Global Strategy for Noncommunicable Disease Prevention

1. An outline of the Global Strategy for the Prevention of Noncommunicable Diseases and its Action Plan Dr Ala Alwan Assistant Director-General World Health Organization

2. Non-communicable diseases are largely preventable by means of effective interventions that tackle shared modifiable risk factors

3. WHO’s work is guided by the vision of the Global Strategy and its Action Plan, supported by the WHO FCTC and DPAS Global Strategy for the Prevention and Control of Noncommunicable Diseases 2000 WHO Framework Convention on Tobacco Control 2003 2004 Global Strategy on Diet,Physical Activityand Health 2008 Action Plan on the Global Strategy for the Prevention and Control of Noncommunicable Diseases

4. Key Components of the NCD Global Strategy

5. Surveillance

6. Gaps and Lessons Leaned • Good progress in risk factors surveillance over the last decade but NCD surveillance systems are still generally weak in member States • No consensus on key components of an NCD surveillance system and lack of standardized indicators to monitor NCD trends at national and global levels – duplication/inconsistencies • When it exists, NCD surveillance work is not institutionalized and rarely integrated into the national health information systems of LMICs • Limited capacity in epidemiology and surveillance in Member States • Limited capacity of WHO and partners

7. Prevention and Health Promotion

8. PreventionReduction of Risk factors • Actions for: • Tobacco control • Promoting healthy diet • Promoting physical activity • Reducing the harmful use of alcohol • Cost effectiveness and best buys..

9. First global health treaty negotiated under auspices of WHO 168 parties Entry into force 27 Feb 2005 Creates international laws to: Establish tobacco control as a priority on the public health agenda Provide an evidence-based tool for adoption of sound tobacco control measures Introduce a mechanism for firm country commitment and accountability Why are the poorest people in low- and middle-income countries affected the most? Objective 3 – WHO's response to date WHO Framework Convention on Tobacco Control (WHO FCTC)

10. WHO Framework Convention on Tobacco Control: Evidence-based tool for adoption of tobacco control measures Core package for interventions at the population level: • Price and tax measures to reduce the demand for tobacco (Article 6) and smuggling control (Article 15) • Protection from exposure to tobacco smoke (Article 8) • Packaging and labeling of tobacco products (Article 11) • Ban of tobacco advertising, promotion and sponsorship (Article 13) • Monitoring and evaluation (Articles 20, 21 and 22) Core package for interventions at the individual level: • Tobacco dependence reduction and cessation (Article 14)

11. MPOWER: Six policies which • build on the WHO FCTC • are an integral part of the NCD Global Strategy Action Plan Monitor tobacco use and prevention policies Protect people from tobacco smoke Offer help to quit tobacco use Warn about the dangers of tobacco Enforce bans on tobacco advertising, promotion and sponsorship Raise taxes on tobacco

12. The obstacles for tobacco control and implementation of WHO FCTC can be addressed by: • Sustainable tobacco control programs including 1. Sustainability 2. Comprehensive multi-sectoral tobacco control 3. Local, regional and nation wide activities • Strengthening human capacity in political, managerial and technical areas of tobacco control • key to a systematic multi-sectoral approach • Resources mobilization for capacity building

13. Example: Policies to promote healthy diet and prevent obesity • Reducing salt and trans fatty acids • Restricting availability of sugar sweetened beverages • Restricting availability of other high calorie snack foods: chips, chocolates and other sweets • Increasing availability of healthier foods • Protecting children from marketing and promotion practices • Reshaping industry supply and consumer demands • Labelling and calorie information • Pricing measures • www.who.int/dietphysicalactivity

14. Policies to promote physical activity and prevent obesityWhat works: Based on the Global Strategy on DPAS • Urban design and land use to encourage PA as part of transportation • Street design that make walking and biking safe and enjoyable (side lanes, bike lanes, improved lighting, public parks • Encourage use of stair (burn calories and not electricity) • Physical education as an important part of the school curriculum • Facilities for sports for adults including women

