TheNCDAllianceisledby:

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NCDAllianceResponse:ZeroDraftShanghaiDeclarationonHealthPromotion

October2016

TheNCDAlliancewelcomesthisopportunitytocommentontheDraftShanghaiDeclarationonHealth

Promotion(theDeclaration).Thirtyyearslater,theprogressionoftheShanghaiDeclarationonHealth

PromotiontoexpanduponthefoundationsoftheOttawaCharteristimelyandnecessary.Wecommend

WHOforinitiatingthisprocessinadvanceofthe9thGlobalConferenceonHealthPromotioninShanghai.

NoncommunicableDiseases,HealthPromotion&SustainableHumanDevelopment

Wecommendtheintegrationofsustainabledevelopmentsymbolizedbythe5Ps-People,Planet,

Prosperity,PartnershipsandPeace,intheHealthPromotionagenda.Thislinkageasanimportantentrypoint

forgreatermultisectoralengagementandcollaborationtoprioritizepolicieswhichhaveco-benefitsfor

healthandplanet.Wearepleasedtoseecivilsocietyhighlightedaskeyactorsinsupportinggovernmentsto

implementhealthpromotionpolicies,andtherecognitionofhealthasapoliticalchoice.

TheDeclarationappropriatelyemphasizesthatpromotinghealthandwellbeingforallandbyallasessential

toequitableandsustainablehumandevelopment.Healthpromotionisalsoanecessaryelementto

effectivelytacklenoncommunicablediseases(NCDs),responsibleforthegreatestburdenofdiseaseglobally,

andlargelypreventable.TheroleofhealthpromotioninreducingtheburdenofNCDsliesnotonlyin

prevention;effectiveimplementationofcomprehensive,well-resourcedhealthpromotionstrategiesshould

includeimprovinghealthliteracytosupportmanagementandmitigationofNCDs,leadingsystemschangeto

equitablyimprovehealth,andaddressingthesocialdeterminantsofhealththatperpetuatepoorhealthand

exacerbateNCDs.ThisDeclarationisanimportanttoolinreinforcingtherangeofsocial,environmentaland

economicconditionsthataffectNCDprevalence,andgovernments’centralrolesinshapingtheseconditions.

Politicalengagementinhealthpromotionprinciplesofprotecting,preservingandmaintaininghealth

equitablyacrosssocietiesisimperativetoreducingtheprevalenceofpreventableNCDs,premature

mortalityfromNCDs,andlived-burdenofNCDs.

TheDeclarationnotestheneedforcarefulcollaboration,asnoonestrategyorsectorwillbesufficientto

addresstheepidemicofNCDs.ActiononNCDsandhealthcanhaveimportanteffectsacrosssustainable

developmentprioritiesandviceversa.However,theDeclarationneglectstoemphasizethespecificneedto

addressNCDpreventionasanurgenthumandevelopmentpriority.

WhiletheAgenda2030forSustainableDevelopmentanditsSDGsareimportant,andusefulframingforthis

document,itisimportanttorecognizespecificglobalcommitmentsalreadymadebyGovernmentsand

referencedintheSDGs,suchastheglobal25x25NCDmortalityreductiontargetwhichhasinformedSDG

3.4.ThenineglobalNCDtargetsandtheevidence-basedpolicyoptionsoutlinedintheWHOGlobalActionPlanforthePreventionandControlofNCDs2013-2020shouldreceivegreaterattentioninthedocument.

TheNCDAllianceacknowledgestheprioritizationofgoodgovernanceinthecontextofhealthpromotionin

theDeclaration.WegreatlyappreciatethatthedocumentcallsattentiontothethirdUnitedNationsGeneral

AssemblyHigh-levelMeetingonNCDsin2018.TheMeetingprovidesanopportunityforhealthpromotion

agenciestohighlightactionsandprogressthattheyhavetakenalready.Healthpromotioniscriticaltothe

achievementofa25%reductioninprematuredeathsfromNCDs;Duetotheimpactofglobalizationof

marketingandtrade,particularlyinthecontextofindustrialriskfactorsofNCDs,nowisthetimetonotonly

articulatetheneedtoputNCDpreventionandhealthimprovementfrontandcenterinhealthpromoting

policiesandinvestment,butalsoactonthecommitmentstodoso.

