Integrated Prevention and Control for Non-communicable Disease in China

1. Integrated Prevention and Control for Non-communicable Disease in China • Dr. Jixiang Ma, • National Center for Chronic and Non-communicable • Disease Control and Prevention (NCNCD) • China CDC

2. Situation Analysis

3. NCD Prevention and Control System in China Chinese Center for Disease Control and Prevention, PR. China

4. China CDC NCNCD Division of Obesity &Metabolic Diseases Control and Prevention Division of NCD Risk Factors Surveillance Division of Vital Registry & Death Cause Surveillance Division of Oral Health Division of Injury Control &Prevention Division of Integrated NCD control and Prevention Division of CVD Control and Prevention Division of Elderly Health Division of Mental & Psychological Health Division of Cancer Control and Prevention WHO Collaborating Center on Community-based Integrated NCD Control & Prevention Society of NCD Control & Prevention, Chinese Preventive Medicine Association

5. Main working areas for NCNCD • NCD Surveillance • Integrated NCD control and Prevention

6. NCD Surveillance

7. Geographic Distribution of DSPs System Urban(64) Rural (97)

8. 31 provinces，160 surveillance points • 50,000 participants，resident population • 31 provinces，170 counties/districts • 50,000 participants，floating population • 31 provinces，162 surveillance points • 100,000， resident population 2010 2012 Development of NCDs and RF Surveillance • Questionnaire based survey • Tobacco use, alcohol consumption • physical activity • diet • Control and treatment for NCDs • Physical measurements • Height • Weight • Hip circumference • Blood pressure • Lab tests • Fast Blood glucose • Lipid • insulin • HbA1c 2007 Funded by central finance • 31 provinces，79surveillance points • 30,000 participants，resident population 2004

9. 31 provinces，160 surveillance points • 50,000 participants，resident population • 31 provinces，170 counties/districts • 50,000 participants，floating population • 31 provinces，162 surveillance points • 100,000， resident population 2010 2012 Development of NCDs and RF Surveillance • Questionnaire based survey • Tobacco use, alcohol consumption • physical activity • diet • Control and treatment for NCDs • Physical measurements • Height • Weight • Hip circumference • Blood pressure • Lab tests • Fast Blood glucose • Lipid • insulin • HbA1c 2007 Funded by central finance • 31 provinces，79surveillance points • 30,000 participants，resident population 2004

10. Facts about NCD in China In total, NCDs accounted for 70.1 million deaths (85%), 18.7% up from 1990* Deaths from NCDs in China, 2010 *Yang G, Wang Y, Zeng Y, et al. Rapid health transition in China, 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet. 2013. 381(9882): 1987-2015.

11. Prevalence of NCD risk factors in adults aged>18 in 2010 80.9% 83.4% 52.8% 47.0% 17.4% 11.9% Excessive alcohol consumption Vegetable & Fruit intake <400g/d Current male smoker Regular Physical exercise Salt intake above 5g/d Oil intake over 25g/d Source：2010 PRC BRFSS

12. Epidemic of Biological Risk Factors of NCDs 305 million 236 million 120 million 97 million 32.9 million Overweight Obesity Hypertension Raised cholesterol Diabetes Source：2010 China Annual Cardiovascular Report（Hypertension）; 2010 PRC BRFSS （Overweight、Obesity、Raised cholesterol、Diabetes）.

13. Trends of Salt Intake in adults (g/d) Salt Soy Sauce 数据来源：1982、1992、2002年营养调查（称重法）；2010年中国慢病行为危险因素监测（食物频率法） Sources: China National nutrition survey 1982, 1992, 2002; National BRFSS 2010

14. Prevalence of hypertension 患病率：% 23millon 50million 110milliono 180million

15. Prevalence of hypertension in Chinese adults from 2004-2010 The national behavior risk factor surveillance indicated 20.5% , 25.1% , 30.7% of hypertension prevalence in adults aged 18-69 in 2004, 2007, 2010

16. 健康危害—糖尿病患病率持续增长 Prevalence of Diabetes % 2010

17. Prevalence of diabetes and prediabetes in adults aged 18-69 in 2010 JAMA. 2013;310(9):948-958. doi:10.1001/jama.2013.168118

18. Diabetes control in Chinese adults, 2010 Awareness of diabetes

19. Diabetes control in Chinese adults, 2010 Treatment rate of Diabetes

20. Diabetes control in Chinese adults, 2010 Control of Blood Glucose for diabetes

21. Trends of Oil intake in adults 克 Recommendation by WHO

22. Trend of Smoking Rate in adults MaleFemaleUrbanRural （年） Prevalence of smoking in adults 15-69 来源：杨功焕，胡鞍钢.《控烟与中国未来》

23. Prevalence of alcohol harmful using %

24. Prevalence of inadequate vegetable and fruit intake in 2010

25. Prevalence of physical inactivity in Chinese adults,2010

26. Continuous increasing of overweight and obesity in adults

27. Prevalence of overweight in Chinese adults 24.3%, 27.7%, 31.0% of adults aged 18-69 were overweight in 2004, 2007, 2010 %

