Policy Makers and Regional Health Institutions Response to NCDs and the Link with Civil Society

1. Policy Makers and Regional HealthInstitutions Response to NCDs and the Link with Civil Society Healthy Caribbean Coalition Conference Barbados, October 2010 C. James Hospedales Senior Advisor and Coordinator, NCD Prevention & Control Pan American/World Health Organization

2. What’s the role of Civil Society and NGOs in the prevention & control of NCDs? • Advocacy, creating mass /popular movements • Monitoring/watchdog role • Providing education and training • Research • Service provision for people with NCDs or risk factors; screening, preventive care, etc. • Health promotion and prevention interventions • Other?

3. Burden of NCDs in the Americas, mid-2000s • Of a total of 5.2 million deaths, 3.2 million (62%) were due NCDs (51% males, 49% females) • 97% in high and upper middle-income countries • Leading causes (per 100,000): • CVD (192), or 1.6M deaths • Cancer (121) • Chronic resp disease (52) • Diabetes (26) • In 2004, approximately 598,000 people died prematurely from NCDs before age 60 years

4. All others Guy, Hai, Hon, Nic, Bol, Guat USA, Can, T&T, Bar, Some OTs MORTALIDAD EN PAISES AGRUPADOS SEGUN INGRESOS REGION DE LAS AMERICAS

5. Risk Factors for Chronic Diseases in the Americas region • 145 million people >15 years are current smokers • Prevalence of hypertension: 13-34%  • Low fruit & vegetable intake in females >18 years: 56-94%; and 57-92% in males • Low physical activity in adults >18 years: 14-46%  • Projected that persons >15 years with obesity will increase from 139 million in 2005 to 289 million in 2015! Majority females

6. Economic Issues: • NCDs reduce the economy of LAC by 2% a year • Expenditure for diabetes ‘07 = $131 billion • 40% of patients with kidney failure pay from their pocket $99/dialysis session, $15,500/year • Treatment/care of NCDs cause catastrophic health expenses because of out-of-pocket expenditure, worsening poverty and increasing health inequities • Access for low-income persons hindered by 39-63% of the population having to pay full cost of basic medications for diabetes and hypertension

7. Some Examples of basic strategies that can help reduce the burden of NCDs • Reduce tobacco use by 20%; salt intake by 15%; and use simple multidrug regimens for patients at high-risk of cardiovascular disease to prevent more than 3.4 million deaths from chronic diseases in the Region over 10 years at reasonable cost. • Two interventions (20% tobacco and 15% salt intake reduction) would be less than $0.40 per person/year in low- and lower middle-income counties, and $0.50-1.00 in upper middle-income countries.

8. What are the policy makers doing in countries and regional institutions

9. NCD Progress Indicator Status / Capacity by Country in Implementing NCD Summit Declaration - September 2010

10. ROLES OF CARIBBEAN REGIONAL INSTITUTIONS AND PAHO/WHO IN SUPPORT OF CHRONIC DISEASE PREVENTION AND CONTROL, AND OTHER FINANCING ORGANIZATION (UNICEF, UNFPA, CDC, PHAC, IADB, WORLD BANK)

11. NCD Capacity Survey 2010 - Main Highlights • 32 countries; 3rd survey since 2001 • Most countries have a capacity installed • Financial resources mainly allocated for treatment • Some have tobacco and alcohol taxes; most not earmarked for NCDs • Most countries have not yet developed specific policies on NCDs • However, most have policies on tobacco, diet and physical activity • Most countries have mortality surveillance systems • But limited information on NCDs incidence and risk factors • Most countries reported addressing NCDs and risk factors with a primary health care approach • Most reported having established a partnership/ collaboration • Although most reported having financial resources for health promotion, it seems most not implementing health promotion activities

12. PUBLIC INFRASTRUCTURE

13. POLICIES, STRATEGIES AND ACTION PLANS

14. Policies/strategies/action plan combining early detection, treatment and care, rehabilitation

15. Cont…Policies/strategies/action plan combine early detection, treatment and care, rehabilitation

16. Health Information Systems, Surveys and Surveillance; Registry on Risk Factors

17. Health Information Systems, Surveys and Surveillance; Risk Factors

18. Health System Capacity for Prevention, Early Detection, Treatment and Care within the Primary Health Care System

19. Does your health system have guidelines/protocols or norms for prevention and management of: Source: PAHO. National Capacity for the Management of Chronic Diseases in Latin America & the Caribbean, Washington, 2010

20. Price and access to medicines for chronic diseases Source: PAHO. National Capacity for the Management of Chronic Diseases in Latin America & the Caribbean, Washington, 2010

21. Health Promotion and Collaboration

22. Health promotion activities implemented:Type

23. Conclusions & Next Steps • Despite the major gains made by Member States on their national chronic disease programs, the attention and resources devoted to this public health issue are not commensurate with the extent of the disease burden and economic costs. • Continue working together to promote inter-sectoral policy changes before, during, and after the high-level meeting of the United Nations on NCDs in September 2011.

24. Next Steps • Member States and PAHO should make a concerted effort to: • build competencies and capacity for comprehensive, integrated prevention and control of chronic diseases at all levels (training), • Improve surveillance, • policy, • tobacco control, • salt reduction, • healthy diets and physical activity, • improved disease management, and • multi-stakeholder engagement mechanisms with a strengthened stewardship role of Ministries of Health.

25. Next Steps • Continue to scale up access to medicines and quality health services for screening, early detection, and control of chronic diseases. • Continue to improve the quality and timeliness of health information designed to guide policy, planning, and evaluation, especially risk factor information, pursue gender-based analysis and novel approaches and technologies

26. Next Steps • Strengthening national & subregional inter-sectoral efforts, partnerships, and alliances as a key cross-cutting strategy • Support the CARMEN Network and Partners Forum as innovative mechanisms to support country efforts to engage private sector and civil society • Review their legislation and norms for addressing chronic diseases and tobacco control • Implementation of WHO guidelines on marketing foods and non-alcoholic beverages to children, as approved at the 63rd World Health Assembly.

27. What’s the role of Civil Society and NGOs in the prevention & control of NCDs? • Advocacy, creating mass movements • Monitoring/watchdog role • Providing education and training • Research • Service provision for people with NCDs or risk factors; screening, preventive care, etc. • Health promotion and prevention NGOs • Other

28. Thank you