Rethinking global health challenges: Towards a “Global Compact” for reducing the burden of chronic disease

Chronic, non-communicable diseases are the leading cause of death and disability in both the developed and developing world (excluding sub-Saharan Africa).  Although often overshadowed by HIV/AIDS, communicable diseases and the threat of pandemic influenza, most countries face a growing health burden from heart disease and stroke, diabetes, various cancers and the many diseases caused by tobacco use.

At present, the global framework for action on chronic disease is strongly “WHO-centric”, defined by two World Health Organisation initiatives: the WHO Framework Convention on Tobacco Control, and the Global Strategy on Diet, Physical Activity and Health.  This paper explores the difficulties of developing a collective response to global health challenges and draws out some implications for chronic disease.  It highlights how improved governance structures and partnerships, economic processes, and international laws and standards function as three, concurrent pathways for encouraging policy implementation at country level and for building collective commitment to address the transnational determinants of chronic disease.

The paper evaluates WHO’s initiatives on chronic disease in terms of these pathways, and makes the case for a Global Compact on Chronic Disease as a possible structure for advancing WHO's free-standing goal of reducing mortality from chronic diseases by an additional 2% between 2005-2015.  Beneath this over-arching structure, the paper argues that global health stakeholders could achieve greater impact by coordinating their efforts within a series of semi-autonomous “policy channels” or workstreams.  These workstreams – including trade and agriculture, consumer health issues, workplace health promotion, and the economics of policy investment and program financing – could act as focal points for collaboration between a wider range of health stakeholders, each working within their areas of comparative advantage.