ensurethebroaddefinitionofmalnutritioninallitsformsisunderstood.
Paragraph9(b):Thecurrentleadsentenceforthisparagraphsuggeststhatglobalizationofmarketingand
tradeareprimaryconcerns.However,tradeshouldnotbedepictedasintrinsicallynegativeparticularlyin
lightofgoal17oftheSDGswhichspecificallyhighlightstheroleoftradetotheattainmentoftheSDGsand
goal17.11whichaimstosignificantlyincreasetheexportsofdevelopingcountries,withaviewtodoubling
theleastdevelopedcountries’shareofglobalexportsby2020.Tothiseffect,paragraph9(b)ofthe
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ShanghaiDeclarationshouldbemodifiedtostate‘theimpactofglobalizationofmarketingandtradeof
productsharmfultohealth’.
WiththelinksdrawnbetweenthehealthofpeopleandplanetinParagaph9(b),werecommendthe
additionofaddressingairpollutionandclimatechange,side-effectsofglobalizationoftrade,tothelistof
actionsrequiredtocountertheirharmfuleffectsonhealthinthecontextofhealthpromotion.
Paragraph10:Thereshouldberecognitionofthegrowingimportanceofregionalpartnerships,agreements
andgovernanceinstruments.E.gParagraph10shouldbemodifiedtoincludereferencetoadaptationand
implementationoftheSDGsatthe‘local,national,regionalandgloballevels’(paragraphs80,81SDGs).
InternationalCooperation:TherecouldbegreaterreferenceintheDeclarationtointernationalcooperationasspecifiedinboththeSDGsandtheAddisAbabaActionAgenda.AchievingtheSDGswillrequire
internationalcooperationincludingtheuseofinternationalpublicfinance,e.g.officialdevelopment
assistance(ODA),tocatalyzeadditionalresourcemobilizationfromothersources,publicandprivate
(paragraphs43SDGs,paragraph22AddisAbabaActionAgenda).
Paragraph12and13:GoodhealthgovernanceiscentraltotheachievementoftheSDGs,andisofcritical
importanceinreducingtheburdenofNCDs.Thesectionongoodgovernancetosupporthealthpromotion
andhealthinallpoliciesisnotasprominentasthatunderhealthliteracy,andthusappearslessimportant.
Tothisend,Paragraph13couldbestrengthenedwithgreaterattentiontothecommitmentsofgovernments
toimprovenational,multilateralandbilateralgovernanceforhealth.Werecommendanadditional
commitmentonconcreteactionforalllevelsofgovernmenttobothengageinandpromotegoodhealth
governance,whilealsoaddressingandresolvingpoorhealthgovernance.Goodgovernanceshouldbe
supportedwithinvestmentinstrengtheningresources,legitimacy,transparencyandaccountability.
Paragraph13(a):Theneedtorecognizethatnotonlyalllevelsofgovernmentbutallrelevantsectorsofgovernmentshouldbeengagedinaddressinghealthpromotioniscurrentlyaddressedinparagraph19(b)
butshouldalsobereferredtoinparagraph13.WerecommendthatParagraph13(a)shouldbeamendedto
state‘Thismeansinvolvingalllevelsandrelevantsectorsofgovernmenttocapitalizeonsynergiesandco-
benefitsthatleadtoincreasedeffectivenessandefficiencyandprovideentrypointstoaddressthe
determinantsofhealth.’
Paragraph13.(a)Thissectioncouldbeenhancedwiththeadditionofanexampleofataxationofunhealthy
transport,forexamplecongestionchargesforroads,withprivatevehicleuseamajorcontributortopoor
healthintermsofperpetuatingphysicalinactivityandcontributingtoairpollution.Congestionchargestaxa
behaviorratherthanaproduct,butcouldreapmultiplehealthbenefits.Further,healthpromotingoptions
couldbeencouragedbycarefulandappropriatesubsidization,forexamplepublicandactivetransport,and
applicationofsubsidiestofreshfruitandvegetablestoreducetheirpurchasecosts.