15.  salt intake 6g/day Stroke24%  CHD 18% FJ He & GA. MacGregor Hypertension 2003;42:1093-99 Worldwide 2.5 million (approx)Stroke & Heart attack deaths prevented / year

16. Management and Health Care

17. Underpinning principles for improving health care for people with NCDs Universal coverage reforms: Ensure availability and eliminate barriers to access Service delivery reforms: Organizing primary care networks accordingly Leadership reforms: Recognition of the key role and responsibilities of government Matching growth in health expenditure with massive reinvestment in capacity for leading and governing the health sector Public policy reforms: Health systems Public health Cross-government: Health in All Policies

18. Integrating NCD Management into PHC

19. Three dimensions for universal coverage and financing of essential NCD interventions Reduce cost sharing for NCD Services Current Public Expenditure On Health Provide NCD services Cover the uninsured

20. Improving NCD Health Care • Health system strengthening • Focus on developing and implementing a package of essential cost-effective interventions (best buys) • Actions to achieve short term gains in promoting access to the essential NCD interventions

21.  There are low cost interventions to prevent NCDs…

22. Challenges addressed by the Global Strategy and its Action Plan • Strengthen understanding and capacity of NCD surveillance and integrating it into the national health information system • Promote Health in All Polices and intersectoral action to address risk factors • Improve access to appropriate and rational health care, particularly in LMICs

23. The NCD Global Strategy Action Plan Six objectives: 1. Raising the priority accorded to noncommunicable diseases in development work at global and national levels, and integrating prevention and control of non-communicable diseases into policies across all government departments 2. Establishing and strengthening national policies and programmes 3. Reducing and preventing risk factors 4. Prioritizing research on prevention and health care 5. Strengthening partnerships 6. Monitoring NCD trends and assessing progress made at country level

24. Objective 1 - Raising the priority in development work • Meetings and a monograph on NCDs and development • Regional Ministerial Meeting on Health Literacy (Beijing, 29-30 April 2009) • Regional Ministerial Meeting on Non-communicable Diseases and Injuries, Poverty and Development (Qatar, 10-11 May 2009) • ECOSOC High-level Segment on Global Health (Geneva, 6-9 July 2009) • ECOSOC Ministerial Roundtable Meeting on Non-communicable Diseases and Injuries (Geneva, 2009) • Current follow up work with the General Assembly – Several meetings with UN DESA and Member States • UNGA resolution on NCDs (May 2010) leading to a Summit on NCDs in 2011 GA resolution: • "Convene a High-level meeting of the UN General Assembly, with the participation of Heads of State and Government, on the Prevention and Control of NCDs in September 2011". • "Encourage Member States to include in their discussions in the 2010 MDG Review Meeting to be held in September 2010, the rising incidence and the socio-economic impact of the high prevalence of NCDs in developing countries" • "Request the UN Secretary-General to develop a global report on NCDs

25. HIV/AIDS & STDs* $7.40 Health Policy & Admin. Management* $1.65 Infectious Disease Control $1.33 Reproductive Health $1.16 Basic Health Care $1.14 Malaria Control $0.80 Family Planning $0.53 Tuberculosis Control $0.45 Basic Nutrition $0.33 Medical Services $0.24 Basic Health Infrastructure $0.23 Medical Research $0.22 Medical Education/Training* $0.21 Health Education $0.06 Water Supply/Sanitation - Large Systems $3.90 Water resources policy/admin. mgmt $0.93 Basic Drinking Water Supply & Sanitation $0.92 Waste Management/Disposal $0.42 River Development $0.10 Water Resources Protection $0.06 Water Education/Training $0.01  Three new developments have led to this Forum Health ODA Commitments (2007) in US$ billions • Total Health ODA: $22.1 billion • Health ODA for NCDs: ? Source: Kaiser Family Foundation (www.kff.org/globalhealth)

