Rethinking global health challenges: towards a 'global compact' for reducing the burden of chronic disease.

Chronic diseases, including cardiovascular disease, diabetes and cancer, are the leading cause of death and disability in both the developed and developing world (excluding sub-Saharan Africa). At present, the global framework for action on chronic disease is strongly 'World Health Organization (WHO)-centric', defined by two WHO initiatives: the WHO Framework Convention on Tobacco Control, and the Global Strategy on Diet, Physical Activity and Health. This paper explores the difficulties of developing a collective response to global health challenges, and draws out some implications for chronic disease. It highlights how political partnerships and improved governance structures, economic processes, and international laws and standards function as three, concurrent pathways for encouraging policy implementation at country level and for building collective commitment to address the transnational determinants of chronic disease. The paper evaluates WHO's initiatives on chronic disease in terms of these pathways, and makes the case for a global compact on chronic disease as a possible structure for advancing WHO's free-standing goal of reducing mortality from chronic diseases by an additional 2% between 2005 and 2015. Beneath this overarching structure, the paper argues that global agencies, donor governments and other global health stakeholders could achieve greater impact by coordinating their efforts within a series of semi-autonomous 'policy channels' or 'workstreams'. These workstreams - including trade and agriculture, consumer health issues and workplace health promotion - could act as focal points for international cooperation, drawing in a wider range of health stakeholders within their areas of comparative advantage.