Dr Ala Alwan Assistant Director General World Health Organization

1. Global Strategy for the Prevention and Control of Noncommunicable Diseases and 2008-2013 Action Plan Dr Ala Alwan Assistant Director General World Health Organization

2. Mobilizing a global response to address NCDs Global Strategy for the Prevention and Control of Non-communicable Diseases 2000 2002 2003 2004 2008 NCDnet 2009

3. Lessons Learned From International Experience - NCDs are preventable through interventions against the common risk factors and their determinants - Strategies to reduce exposure to established risk factors should be combined with strategies to prevent the emergence of risk factors in the first place • Early life: • Nutrition in early life • Adolescence: • Smoking • Physical inactivity • Unhealthy diet

4. Lessons Learned From International Experience - Strategies should combine population and high risk approaches - To have an impact, interventions should be of appropriate intensity and sustained over extended periods of time - Success requires community participation, supportive policy decisions, legislation, intersectoral action and health care reforms - More health gains are achieved by influencing public policies in other sectors like trade, education, agriculture, food production, urban development and taxation than by changes in health policy alone. ……

5. Mobilizing a global response to address NCDs 1 2 3

6. Key Components of the Global Strategy 1. Surveillance: to quantify and track NCDs and their risk factors and determinants to provide the foundation for advocacy, national policy and global action -integrating monitoring of NCD trends into the national surveillancesystem 2. Promotion of health across the life course and preventionof risk factors -Nationwide risk factors reduction through intersectoral action -Community-based primary prevention programmes 3. Improving access to, and quality of, health care,focusing on cost-effective and equitable interventions for people with chronic diseases (PHC reforms) -Integrating health care for NCDs into PHC -Strengthening health systems for more effective chronic care

7. Mobilizing a global response to address NCDs Endorsed by the World Health Assembly in May 2008 by all Member States Six objectives: 1. Raising the priority accorded to non-communicable diseases in development work at global and national levels 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 Under each of the six objectives, there are sets of actions for member states, WHO Secretariat and international partners

8. Objective 1 – Raising the priority accorded to NCDs in development work Endorsed by the World Health Assembly in May 2008 by all Member States Six objectives: 1. Raising the priority accorded to non-communicable diseases in development work at global and national levels 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 Under each of the six objectives, there are sets of actions for member states, WHO Secretariat and international partners

9. Objective 1NCDs and Development Assess and monitor the public-health burden imposed by NCDs with special reference to poor and marginalized populations. Incorporate the prevention and control of noncommunicable diseases explicitly in all 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 noncommunicable diseases 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.

10. Objective 1 – Raising the priority accorded to NCDs in development work • Action for the WHO Secretariat: • Raise the priority given to the prevention of NCDs on the agendas of high-level forums and meetings • Work with countries in building the evidence base and surveillance data on the relationship between NCDs, poverty and development to inform policy-makers • Develop tools that enable decision-makers to assess the impact of policies on NCDs, risk factors and determinants • Take forward the work on social determinants of health as it relates to NCDs

11. Why are the poorest people in low- and middle-income countries affected the most? Objective 1 – WHO's response to date • 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, 8 July 2009) 64th Session of the General Assembly: • Prime-Minister of Trinidad and Tobago proposed that a UN General Assembly Special Session (UNGASS) be convened at the earliest opportunity • Various countries are supporting this proposal and a consensus may be emerging • Operative paragraphs for a possible resolution considered by some groups: • Requests the President of the General Assembly to hold a Special Session on preventing and controlling non-communicable diseases in [2010], • Recommends further that the Special Session will result in a political declaration highlighting the need to scale up efforts to prevent and control non-communicable diseases and its socio-economic impact, with effective involvement of sectors outside health, • Decides to include in the provisional agenda of the United Nations High-level Meeting to Review Progress in 2010 on the Millennium Development Goals, an item to consider adding indicators to prevent premature deaths from non-communicable diseases to Millennium Development Goal 6 Combating HIV/AIDS, malaria and other diseases to evaluate progress towards target 6c Halt and begin to reverse the incidence of malaria and other major diseases. Relevant indicators for consideration by Member States may include [TBD].

12. Social Determinants of HealthThree Broad recommendations Improve daily living conditions Tackle inequitable distribution of power and resources Monitor inequalities and assess response

13. Objective 2– National NCD policies and plans Endorsed by the World Health Assembly in May 2008 by all Member States Six objectives: 1. Raising the priority accorded to non-communicable diseases in development work at global and national levels 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 Under each of the six objectives, there are sets of actions for member states, WHO Secretariat and international partners

14. Objective 2: Establishing and strengthening national programmes with emphasis on PHC Developing a national multisectoral framework for NCD prevention • Mechanisms of ISA for Health • Legislation and fiscal policies Integrating NCD prevention into the national health development plan • Comprehensive policy and plan • Infrastructure • NCD Surveillance and monitoring system • Evidence-based and cost-effective interventions in primary and secondary prevention (packages) Reorienting/strengthening health systems to address chronic care • Ensure that Health System Strengthening covers basic elements: appropriate policies based on PHC and integrated care, trained human resources, access to medicines and standards of care as well as a well functioning referral systems • Address obstacles to continuity of care like patients records

15. Health reforms are driven by the challenges of a changing worldWorld Health Report 2008: PHC – Now More than Ever • A globalized, urbanized and ageing world • Widening health gaps and unequal health outcomes • Trends undermining health systems: hospital centrism, fragmentation, unregulated commercialization