26. Objective 1 – Intersectoral action Key deliverables 2009 - 2010: • Mechanisms of strengthening intersectoral action for NCD prevention • Finalization of URBAN HEART (= health equity assessment and response tool) • World Health Day 2010: Urbanization and Healthwww.who.int/world-health-day/2010

27. Objective 2 – National policies and plans • Benin • Bhutan • Eritrea • Sri Lanka • Sudan • Syria • Vietnam • Global Survey on Assessment of National capacity for NCD Prevention • Guidelines on national surveillance systems- development of core indicators • Framework for country action • Review of diagnostic criteria • Strengthening health care for people with noncommunicable diseases: • WHO technical support package of essential interventions in primary care • Strengthening national cancer control in collaboration with international partners • International seminar for managers of national NCD programmes • Albania • Nicaragua • Sri Lanka • Tanzania • Vietnam • Yemen

28. Activity to date on Surveillance • Development of Objective 6 Implementation Plan (January 2009) • Expert Reference Group for NCD Surveillance and Monitoring established (February 2009) • Development of tools for monitoring NCD trends, progress and country capacity (ongoing from February 2009 with data collection underway in 2010) • Meeting of Expert Reference Group on key components of a national NCD surveillance system (April 2009) • NCD Surveillance meeting with HQ Clusters, Regional Advisers, representatives of the Epidemiology reference Group (August 2009) • Overview document in preparation dealing with technical issues for national NCD surveillance systems development • Third Global Survey on Assessing National Capacity for NCD Prevention & Control

29. Recommendations from the ERG and WHO staff Framework for a national NCD surveillance system • Exposures (Risk factors) • Behavioral and dietary/nutritional risk factors • Physiological and metabolic risk factors • Outcomes • Mortality • Morbidity • Health System Response • Interventions • Health system capacity Determinants of Health • Education, Gender, Material well being … What is Core?

30. Surveillance indicators An indicator should be • central to NCD with an established science base • modifiable as a result of intervention • measurable with valid tools • feasible and affordable to collect • practical and achievable within a country's technical capacity • acceptable (culturally) • policy relevant WHO-wide consensus on the core indicators for the three components of the NCD surveillance system

31. First global health treaty negotiated under auspices of WHO 169 parties Entry into force 27 Feb 2005 Creates international laws to: Establish tobacco control as a priority on the public health agenda Provide an evidence-based tool for adoption of sound tobacco control measures Introduce a mechanism for firm country commitment and accountability Objective 3 – Reducing and preventing risks WHO Framework Convention on Tobacco Control (WHO FCTC)

32. Six proven interventions building on WHO FCTC measures for reducing demandGlobal Report on the Tobacco Epidemic -2009 & 2010Economics on Tobacco Control- innovative financing Objective 3 – Reducing and preventing risks

33. Objective 3 – Reducing and preventing risks

34. Objective 3 – Reducing and preventing risks Africa Purpose: To create a "hub" to prevent further increases in the prevalence of tobacco use in Africa by providing technical assistance, mobilizing resources, and building capacity to implement sustained tobacco control interventions through the "hub", which will represent a cross-sectoral partnership of governmental and non-governmental organizations across the region.

35. Objective 3 – Reducing and preventing risks • Benin • Cape Verde • China • Fiji • India • Lebanon • Mali • Mauritania • Mauritius • Pakistan • Tunisia • Uganda • Vietnam • Yemen Reducing the level of exposure of individuals and populations to unhealthy diets and physical inactivity: • Population salt reduction platforms & strategies • Population prevention strategies for childhood obesity • Recommendations on the marketing of foods and non-alcoholic beverages to children • Global Recommendations on physical activity and health • IER/NMH work on cost-effectiveness • NCD Prevention through Diet and Physical Activity in Schools and Worksites

