ECOSOC Western Asia Ministerial Meeting Addressing noncommunicable diseases and injuries: major...

ECOSOC Western Asia Ministerial Meeting

“Addressing noncommunicable diseases and injuries:major challenges to sustainable development

in the 21st century”

Addressing common, modifiable risk factors for noncommunicable diseases

Dr Fiona AdsheadDirector, Chronic Diseases and Health Promotion

World Health Organization

10-11 May 2009Doha, Qatar

ECOSOC Western Asia Ministerial Meeting, Doha, Qatar | 10-11 May 2009Addressing noncommunicable diseases and injuries: major challenges to sustainable development in the 21st century

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Four diseases:– Cardiovascular diseases– Diabetes– Cancers– Chronic respiratory diseases

Four risk factors:– Tobacco use– Unhealthy diet– Physical inactivity– Harmful use of alcohol

These diseases predominantly affect poor people in developing countries, but they are preventable through action on four risk factors.

Noncommunicable Diseases and their shared risk factorsNoncommunicable Diseases and their shared risk factors


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Know your risk: Countries with STEPS surveys

Know your risk: Countries with STEPS surveys

STEPS survey completed

Survey or data analysis under way


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STEPwise approach to surveillance (STEPS)

STEPwise approach to surveillance (STEPS)

A simple, standardized method for collecting, analysing and disseminating risk factor data in countries.

Three different "steps" of risk factor assessment:

– Questionnaire, – Physical measurements, – Biochemical measurements.

Multiple modules on different topics.


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From data to policyFrom data to policy

Using the STEPS data for programs:

– To target your audience,– To target your intervention,– To target your location,– To monitor progress.


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Tackling obesity: how we respond to challengesTackling obesity: how we respond to challenges

Modelling work has shown the need to: – anticipate and prepare for change, – aim for impact at a societal level.

Combined approaches to tackle multiple risk factors can be effective:

– involve all stakeholders,– create enabling environments, – improve health literacy, – use "daily life" interventions where people live and work:

• improving urban or rural "walkability" or "cyclability", • school or worksite based health promotion programmes.


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Goal: to improve the health of people in Nizwa through community based projects for primary prevention of NCDs (2004-2009).

Nizwa Healthy Lifestyle Project – OmanNizwa Healthy Lifestyle Project – Oman

Interventions tackle following risk factors: - physical inactivity, - unhealthy diet, - unhealthy environment, - smoking, - traffic accidents.


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School based interventions: School based interventions: " "Know Your Body"Know Your Body" – Crete, Greece – Crete, GreeceSchool based interventions: School based interventions: " "Know Your Body"Know Your Body" – Crete, Greece – Crete, Greece

Intervention: Know Your Body: 6-year programme (grades 1 to 6),

Characteristics: Comprehensive, multi-component, school-based, focus on diet and PA, Constructs from social learning theory, Curricula offered by trained teachers, Strong parental focus,

Outcomes: significant improvements in knowledge and food choices, substantive reductions in intake of dietary fat, particularly saturated fat, and four- to five-fold increases in

self-reported leisure-time activity.

Source: WHO, What Works, 2009


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Improving health at work: shared benefitsImproving health at work: shared benefits

Workplace health promotion can

achieve a 25-30% reduction in

medical and absenteeism costs.

≈ 27% reduction in sick leave absenteeism,

≈ 26% reduction in healthcare costs,

≈ return on investment: $1 invested results in $3 savings.

Source: Chapman LS, 2003


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Community intervention – Pasos AdelanteCommunity intervention – Pasos Adelante

The programme:Pasos Adelante, or "Steps Forward", is a community-participation campaign for chronic NCD prevention, targeting border counties between USA and Mexico.

The basis for the intervention:Individuals received culturally appropriate educational classes and participated in a walking club.

The outcomes:The programme has an 87% completion rate, with a 120-minute median increase in physical activity, and a four-serving increase in fruit and vegetables per person per week.

Source: Staten LK et al, 2005


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Risk factor reduction: at the heart of NCD prevention and controlRisk factor reduction: at the heart of NCD prevention and controlPrevent NCDs through four key risk factors:

tobacco, unhealthy diet, physical inactivity, harmful use of alcohol,

Target action based on risk factors,

Target action where people live their lives,

Multistakeholder and community-level approaches are best.


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Background material


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Physical inactivityPhysical inactivity

0 10 20 30 40 50 60 70 80 90 100

Tunisia (WHS 2003, 18-69)

Pakistan (WHS 2003, 18-69)

United Arab Emirates (WHS 2003, 18-69)

Egypt (STEPS 2005, 15-65)

Kuwait (STEPS 2006, 20-64)

Saudi Arabia (STEPS 2005, 15-64)

Iraq (STEPS 2006, 25-65)

Sudan (Khartoum State, 2005, 25-64)

% inactive* fem ales

% inactive* m ales

* <600 MET-mins/week (=5x30 minutes of moderate activityData collected using WHO STEPS surveillance tools


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% <5 servings of fruits and vegetables% <5 servings of fruits and vegetables

0 10 20 30 40 50 60 70 80 90 100

United Arab Emirates(WHS 2003, 18-69)


Kuwait (STEPS 2006,20-64)

Iraq (STEPS 2006, 25-65)

Saudi Arabia (STEPS2005, 15-64)

Syrian Arab Republic(STEPS 2003, 15-64)

Data collected using WHO STEPS surveillance tools


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% with elevated blood pressure% with elevated blood pressure

0 5 10 15 20 25 30 35 40 45


Sudan (Khartoum State, 2005,25-64)

Saudi Arabia (STEPS 2005,15-64)


Syrian Arab Republic (STEPS2003, 15-64)*

Iraq (STEPS 2006, 25-65)

*note: For Syria: labeled as 'high blood pressure', actual definition unknown

(>=SBP 140 and/or DBP >=90)

Data collected using WHO STEPS surveillance tools


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% with elevated cholesterol % with elevated cholesterol

0 5 10 15 20 25 30 35 40




Syrian Arab Republic (STEPS2003, 15-64)

Iraq (STEPS 2006, 25-65)


(Plasma Cholesterol >= 5.2 mmol/L) Data collected using WHO STEPS surveillance tools


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% with elevated fasting blood glucose% with elevated fasting blood glucose

0 2 4 6 8 10 12 14 16 18 20


Iraq (STEPS 2006, 25-65)




(capillary blood glucose >=7.0 mmol/L)Data collected using WHO STEPS surveillance tools

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