N o n - c ommu n i c a b l e d i s e a s e s a n d d i s a b i l i t i e s to enjoy the highest attainable standard of physical and mental health (UN, 2011b). The landmark Convention on the Rights of Persons with Disabilities (CRPD) outlines the civil, cultural, political, social and economic rights of people with disabilities. Similarly, there have been international declarations and commitments with respect to ageing, as well as NCDs (UN, 2002). In practice, these international commitments and principles are often not upheld. Persons with disabilities, people living with or at risk of NCDs, children and older people are too often denied their right to accessible and appropriate health care. Barriers to accessing the full continuum of health services can be found in many countries and communities. Given the chronic nature of NCDs and the need for access to continuous care, people with physical disabilities experience particular challenges. For these reasons, the global response to the interrelated challenges of NCDs, disability and ageing must be underpinned by a rights-based approach. People living with disabilities must enjoy unimpaired, equitable and non-discriminatory access to a full continuity of health services for NCDs – from primary, secondary and tertiary prevention and treatment through to care support and palliation. This will involve empowering people living with disabilities and removing the barriers that prevent them participating in their communities. A way forward As the expiry date of the current Millennium Development Goals (MDGs) fast approaches, there is a unique opportunity to shape the successor framework and redefine what constitutes universal, healthy, equitable and sustainable human development. For the post-2015 development framework to address NCDs, disability and changing population demographics effectively, the following recommendations should be taken into consideration: Health after 2015 must measure and drive progress in quality of life, mortality, morbidity and disability. An overarching health goal that measures healthy life expectancy (HALE) would be applicable to all countries in the post-2015 era. HALE across the life course would measure and drive progress in reducing mortality, morbidity and disability at all ages and for all causes. Adopt a life-course approach to health. From an NCD and disability perspective, promoting good health and healthy behaviours at all ages is critical. All people, regardless of their age or ability, must be included in strategies on prevention (including behaviour change and communication), detection and diagnosis, management, rehabilitation, treatment and care in the post-2015 era. Provide equitable, universal access to the full continuum of health services, including rehabilitation. A key enabler for health post-2015 should be universal health coverage (UHC). But to ensure UHC allows for NCDs, disability and ageing, it must incorporate NCDs and disability services, including rehabilitation, functional support, access to quality-assured essential medicines, and assistive devices and technologies. Promote health literacy and self-management education for all. Both are critical for empowering people to improve health outcomes – and enabling people with disabilities or incurable chronic conditions to lead full, healthy lives. Build upon existing commitments and policy frameworks for NCDs, ageing and disabilities. Existing declarations, treaties and action plans, particularly the WHO Disability Action Plan 2014–21, UN Political Declaration on NCDs, Convention on the Rights of Persons with Disabilities, and Madrid Plan of Action, must be reflected in the post-2015 agenda. Agree the proposed global NCD mortality target. The proposed target by the Open Working Group to ‘by 2030 reduce by one-third premature mortality from NCDs through prevention and treatment, and promote mental health and well-being’ should be supported in the final Sustainable Development Goal (SDG) framework. This target is adapted from the adopted target to achieve a 25 per cent reduction in overall preventable mortality from NCDs by 2025 – referred to as ‘25 by 25’. Agreeing to this target for 2030 will ensure that NCDs remain a top priority within the new development agenda, and that the goal drives progress for all people of all ages across the life course. Ensure a strong equity focus. Echoing the report of the UN High-Level Panel of Eminent Persons, the post-2015 framework should ‘leave no one behind’. All goals and targets must have a strong equity focus in order to measure progress within the poorest and most marginalised populations. Disaggregated data by gender, age, disability and income will be necessary. References 10/66 Dementia Research Group, 2004. ‘Behavioral and psychological symptoms of dementia in developing countries’. International Psychogeriatrics, 16 (4), pp. 441–459. ADI (Alzheimer’s Disease International), 2009. World Alzheimer’s Report 2009. London: ADI. ADI (Alzheimer’s Disease International), 2013. The Global Impact of Dementia 2013–50. London: ADI. Murray, C. J., Vos, T., Lozano, R. et al., 2012. ‘Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: A systematic analysis for the Global Burden of Disease Study 2010’. The Lancet, 380, pp. 2197–2223. ODI (Overseas Development Institute), 2013. ‘Inequalities: Ageing and disability in the post-2015 development agenda’. Background paper for the event ‘How should inequality feature in a post- 2015 development agenda?’, 18 April 2013, with participation from Alzheimer’s Disease International, ADD International, HelpAge International and Sightsavers. UN (United Nations), 2002. Political Declaration and Madrid International Plan of Action on Ageing. Spain: UN. UN (United Nations), 2011a. Prevention and Control of Noncommunicable Diseases: Report of the Secretary-General. New York: UN. UN (United Nations), 2011b. Political Declaration on the Prevention and Control of Non-communicable Diseases. New York: UN. UN (United Nations), 2015. Sendai Framework for Disaster Risk Reduction 2015–30. Sendai: UN. WEF (World Economic Forum) and Harvard School of Public Health, 2011. The Global Economic Burden of Non-communicable Disease. Geneva: WEF. 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Commonwealth Health Partnerships 2015
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