36. Global Strategy on Harmful Use of Alcohol • Endorsed by the 63rd World Health Assembly, 201

37. Objective 4 – Prioritizing research WHO Advisory Committee on Health Research WHO Meeting on A Prioritized Research Agenda Geneva, 25-26 August 2008) Ministerial Forum on Research for Health, Bamako, 17-19 November 2008 Jan-July 2010: Consultations with international partners and development of the first public version October 2009: Second draft A Prioritized NCD Research Agenda

38. What has WHO been doing to mobilize a global response? Six objectives: 1. Raising the priority accorded to NCDs in development work at global and national levels and promote intersectoral action 2. Establishing and strengthening national policies and programmes 3. Reducing and preventing risk factors 4. Prioritizing research on prevention and health care 5. Strengthening partnerships 6. Monitoring NCD trends and assessing progress made at country level

39. Objective 5 – Promoting partnerships NCDnet: a new network to combat NCDs in developing countries

40. Objective 6 – Monitoring and evaluating progress Surveillance tool (2009): Country capacity assessment WHO Global status report on noncommunicable diseases Data collection in 193 Member States (2009/2010) Data analysis (2010) 2010 Assessing trends in mortality, morbidity and risk factors Assessing the progress made by countries in addressing NCDs

41. Main implementation challenges(to be discussed at the upcoming World Health Assembly) • Moving forward on NCD surveillance • "Health in All Policies": prevention and intersectoral action • Health care financing http://apps.who.int/gb/e/e_wha63.html

42. OBJECTIVE 1: To raise the priority accorded to noncommunicable disease indevelopment work at global and national levels, and to integrate prevention and control of such diseases into policies across all government departments Proposed action for Member States • Assess and monitor the public-health burden imposed by NCDs and their determinants, with special reference to poor and marginalized populations. • Incorporate the prevention and control of NCDs explicitly in poverty-reduction strategies and in relevant social and economic policies. • Adopt approaches to policy development that involve all government departments, ensuring that public-health issues receive an appropriate cross-sectoral response. • Implement programmes that tackle the social determinants of NCDs with particular reference to the following: health in early childhood, the health of the urban poor, fair financing and equitable access to primary health care services.

43. OBJECTIVE 1: To raise the priority accorded to noncommunicable disease indevelopment work at global and national levels, and to integrate prevention and control of such diseases into policies across all government departments Action for the Secretariat • Raise the priority given to the prevention and control of NCDs on the agendas of relevant high-level forums and meetings of national and international leaders. • Work with countries in building and disseminating information about the necessary evidence base and surveillance data in order to inform policy-makers, with special emphasis on the relationship between NCDs, poverty and development. • Develop and disseminate tools that enable decision-makers to assess the impact of policies on the determinants of, risk factors for, and consequences of NCDs; and provide models of effective, evidence-based policy-making. • Draw up a document in support of policy coherence, pointing out connections between the findings of the Commission on Social Determinants of Health and the prevention and control of NCDs; and take forward the work on social determinants of health as it relates to NCDs.

44. OBJECTIVE 1: To raise the priority accorded to noncommunicable disease indevelopment work at global and national levels, and to integrate prevention and control of such diseases into policies across all government departments Proposed action for International Partners • Include the prevention and control of NCDs as an integral part of work on global development and in related investment decisions. • Work with WHO to involve all stakeholders in advocacy in order to raise awareness of the increasing magnitude of the public-health problems posed by NCDs, and of the fact that tackling the determinants of and risk factors for such diseases has the potential to be a significant method of prevention. • Support WHO in creating forums where key stakeholders – including NGOs, professional associations, academia, research institutions and the private sector – can contribute and take concerted action against noncommunicable diseases.