TheNCDAllianceisledby:

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GeneralComments

OurcommentsbelowdrawtogethertheperspectivesofdifferentstakeholdersfromtheNCDAlliance

networkwiththeobjectiveofstrengtheningfutureiterationsoftheDeclarationtobepresentedtotheWHOGlobalConferenceonHealthPromotioninNovember2016.

i) ‘HealthInAll’terminology:ThetermHealthInAll(HiA)appearstohavereplacedmorewidely

usedHealthinAllPolicies(HiAP).Thiscouldbeduetoanassumedunderstandingthat‘Healthin

All’referstoHealthinAllPolicies.Ifthisisanofficialshiftinlanguagefromthatarticulatedin

the2013HealthinAllPolicies:FrameworkforCountryActionadoptedatthelastWHOGlobal

ConferenceonHealthPromotioninHelsinki,toensurebroadinterpretationitmaybe

worthwhileprovidingcontextfortheterminologychange.Forexample,fromtheWHOwebsite:

‘Healthpromotionrequirespolicymakersacrossallgovernmentdepartmentstomakehealthacentrallineofgovernmentpolicy.Thismeanstheymustfactorhealthimplicationsintoallthedecisionstheytake,andprioritizepoliciesthatpreventpeoplefrombecomingillandprotectthemfrominjuries.’

ii) Referencetointernationalinstrumentsforhealthaccountability:Weenvisagethatthe

commitmentshighlightedwithintheDeclarationwillhelptoinformapotentialstrategyor

actionplanonhealthpromotionasproposedbytheDeclarationinParagraph29,todrive

momentumtowardsachieving2030goalsandtargets.ThisDeclarationonHealthPromotionis

aninstrumentwhichcanalsoreiterateexistingglobalcommitmentsrelevanttohealth

promotion,particularlytheGlobalNCDMonitoringFramework.

SpecificSectionsoftheDeclaration

Paragraph6:Theachievementsandpotentialofhealthpromotionasacomponentofeffectivedisease

preventionisworthyofrecognition.HoweveritisimportanttoalsonotethattheburdenofNCDscontinues

togrow,suggestingalackofsystematicapplicationofhealthpromotionprinciplesacrossNCDriskfactors.

Forexample,inspiteofhealthpromotionefforts,nocountryhasyetreverseditsobesityepidemic;alcohol

use,physicalinactivity,andtobaccousecontinuetobeprominentcontributorstoNCDs.Withtheserisk

factorscontinuingtoconstrainhumandevelopmentacrosstheglobalsustainabledevelopmentagenda,itis

crucialthathealthpromotionissystematicallyintegratedasacomponentofabroadsuiteofeffectivepolicy

interventions.

Paragraph9(a):TheacknowledgementoftheprominenceofNCDs,mentalandneurologicaldisorders,

environmentaldiseases,andmalnutritioninallitsformsasmanifestationsofinequalityofdevelopmentis

welcome.Wedo,howeverrecommendthatthissectionbestrengthenedbyemphasizingthatNCDsarea

symptomoffailureofthedominantdevelopmentparadigm,andthatthisneedstochangetoprioritize

sustainablehumandevelopment.

Malnutritioninallitsformsisanevolvingtermnotyetwidelyacknowledgedasencompassingtheunique

challengesofdietrelatedNCDsandobesity.Itwouldbeusefultoexpanduponthistermswithspecificityto

ensurethebroaddefinitionofmalnutritioninallitsformsisunderstood.

