In 2011, attention to NCDs reached unprecedented levels during the first United Nations (UN) high-level meeting on NCDs. The global community and all European leaders can no longer ignore the fact that, globally, 36 million deaths (63% of the total of 57 million deaths that occurred in 2008) were due to NCDs. Data reported at the summit showed that the death toll due to NCDs is mainly due to four classes of disease: cardiovascular disease (48%), cancer (21%) – with lung cancer having the highest mortality rate – chronic respiratory disease (12%) and diabetes (3.5%). In the WHO European region, this broad group of disorders accounts for 86% of deaths and 77% of the disease burden.
It is also noteworthy that NCDs are linked by common risk factors and underlying determinants, such as smoking and air pollution, which can be addressed by horizontal policy interventions, and which, in turn, could reduce premature death and preventable morbidity and disability. This is true at the global, European and national levels.
While the WHO has taken steps to encourage European countries to do more, the European Union (EU) has been very slow to act. The Council of the EU, under the Belgian presidency in 2010, invited the member states and the European Commission to initiate a reflection process on chronic diseases. Yet, in 2013, the EU still does not have a strategy.
In terms of policy developments related to NCDs, European countries have shown a growing interest, mainly developed in partnership with the WHO. We do not aim to list all the NCD policy documents that have emerged in the past 10 years, but we would draw particular attention to the following: first, the WHO European NCD action plan 2012. This is notable because it was developed against a backdrop of other key European policies and strategies in the past 10 years (Health 2020, the First Global Ministerial Conference on Healthy Lifestyles and Noncommunicable Disease Control, the United Nations High-Level Meeting on Noncommunicable Diseases) and because it takes into account the existing commitments of European countries and focuses on specific priority action areas and interventions for the next 5 years (2012–2016). The second document of note is the first draft of the Global Action Plan 2013–2020 (GAP), which builds upon the Zero Draft published in October 2012 and takes into account outcomes of consultations with member states, UN agencies, nongovernmental organisations (NGOs) and the private sector in 2012.
An overall assessment of the different NCD policy developments shows that European countries now have a greater understanding of needs, capacities and gaps in implementation. However, it should be noted that coverage of interventions for NCD prevention and care is still very patchy. Notably, the overall picture of the disease burden and risk factors remains incomplete and the harmonisation of data collection instruments and definitions is still a key challenge, particularly for respiratory diseases. Indeed, the morbidity and mortality related to respiratory diseases are still grossly underestimated. This conclusion is unambiguous if one takes a closer look at the WHO global report on NCDs published in 2011. This report provides estimates for each member state on the burden of NCD mortality, prevalence and trends of selected major behavioural and metabolic risk factors and the country’s capacity to respond to the NCD crisis. Focusing more specifically on chronic respiratory disease, the country profiles reveal worrying problems, in terms of both diagnosis and basic care. Firstly, proportional mortality due to chronic respiratory diseases is systematically higher in countries where surveillance and diagnosis are most accurate. (For instance, in Sweden, the proportional mortality due to chronic respiratory disease is 4%, while in Latvia, where tobacco prevalence is much higher (27.8%), the reported proportional mortality due to chronic respiratory diseases is only 1%. In addition, Spain and the UK report the highest level of proportional mortality due to chronic respiratory disease (9% and 8%), yet these countries have chronic respiratory disease-specific policies/ programmes/action plans.) Secondly, only 10 of the 28 EU member states have developed an integrated or topic-specific policy/programme/action plan for chronic respiratory disease. This indicates a worrying vicious circle: the lack of surveillance data leads to a lack of awareness which in turns leads to a lack of policy interventions.
If European countries genuinely wish to reduce the toll of chronic respiratory diseases, the following recommendations should be implemented urgently:
Dedicated NCD units should be set up in health ministries, paying special attention to chronic respiratory disease. As discussed above, this is often completely overlooked in European countries. These units should have suitable expertise, resources and responsibility for needs assessment, strategic planning, policy development, multi-sectoral coordination, implementation and evaluation.
Each special unit should first conduct an assessment of epidemiological and resource needs in order to inform the development of national policies and plans to address chronic respiratory disease.
Where data collection and surveillance is inadequate, this should be given a high priority. The government should allocate a budget commensurate with identified gaps in surveillance.
Identified human and other resources needed to implement the national action plan for prevention and control of chronic respiratory disease should also be allocated a specific budget.
Health systems for the care of people suffering from chronic respiratory disease should be improved.
Countries should make sure that the health workforce is adequately trained and appropriately deployed, if necessary revising and reorienting the curricula of medical, nursing and public health institutions in order to deal with the complexity of issues relating to chronic respiratory disease.
Finally, all governments should work in partnership with stakeholder groups that are already supporting and contributing to a national response to chronic respiratory disease (e.g. patient groups, NGOs, civil society and academic research centres).