45. OBJECTIVE 2: To establish and strengthen national policies and plans for theprevention and control of noncommunicable diseases Proposed action for Member States • the development of a national multisectoral framework for the prevention and control of NCDs; • the integration of the prevention and control of NCDs into the national health development plan; • the reorientation and strengthening of health systems, enabling them to respond more effectively and equitably to the health-care needs of people with NCDs, in line with the WHO-developed strategy for strengthening health systems.

46. OBJECTIVE 2: To establish and strengthen national policies and plans for theprevention and control of noncommunicable diseases Proposed action for Member States • the development of a national multisectoral framework for the prevention and control of NCDs: • Develop and implement a comprehensive policy and plan for the prevention and control of major NCDs, and for the reduction of modifiable risk factors. • Establish a high-level national multisectoral mechanism for planning, guiding, monitoring and evaluating enactment of the national policy with the effective involvement of sectors outside health. • Conduct a comprehensive assessment of the characteristics of NCDs and the scale of the problems they pose, including an analysis of the impact on such diseases of the policies of the different government sectors. • Review and strengthen, when necessary, evidence-based legislation, together with fiscal and other relevant policies that are effective in reducing modifiable risk factors and their determinants.

47. OBJECTIVE 2: To establish and strengthen national policies and plans for theprevention and control of noncommunicable diseases Proposed action for Member States • the integration of the prevention and control of NCDs into the national health development plan: • Establish an adequately staffed and funded NCD and health promotion unit within the Ministry of Health or other comparable government health authority. • Establish a high-quality surveillance and monitoring system that should provide, as minimum standards, reliable population-based mortality statistics and standardized data on NCDs, key risk factors and behavioural patterns, based on the WHO STEPwise approach to risk factor surveillance. • Incorporate evidence-based, cost-effective primary and secondary prevention interventions into the health system with emphasis on primary health care.

48. OBJECTIVE 2: To establish and strengthen national policies and plans for theprevention and control of noncommunicable diseases Proposed action for Member States • the reorientation and strengthening of health systems: • Ensure that provision of health care for NCDs is dealt with in the context of overall health system strengthening. • Adopt, implement and monitor the use of evidence-based guidelines and establish standards of health care for common conditions like cardiovascular diseases, cancers, diabetes and chronic respiratory diseases, integrating whenever feasible, their management into primary health care. • Implement and monitor cost-effective approaches for the early detection of breast and cervical cancers, diabetes, hypertension and other cardiovascular risk factors. • Strengthen human resources capacity, improve training of physicians, nurses and other health personnel and establish a continuing education programme at all levels of the health-care system, with a special focus on primary health care. • Take action to help people with NCDs to manage their own conditions better, and provide education, incentives and tools for self-management and care. • Develop mechanisms for sustainable health financing in order to reduce inequities in accessing health care.

49. OBJECTIVE 2: To establish and strengthen national policies and plans for theprevention and control of noncommunicable diseases Action for the Secretariat • Recommend, based on a review of international experience, successful approaches for intersectoral action against NCDs • Provide guidance for the development of national policy frameworks • Expand the technical capacity of WHO’s regional and country offices. • Develop norms for surveillance and guidelines for primary and secondary prevention • Review and update diagnostic criteria, classifications and, management guidelines. • Provide support to countries, in collaboration with international partners, in strengthening opportunities for training and capacity-building • Ensure that the response to NCDs is placed at the forefront of efforts to strengthen health systems. • Provide technical guidance to countries in integrating cost-effective interventions against major NCDs into their health systems. • Provide support to countries in enhancing access to essential medicines and affordable medical technology. • Assess existing models for self-examination and self-care.

50. OBJECTIVE 2: To establish and strengthen national policies and plans for theprevention and control of noncommunicable diseases Proposed action for international partners • Support the development and strengthening of international, regional, and national alliances, networks and partnerships in order to support countries in mobilizing resources, building effective national programmes and strengthening health systems so that they can meet the growing challenges posed by NCDs • Support implementation of intervention projects, exchange of experience among stakeholders, and regional and international capacity-building programmes.