Paragraph9(b):Thecurrentleadsentenceforthisparagraphsuggeststhatglobalizationofmarketingand

tradeareprimaryconcerns.However,tradeshouldnotbedepictedasintrinsicallynegativeparticularlyin

lightofgoal17oftheSDGswhichspecificallyhighlightstheroleoftradetotheattainmentoftheSDGsand

goal17.11whichaimstosignificantlyincreasetheexportsofdevelopingcountries,withaviewtodoubling

theleastdevelopedcountries’shareofglobalexportsby2020.Tothiseffect,paragraph9(b)ofthe

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ShanghaiDeclarationshouldbemodifiedtostate‘theimpactofglobalizationofmarketingandtradeof

productsharmfultohealth’.

WiththelinksdrawnbetweenthehealthofpeopleandplanetinParagaph9(b),werecommendthe

additionofaddressingairpollutionandclimatechange,side-effectsofglobalizationoftrade,tothelistof

actionsrequiredtocountertheirharmfuleffectsonhealthinthecontextofhealthpromotion.

Paragraph10:Thereshouldberecognitionofthegrowingimportanceofregionalpartnerships,agreements

andgovernanceinstruments.E.gParagraph10shouldbemodifiedtoincludereferencetoadaptationand

implementationoftheSDGsatthe‘local,national,regionalandgloballevels’(paragraphs80,81SDGs).

InternationalCooperation:TherecouldbegreaterreferenceintheDeclarationtointernationalcooperationasspecifiedinboththeSDGsandtheAddisAbabaActionAgenda.AchievingtheSDGswillrequire

internationalcooperationincludingtheuseofinternationalpublicfinance,e.g.officialdevelopment

assistance(ODA),tocatalyzeadditionalresourcemobilizationfromothersources,publicandprivate

(paragraphs43SDGs,paragraph22AddisAbabaActionAgenda).

Paragraph12and13:GoodhealthgovernanceiscentraltotheachievementoftheSDGs,andisofcritical

importanceinreducingtheburdenofNCDs.Thesectionongoodgovernancetosupporthealthpromotion

andhealthinallpoliciesisnotasprominentasthatunderhealthliteracy,andthusappearslessimportant.

Tothisend,Paragraph13couldbestrengthenedwithgreaterattentiontothecommitmentsofgovernments

toimprovenational,multilateralandbilateralgovernanceforhealth.Werecommendanadditional

commitmentonconcreteactionforalllevelsofgovernmenttobothengageinandpromotegoodhealth

governance,whilealsoaddressingandresolvingpoorhealthgovernance.Goodgovernanceshouldbe

supportedwithinvestmentinstrengtheningresources,legitimacy,transparencyandaccountability.

Paragraph13(a):Theneedtorecognizethatnotonlyalllevelsofgovernmentbutallrelevantsectorsofgovernmentshouldbeengagedinaddressinghealthpromotioniscurrentlyaddressedinparagraph19(b)

butshouldalsobereferredtoinparagraph13.WerecommendthatParagraph13(a)shouldbeamendedto

state‘Thismeansinvolvingalllevelsandrelevantsectorsofgovernmenttocapitalizeonsynergiesandco-

benefitsthatleadtoincreasedeffectivenessandefficiencyandprovideentrypointstoaddressthe

determinantsofhealth.’

Paragraph13.(a)Thissectioncouldbeenhancedwiththeadditionofanexampleofataxationofunhealthy

transport,forexamplecongestionchargesforroads,withprivatevehicleuseamajorcontributortopoor

healthintermsofperpetuatingphysicalinactivityandcontributingtoairpollution.Congestionchargestaxa

behaviorratherthanaproduct,butcouldreapmultiplehealthbenefits.Further,healthpromotingoptions

couldbeencouragedbycarefulandappropriatesubsidization,forexamplepublicandactivetransport,and

applicationofsubsidiestofreshfruitandvegetablestoreducetheirpurchasecosts.

