Building the case for NCDs

Author: Yildiz Arslan

We find ourselves in Geneva, in the office of Dr Bente Mikkelsen at the World Health Organization (WHO) headquarters. WDF’s Sanne Frost Helt has just arrived from Copenhagen. The two directors, Dr Mikkelsen from WHO's Department of Noncommunicable Diseases, Rehabilitation and Disability (NCD) and Sanne Frost Helt from WDF’s Policy, Programme, and Partnership section, have agreed to meet for a conversation on the partnership between WHO and WDF over the years.

They spend the next hour reflecting on NCDs and the impact of WDF’s work, recognising the great policy landmarks that have been achieved, while also acknowledging the gravity of the NCD burden in low- and middle-income settings and a shared mission that is far from being cleared. As Dr Mikkelsen stresses, "around 75% of deaths are caused by NCDs, yet the area only receives 2% of the international funding." 

Leading by example with predictability and sustainability at heart

WDF's Senior Director has been following the NCD agenda since the establishment of WDF back in 2002. “When I started out working on the agenda, nobody would recognise that NCDs were a challenge in low- and middle-income countries,” she notes. However, today, we have the UN Sustainable Development Goals (SDGs), global targets, three high-level meetings with Political Declarations and strong commitments from Heads of States and Governments and now preparing for the fourth in 2025, and an increased awareness globally due to the rising burden on people and national economies. "In your view, what would you say have been the most remarkable advancements on the global NCD agenda?", she asks Bente Mikkelsen. 

Without hesitation, Dr Mikkelsen responds, "The pure fact that NCDs are on the agenda is a big win." It was with the introduction of the NCD Global Action Plan, the Political Declaration in 2011 as well as the Global Monitoring Framework that noncommunicable diseases like cardiovascular diseases, diabetes, cancer, chronic respiratory diseases including their risk factors (such as tobacco use, alcohol consumption, physical inactivity, and unhealthy diets) transformed from hidden, misunderstood and neglected into visible and actionable. WHO developed the so-called Best Buys - a set of cost-effective interventions that will help countries to reach the NCD-related SDG target 3.4 – to help member states work towards the one third reduction in premature mortality before 2030. These global policy initiatives have made it possible to advocate for NCDs with one voice and trigger new partnerships. Chronic conditions became a priority for policymakers at national and global levels with huge commitments from Heads of States and Governments. 

When WHO act on their mandate to address a global health intervention, the funding comes from Member State contributions to WHO and additional voluntary contributions. Traditionally these voluntary contributions came through bilateral funding agreements with national governments or big international organisations like the EU. In the early days partnership with non-state actors was limited. The international funding landscape was established during the Millenium Development Goals but did not include NCDs and has not changed with the introduction of SDGs. For an under-prioritised area like NCDs, the lack of investments both programmatically and in health system strengthening has led to a lack of progress towards reaching the NCD targets and reducing premature mortality. It has also led to vulnerability and a lack of preparedness to respond during pandemics and humanitarian crises. 

With the 2018 WHO first dialogue on sustainable financing and partnership, supported by WDF, a momentum to join forces and think creatively to mobilise much-needed funding was addressed at the highest political level. “You supported a much-needed gap in the NCDs agenda and lead by example, showing that partnership is an essential part of the picture,” she concludes. 

Throughout Dr Mikkelsen's reflections on WDF's impact, a red thread emerges: How the Foundation was willing to show up and support WHO's work on NCDs at a time when very few others paid any attention to an invisible group of health conditions with a sad record of causing most deaths worldwide. WDF's contribution was to enable networking, collaboration, and policymaking across the health stakeholder landscape with conscious and active management of any conflict of interest. “This support in the early days was eminent,” she points out.

Paving a Path for Multi-Sector Collaboration: The Global Coordination Mechanism on NCDs 

Bente Mikkelsen elaborates on the impact of these early days of WDF’s support to WHO, underscoring that – thanks to The Framework on Engagement with Non-State Actors (FENSA) - there is a clear red line to the types of workstreams that WHO will collaborate on with non-state actors. We all have separate roles to play, and we can complement each other. “The workstream, where we cannot partner with non-state actors is on the normative work,” Dr Mikkelsen continues. WHO’s normative work encompasses a number of standard setting products at global, regional, and national levels, including clinical and public health guidance, evidence briefs where undue influence and management of conflict of interest is key.  

From 2011 to 2018, WDF supported WHO in different tracks of collaboration without breaking these fundamental red lines. “You were the first ones to support The Global Coordination Mechanism on NCDs,” she says, “it was the really early days to try to explore, how we could collaborate with non-state actors”  

The Global Coordination Mechanism on the Prevention and Control of NCDs (GCM) became a platform that allowed WHO to explore new types of partnerships, even with private donors. “You were willing to invest in something that was very grounded. We did not know what it was going to lead to. And looking back, it was very important.” 

The exploration of multisector partnerships paved the way for more openness in WHO to be supported with funding from philanthropies like WDF, to facilitate the needed policy level discussions, establish networks and build the case for NCDs as a priority for global and national level stakeholders.  

The 2011, 2014 and 2018 UN High-Level Meetings (HLMs) on NCDs are tangible examples of how the Political commitments build the momentum. The 2011 HLM was a game-changer for NCDs and helped form new alliances and a unified language across chronic disease areas. The third HLM in 2018 emphasised that multi-sector partnerships were not only acceptable but essential if member states, international actors and civil societies want to be able take on the burden of NCDs on the horizon.  

