IFMSA International Secretariat, c/o IMCC, Nørre Allé 14, 2200 København N., Denmark

IFMSA Policy Document

Non-communicable diseases

Proposed by Team of Officials

Adopted by the IFMSA General Assembly March Meeting 2019, in Portorož, Slovenia.

Policy Statement

Introduction:

Noncommunicable diseases (NCDs), including cardiovascular diseases, cancer, diabetes, chronic

respiratory diseases and mental health disorders, account for major morbidity and premature death.

Collectively they are responsible for the major global burden of disease, especially in low- and middle-

income countries (LMICs). This makes it crucial to develop effective, context specific interventions.

The impact of NCDs extends beyond ill-health with major economic consequences worldwide and the

likelihood to impede poverty reduction initiatives in LMICs. The rise of NCDs has been largely driven

by five risk factors: tobacco use, physical inactivity, harmful use of alcohol, unhealthy diets and air

pollution. These risk factors are interrelated and rooted in social, political, economic, cultural,

environmental and commercial factors that are often outside of individuals’ control. Underfunding, lack

of social mobilization and conflicts of interest with the private sector make NCDs a challenging global

public health issue. NCDs’ prevention, control and management is essential to achieve the sustainable

development goals’ (SDG) target of a one-third reduction in premature NCD deaths by 2030.

IFMSA position:

The International Federation of Medical Students’ Associations (IFMSA) affirms the need for urgent

global multi-sectoral action on awareness, surveillance, prevention, control and management of

NCDs. As NCDs share common risk factors there is an opportunity for comprehensive, coordinated,

preventive action to tackle them as a group. The IFMSA believes that the global youth have a

powerful role to play in the prevention and control of NCDs’. Both as a vulnerable and powerful group,

youth has the unique capacity to add value to solutions for NCDs and to help lead their

implementation in the society.

Call to Action:

Therefore, the IFMSA calls on:

Governments to:

• Recognize NCDs as a major public health threat, and commit to surveillance, prevention,

control and management of NCDs at all levels particularly in low- and middle- income countries;

• Take affirmative steps to strengthen and orient health systems towards a life-course approach

that addresses the burden of NCDs and the underlying social determinants;

• Establish mechanisms ensuring multi and intersectoral coordination for NCDs awareness,

prevention, care and rehabilitation;

• Prioritize activities focused on vulnerable and disadvantaged groups, including youth;

• Monitor progress and trends of NCDs and their risk factors;

• Adhere to the WHO Framework Convention for Tobacco Control (FCTC) and adopt the WHO's

Global Strategy to Reduce the Hazardous and Harmful Use of Alcohol;

IFMSA International Secretariat, c/o IMCC, Nørre Allé 14, 2200 København N., Denmark

• Regulate the marketing, advertising and sale of alcoholic beverages, tobacco products and

unhealthy food products;

• Consider re-evaluating pricing and taxation policies including, but not limited to:

a. Implementing an effective tax on sugar-sweetened beverages, ideally based on sugar

content, rather than volume;

b. Providing subsidies for fresh foods where economically feasible.

• Consider policies including but not limited to: banning or limiting the availability of unhealthy

products in government-run institutions, such as public hospitals and schools;

• Consider the above mentioned policy options in accordance with the WHO Action Plan 2013-

2020 on prevention and control of NCDs, especially the cost-effective and evidence-based

policies that can be adapted to meet the diverse needs of countries.

Private sector companies to:

• Act in the interest of public health wherever and whenever possible;

• Ensure advertising of potentially unhealthy products conforms to regulations;

• Go forward with the labelling of all products that are harmful to health.

Healthcare professionals to:

• Adequately inform patients about the influence of risk factors and upstream determinants on

the development and outcome of NCDs and offer different alternatives to reduce NCDs risk

factors, such as smoking and alcohol cessation programs, dietetic counseling and physical

activity.

• Actively engage with an interdisciplinary approach in evidence-based strategies to screen, treat

and prevent NCDs;

Universities and other providers of medical education to:

• Incorporate NCDs and their risk factors comprehensively into the medical curriculum, promoting

a holistic approach to their prevention and control;

• Involving different stakeholders including youth and medical students.