Paragraph13(c):Ensurethatbilateralandtradeandinvestmentagreementsinsupportingallthree
dimensionsofsustainablehumandevelopmentprovidepolicyspace,asrecognizedforinparagraph21,goal
17.15,paragraphs63and74(a)and81oftheSDGs,forbona-fidepublichealthmeasures.E.g13(c)‘Support
thesenationalmeasuresbystrengtheningcoherenceandconsistencyamongbilateralandregionaltrade
andinvestmentagreementsinsupportofallthreedimensionsofsustainablehumandevelopment
includingensuringtheseagreementsprovidepolicyspaceforhealthpromotionandprotectionmeasures’.
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Paragraph15(a):TheemergingworldwideHealthyCitiesmovementshouldhavefollow-upontheNew
UrbanAgendaasoneofitspriorities,andwethereforesuggesttheadditionofthefollowinglineto15(a)
‘identify,implement,andpromoteconcreteactionstoachievethehealth-relatedaspirationsoutlinedin
theNewUrbanAgenda.’
Paragraph15(b):Wesuggestaddingtolistofissues:‘unsustainablefoodsystemsandphysicalinactivity
andsedentarybehaviors’.
Paragraph17(a):Werecommendemphasizingtheimportanceofimprovementsinthehealthliteracyofthe
generalpopulationbyaddingthefollowing:‘developandimplementaninter-sectoralnationalstrategyand
planforstrengtheninghealthliteracy,withcleargoalsforimprovinghealthliteracyinthegeneral
population,ensurefunding,withanysuchplansalignedwithNationalNCDplans.’
Paragraph17(b):Werecommendbroadeningthebaseofmeasuresspecifiedtoincludepackagingand
broaderformsofpromotionandsponsorshipotherthanmarketingandadvertising,andidentifyingthe
particularvulnerabilityofchildrenintermsofhealthliteracyasrecognizedbytheWHOSetof
recommendationsontheMarketingoffoodsandnon-alcoholicbeveragestochildrenandFinalSetof
RecommendationsoftheCommissiononEndingChildhoodObesity(ECHO).E.gParagraph17(b)‘Increase
oureffortstoensurethatconsumerenvironmentssupporthealthychoicesthroughtransparent,
accessibleinformation,andmeasuresincludingpackagingandlabelling,andtheregulationofadvertising,
promotionandsponsorship,particularlyinrelationtochildren,includingsocialmediastrategies’.
Paragraph17(c):Includereferencetohealthliteracyincludingensuringinformeddecision-makingonhealth
servicesE.gParagraph17(c)Investinmakinghealthcareinstitutionsmoreunderstandable,friendlyand
people-centered,andensureinformeddecision-makingbysettingstandardsforhealthliterate
organizations.
Paragraph17(c):Therecouldalsobeanexplicitreferencein17(c)toimprovingthehealthliteracy,in
termsofcommunicatinghealthinformation,ofthehealthworkforce,withinhealthcareinstitutions.This
acknowledgespatient-providercommunicationastheprimary(andsometimesonly)opportunityforthe
provisionofhealthcareinformationinaprimarycaresetting,andfurtheracknowledgesthatapatient-
providerinteractionmayoccurinsettingsotherthanahealthcareinstitution,whetherbecauseofamobile
workforce,ortheutilizationofdigitaltechnologytodeliverinformationremotely.
Paragraph17(d):Wecommendtheinclusionofstrengtheninghealthliteracyofdecisionmakersinsectors
otherthanhealth,signalinganexpansionofthecommonlyrecognizedemphasisofhealthliteracybeing
mostpertinentforcitizens.ThisrelatesdirectlytoParagraph23andtheneedtostrengthenhealth
diplomacyskills.
Paragraph17(e):Thiscommitmentcouldbeexpandedto‘…increasingcitizens’accesstoanduseof
knowledgeandinformation…’recognizingthataccesstoinformationmustbeaccompaniedbysupportive
structuresthatencouragecitizenstoactuponthisknowledgeandinformation.