16. Underpinning principles for integrating NCD prevention and control into PHC 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

17. Integrating NCD Management into PHC

18. 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

19. Three levels of Public Policies 1. Systems Policies to achieve universal coverage • Essential drugs and basic technologies • Human resources 2. Public health policies to address priority NCDs • Health promotion policies • Monitoring health risks and behaviours; better information & evidence • Secondary prevention; a package of cost-effective interventions 3. Policies in other sectors (Health in All Policies) • Intersectoral Action for Health • Healthy settings and healthy urbanization

20. Objective 3Addressing the main shared modifiable risk factors Actions for: Tobacco control Promoting healthy diet Promoting physical activity Reducing the harmful use of alcohol

21. 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)

22. Six proven interventions building on WHO FCTC measures for reducing demand • Monitor tobacco use and tobacco-prevention policies • Protect people from tobacco smoke in public places and workplaces • Offer help to people who want to stop using tobacco • Warn people about the dangers of tobacco • Enforce bans on tobacco advertising, promotion and sponsorship • Raise tobacco taxes and prices

23. WHO report on the global tobacco epidemic, 2009 http://www.who.int/tobacco/en/

24. WHO report on the global tobacco epidemic, 2009 http://www.who.int/tobacco/en/

25. The Global Strategy on Diet Physical Activity and Health (DPAS) www.who.int/dietphysicalactivity

26. 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

27. 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

28. Objective 4: To promote research for the prevention and control of noncommunicable diseases • Proposed action for Member States: • Invest in epidemiological, behavioural, and health-system research as part of national programmes and develop – jointly with academic and research institutions – a shared agenda for research, based on national priorities. • Encourage the establishment of national reference centres and networks to conduct research on socio-economic determinants, gender, the cost-effectiveness of interventions, affordable technology, health system reorientation and workforce development.

29. Global NCD Action Plan 2008-2013 Objective 4: To promote research for the prevention and control of noncommunicable diseases • Action for the WHO Secretariat: • Develop a research agenda for NCDs in line with WHO's global research strategy, collaborate with partners and the research community and involve major relevant constituencies in prioritizing, implementing, and funding research projects. • Encourage WHO collaborating centres to incorporate the research agenda into their plans and facilitate collaborative research through bilateral and multilateral collaboration and multicentre projects.

30. Global NCD Action Plan 2008-2013 Objective 4: To promote research for the prevention and control of noncommunicable diseases ACHR May 2008 WHO Meeting on A Prioritized Research Agenda for Prevention and Control of NCDs (Geneva, 25-26 August 2008) Global Ministerial Forum on Research for Health (Bamako, 17-19 November 2008 • Circulate a draft NCD agenda • Peer reviews and publish series • Consultation to finalize (May 2009) A Prioritized NCD Research Agenda (2009)

31. Objective 5 Partnerships • Establish effective partnerships for NCD prevention and develop collaborative networks, involving key stakeholders, as appropriate

32. Objective 6Monitoring & Evaluation • Strengthen surveillance systems and standardized data collection of risk factors, disease incidence and mortality by cause, using existing WHO tools (action for Member States) • Develop and maintain information system to collect, analyse and disseminate information on trends in mortality, disease burden, risk factors, policies, plans, and programmes (action for WHO)

33. Objective 6 – Monitoring NCD trends • Proposed action for Member States: • Strengthen surveillance systems and standardized data collection • Contribute national data and information on trends and on progress made in implementation of national NCD strategies and plans to WHO • Action for the WHO Secretariat: • Develop and maintain an information system • Establish a reference group • Strengthen technical support • Convene a group of stakeholders to evaluate global progress • Prepare global status reports in 2010 and 2013

34. First Global Status Report on NCDs (Dec 2010) Why are the poorest people in low- and middle-income countries affected the most? What will NCDnet be doing? Objective 6 – WHO's progress to date Surveillance tool (2009): Country capacity assessment Data collection in 193 Member States (2009/2010) Data analysis (2010) Assessing trends in mortality, morbidity and risk factors (data will be derived from existing WHO data sources)

35. Why are the poorest people in low- and middle-income countries affected the most? What will NCDnet be doing? Objective 6 – WHO's progress to date • Epidemiological monitoring: • Assess trends in mortality, morbidity and risk factors • Existing data sources available from WHO Departments and the WHO statistical information system (for age standardized mortality data): • the Global Burden of Disease Project • the Health Metrics Network • the Global Tobacco Surveillance System surveys • data on diet and physical activity from national and sub-national surveys • the Global Information System on Alcohol and Health • the WHO STEP-wise approach to risk factor surveillance • Prepare technical guidance for Member States on core components of national NCD surveillance systems, • Offer standardized methodologies for data collection on core indicators (risk factors, mortality and morbidity.

36. Why are the poorest people in low- and middle-income countries affected the most? What will NCDnet be doing? Objective 6 – WHO's progress to date • Country capacity assessment: • Data to measure individual country capacity to address NCDs in a comprehensive manner and to measure progress in dealing with these conditions, • New data collection needed at the country level (using a country capacity questionnaire), • Build upon the experience and lessons learned from previous surveys of country capacity for NCDs which were carried out by WHO Headquarters in collaboration with WHO Regional Offices and Country Offices in 2000 and 2005.