So, Dr. Gauden Galea, thank you very much for joining us today, for this quick discussion. I want to start by asking you, what exactly is the role of the World Health Organization in shaping global health and how is the role of WHO relates or compare to the role of government, non-government, and other sectors? I'd like to answer that from the point of view of our role in non-communicable diseases, which is where I've been working most of my career. WHO has three levels: the global, regional- where we are located in Copenhagen covering 53 European countries. There are five other regional offices and then, numerous country offices that have direct national response. Within the non-communicable disease arena, WHO has been empowered to take the leadership in a number of areas. This over the past two years, since the UN General Assembly adopted the declaration, has translated into setting a global agenda with a global action plan, setting a monitoring framework, identifying what are the targets and what are the indicators that country should be working to, and then delivering that in collaboration with other UN agencies and other sectors. And current discussions are about how to bring the UN agencies together such that UNDP and UNICEF, UNFPA and other arms of the UN family are coordinated with WHO. So, that's what happens at the global level. Regionally, we translate those global policies into actionable programs that are targeted. What we can do in Europe is different than what can be done in Southeast Asia, for example. And indeed in Europe, what one would do with the European Union, it may be different than what one would do in the Commonwealth of Independent States. So, there is a lot of nuancing that has to be done at the regional level. At country level, then much more focused work where integrated programs and technical support is given to countries in planning, in monitoring, in evaluating their public health programs. So, we've heard a lot about a health in all policies approach. What exactly is this and why is it important for NCDs in particular? So, what's health in all policies? There are many terms around that are used to some extent interchangeably. Health in all policies, whole of government approach, whole of society, intersectoral action has been around for the last 30 years. Health in all policies, in particular, was introduced as a term in public health by the Finnish presidency of the European Union, which promoted it as the theme of its own presidency. Since then, it has gained global adoption and interest. A slogan way of saying it is to say every minister is a health minister. The trade decisions that are taken, agreements between countries on what they buy and sell to each other, foreign direct investment, levels of employment, types of employment, the access to safe and decent jobs, levels of education, income redistribution or otherwise. Each of these are decided and defined by sectors other than health. And within non-communicable disease where, for example, the price of tobacco is a major determinant of how much cigarettes are bought and smoked, or the price of alcohol does the same, or where how food is marketed to children is a determinant of their own risk of becoming overweight or obese, where the types of food that are produced by the agriculture system determine the reach of local produce and how much people can afford fresh vegetables and fruit versus processed foods. These are just a few of the large range of policy contexts within which people have to take their choices for everyday life. So, to some extent, the claim is made that people are responsible for their own choices and, at the final level, this must be true. No one can force me to put a cigarette in my mouth. But fundamentally, the policy context in which I live makes healthy choices easier or more difficult. And thence comes the importance of health in all policies. Every time a road is built, every time a trade agreement is signed, every time some consideration is given to a labor policy, these are known to have an impact on health and they should be regarded and valued as such. And that is the main thrust behind the advocacy for health in all policies. Second, many NGOs and policy groups are calling for an integrated response to NC days with an overarching goal of health for all. What does this meant for you? Can you explain this to us? What's the role of an integrated approach? In public health in general and the non-communicable diseases in particular, it's interesting as one looks at the history of global health policy making. One sees this constant struggle between the horizontal and the vertical, the thematic, the single disease versus the more integrated health systems based approaches. It is very clear that they both have a space, they both are needed. It is quite clear within the area of chronic disease that there are group especially in the four main diseases what we are talking about: cardiovascular, diabetes, cancer, and chronic respiratory diseases. There are a group of risk factors that are held in common: tobacco, alcohol, diet, and physical activity. It is very clear that there is a lot of common prevention that one can do. And indeed, with the chronicity of these conditions, there is a lot that can be done by the health system to provide integrated care. The benefits of diabetes: glucose control. And persons with diabetes, the public health benefits are not accrued unless one is also controlling the blood pressure. To give a very trivial example, but telling, you cant have a hypertension clinic at one end and a diabetes clinic at the other. So, there are many levels of possible coordination or integration: coordination of prevention, coordination of health services, that is very important. It is also equally important that at certain points in time, it is very relevant to have focused action on specific conditions. For example, we are having this interview just a day after a decision has been taken to approve the tobacco products directive in Europe. In the European Union, this decision would not have been possible given the amount of opposition lobbying and even heckling by the tobacco industry. This would not have been possible unless there had been a very concerted effort by public health agencies, civil society, in order to address and advocate for public health. And this sort of mix of occasional vertical and general horizontal approaches are what I prefer in a public health approach. What about integration of NC days with the so-called unfinished agenda, that is maternal child health communicable diseases, do you see that there's a role for an integrated approach? Absolutely. Absolutely. I think one of my favorite sayings is that 'pathogens don't know the boundaries of organizations.' If one looks at, for example, tuberculosis, a major issue even in many countries in Europe. Tuberculosis, in the high burden countries, is to a great extent attributable to the amount of tobacco, poor nutrition, and alcohol. Quite alongside, other more well-known associations with HIV, for example. Mycobacterium was never told that non-communicable diseases are handled by one part of an organization and, HIV and TB are handled by another. These conditions of vulnerability and complex risk play together in society, and they need to be addressed together. Another reason for moving forward together is in health systems approaches. Today, take the HIV example. AIDS, for people who are getting the treatment has been converted into a chronic disease. The principles of chronic disease management are the same. And so, there are many issues about access to care, affordability, the way people with disease are treated as partners or otherwise, whether they are empowered, whether they are given the possibility of self-management. It doesn't matter which disease you have. A third reason why a certain level of integration is important, is that if you go at the global level, and you want to set for example, goals post 2015, once the millennium goals have run their course and they're evaluated and replaced in 2015 by some new agenda that unifies the development world, you can't go and have a list of goals that as long as your medicine textbook table of contents and you need to have some unifying factors such as universal health coverage, which is one of the areas being proposed. And, these are unifying approaches that one needs to consider in taking forward the global health agenda.