Paragraph19(b):Thereisanurgentneedforagreateremphasisoftheneedtoprotectpolicymakingand
policymakersfrominfluenceofthosewithvestedinterestsincorporatedriversofill-health.However,
concernsaroundconflictofinterest,whileaprimaryguidingprincipleinshapingpartnerships,canstifle
constructivecollaborationwithprivatesectorwithinterestsalignedwiththoseofthehealthpromotion
sector.Emphasishereshouldbeoninformedinvolvementofdifferentsectorstosupporthealthpromotion
actionsbeyondthehealthsector.Paragraph19couldbestrengthenedbyrevising19(b)to‘strengthen
appropriateinteractionbetweendifferentsectors,andestablishmechanismsforeffectivecooperation
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acrossdifferentsectors.Thisincludestheidentificationofcommonobjectivesandcross-sectoral
knowledgesharinginordertosupporthealthpromotionactionsrequiringengagementbeyondthehealth
sector,suchaslinksbetweenhealthandtradeoragricultureintobaccocontrol.’
Paragraph19(c):Paragraph19couldbestrengthenedwiththeadditionofanewcommitment19(c)to‘find
andforgeallianceswiththosepartsofprivatesectorwhichhaveinterestsalignedwithhealthpromotion
andNCDprevention,anddonotengageinhealthpromotioninitiativestodistractfromtheharmful
impactsoftheircorebusiness.’
Paragraph23:Notonlydowerequirestrengtheningofhealthliteracyacrossallsectorsandlevelsof
governance,butwealsoneedtostrengthenthehealthdiplomacyskillsofpublichealthadvocatestoengage
withandsupportthestrengtheningofhealthliteracyacrossallsectorsofgovernments,andtoassistpolicy
makersinnon-healthsectorstounderstandthepotentialhealthimplicationsofdecisionsandpoliciesthey
aremaking.Effectivehealthdiplomacydrivesthesuccessofhealthinallpoliciesandhealthypublicpolicies
approaches.Healthdiplomacyishealthpromotioninaction.Civilsocietyorganizationshaveakeyrolein
healthpromotionadvocacy,makingtheenhancementofhealthdiplomacyskillsnotonlyacapacity
strengtheningissueforgovernments.Thusitisimportantthatallsectorsofgovernmentsareopento
engagingwithcivilsocietyhealthpromotionadvocates.
Paragraph25&26:
Ageneralcommentinrelationtothissection:inresourcelimitedsettings,wheretheprovisionofessential
andminimumhealthservicesmaybeinadequate,reorientinghealthsystemstowardshealthpromotionand
preventionshouldnotcomeattheexpenseofhealthservices.Thissectioncouldhighlightthevalueof
integratinghealthpromotionandhealthpreventionstrategiesaspartofoverallhealthsystemsandprimary
healthcarestrengthening.
Paragraph25:theremaybevalueinsettingoutwhatisincludedintheconceptof‘healthservice’.
Paragraph26(a)Theremaybevalueinprovidingexamplesofhealthsectoractionsforhealthpromotion
anddiseaseprevention,suchasimprovedaccesstoscreening,immunizationprogramsandpreventive
medicines.
Paragraph29:ProposedWHOglobalstrategyandactionplanonhealthpromotionto2030:Inprinciple,we
supporttheproposeddevelopmentofastrategyand/oractionplanonhealthpromotionbyWHO,that
wouldoperatealongsideandreinforcetheGlobalActionPlanforthePreventionandControlofNCDs2013-2020,withthebroaderobjectiveofcontributingtowardtheattainmentoftheSustainableDevelopment
Goals.Toensureacomprehensiveandeffectiveactionplanand/orstrategy,comprisingaroadmapof
actionsandanaccountabilityframework,werecommendthatthisisalignedwithexistingrelevantplans,for
examplethoseonNCDs;issufficientlyresourcedbystrengtheningofWHO’scapacityforoversightand
accountability;andisdevelopedthroughathoroughconsultationprocessbringingincivilsocietyvoicesat
thefrontlinesofhealthpromotionpractice,andthepreventionandcontrolofdiseases.