With COVID-19 in 2020, NCDs became a hot topic. People with chronic diseases were more vulnerable to the new virus, and data showed that they were more prone to develop serious symptoms or die. People stayed undiagnosed, untreated, and unprotected and as the disease spread, the weakness of the health system to respond to NCDs was disclosed. NCDs very clearly put further pressure on health systems in a state of emergency. We were in the middle of a syndemic. Overnight, governments and the international community were forced to take NCDs seriously, both when it came to the integration of NCDs in primary healthcare, improve financial protection as well as building health systems stronger by including NCDs into universal health coverage.  

Having already paved the path for collaboration the past decade, WDF was able to carry on in their support to WHO, scale efforts and exploit this sudden global attention to benefit people in LMICs.

“We really need you there”: WDF’s impact on NCDs in humanitarian settings

Globally, the number of forcibly displaced individuals has reached a staggering 110 million, with 75% of them seeking refuge in low- and middle-income countries. These countries are often impacted by protracted crises, which place an additional burden on their already fragile healthcare systems. For refugees, internally displaced persons, and vulnerable host populations this results in higher risk and disruptions in their regular medical treatment.  

To address this issue, WDF is committed to ensuring continuity of care for people living with diabetes or related NCDs in humanitarian settings. This is achieved by supporting government health systems capacity at the country level and enhancing integration between the humanitarian and health sectors. 

Bente Mikkelsen is well aware of WDF’s efforts in emergency settings. “People with NCDs are the most vulnerable. We see it in Gaza, we see it in Ukraine, we see it everywhere,” she says. “We really need you there,” she continues, “you have been spearheading this, continue that work. Use your convening power to create traction with other like-minded NGOs.”   

Looking ahead, Dr Mikkelsen sees WDF as a key global driving force in humanitarian settings. In her view, the 2024 Global High-Level Technical Meeting on NCDs in Humanitarian Settings was the landmark of a momentum that WDF has helped to build. The meeting, which was co-organised by WHO, UNHCR and supported by WDF, was an example of how care for chronic diseases is being recognised as a fundamental human need not only in classic development programmes but also when earthquakes strike, or bombs fall as well in the preparedness agenda. NCDs need to be core to any national preparedness plan and in every response to crises and protracted emergency.

A watchdog for GDM in low- and middle-income countries

The conversation zooms in on the significance that WDF's voice has acquired in the global NCD space. As Bente Mikkelsen notes, this is, to a significant extent, a result of WDF’s persistent presence on the ground, strengthening civil society organisations and health systems from the bottom up.  

A strong example of this, is how WDF has addressed diabetes and pregnancy, “Organisations like yours have a watchdog function. For example, you have been pushing quite hard on gestational diabetes (GDM),” she adds. WDF was joining the strong push from regional offices of WHO as well as the Department of Maternal and Childhood at WHO, and the advocacy efforts on GDM was beginning to pay off. "WHO needs these brave voices" in civil society and Dr Mikkelsen underscores that none of the high-level meetings on NCDs would be possible without a civil society to support the global NCD agenda and also challenge WHO and governments. As civil society actors raise their voices, they also create a demand from their governments to address the challenges at international level.  

Sanne Frost Helt agrees. WDF’s credible voice was cemented at the 2023 UN General Assembly in New York, where the Foundation spoke on behalf of non-state actors highlighting the interface with NCDs in the High-Level Meetings on Tuberculosis and Pandemic Prevention, Preparedness, and Response. WDF has been present at national levels and become a reliable and trusted partner to those local voices, including local champions, healthcare systems, and patient associations that many organisations would not have granted any funding because they were mostly not even registered and with poor organisational capacity.

The Global Diabetes Compact – a milestone for the fight against diabetes

The impact of WDF’s efforts over the past two decades seems crystal clear to the Director of NCDs at WHO. A joint push from donors, non-governmental organisations, international organisations, and national governments has enabled a positive change for the visibility and priority of chronic diseases globally, not least diabetes.  

In 2021, on the 100-year anniversary of insulin discovery, the WHO launched its flagship programme ‘the Global Diabetes Compact’ - a global initiative to reduce the risk of diabetes and to ensure that all people diagnosed have access to equitable, comprehensive, affordable, and quality treatment and care.  

“The Global Diabetes Compact is a first-ever WHO-led framework of such magnitude developed to strengthen the diabetes response worldwide in order to meet global diabetes targets, and WDF was there right from the start to engage on and support this important initiative” says the WHO NCD Director. The launch of the Global Diabetes Compact marked a special milestone in WDF’s engagement with the WHO and in 2023 WDF committed to support the implementation of key Global Diabetes Compact workstreams at the global, regional, and country level – the latter with a focus on sub-Saharan Africa. WDF is also part of the Global Diabetes Compact Forum as well as the core group of supporters of the Compact together with other funding agencies in the diabetes and NCD space, hoping to build synergies and co-financing with others to support WHO’s work and help the Compact reach its ambition.

What should be next for the global NCD community? 

Learn more 

• Global high-level technical meeting on noncommunicable diseases in humanitarian settings: building resilient health systems, leaving no-one behind
• The Global Coordination Mechanism on the Prevention and Control of NCDs
• The Global Diabetes Compact
• The WHO Global Dialogue on Partnerships for Sustainable Financing of Noncommunicable Disease Prevention and Control
• WHO/World Bank Second global dialogue on sustainable financing for noncommunicable diseases (NCDs) and mental health
• Tackling NCDs: "best buys" and recommended interventions for the prevention and control of noncommunicable diseases
• WHO Technical Advisory Group of Experts on NCD-related Research and Innovation (TAG-NCD-R&I)
• Implementation roadmap 2023-2030 for the Global action plan