IFMSA National Member Organizations (NMOs) and medical students to:

• Promote healthy behavior among themselves and lead by example;

• Raise awareness, especially among peers, and advocate towards the reduction of NCDs;

Finally, all relevant stakeholders to:

• Ensure comprehensive consultation and collaboration across sectors, including civil society

organizations;

• Actively campaign to promote the importance of a healthy lifestyle and life-course approach;

• Recognize the importance of meaningful youth participation in processes related to the

prevention and control of NCDs and recognizing that young people will be living in a world

informed by decisions made today.

IFMSA International Secretariat, c/o IMCC, Nørre Allé 14, 2200 København N., Denmark

Position Paper

Background information:

Of 56.4 million global deaths in 2015, 39.5 million (71%) were due to noncommunicable diseases

(NCDs). The five most common NCDs are cardiovascular diseases, cancers, diabetes, chronic lung

diseases and mental health illness. The burden of these diseases is rising disproportionately among

lower income countries. In 2015, over three quarters of NCD related deaths (31.5 million) occurred in

low- and middle-income countries (LMIC), with about 46% of deaths in these countries occurring before

the age of 70. (1)

The leading causes of NCD related deaths in 2015 were cardiovascular diseases (17.7 million deaths,

or 45% of all NCD deaths), cancers (8.8 million, or 22% of all NCD deaths), and respiratory diseases,

including asthma and chronic obstructive pulmonary disease (3.9 million). Diabetes caused another 1.6

million deaths (1). As for mental health, the global burden of mental illness accounts for 32.4% of years

lived with disability (YLDs) and 13.0% of disability-adjusted life-years (DALYs) (2). This group of

illnesses tends to target younger people and remains an important cause of death in younger people in

many countries. Including other non-communicable diseases such as digestive and kidney diseases,

gynaecological conditions and musculoskeletal disorders, NCDs in total contribute to 19.6% of deaths

and over half of disability-adjusted life-years (DALYs) (63).

The health, social, and economic burdens of NCDs are set to increase in the coming years and

decades, and this group of largely preventable diseases threatens to undermine social and economic

development in LMIC (3).

NCD processes

In order to address NCDs at an international level, WHO has developed an action plan (the WHO NCD

Action Plan 2013-2020), containing a 4X4 approach, addressing the 4 most common NCDs and their 4

modifiable risk factors, and 9 voluntary targets for countries to achieve to overcome them. Appendix 3

of the Plan sets out evidence-based and cost-effective policies that can be implemented at the national

level. In order to increase the achievement of these processes (8). WHO member states adopted a

Global Coordination Mechanism (WHO GCM on NCDs, 2014) to accelerate the implementation of the

WHO Action plan, and support multi-sectoral action involving WHO member states, UN organizations

and non-state actors (9).

In 2015 action on NCDs was furthermore implemented into the 2030 agenda for Sustainable

Development, under Sustainable Development goal 3: healthy life and wellbeing for all. Target 3.4 aims

to reduce the premature mortality from NCDs by one third by 2030, through prevention, treatment and

the promotion of mental health and wellbeing. Additionally, target 3.5 mentions the prevention of harmful

alcohol use (10). In 2017, the Montevideo Roadmap 2018-2030 on NCDs as a Sustainable

Development priority was launched to further commit to these targets (11). In 2018, the Third UN High-

level Meeting on NCDs was hosted by the President of the 73rd session of the General Assembly. The

purpose of the meeting was to allow Heads of State and Government to conduct a comprehensive

review of the progress achieved in reducing the risk of dying prematurely from NCDs, as agreed at the

First High-level Meeting in 2011 and reaffirmed at the Second High-level Meeting in 2014. The meeting

on NCDs confirmed the scope at the global level to include mental health conditions as a fifth disease

and air pollution as a fifth NCD risk factor (85).

Discussion:

Social determinants of Health

IFMSA International Secretariat, c/o IMCC, Nørre Allé 14, 2200 København N., Denmark

The Social Determinants of Health are social, political, cultural and environmental factors

which influence individual and group differences in health status. These health determinants are

recognized as the major barrier to health equity, creating an urgent need to act upon those determinants

to achieve better health for all. Below, a few social determinants specifically important to the NCD

debate are highlighted.