Paragraph13(c):Ensurethatbilateralandtradeandinvestmentagreementsinsupportingallthree

dimensionsofsustainablehumandevelopmentprovidepolicyspace,asrecognizedforinparagraph21,goal

17.15,paragraphs63and74(a)and81oftheSDGs,forbona-fidepublichealthmeasures.E.g13(c)‘Support

thesenationalmeasuresbystrengtheningcoherenceandconsistencyamongbilateralandregionaltrade

andinvestmentagreementsinsupportofallthreedimensionsofsustainablehumandevelopment

includingensuringtheseagreementsprovidepolicyspaceforhealthpromotionandprotectionmeasures’.

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Paragraph15(a):TheemergingworldwideHealthyCitiesmovementshouldhavefollow-upontheNew

UrbanAgendaasoneofitspriorities,andwethereforesuggesttheadditionofthefollowinglineto15(a)

‘identify,implement,andpromoteconcreteactionstoachievethehealth-relatedaspirationsoutlinedin

theNewUrbanAgenda.’

Paragraph15(b):Wesuggestaddingtolistofissues:‘unsustainablefoodsystemsandphysicalinactivity

andsedentarybehaviors’.

Paragraph17(a):Werecommendemphasizingtheimportanceofimprovementsinthehealthliteracyofthe

generalpopulationbyaddingthefollowing:‘developandimplementaninter-sectoralnationalstrategyand

planforstrengtheninghealthliteracy,withcleargoalsforimprovinghealthliteracyinthegeneral

population,ensurefunding,withanysuchplansalignedwithNationalNCDplans.’

Paragraph17(b):Werecommendbroadeningthebaseofmeasuresspecifiedtoincludepackagingand

broaderformsofpromotionandsponsorshipotherthanmarketingandadvertising,andidentifyingthe

particularvulnerabilityofchildrenintermsofhealthliteracyasrecognizedbytheWHOSetof

recommendationsontheMarketingoffoodsandnon-alcoholicbeveragestochildrenandFinalSetof

RecommendationsoftheCommissiononEndingChildhoodObesity(ECHO).E.gParagraph17(b)‘Increase

oureffortstoensurethatconsumerenvironmentssupporthealthychoicesthroughtransparent,

accessibleinformation,andmeasuresincludingpackagingandlabelling,andtheregulationofadvertising,

promotionandsponsorship,particularlyinrelationtochildren,includingsocialmediastrategies’.

Paragraph17(c):Includereferencetohealthliteracyincludingensuringinformeddecision-makingonhealth

servicesE.gParagraph17(c)Investinmakinghealthcareinstitutionsmoreunderstandable,friendlyand

people-centered,andensureinformeddecision-makingbysettingstandardsforhealthliterate

organizations.

Paragraph17(c):Therecouldalsobeanexplicitreferencein17(c)toimprovingthehealthliteracy,in

termsofcommunicatinghealthinformation,ofthehealthworkforce,withinhealthcareinstitutions.This

acknowledgespatient-providercommunicationastheprimary(andsometimesonly)opportunityforthe

provisionofhealthcareinformationinaprimarycaresetting,andfurtheracknowledgesthatapatient-

providerinteractionmayoccurinsettingsotherthanahealthcareinstitution,whetherbecauseofamobile

workforce,ortheutilizationofdigitaltechnologytodeliverinformationremotely.

Paragraph17(d):Wecommendtheinclusionofstrengtheninghealthliteracyofdecisionmakersinsectors

otherthanhealth,signalinganexpansionofthecommonlyrecognizedemphasisofhealthliteracybeing

mostpertinentforcitizens.ThisrelatesdirectlytoParagraph23andtheneedtostrengthenhealth

diplomacyskills.

Paragraph17(e):Thiscommitmentcouldbeexpandedto‘…increasingcitizens’accesstoanduseof

knowledgeandinformation…’recognizingthataccesstoinformationmustbeaccompaniedbysupportive

structuresthatencouragecitizenstoactuponthisknowledgeandinformation.

