The NCD Alliance — Putting non-communicable diseases on the global agenda

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FCA comments on WHO Discussion Paper (20 December 2011) “A comprehensive global monitoring framework and voluntary global targets for the prevention and control of NCDs”

FCA welcomes this WHO Discussion Paper and the start of consultation on a comprehensive global monitoring framework and recommendations for a set of voluntary global targets mandated by the Political Declaration of the UN General Assembly High Level Meeting on the Prevention and Control of NCDs (resolution 66/2). In response to this discussion paper FCA provides the comments below on specific elements of the proposals outlined.

Key elements of a Global Monitoring Framework

To be effective for reducing prevalence of tobacco use, a global target should be broken down into regional (and possibly sub-regional and national targets) to take into account differences in circumstances, and stages in the tobacco epidemic. For example, in some countries, stopping the rise in prevalence would already be progress, whereas for others already on the downward slope, acceleration of the decline would mark progress.

Governance, Secretariat, and tools

The WHO Framework Convention on Tobacco Control (FCTC) Conference of the Parties (COP) provides a global forum for discussion of tobacco control implementation and accountability. The role of the FCTC COP should be explicitly recognised in this Global Monitoring Framework proposal.

The timing for establishing the Global Monitoring Framework and Voluntary Global Targets established by the UN Summit Political Declaration (paragraphs 61 and 62) does not allow for consultation with this body whose next (fifth) session (COP5) will be held 12-17 November 2012. The COP should however be involved in establishing how those global targets are translated into regional or national targets, and what the strategy is for achieving them.
Given that the achievement of progress on the health targets proposed will require multi-sectoral action, it is critical that reporting does not stop at the World Health Assembly.

Recommendations for a set of voluntary global targets and indicators

FCA notes the specific proposal for a target for tobacco smoking (target 3. in Table 2 of the document) proposing a 40 per cent relative reduction in prevalence of current tobacco smoking and using the indicator of age-standardized prevalence of current tobacco smoking among persons aged 15+ years. This target is ambitious and would require immediate, forceful action, particularly in the taxation area. Hence FCA stresses the importance of rapidly arriving at interim targets that would actually put countries on a trajectory to achieving it.

Reporting and review

Accountability for progress against interim targets will be critical to generate the political will necessary for the policy changes required for achieving any proposed tobacco control targets.  Application of a simple linear progression, however, will not provide suitable interim targets. The calculation of these interim targets must take into account evidence of the trends in tobacco use and effective tobacco control policy.

FCA seeks clarification regarding the relationship between the proposed the five-year cycle (2015-2020-2025) and the “comprehensive review and assessment in 2014” of progress achieved mandated in the Political Declaration.
FCA also seeks clarification regarding how the progress on these targets and this reporting cycle will be fed into the development of the successors to the Millennium Development Goals.

Effort should be made to harmonise WHO and FCTC COP reporting mechanisms. Decision 16 of the last (fourth) Session of the FCTC COP (COP4)  included the decision “to invite WHO to use the data received through Parties’ implementation reports as a principal source of information for relevant surveillance and monitoring activities, avoiding the use of a parallel international system for regular collection of data concerning tobacco control.”  The annex to the paper mentions the Global Adult Tobacco Survey and Global Youth Tobacco Survey but does not refer to the FCTC COP reporting mechanism.

174 countries are now parties to the FCTC, and so use of the treaty reporting system for tracking progress against the tobacco use prevalence target would avoid duplication of effort by the majority WHO member states. Non-parties might be invited to use the same format for reporting directly to WHO.