Does evidence exist to inform NCD policies? How can evidence be translated into policies?

1. Translation of Research Findings for Prevention and Control of NCDs Shanthi MendisChronic Disease Prevention and Management World Health Organization

2. Translation of Research Findings (Evidence) into national NCD policies and programs in low- and- middle- income countries • Does evidence exist to inform NCD policies? • How can evidence be translated into policies?

3. Global mortality Major NCDs = Heart disease, Stroke, Cancer, Diabetes, asthma Communicable maternal infant 30% Other NCDs, injuries & mental health 18% Cancer 13% Diabetes 2% Asthma/COPD 7% Cardiovascular diseases 30%

4. What research findings do we have ? Research has found the causes of major NCDs. Research findings on effective interventions that protect the population from NCDs address people with NCDs or at high risk These interventions have been effectively implemented in developed countries to reverse NCD trends.

5. What are the evidence informed NCD Policies ? Promote physical Activity Promote fruits/vegetables intake Reduce salt and fat intake Control tobacco Early detection and management National NCD Policies

6. Potential Impact of evidence based NCD policies Reduce recurrent heart attacks and strokes 75% Reduce mortality from heart disease 50% Reduce mortality from cancer, asthma, COPD Reduce health care costs Reduce social and macroeconomic costs 6

7. Wider determinants of NCD policies and programs Social determinants Primary health care Protection of Health Housing Employment Environment For healthy living Education & health literacy

8. Projected Mortality Trends 2000-2030 Cancers Ischaemic HD Stroke Acute respiratoryinfections Road trafficaccidents Perinatal HIV/AIDS TB Malaria Projected global deaths (2004-2030) Global Burden of Disease 2004 data

9. Gap in Knowledge Translation What are the challenges for evidence informed policy making? What factors affect the policy environment ? How can policy making be made more open to the influence of evidence ? 9

10. Challenges Intersectoral nature of NCD policies Associated with the pressures of globalization Constraints to knowledge translation control tobacco e.g. increase in tobacco tax reduce salt/fat intake e.g. agreement with food industry promote healthy eating e.g. regulate fast food chains increase fruits/vegetable intake e.g. agriculture subsidies 10

11. Per capita expenditure on health (International dollars ) Expenditure Number of countries 33 25 72 24 19 18 Less than 50 $ 50 – 99 100-499 500-999 1000-1999 >2000 LMIC < 5% of GDP on health aim at 10-15%

12. Evidence informed policy making 12

13. Political, Social, Economic and other Factors that influence policy making Resource constraints Competing interests and priorities Agenda of donors Governments that encourage policy debate Governance Legislation, mandatory regulations Partnerships Networks 13

14. The Need for Partnerships and Governance Food labelling • Governance e.g. mandatory regulations or supervisory bodies Partnership with industry to reduce salt in processed food

15. Partnerships are key Causes/solutions often outside health systems Need to look across society for the solutions Work intersectorally across ministries Alliances and coalitions, public/private

16. Evidence informed NCD policies Researchers Technocrats and civil Servants Need for Knowledgebrokers Evidence makers Policy makers e.g. Loose networks Lobbying NGO or civil society groups Media Professional associations Community organizations 16

17. Support evidence informed policy making Empowerment of the community New ways to engage people so that they can influence policy – • Radio • Internet • Mobiles • Interactive TV Improve Health Literacy - Helping People to:

18. How can networks Influence policy process ?

19. Enable effective use of… Require… Tools Enable effective use of… Skills Require… Staff and infrastructure Enable effective use of… Require… Structures, systems roles Need to Strengthen Country Capacity For Broader Intersectoral Approaches to Research and Knowledge Translation that goes beyond the health sector Source: Potter and Brough (2004).

20. World Health Organization Tools for translation of evidence into policies • Action Plan for Prevention and Control of NCD • Framework Convention on Tobacco Control • Global Strategy for Diet, Physical activity and Health Primary Care Package of Essential NCD interventions

21. Conclusions Requirements for prevention and control of NCDs Broader intersectoral approaches to research Translation of research findings into policies Recognition of the widespread failure to implement evidence-based Health Interventions 21

22. Conclusions For prevention and control of NCDs we need • To find better ways for evidence informed policy making • Partnerships to support intersectoral policies • Networks to link researchers and technocrats • Strong role of the State and better governance • Knowledge translation that goes beyond the health sector

23. Health in all Policies

24. THANK YOU