Socioeconomic determinants

Contrary to popular belief, the biggest toll from NCDs is in LMIC. More than three quarters of all deaths,

and over 80% of premature deaths, occur in these countries (12). This disproportionate disease burden

is not just felt on a global scale, however. People of low socioeconomic status in all countries suffer more

from NCDs, and are more likely to exhibit many of the causes of these diseases. Smoking, poor diets,

and, increasingly, physical inactivity are more common in these populations, and the burden increases

along the social gradient (13).

A large proportion of deaths in many low-income countries is still caused by communicable diseases,

especially lower respiratory diseases and diarrheal diseases. Despite the larger absolute burden of NCDs

in LMIC than in higher income countries, the proportion of deaths due to these conditions decreases

steadily as income drops (14). Nonetheless, many countries are now facing a double burden of

communicable and noncommunicable diseases, which may place already fragile healthcare systems

under greater pressure (15). Furthermore, this trend is increasing rapidly – by 2020 it is predicted that

70% of deaths in these countries will be due to NCDs (16). NCDs are becoming more common, while

rates of communicable diseases are dropping. To prevent this from reaching a breaking point, investment

in prevention is needed, and attention must be focused first and foremost on LMIC if we are to see the

greatest benefits.

The vast differences in prevalence of NCDs between and within communities and countries of differing

socioeconomic status and income is striking. NCDs cause and perpetuate inequality, and will continue

to do so without coordinated action.

Commercial determinants

Beyond social determinants, there has always been critical public health analysis of the power of the

corporate sector and attention has turned to other areas of influence in recent years, including profit-

driven and corporate practices harmful to health. The focus on NCDs as just a consequence of lifestyle

choices has also been extensively critiqued, especially in relation to marketing to children (17).

A growing argument is that these choices are largely driven by the so called commercial determinants of

health, defined as “strategies and approaches used by the private sector to promote products and

choices that are detrimental to health”. This concept unites consumer behavior, individualization and

choice on the micro-level as well as global risk society, global consumer society and the political economy

of globalization on the macro level (18).

Corporations gain influence through four main channels:

i) marketing, which makes the desirability and acceptability of unhealthy commodities grow;

ii) lobbying, which can limit policy barriers such as plain packaging and minimum drinking ages;

iii) corporate social responsibility strategies, which can rebuild corporate reputation and redirect

attention;

iv) and extensive supply chains, which amplifies company’s influence around the globe (18). Health

outcomes are determined by the influence of corporate activities on the social environment in which

people live and work: namely the availability, cultural desirability, and prices of unhealthy products. The

environment shapes the so-called lifeworlds, lifestyles, and choices of individual consumers—ultimately

determining health outcomes (19).

Urbanization and its impact on NCDs

IFMSA International Secretariat, c/o IMCC, Nørre Allé 14, 2200 København N., Denmark

Over the last few decades, traditional societies in many developing countries have experienced rapid

and unplanned urbanization, which has led to lifestyles characterized by unhealthy nutrition, reduced

physical activity and increased tobacco consumption (20). The United Nations (UN) recognizes that

urbanization has implications for health including increased pollution and higher rates of both

communicable and non-communicable diseases (21).

Throughout the process of development and urbanization, national economies further shift away from

physically active economic activities such as farming, mining and forestry, and move towards more

sedentary occupations, many of which are office-based. Technological innovation leads to decreased

activity in previously physically demanding jobs (22). Studies found positive associations between

urbanization and the prevalence of NCD risk factors, especially in developing countries (23).

Tobacco

Tobacco remains one of the leading risk factors for NCDs as a result of both direct use and exposure

to secondhand smoke. Each year it is responsible for over 7 million deaths worldwide(24). Tobacco use

is also a significant contributor to health inequalities, with people from low and middle socio-economic

groups representing 80% of cigarette consumers (25). In addition, nearly 40% of adults who are

smokers or ex-smokers started smoking before the age of 16 (26). Therefore, we believe that the

protection of young people and the fight against health inequalities must be the focus for any new

tobacco control strategy. Further steps need to be taken in preventing young people from becoming

addicted to this lethal habit.