Paragraph19(b):Thereisanurgentneedforagreateremphasisoftheneedtoprotectpolicymakingand

policymakersfrominfluenceofthosewithvestedinterestsincorporatedriversofill-health.However,

concernsaroundconflictofinterest,whileaprimaryguidingprincipleinshapingpartnerships,canstifle

constructivecollaborationwithprivatesectorwithinterestsalignedwiththoseofthehealthpromotion

sector.Emphasishereshouldbeoninformedinvolvementofdifferentsectorstosupporthealthpromotion

actionsbeyondthehealthsector.Paragraph19couldbestrengthenedbyrevising19(b)to‘strengthen

appropriateinteractionbetweendifferentsectors,andestablishmechanismsforeffectivecooperation

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acrossdifferentsectors.Thisincludestheidentificationofcommonobjectivesandcross-sectoral

knowledgesharinginordertosupporthealthpromotionactionsrequiringengagementbeyondthehealth

sector,suchaslinksbetweenhealthandtradeoragricultureintobaccocontrol.’

Paragraph19(c):Paragraph19couldbestrengthenedwiththeadditionofanewcommitment19(c)to‘find

andforgeallianceswiththosepartsofprivatesectorwhichhaveinterestsalignedwithhealthpromotion

andNCDprevention,anddonotengageinhealthpromotioninitiativestodistractfromtheharmful

impactsoftheircorebusiness.’

Paragraph23:Notonlydowerequirestrengtheningofhealthliteracyacrossallsectorsandlevelsof

governance,butwealsoneedtostrengthenthehealthdiplomacyskillsofpublichealthadvocatestoengage

withandsupportthestrengtheningofhealthliteracyacrossallsectorsofgovernments,andtoassistpolicy

makersinnon-healthsectorstounderstandthepotentialhealthimplicationsofdecisionsandpoliciesthey

aremaking.Effectivehealthdiplomacydrivesthesuccessofhealthinallpoliciesandhealthypublicpolicies

approaches.Healthdiplomacyishealthpromotioninaction.Civilsocietyorganizationshaveakeyrolein

healthpromotionadvocacy,makingtheenhancementofhealthdiplomacyskillsnotonlyacapacity

strengtheningissueforgovernments.Thusitisimportantthatallsectorsofgovernmentsareopento

engagingwithcivilsocietyhealthpromotionadvocates.

Paragraph25&26:

Ageneralcommentinrelationtothissection:inresourcelimitedsettings,wheretheprovisionofessential

andminimumhealthservicesmaybeinadequate,reorientinghealthsystemstowardshealthpromotionand

preventionshouldnotcomeattheexpenseofhealthservices.Thissectioncouldhighlightthevalueof

integratinghealthpromotionandhealthpreventionstrategiesaspartofoverallhealthsystemsandprimary

healthcarestrengthening.

Paragraph25:theremaybevalueinsettingoutwhatisincludedintheconceptof‘healthservice’.

Paragraph26(a)Theremaybevalueinprovidingexamplesofhealthsectoractionsforhealthpromotion

anddiseaseprevention,suchasimprovedaccesstoscreening,immunizationprogramsandpreventive

medicines.

Paragraph29:ProposedWHOglobalstrategyandactionplanonhealthpromotionto2030:Inprinciple,we

supporttheproposeddevelopmentofastrategyand/oractionplanonhealthpromotionbyWHO,that

wouldoperatealongsideandreinforcetheGlobalActionPlanforthePreventionandControlofNCDs2013-2020,withthebroaderobjectiveofcontributingtowardtheattainmentoftheSustainableDevelopment

Goals.Toensureacomprehensiveandeffectiveactionplanand/orstrategy,comprisingaroadmapof

actionsandanaccountabilityframework,werecommendthatthisisalignedwithexistingrelevantplans,for

examplethoseonNCDs;issufficientlyresourcedbystrengtheningofWHO’scapacityforoversightand

accountability;andisdevelopedthroughathoroughconsultationprocessbringingincivilsocietyvoicesat

thefrontlinesofhealthpromotionpractice,andthepreventionandcontrolofdiseases.