NCDs & Mental Health: A Multisectoral Blueprint

The global impact of noncommunicable diseases (NCDs) and mental health conditions extends far beyond just health and well-being. The sheer scale of the problem – 43 million deaths annually attributable to NCDs and a staggering one billion individuals worldwide living with mental health conditions – highlights the significant economic, developmental, and equity implications of this critical global health issue.

NCDs, encompassing heart disease, stroke, cancer, diabetes, and chronic lung disease, not only claim countless lives but also impede economic and human progress, placing a disproportionate burden on vulnerable populations. The major modifiable risk factors associated with NCDs – including tobacco and alcohol consumption, physical inactivity, unhealthy dietary habits, and air pollution – are often influenced by socioeconomic, environmental, and commercial determinants. Factors such as income level, social standing, educational attainment, the environment in which individuals are born and reside, and their ability to access and afford appropriate care all play a crucial role in effective NCD prevention, management, and treatment.

A Vital Component of Sustainable Development

Given that the underlying causes and consequences of NCDs often lie outside the traditional realm of public health, effective governance and policymaking must be multisectoral. This requires the active engagement of various government sectors, including finance, trade, social affairs, economic development, treasury, technology, and education.

The upcoming political declaration from the Fourth High-Level meeting of the United Nations General Assembly on the prevention and control of noncommunicable diseases and the promotion of mental health and well-being recognizes that health is both a prerequisite for and a result of overall sustainable development. The declaration urges countries to implement operational, multisectoral, and integrated policies or action plans focused on NCDs and mental health by 2030.

However, many countries face practical challenges in implementing multisectoral governance and formulating coherent policies. Institutionalizing cross-sectoral governance and adopting a "whole-of-government" approach with clear accountability, fostering leadership, utilizing interdisciplinary data and evidence, and reframing NCDs beyond a purely health-related issue can prove complex, costly, and difficult to sustain over the long term.

Despite these challenges, some countries are making significant strides in formalizing, informing, and promoting multisectoral action.

Incentivizing and Sustaining Multisectoral Governance

Effective multisectoral collaboration hinges on shared governance and accountability among different government sectors and public agencies, leadership at all levels, a culture of interdisciplinary communication and cooperation, and the allocation of dedicated human and financial resources. These strategic pillars of multisectoral governance and action should be formalized through mechanisms such as presidential decrees, municipal ordinances, high-level cross-sectoral committees or working groups, dedicated workstreams and meetings, and targeted financing and budgeting.

• Finland: An Advisory Board for Public Health brings together representatives from various ministries, including Agriculture and Forestry, Finance, Education and Culture, Employment and the Economy, Environment, Interior, Justice, Social Affairs and Health, and Transport and Communications. This board has facilitated improved decision-making on complex issues, such as the impact of obesity on the workforce, through several national initiatives.
• Tanzania: The multisectoral National NCD Programme, overseen by the Prime Minister's Office, includes an annual multisectoral steering meeting and is supported by a network of dedicated focal points specializing in health in all policies across multiple government agencies.

Leveraging Multistakeholder Data and Knowledge Sharing

Multisectoral NCD policies and programs should integrate diverse data sources, different types of evidence, and interdisciplinary expertise, including input from stakeholders beyond the health sector. It is also crucial to involve individuals living with NCDs, mental health conditions, and neurological conditions in the design and implementation of these policies.

The production, exchange, and application of multisectoral evidence can be facilitated through multistakeholder collaboration, while ensuring clear lines of measurable accountability for implementation. Governments should utilize the expertise of academia, communities, civil society organizations, and people living with NCDs, mental health conditions, and neurological conditions to ensure their meaningful engagement in NCD initiatives.

• Canada: The Quality of Life Framework integrates health data with economic, social, governance, and environmental indicators to measure well-being and inform federal budgeting processes and reporting.
• Paipa, Colombia: A digital information system enables policymakers and public health specialists to monitor the health status of urban and rural communities by combining data on social, economic, housing, environmental, and health needs within a single municipal system that informs multisectoral policies and programs.

Reframing the NCD Narrative

Formalizing multisectoral governance and leveraging interdisciplinary evidence also contribute to reframing the narrative surrounding NCDs, positioning them as a pressing and growing socioeconomic, environmental, and developmental issue.

Strategies to address this communication challenge include:

• Emphasizing the co-benefits of multisectoral action, such as economic gains, social equity, and environmental impact.
• Highlighting the unsustainable costs of inaction and the devastating impact of health inequities.
• Anchoring NCD prevention and control in the principles of the right to health, universal health coverage, and integrated primary health care.

Strong, multisectoral narratives on NCDs are essential for mobilizing diverse stakeholders, building trust, and reducing siloed structures and competing priorities.

• Sri Lanka: An educational initiative for the prevention of cardiovascular diseases and diabetes framed education as a tool for prevention, a long-term investment in human capital, and a cross-sectoral responsibility, rather than solely a health or education issue. The resulting multisectoral school health, screening, and health promotion program achieved a lasting positive impact on addressing challenges related to unhealthy diets, obesity, and physical inactivity.
• Philippines: A campaign to promote physical activity was reframed as an initiative for active transport and open spaces, presenting a health concern as a challenge for transport and urban planning. Since its inception in 2021, the Active Transport program has led to the construction or improvement of over 500 kilometers of bicycle lanes in the metropolitan areas of Manila, Davao, and Cebu.

Key Steps to Advancing Multisectoral Governance and Action on NCDs

In support of the global commitment by Member States to multisectoral collaboration, governments, in collaboration with civil society and relevant partners, can advance cross-sectoral NCD policies and programs in three key areas:

1. Institutionalize multisectoral governance with clear and transparent accountability: Implement coherent NCD policies and joint action as sustainable and resilient government mechanisms, financing mechanisms, or national priority initiatives.
2. Strengthen coherent multisectoral data governance and evidence frameworks: Establish standardized, interoperable data collection systems and leverage expertise from diverse communities and people with lived experience.
3. Reshape the predominant NCD narrative: Highlight the co-benefits of multisectoral action and emphasize shared roles and accountability across sectors and actors.