28. Prevalence of obesity in Chinese adults 7.5% , 8.1% , 12.6% of adults aged 18-69 were obesity in 2004, 2007, 2010 % 2004、2007和2010年我国18-69岁居民肥胖率比较（%）

29. Major Activity and Program

30. Opportunities: Health Care Reform for NCD Prevention and Management Affordable treatment Affordable medicine Convenient service Free from disease Better services Public Hospital Reform Pilots Essential Medicine Basic Health Insurance System Primary Health Care System Essential Public Health Services Five Priorities of Health Care Reform (2009-2011)

31. NCD Management—Health Financing Coverage of Basic Health Insurance System 31.3US$ 3.1US$ Health insurance schemes coverage NRCMS Essential Medicine Policy Public Health Services Programs Essential public health services programs: 3.9US$ per person lowering down the price of common essential drugs by 30 to 40 percent Priority public health services (NCDs）investment 780 000 US$ 38.5 Million US$ Chinese Center for Disease Control and Prevention, PR. China

33. National Plan for NCD Prevention and Treatment (2012-2015) issued by 15 Ministries and Commissions. • MOH • National development and Reform Commission • Ministry of Education • Ministry of Science & Technology • Ministry of industry and information technology • Ministry of Civil Affairs • Ministry of finance • Ministry of human resources and social security • Ministry of environmental protection • Ministry of Agriculture • Ministry of Commerce • The State Administration of Radio Film and Television • General Administration of Press and Publication • General Administration of sport • State Food and Drug Administration

34. Promoting regulation & laws for tobacco control at national level • Criteria for smoke-free medical and health institutions, was issued by MOH and Patriotic Health Campaign Committee in March, 2008. • Ban on Smoking in Public Places becomes an important task of the 12th Five Year Plan (March 2011). • The Public Place Hygiene Management Regulation Implementation Plan stipulate smoke free in indoor public places (March 2011). • The Evaluation System of Civilized City stipulates smoking free environment is one of the indicators of evaluating civilized city (February 2011). Smoke free environments becomes one of the key indicators of the accreditation of civilized city.

35. Promoting regulation & laws for tobacco control at provincial level • Regulations on Areas of Public Place for Banning Smoking in Beijing Municipality was took effect in 2008. • Regulation on Banning Smoking in Public Place was issued by Shanghai, Hangzhou, Guangzhou in 2011. • Harbin passed the legislation named “Preventing Hazards of Secondhand Smoke” in 2011. • Tianjin passed the legislation named “Prohibiting Smoking in the Public Place” in 2011. • Under the way: Guangdong Province, Luoyang, Qingdao, Lanzhou, Jinan. Shenyang, and Shenzhen

36. Shandong salt reduction & hypertension control program(2011-2015) Shandong-Moh Action on Salt and Hypertension (SMASH) Initiated by MOH and Shandong Province Government Goal: by 2015, the average daily salt intake per person in Shandong reduced to 10 grams;

37. 总体思路 Strategy • Advocacy: leadership building; food industry and food catering • Health communication for salt and hypertension • Community-based behavior change communication • Setting-based intervention • Schools • Healthcare setting • Supermarkets • Food catering • Nutrition labeling to include sodium contents • Evaluation: Population-based survey pre- and post-interventions

38. Shandong-Moh Action on Salt and Hypertension (SMASH) • Shandong provincial progress of salt reduction intervention • Social mobilization and public health education campaign • Issued 2.03 million copies of health education material, hold 190 thousand times health lectures and mass media propaganda • Restaurant salt reduction action • 8308 restaurants have taken salt reduction measures • Promotion of Food nutrition label of processed food • 1783 enterprises has indicated the sodium content on packages • Training of key populations (chefs, teachers,doctors) • Healthy kitchen campaign • Supermarket salt reduction action Shandong-MohAction on Salt and Hypertension

39. Shandong-Moh Action on Salt and Hypertension (SMASH) • Pilot sites salt reduction action • Chose Fushan district in Yantai and Gaomi city in Weifang as pilot sites • Launched the pilot salt reduction program officially by ministry of health, China CDC and local government • Distribute the intervention protocol by local government and define the multi-sector duties on salt reduction

40. 山东省居民膳食盐食用量偏高 Salt Intake: High 目标群体 Target population Distribution of Daily Salt Intake (g) Percent Grams Average Daily Salt Intake (g) Male Female Urban Rural Grams of Salt per Day

41. 成人钠摄入来源 Source of Sodium (adult) pickles sauces soy sauce MSG vinegar cereal egg fish and shrimp meat others others salt 调味品占膳食钠总摄入量的81.0%，加工食品占膳食钠总摄入量的10.0% 81.0% sodium from condiments, and 10% from processed food

42. Establishment of Non-communicable Disease Control and Prevention Demonstrative Districts A national wide project launched in 2010 with financial support from central government. Aiming to establish demonstrative districts/counties nationwide in 3-5 years, to cover more than 10% of the countiesnationwide by 2015 Strategies include government leading, community involved, partnership building, and comprehensive prevention.

43. 140 counties/districts from 30 provinces by 2012 • Local government takes the leadership • Multi-sectors gets involved • Comprehensive prevention-oriented services, promote healthy lifestyles • Collect and disseminate best practices

45. Thanks for your attention!