Prevention and promotion as key aspects of Universal Health Coverage: the UK Working Group on NCDs with Chatham House event

Contributed by Christine Hancock, C3 Collaborating for Health

40 mainly global NGOs met at Chatham House on 9 September 2019, with key people joining online, including Dr Rachel Nugent, Sir Trevor Hassell and Dr Andrea Feigl, and the meeting was facilitated by Richard Smith, former editor of the BMJ, who has been working globally in NCDs for more than a decade.

Delegates included Dr Jennifer Bute, who used to be a GP but retired with early onset Alzheimer’s Disease. Since then it has become her passion to try to help people understand about it, and she has written Dementia from the Inside: A Doctor’s Personal Journey of Hope.

Many of us have trouble seeing how prevention really fits into the narrative of UHC, although everyone agrees it has to as all countries will be overwhelmed with the disease burden unless they take every opportunity to prevent the economic cost and burden of suffering and premature mortality that will come.  The compelling case is the cost of treatment and the suffering of people who can’t get access; the challenge is that 70% of people that die from NCD started their risky behaviour as a child: smoking, poor diet, alcohol and physical inactivity.

Lord Nigel Crisp, who joined the discussion, co-chairs the All-Party Parliamentary Group on Global Health and co-chairs Nursing Now, the global campaign on nursing and challenged the meeting to mobilise the nurses. Nurses’ voices are often not heard, as they are predominantly women, are less powerful within the health system, and have little political power. They should also be supported in their own health, which will also better position them to help and advise others. The Year of the Nurse and the Midwife in 2020 is an opportunity to raise the profile of this most trusted of professions, and to harness their political power.

A significant part of the meeting was devoted to fiscal policies: the Task Force on Fiscal Policy for Health, co-chaired by Michael Bloomberg and Larry Summers, recommends using taxes to change behaviour for health purposes. They argue such taxes are not regressive but help the poor, and that illegal trade is not a big issue. The data is not clear about subsidies, but cross-border trade is an issue. There are now sugar taxes in over 50 places, which have resulted in price increase and reduced purchases. There is currently less evidence about impact on different groups and what people buy instead. In the UK, both reformulation and changed behaviour occurred after the law and before implementation. Taxes on tobacco and alcohol were agreed as the single most important policy to benefit prevention. The politics of increasing taxes is just as complex as the economics, and the meeting agreed that it would be good to have a global body that could provide economic, legal, and political assistance to countries interested in raising taxes to reduce harm.

There is no group more important in bringing health promotion and prevention front and centre in UHC than policymakers. Political commitment is essential to success. Civil society has a key role to play in highlighting a sense of injustice, in order to create the conditions within which political commitment can take root.

The formal summary report published by Chatham House, co-host of the event, is available below and a blog by Richard Smith (who moderated the event) can be read here.

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