SYNTHESIS Summary, Conclusion & Recommendations

3 February 2019

09:00-10:30

2

• Pre-conference: 29 – 31 January 2019 52 side meetings 6 field trips

• Main conference: 1 – 3 February 2019 3 keynote addresses 4 plenary sessions 15 parallel sessions 4 abstract sessions 6 special events 34 E-poster presentations 421 entries of World Art Contest

• Total registered participants 1,090 participants from 77 countries (F 52%, M 48%)

Conference programme structure

3

19 Plenary and parallel sessions 121 Moderators/speakers/panelists

Gender

OrganizationWHORegions

0

18

35

53

70

Female Male

67

54

N/A

PrivateSector

PublicSecofDevelopingcountry

PublicSecofDevelopedcountry

Bilat/MulDlat/InterAgency

UNAgency

NGO/CSO

Academic/ResearchInsDtute

0 13 25 38 50

48

20

14

12

9

9

3

6

0

13

25

38

50

AMR EUR WPR SEAR AFR EMR

2

1117

2228

41

Conference Summary and Synthesis

1. BACKGROUND1.1 Global commitment on NCDs

Politicaldeclarationofthe1st,2nd3rdHLMoftheGAonthepreventionandcontrolofNCDs(2011,2014,2018)

1.2 NCD situation • NCDscausethehighestburdenofdiseaseacrosstheworld,andyetfinancingofNCDpreventionandcontrolislargelyinadequate.

• NCDsarerootedinthesocial,economic,environmentalandcommercialdeterminantsofhealthandcannotbestoppedthroughindividualactionalone.

• Despiteavailabilityofscientificevidenceandcost-effectiveinterventions,implementationofhigh-levelcommitmentshasbeenslowinmanyLMICs.

Painful facts NCD causes 41 Million deaths of the 57 Million global deaths

Source:WHONCDcountryprofiles2018

NCD Countdown 2030 Collaborators Lancet 2018

78% of NCD deaths occurred in LMICs

•6.4litresofconsumption•11%ofglobaldeaths

28%ofadultsandhavenotdecreasedinthepast15years

Averageintakeof9-12grams

Attributedto>180,000globaldeaths

Killsmorethan7million

7millionprematuredeaths

22%ofadults

Nearlyquadrupledsince1980

650Millionobeseadults

Key fact: Risk factors, metabolic risk factors

2. Problem stream and root causes 2.1NCDs,riskfactorsandconsequences

• Influencedbyaseriesofcomplex,dynamicandintertwineddeterminantsrequiringeffectivemultisectoralactions

• Neglectedinparticularinhighburdenofcommunicablediseases.

• Emergingriskfactors:airpollution,climatechangecontributesignificantlytoNCD

2.2SocialdeterminantsofNCDs• Socialinequality;poverty,lackofeducation,unemployment

2.3 Commercial determinants of NCDs

• Unhealthycommoditiesindustryandharmfulcorporatepractices:powerful,deeppocket,unethicalmarketing–e.g.promotingunhealthyfoodstochildren,misleddiscourse

• Lobbyingbytrans-nationalcorporation,digitalmarketing,andinterferencesbyindustrytopolicymakers– Tobaccoindustrycigarettesaccountforaround2/3oftheillicitcigarettemarket,

industryresistsandinterfereswiththe“IllicitTradeProtocol”Litigationininternationalanddomestictrades

• PerceivedCOIbetweenregulators,governmentofficialsandindustries,regulatorycaptureandindustryfundedresearchandfoundationsuchasFoundationforaSmoke-FreeWorldwasfundedbyPMI

3. Challenges 3.1 Policy and implementation gaps

1. LackofinternationallylegallybindinginstrumentinregulatingNCDsriskfactors,exceptFCTC

2. Lowengagementofsocialandcommunity

3. Policyinertia:Lackofaccountabilitymechanism

4. Unethicalglobalfinancingsystems

1. Lackofpoliticalwillandleadership2. Weakgovernance:corruption,COI3. Poorprogressinclosingthe“know-dogaps”4. Lackofeffective,timelyM&Etoholdpartners

accountable5. Lackofmechanisms,infrastructure,resourcesto

facilitatepolicyadoptionandimplementation,especiallyinLMICs

6. Limitedinvestmentinhealth7. Inadequatemulti-sectoralaction8. Policyinertia:weakregulatorycapacities9. Lackofpolicycoherencebetweenpublichealth

goalsandeconomicgrowth10.Shorttenureofpoliticalleaders

Atgloballevels Atnationallevels

3.2 Evidence gaps • Lackofpoliticaleconomyanalysisinpublichealtharena

• Lackofpolicyevaluationandassessment– inholisticapproach– onhealthoutcomes(suchastaxation,SSBtax)