Second-hand smoke exposes the public, including children to the noxious and carcinogenic effects of

tobacco. Smoke-free laws are a crucial part of the solution as they protect the health of non-smokers

and encourage smokers to quit without directly harming the industry (86).Taking into account that

counselling and medication can more than double the chances of quitting successfully (50). Progress

still needs to be made, as only 18% of the world’s population is protected by national smoke-free laws

and that 15% have access to comprehensive cessation services with cost-coverage (24).

The WHO Framework Convention on Tobacco Control is one of the most rapidly embraced treaties in

the history of the United Nations, with 186 signatories and Parties covering 95.8% of the world’s

population (28). It contains legally binding obligations for its Parties, addresses the need to reduce both

demand for and supply of tobacco, and provides a comprehensive direction for implementing tobacco

control policy at all levels of government. To help make the guidelines set by the FCTC, MPOWER

measures were introduced corresponding to the articles of the Framework Convention (29). In 2017,

4.7 billion people were covered by at least one best-practice policy intervention from MPOWER, a

steady increase from the 1 billion 10 years ago (30). Progress in the implementation has been steady

since it entry into force, but varies between different articles, ranging from 20 to 88% (31). There is a

need for parties to accelerate their activities in order to reach the NCD target to reduce tobacco use by

30% between 2010 and 2025 (31).

The economical and legal stakes of the tobacco industry have a major impact on health. WHO has

recommended several cost-effective measures in this regard such as adding a tax to tobacco products,

labelling tobacco products with warnings about associated health risks, introducing plain packaging,

placing comprehensive bans on tobacco advertising and disseminating educational mass media

campaigns (32). Furthermore, limiting tobacco purchase and consumption to a certain minimal age and

eliminating all forms of illicit trade in tobacco products are important measures that need to be

considered around the world (33).

The WHO and other relevant stakeholders recently drew attention to the harmful impact of tobacco on

the environment in terms of water pollution, deforestation, climate change, and the waste it produces

(34, 35). Tobacco farming is a complicated process involving heavy use of chemicals that can create

environmental health problems, particularly in low and middle-income countries. For example, the

IFMSA International Secretariat, c/o IMCC, Nørre Allé 14, 2200 København N., Denmark

industry in those regions frequently hire children, putting them at risk of green-tobacco sickness

(nicotine absorbed through the skin) (35).

Additionally, there is increasing interest surrounding the use of electronic nicotine delivery systems,

with electronic cigarettes being the most common type (78, 79). The health impacts of electronic

cigarettes are still debated, with some brands posing a higher risk than others (79). Importantly,

although electronic cigarette use is touted as a harm reduction strategy for regular cigarette smokers,

almost 80% do not quit smoking upon switching to e-cigarettes - this places them at higher risk of

adverse health outcomes. This highlights the need for more research and regulatory policy in this area.

A wide range of regulatory strategies pertaining to e-cigarettes exists globally, with many countries

lacking specific legislature about this issue (80).

Alcohol

The harmful use of alcohol results in approximately 3.3 million deaths each year; accounting for 5.9%

of all global deaths and 5.1% of the burden of injury and disease as measured in disability-adjusted life

years (DALY) (36).

The level of alcohol consumption considered harmful by the WHO is defined as an average of more

than 40 grams of pure alcohol per day for males, and 20 grams per day for females. Whereas Heavy

Episodic Drinking (HED) is defined as 60 or more grams of pure alcohol on at least one occasion at

least once a month (81). It should however be noted that recommended alcohol consumption

implemented by governments vary across the world (38).

Alcohol consumption is associated with many harmful diseases and is targeted in SDG 3.5; “Strengthen

the prevention and treatment of substance abuse, including narcotic drug abuse and the harmful use

of alcohol” (82). In addition to this, it is a causal factor in more than 200 disease and injury conditions

(as described in Classiﬁcation of Diseases and Related Health Problems (ICD): alcohol dependence,

liver cirrhosis, cancers and injuries. Alcohol consumption can have an impact not only on the incidence

of diseases, injuries and other health conditions, but also on the course of disorders and their outcomes

in individuals.

Drunk – driving injuries are also strongly linked to the harmful use of alcohol. Majority of the WHO

member states have enforced a limit on the Blood Alcohol Level (BAC) to reduce drunk - driving (ranging

from 0.05% to 0.08%), with 31 countries yet to impose any sort of limit.

