Alexey Kulikov : A Leading Force in the Fight Against Non-Communicable Diseases

In the lead up to the third United Nations High-level Meeting on Non-Communicable Diseases (NCDs) in September 2018, the UN Social 500’s Emily Robinson spoke with Dr. Alexey Kulikov, who ranked #7 on the June 2018 Leaderboard, to find out more about his work in the crucial area of international health policy.

The following transcript is edited lightly for brevity and flow.

Dr. Alexey Kulikov, External Relations Officer, World Health Organization. Credit: World Health Organisation/F Tanggol.

 

Robinson: Tell us a little bit about yourself. Where are you from? Where did you go to school?

Kulikov: I have been working for the World Health Organisation for about four years now and before joining the UN family I was serving as a health attaché in the Russian mission in Geneva, dealing with organizations such as WHO, UNAIDS, and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

I am a medical doctor and have a PHD in public health from Russia and a Masters in Public Health from Liverpool University. I worked in the Ministry of Health in Moscow for about five years before I moved to New York and then to Geneva. I went to school in Moscow where I also graduated from two universities.

Robinson: What does your work as an External Relations Officer with WHO involve?

Kulikov: I work at the Secretariat of the UN Interagency Task Force (UNIATF) on the Prevention and Control of Noncommunicable Diseases, which is housed in the WHO Headquarters [in Switzerland]. It is quite a small team, which means that everyone is involved in everything.  I focus on country support, including planning for and conducting joint UN missions on NCDs, maintaining day-to-day communication between agencies, programmes and funds and preparing face-to-face meetings of the Task Force twice a year.

I also deal with relations with Member States and our governing board, the Economic and Social Council (ECOSOC). Task Force reports on its progress through the UN Secretary General on an annual basis.

In the last 4 years, ECOSOC has been adopting action oriented resolutions that have urged the UN system to increase support to countries in achieving NCD-related SDGs and made a strong call for increased financing for both the Task Force work and the global NCD response in general.  

I also cover all of the Task Force’s communications activities, including on social media.

Finally, I support WHO Assistant Director General on NCDs and Mental health when it comes to UN interagency collaboration or country work.

Robinson: How did you get involved with UNIATF on non-communicable diseases?

As a diplomat in Geneva I was deeply involved in negotiations on the architecture of the global NCD response and I became instrumental in making this Task Force happen.

In 2011 the UN General Assembly Political Declaration on NCDs called upon UN system agencies to work together in a coordinated manner to support national efforts to prevent and control NCDs. As a diplomat in Geneva I was deeply involved in negotiations on the architecture of the global NCD response and I became instrumental in making this Task Force happen.

That involved preparatory work in the WHO Executive Board and the World Health Assembly and a number of intergovernmental talks that finally resulted in the ECOSOC resolution E/RES/2013/12 initiated by Russia and the USA, which created the Task Force with unprecedented support from 109 co-sponsoring Member States.

I was then asked to work in the  WHO liaison office in New York to prepare the second High-level meeting of the UN General Assembly on NCDs in 2014 and after that, I joined the Secretariat of the Task Force shortly after its terms of reference were agreed and it became operational.

Robinson: Can you tell us more about what Non-Communicable Diseases are?

Kulikov: We consider hundreds of diseases to be non-communicable, grouped around cardiovascular diseases, diabetes, cancers and chronic respiratory diseases, because these are linked with four major risk factors; namely tobacco use, harmful use of alcohol, unhealthy diets, and physical inactivity.

NCDs kill almost 80% of all people worldwide, and what is most worrisome is that 15 million people annually die prematurely between the ages of 30 and 70 years as a result of NCDs. That number is rising disproportionately in low-income and lower-middle-income countries because of lower capacity to respond to NCDs whilst at the same time dealing with the ongoing burden of communicable diseases, including HIV, TB and malaria.

NCDs are now the single greatest cause of preventable illness, disability and mortality worldwide, accounting for more death and disease than all other causes combined.  In addition to the burden of NCDs on health systems, they are also a leading development challenge. NCDs hold back individuals, families and countries from realising their social, economic and environmental potential.

Robinson: Why does the task force exist and what is your mission?

Kulikov: As I just mentioned, the impact of NCDs and mental health on the social and economic development of countries is enormous – and growing fast.

The good news is that there are a number of low-cost, high-impact interventions that can help countries prevent and treat NCDs. To see these work, governments need to work as one – and join forces with other partners. The Task Force supports different parts of governments to work together as well as with other partners, building the case for action on NCDs and mental health.

The shocking truth is that while NCDs, mental health and NCD-related SDGs have a disproportionate impact on the poor, they are still attracting insufficient support in the overall SDG response. One of the Task Force’s roles is to help change this.

Engaging beyond the health sector is critical for developing ambitious national responses to NCD-related targets included in the SDGs (including mental health, nutrition, environment, legislation, road safety and others). Reaching these targets will require action from all government departments, as well as the engagement of civil society and the private sector.

