World leaders have pledged to take wide-ranging action to prevent millions of deaths from cancer, diabetes, and heart and lung disease by tackling the key causes -- smoking, excessive drinking, lack of exercise and unhealthy diets dominated by fast food.
But the 13-page political declaration approved at the first-ever General Assembly meeting on chronic diseases which ended Tuesday left unanswered the question of coordinating an international response to what the leaders called "a challenge of epidemic proportions."
The declaration notes "with profound concern" that according to the World Health Organization, an estimated 36 million of the 57 million global deaths in 2008 were due principally to cancer, diabetes and heart and lung diseases -- including about 9 million men and women below the age of 60. WHO said 80 percent of these deaths were in developing countries.
At a final round-table discussion, Prime Minister Denzil Douglas of St. Kitts and Nevis said, "Our response must be urgent, it must be comprehensive, and it has to be fully coordinated at the national, regional and local levels."
Douglas, who chairs the Caribbean Community known as CARICOM, said priority must be given to international coordination so there can be effective monitoring of the diseases and effective measures to reduce the risk factors and strengthen health care systems, especially in developing countries where cases of the four diseases are increasing rapidly.
The only other high-level General Assembly meeting on a health issue, in 2001, led to creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria, with billions of dollars provided by governments and private groups such as the Bill & Melinda Gates Foundation.
At the round-table, many speakers proposed that the global fight against non-communicable diseases follow the same model. Some proposed a coordinating body, possibly under the World Health Organization, and Poland said an international network of organizations specializing in chronic diseases would be valuable.
The declaration asks U.N. Secretary-General Ban Ki-moon to submit options to strengthen and facilitate global action to combat these diseases to the General Assembly by the end of 2012.
"Non-communicable diseases can be prevented and their impacts reduced, with millions of lives saved and untold suffering avoided," the declaration said.
To achieve this, the leaders pledged to accelerate implementation of WHO's anti-smoking treaty and its global strategies to promote healthy diets and physical activity, and reduce the harmful use of alcohol.
They also pledged to promote cost-effective measures to reduce salt, sugar and saturated fats and eliminate industrially produced transfats in foods and to encourage policies that support the production and consumption of foods that contribute to healthy diets.
The leaders also pledged to promote increased access to cost effective cancer screening programs, help improve "access and affordability for medicines and technologies" to prevent and control chronic diseases, and try to identify and mobilize sustained funding.
Many countries said they were already taking action to address the crisis.
South Africa said it had just passed regulations to reduce the use of trans fats and is drawing up regulations to reduce salt content in processed food. Kenya said its parliament has banned smoking in all public places and prohibited tobacco advertising and the sale of tobacco products to anyone under the age of 21. Australia announced it is giving $25 million to help Pacific island countries tackle non-communicable diseases -- and starting next year it will require all tobacco products sold in Australia to have the same "unattractive dark brown" packaging covered by graphic health warnings to discourage smoking.
WHO Director General Margaret Chan, who urged world leaders to stand up to the tobacco and fast food industries in a keynote speech Monday, applauded efforts in Australia, Uruguay and elsewhere to counter tobacco company advertising campaigns.
But she urged vigilance, telling Tuesday's round-table participants: "Watch out. Even an old dog like the tobacco industry can learn some dirty new tricks."