Moreover, there is a close relationship between drinking and violent crime, including domestic violence.

Alcohol - related harm is determined by three related dimensions of drinking: the volume of alcohol

consumed, the pattern of drinking and the quality of alcohol consumed (36).

Marketing and advertising of alcohol is known to increase consumption (83). While a majority of

countries have some sort of ban on beer advertisements on TV and radio, almost half of countries have

not imposed a ban on advertising through the internet. An alarming thirty - five countries have no ban

on advertising in any sort, mostly located in the Africa and Americas.

Obesogenic environment

Many people today are faced with an environment that simultaneously promotes physical inactivity

and unhealthy eating. This makes it difficult for people to make healthy choices, as it is often easier,

more accessible, and more convenient to take the unhealthy option. The impact of environment on the

development of NCDs, as for other risk factors, follows the social gradient. Shaping our environment,

then, must be key in any effort to combat obesity and NCDs (19).

Childhood and Adolescence Obesity

IFMSA International Secretariat, c/o IMCC, Nørre Allé 14, 2200 København N., Denmark

In 2016, a total of 124 million children and adolescents (aged 5 to 19) were obese in comparison to one

tenth of this number (11 million) in 1975. In addition, a total of 213 million are overweight yet didn’t cross

the threshold of being obese (87). Factors driving this rise include poor diet and lack of exercise,

and are mainly driven by systemic factors such as a lack of fiscal policy discouraging intake of

unhealthy food and drinks, poor access to healthy food and exercise-conducive

environments, rather than individual choice (44). Many children are growing up in a society which

promotes high energy intake while encouraging physical inactivity. Consequently, many are becoming

overweight or obese. Most of these children will remain above the recommended BMI into adulthood,

which makes them more susceptible to develop NCDs (45).

Education plays a vital role in reducing obesity through its relationship with diet and physical activity.

Education is also paramount in inculcating good lifestyle habits as well as providing teaching on health

prevention and establishing a life-course approach to combat obesity and NCDs in general (42). It is

thus important for states and institutions to continue to promote physical activity and healthy diet in

schools, but also to raise awareness about a healthy lifestyle.

The nutrition transition

The economical and technical improvements that have come with urbanization, have increased access

to supermarkets resulting in large-scale reduction in the prices of unhealthy food (46).

These developments are partially responsible for a change in diet contributing to the obesity

epidemic, in which children and adults are both victims. The habitual food consumption changed

into a diet dominated by higher intakes of fat, added sugars, animal source foods, refined and processed

foods, coupled with a fall in fiber and cereal intake (46,47). Despite the fact that access to supermarkets

has been improved in many countries, there is still a lack of access to healthy and nutritious food for

many people, especially in rural and poorer urban areas. Economically disadvantaged areas have been

referred to as ‘food deserts’ due to the absence of modern supermarkets (48). The relatively poor

access to affordable and nutritious food can result in malnutrition.

Food marketing and advertisements

Multinational food and beverage companies are an indisputable cause of the obesogenic

environment, encouraging the over-consumption of unhealthy food and beverages for profits through

industry tactics such as lobbying, undermining independent science and the threat of litigation. Besides,

industry promoted voluntary guidelines, codes of conducts and cooperation with the government are

often used to avoid governmental regulations (51). Multinational food corporations have billions of

dollars available to block or manipulate governmental actions or regulations, with the overall aim to

prevent a decrease in the consumption of their products.

Despite this, it has been proven that government regulations such as taxes, labeling and

marketing restrictions have a significant effect on the consumption of unhealthy food products [ref].

One specific sugar-control policy that has gained significant support and evidence in recent years is a

tax on sugar-sweetened beverages (SSBs). Mexico implemented the tax in 2014, and the results

suggest that taxation has a strong influence on purchasing patterns, which has the potential to greatly

reduce obesity (52,53). Furthermore, it has also been proven that different front-of pack labeling

systems guide healthier food choices amongst consumers (54). Countries like the United Kingdom,

Ecuador and South Korea have adopted the so called ‘traffic light labelling system’, in which red,

amber and green colors are used on food packages to represent high, medium and low amounts of

each nutrient respectively (55). Food marketing and advertisements towards children and young

adults also contribute to the incidence of obesity. It has been demonstrated that children prefer

branded packages over plain packages, and that they would prefer packages that feature characters

from children’s movies (56).

