The road to 25×25: How can the five-target strategy reach its goal?

In September, 2011, at the UN high-level meeting on non-communicable diseases (NCDs), the world's leaders committed to tackling this emerging global epidemic. The need was urgent, in view of how NCD risk factors are increasing in most low-income and middle-income countries (LMICs) and 8 months later, the World Health Assembly set a target of a 25% relative reduction in NCD mortality by 2025. Known as the 25×25 strategy, this goal is now incorporated into WHO's Global NCD Action Plan 20132020. This Plan lists nine voluntary national targets. Two are overarching: to reduce mortality from NCDs, and to halt the rise in diabetes and obesity. The remaining seven are specific, including reduced alcohol consumption, increased physical activity, reduced dietary salt, reduced smoking, improved blood pressure control, and enhanced treatment of those at risk from the major NCDs. The Plan takes a broad view, acknowledging the social, economic, and political determinants of disease. However, that these statements of intent can be translated into policy is less clear, because of the limited scope for action from within the health services. Indeed, some of the more ambitious calls to action have fallen on deaf ears.10 We propose that a more comprehensive approach to NCDs is taken.