However, another health threat will take centre stage at a United Nations (UN) High Level Meeting on Non-Communicable Diseases (NCD) on 19 and 20 September.

NCD’€™s, which includes cancer, cardiovascular disease, chronic respiratory diseases and diabetes, will officially join HIV on the UN agenda as one of the biggest health threats to the world.

There is agreement that for too long, NCDs have been silent killers, the leading cause of death worldwide each year, causing 36-million deaths in 2008 and accounting for 63% of all global deaths.

UN Secretary General Ban Ki-Moon, said they represent a “public health emergency in slow motion”, which explains why the response by policymakers and governments has been slow.

However, progress to date on NCDs has been vastly inadequate and has resulted in the global catastrophe facing the world today.

The World Economic Forum’s 2010 Global Risks Report identifies NCDs as one of the most severe threats to the global economy in terms of likelihood and potential economic loss. According to the Global Risk Report, NCDs are a global risk equal in cost to the current global financial crisis.

Because of the size of the epidemic, the diverse causes, and the universal impact, NCDs are everyone’s problem. Like HIV, the epidemic is too big for governments to solve alone.

Tackling the global NCD crisis head on requires a concerted and coordinated multi-sectoral response, committed to by world decision makers and business leaders, and stimulated and monitored by a strong civil society movement. This is why the UN meeting is important.

However, with the UN meeting less than a month away indications are that some member states, especially the United States, Canada and the European Union, are trying to postpone and weaken the UN negotiations.

The NCD Alliance, a coalition of over 2 000 organisations, has sent a letter to Ki-Moon accusing some countries of systematically deleting, downgrading and diluting time-bound commitments and targets that need to be included in the political declaration.

One of their concerns are the actions of the US, Canada and the EU to block a World Health Organisation proposal for the overarching goal to cut preventable deaths from NCDs by 25% by 2025.

According to the NCD Alliance donor countries are also currently operating a policy ban on funding NCDs, thereby starving low-income governments of the financial and technical assistance needed to turn around the NCD epidemic.

NCDs also stand as a major barrier to the achievement of the Millennium Development Goals (MDGs) with only four years remaining to the MDG end date.

The UN will hold the historic High-Level Meeting on NCDs in conjunction with its annual General Assembly.

Although the meeting itself represents an opportunity to generate critical awareness and resources and sustainable plans to address the growing global burden of NCDs, much still needs to be done in the run-up to the meeting.

Advocacy is key to sustaining the momentum that has been created to date.

Activists and civil society still need to remind governments to send high-level delegations. Indications are that President Jacob Zuma will lead the South Africa delegation, but local organisations need to ensure that South Africa plays a significant role in negotiating a significant political declaration.

It is critical that South Africa’€™s joins others in committing to specific and time-bound efforts to tackle NCDs, such as national tobacco tax strategies and supports the setting up of a mechanism to follow up on commitments and review progress.

From a cancer standpoint South Africa also needs to advocate for the political declaration to include strong language on increased access to cancer vaccines as well as screening for breast and cervical cancers.

The issue of vaccines is particularly important as the technology exists to prevent cancer cases before they even happen (for liver cancer – hepatitis B vaccination, and for cervical cancer – Human papilloma virus vaccination).

For South Africa, with a high burden of HIV, it is also important to note that HIV isn’t  isolated  from NCDs – women living with HIV have an increased risk of human papilloma virus infection and cervical cancer.  

Negotiations on the NCD political declaration were suspended last week and postponed until September 1 after UN Member States were unable to come to consensus on the key points: specific commitments ‘€“ such as tobacco tax strategies ‘€“ funding, and follow-up mechanisms.  

This move signals ominously the risk that the meeting might not result in strong action on NCDs in general and tobacco control in particular. However, the delay in drafting provides advocates with an opportunity to ensure that this doesn’€™t happen.

Advocates need to insist that the political declaration include strong commitments to:

 * New efforts to address risk factors, such as targets for tobacco taxation and salt reduction ‘€“ the current text contains only generic language regarding previously made commitments. Countries need to commit to do more;

* Set up national NCD plans and tobacco taxation plans by 2013 to achieve continual and substantial reduction in tobacco consumption, reduce levels of other risk factors, and decrease morbidity and mortality due to NCDs;

* Commit financial resources for NCDs ‘€“ G77 countries are calling for increased resources through domestic, bilateral and multilateral channels. We need to tell the EU and other donor countries such as Canada and the US to stop opposing such commitments;

* Creation of a global NCD Partnership by 2012 ‘€“ a mechanism where Member States, all UN agencies, other multilateral institutions and civil society can work together to coordinate activities and mobilise resources for NCDs;

* A high-level comprehensive review in 2014 ‘€“ countries must come together and assess progress on control and prevention of NCDs.

These demands are realistic and based on the practices of other major global health efforts.

* A commitment to make cancer vaccines available and improved access to anti-cancer screening.

The NCD political declaration needs to contain measurable and time-bound commitments, because without assessment, any progress on the meeting outcomes is impossible.

While NCDs are a threat to the entire world, Africa and South Africa can ill afford another health tsunami. Already, buckling under the strain of HIV, the health system cannot cope with an increasing burden of cancer and other NCDs.

Already cancer activists in South Africa are receiving increasing reports of patients not accessing cancer treatment or pain medication. Many are being diagnosed when it is too late, access treatment when they are already very ill or misdiagnosed. Access to vaccines is poor.  

Further tightening of our tobacco control legislation, specifically increased taxation of tobacco products would be a positive step forward as the tobacco industry sets it sights on Africa.

South Africa needs to take the lead and ensure that the NCD Political declaration presented at the UN contains strong commitments. Failing to do so will have dire consequences.