Physical inactivity

IFMSA International Secretariat, c/o IMCC, Nørre Allé 14, 2200 København N., Denmark

Physical inactivity attributes to 3.2 million deaths globally (57). It is estimated that physical inactivity is

implicated in 21–25% of breast and colon cancers, 27% of diabetes and 30% of ischemic heart disease

(58). Globally, 23% of adults and 81% school-going adolescents are insufficiently active (59). In 2008,

a range of 31% of adults globally were reported to be insufficiently active and hence at risk of NCDs on

the long term.

Modern lifestyle patterns such as sedentary behavior at work and home, and insufficient participation

in recreational sports has lead to an overall decreased level of physical activity. Urbanization has

furthermore created an unfavorable environment of increased violence, high-density traffic, low air

quality, pollution, and a lack of parks, sidewalks and sports/recreation facilities has discouraged

participation in physical activity (60).

For the 10% relative reduction in prevalence of insufficient physical activity by 2025 agreed in WHA

66.10, key areas of the interventions namely Environment (urban design and transport), Schools,

Healthcare, Sports, Community-wide programs, Workplaces and Public Education/awareness are

recommended. Providing counseling as part of primary health care services and implementing

community wide public awareness campaigns have been shown to be cost-effective measures (61).

Environmental Health Risk Factors

23% of all global deaths are linked to the environment (84). Two thirds of the 12.6 million deaths

resulting from environmental health risk factors are due to NCDs. The most leading environmental

health risk factor in the death toll is air pollution. Environmental Health Risk Factors contribute to

increasing global burden of disease of the NCDs through sharing in the upscaling and wide spreading

of cancers, mental illness, Cardiovascular diseases, COPD, Asthma and Musculoskeletal diseases.

According to the World Health Organization, around 91% of the world’s population is living in areas

where the quality of air is not matching the WHO guideline limits (90). Air pollution as a risk factor for

NCDs can be subdivided into Ambient and Household Pollution. 4.2 million lose their lives annually due

to ambient air pollution and 3.8 million face the same consequence as a result of the usage of and the

exposure to primitive cookstoves and their fuel.

Ambient air pollution contributes to 29% of DALYs lost by lung cancer, 43% of DALYs lost due to chronic

obstructive pulmonary disease, as well as 24% and 25% of strokes and ischemic heart disease

respectively (88).

Household air pollution on the other hand, contributes to the upscaling of NCDs through releasing

dangerous chemicals within the confined environment of primitive housing. Such chemicals include

carbon monoxide, polyaromatic hydrocarbon, particulate matter, methane and volatile organic

compounds as a result of incomplete combustion of solid fuels like wood, dung and coal in inefficient

stoves (89).

Finances

Globally, domestic and international funding for cost effective interventions for NCDs is grossly

inadequate compared to the financial burden of disease. Consensus is growing that the SDGs will not

be primarily financed from international aid budgets, and countries require catalytic funds to build

national capacity to address NCDs. Despite the fact that NCDs account for almost 70% of global

deaths (many of which are premature) (66), donor support for programs such as communicable

disease and maternal and child health greatly outweighs that of NCDs (67).

Regulatory and fiscal policies such as taxation on health-harming products have been proven in many

occasions to be effective as part of a comprehensive strategy, to prevent and control NCDs. A financial

incentive for individuals to avoid health- harming behaviors sends a strong message about the

importance of preventing NCDs, and when combined with education,empowers individuals to feel

confident in making the right choices for their health. Not only do regulatory and fiscal policies prevent

IFMSA International Secretariat, c/o IMCC, Nørre Allé 14, 2200 København N., Denmark

NCDs, they are also highly cost effective for governments, and provide an opportunity to increase

financing for health and development at a national level. A cost-benefit study showed that for every

US dollar invested in implementing a tobacco price increase of 125% in a low or middle income country

(LMIC), which would achieve a 50% reduction in tobacco use, the government would receive 10 US

dollars in return (68). A meta-review on the effectiveness of fiscal policy interventions for improving

diets and preventing NCDs showed that evidence was strongest for the effectiveness of sugar

sweetened beverages (SSBs) taxes in reducing consumption, and of fruit and vegetable subsidies in

increasing consumption (69). Money raised through the taxation of health-harming products can be

reinvested into other public health programs such as health education and promotion activities and

subsidizing health-promoting behaviors.