To support governments in responding to the multisectoral challenges of NCDs, a WHO-led UN Interagency Task Force on the Prevention and Control of NCDs was established by the UN Secretary-General in 2013.

It coordinates the activities of relevant UN organizations and other inter-governmental organizations to support governments to meet high-level commitments to respond to NCD epidemics worldwide.

UNIATF visit to a community health centre in Ha Nam Province, Vietnam. Credit: World Health Organisation/LT Luong.

Task Force is a unique mechanism that facilitates global cooperation and brings different UN agencies and other partners together to help countries achieve NCD-related SDGs.

Bringing together over 40 UN agencies as well as the World Bank and regional development banks, the Task Force promotes a whole of government and whole of society approach. Our work acts as a catalyst for action against NCDs and helps to bring countries a step closer towards universal health coverage and the Sustainable Development Goals.

The UN Secretary General issued a report last year on the ways of repositioning the UN system to put the key focus on empowering the institution of UN resident coordinators and scaling up country action. I’m happy to say that Task Force is already doing that in the area of NCDs and so serves as an exemplar of an effective UN-wide response at the country level.

The Task Force has undertaken about 30 missions to countries over the past four years. 17 UN system agencies, including the World Bank, have participated. These missions help to influence Heads of State, ministers, parliamentarians and non-State actors and encourage positive changes to policy.

Joint programming missions also leave the legacy of stronger UN Country Teams ready to scale up support to governments in tackling NCDs as part of their broader national development mission.

But these missions are only the first step. The Task Force then provides follow up support and encouragement to ensure that momentum is maintained.

Robinson: What has the task force achieved so far?

Kulikov: Let me provide you with a set of concrete examples from across the globe:

In the Americas, following a recommendation from an NCD investment case developed by the Task Force, the Government of Barbados adopted a sugar-sweetened beverage tax in 2015.

In South-East Asia, Sri Lanka following a joint mission in 2015 introduced traffic light labelling system for products high in sugar – the first of its kind in the region. A maximum price policy was also introduced in 2016 to reduce the out of pocket cost for 48 essential medicines, including all medicines used as essential treatment for NCDs.

Almost all of the 30 countries where Task Force has a footprint have fast-tracked their response to NCDs.

Another achievement is the support to countries in developing national NCD investment cases in reply to the call for the UN in quantifying the costs – to the health sector and the economy at large – and the benefits of scaled up action on NCDs.  

The ability of governments – especially ministries of health – to make a compelling, evidence-informed advocacy case for NCD investments is crucial in reversing the trend of more people falling ill and living with chronic and debilitating conditions and dying of NCDs.

Task Force have so far received more than 40 requests for support in making for these cases. WHO and UNDP, who lead this activity, have made around 10 tailor-made national business cases on investments in NCDs. We are very grateful to the governments of the Russian Federation and Japan for financing this work.

Robinson: In September there will be a UN high-level meeting on non-communicable diseases, what are you expecting to be the outcome of the meeting?

Kulikov: Indeed, in September we will have a Third High-level Meeting of the UN General Assembly on NCDs in New York.

In order to reach target 3.4 of the Sustainable Development Goals of reducing premature mortality from non-communicable diseases by one third through prevention and treatment and promote mental health and well-being, the existing political commitments made at the General Assembly in 2011 and 2014 need to be implemented on a dramatically higher scale. Without a significant scaling up of efforts before 2020, the current rate of decline in the risk of dying prematurely from non-communicable diseases is insufficient to meet the target by 2030.

We expect a paradigm shift to do things differently to address obstacles in a new development era. The outcome document of the high-level meeting on NCDs in 2018 will need to encourage more holistic approaches to NCDs, within the broader global health and universal health coverage agenda.

There is a pressing need for bolder commitments at the General Assembly in 2018 to ensure that all countries stand a chance of reaching target 3.4 by 2030. The forces that are impeding progress will remain largely unopposed unless countries work together and receive a higher level of support through international cooperation. Without significant investment now, premature mortality from NCDs in developing countries will continue to increase.

We also expect broad consensus around the fact that health gains to reduce premature deaths from NCDs can be achieved much more readily by influencing public policies in sectors beyond health than by making changes in health policy alone.

Robinson: You’re performing pretty well on the UN Social 500 leaderboard, currently at number 7. Do you have any top tips for getting the most out of social media?

Kulikov: Like it or not, social media has become part of our reality. Anyone who wants to be successful on social media should consider keeping messages interesting for others, be that by talking about new research, information about current work, or posting about thought-provoking topics.

Like it or not, social media has become part of our reality.

My posts are mainly about the work of the Task Force, country progress in beating NCDs and the efforts of the UN to make this world healthier. The value of health is growing rapidly and so people find my posts interesting. People are interested in making their lives healthier and contribute to making a stronger environment that allows populations to make healthy choices.

Robinson: Why did you decide to join the UNSocial500? Do you find it has benefited your work?

Kulikov: UN Social 500 is a great project helping to identify online influencers from across the UN and allowing us all to learn from them. The leaderboard also serves as the perfect incentive for more active and broad messaging about the work of UN system agencies.