The role of youth as a vulnerable group with an operational role

Adolescents and youth are a tremendous resource that is often overlooked in the fight against NCDs.

The WHO estimates that 70% of premature deaths in adults are the result of risk factor behaviors that

began during adolescence and youth (70). As a result, two thirds of premature deaths in adulthood are

associated with childhood conditions and behaviors. Behavior associated with NCD risk factors is

common in young people: over 150 million young people smoke; 81% adolescents don’t get enough

physical activity; 11.7% of adolescents partake in heavy episodic drinking and 41 million children under

5 years old are overweight or obese. Adolescence is an opportunity to reinforce the benefits of positive

behaviors through appropriate messages and programs. Experts estimate that the projected burden of

NCDs could be cut in half or more by focusing on health promotion and disease prevention (71).

Furthermore, young people are generally considered to be healthy, and a likely consequence of this

misconception, adolescents benefited the least from the epidemiological transition as represented by

the smallest drop in mortality across all age groups since 2000 (72). Recently, there has been an

increased focus on the specific needs, characteristics and potential contribution of young people in

health, although, at the global level, this recognition has largely been confined to the area of sexual and

reproductive health. However, non- communicable diseases (NCDs) and its risk factors have great

importance to young people as well. For example, suicide is the third largest cause of death during

adolescence, and depression is the top cause of illness and disability (73).

Apathy to change current behaviors and practices will add to the current and future NCD burden, with

severe consequences for future populations and their health systems. Today’s youth are today’s and

tomorrow’s leaders and carers will bear the brunt of these costs, both financially and personally. Youth

everywhere therefore have a vested interest in NCD prevention. Young people have the capacity to

add value to solutions for NCDs. Complementary to the technical expertise that older generations might

offer, the voices of youth may bring new perspectives, media channels and solutions to NCDs.

Youth have a right to the highest attainable standard of health and well-being. However, they often

lack access to relevant and reliable health information and to high-quality and youth- friendly health

services without facing discrimination or other obstacles. Young people are often targeted by

companies advertising unhealthy food, tobacco or alcohol. Furthermore, many people grow up at the

moment in environments that are not favorable to adopting healthy lifestyles, such as participating in

sports and adopting and maintaining a balanced and healthy diet (74). Young people are furthermore

highly susceptible to marketing messages (76) with those living in low- and middle-income countries

experiencing the greatest barriers (75). An important aspect of NCDs prevention is therefore to limit

the marketing of health compromising behaviors and products to young people.

Since youth spend much of their time at school, the school environment should also promote healthy

lifestyles and reduce NCD risk factors, for example, by prohibiting smoking on school grounds,

ensuring that nutritious meals are served, implementing physical activity programs, and teaching other

important life skills for a healthy future.

NCDs in the medical curriculum

IFMSA International Secretariat, c/o IMCC, Nørre Allé 14, 2200 København N., Denmark

In preparation for the IFMSA March Meeting 2017 and NCD Youth Caucus, Budva Montenegro, a

survey was conducted within IFMSA National Member Organizations (NMOs) on current medical

education practices around NCDs. There were 128 respondents of the survey, each representing the

medical student population in their respective country. In the survey, around 75% of NMOs agreed or

strongly agreed that more teaching was required on the topic of upstream determinants of health - that

is, the social, cultural, environmental, and political conditions in which we are born, grow, study, work

and age - at their medical schools. Only 7% believed that teaching on upstream determinants was

adequate (77).

Another question revealed that perceptions are hugely variable concerning the perceived quality of

teaching on preventive health, including the main risk factors for NCDs. Encouragingly, almost 40% of

NMOs thought the quality of their education on preventative health was good or excellent. However,

32% rated it as insufficient, and 5 countries rated the quality of their medical education on preventive

health as very poor. These results demonstrate the need for new and innovative ways to incorporate

important topics, such as the social determinants of health, into the medical curricula, such that future

medical professionals are equipped to address NCDs in a holistic and effective fashion. (77)

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[accessed 9 January 2018]

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