• Limitedevidenceonemerginghealthrisks(pollution,climatechanges)

• LimitedevidenceinLMICs

4. Solutions and role of actors

4.1Actionsbyglobalactorsa.Globalgovernanceregimes

•Internationalagreements:–LearningfromFCTC,UNmemberstatescannegotiateforFCAC,FCFS–Ithelpsfostercoherentpoliciesandregulatorymeasuresagainstindustryinterferences

•GlobalNCDsframework–ContinuouslyreviewandimplementGlobalFrameworkswhichpromotesmulti-sectoralcollaborationsandfosterimpacts

–Strengthenaccountabilityacrossallstakeholders:health,non-health,publicandprivate,atcountry,regional,andgloballevels

4. Solutions and role of actors (continue)

b.Globalfinancingmechanisms• FillthefundinggapsforNCDsimplementationinparticularinLIC

• AlignDevelopmentAssistanceforHealthwithcountries’NCDpreventionandcontrolplansandimproveeffectivenessandefficiencyofODApool

• IntegrateNCDintoexistingfinancingmechanismsandexplorenewinnovativefinancingsourcesandmodelsthroughbilateral&multilateralcooperation(e.g.catalytictrustfundforNCD)

• Regionaltobaccotaxharmonizationcanreducecrossbordersmuggling;shiftingprofitsoutofhigher-taxjurisdictionandtaxevasion

4.2Actionsbynationalactorsa.Improvegovernanceandleadership

• Strategicleadership,prioritizehealthinpublicsectorbudgetandresourceallocationforNCD

• Greaterpolicycoherencethroughwhole-of-governmentandhealth-in-all-policiesapproaches

• Strengthengoodgovernance,transparency,accountability,regulatoryandenforcementcapacities,improvelegalcapacities

4.2Actionsbynationalactorsa.Improvegovernanceandleadership(cont.)

• Paradigmshift:beyondthehealthsector– Fromhealthsystemstosystemsforhealth;– Fromsurvivalandtreatingdiseasestoenablingpeopletolivehealthylives

• Implementthecost-effective,affordableinterventions,goodpractices,andWHO16best-buys

• Strengthenleadership– Establisheffectivemulti-stakeholderandmulti-sectoralcoordinationmechanismsatthehighestleveltoensurethewholeofgovernment,wholeofsocietyapproach

Source:YikYingTeo

• AdequatefundingforimplementationofNCDactionplan,multi-sectoralaction

• Mobilizingadditionalfund:introducepro-healthtaxes

Source:Dr.JohannaBirckmayer

4.2 Actions by national actorsb. Address financing gaps

4.2 Actions by national actorsb. Address financing gaps(cont.)

• Prioritization:explicitcriteriatoprioritizebudgetsforpreventionandpromotion

• Providerpayment:designproviderpaymenttosupportcontinuumofcare;utilizepaymentinformationtoinformserviceprovision– Shiftingfrompayingindividualservicecontacttosupportcarecoordination

4.2 Actions by national actorsc. Improve implementation capacities

• Reforminghealthdeliverysystemstorespondtodemographicandepidemiologictransitions

• Improvehealthsystemsresponse• EnsurediagnosticandessentialmedicinesforNCDand

mentalhealthavailableatPHClevel• StrengthenFCTCimplementationinparticularinLMIC

– Legislatione.g.plainpackaging– effectiveenforcementandimplementation

• Implement16bestbuysinlinewithcountrycontext– Singapore’sWaronDiabetes:NationalpoliciesonNCDpreventionguidedbyglobalintelligence

SSB interventions – evidence base

Source:YikYingTeo(PS2.2)

4.2 Actions by national actors d. A whole of society approach

• Politicaleconomylens• UsingUniversalHealthCoveragelens• ExampleofSingaporeandPhilippines:Whole-of-GovernmentandWhole-of-Nationstrategy

4.2 Actions by national actors d. A whole of society approach (cont.)

• Collaborationandpartnership:–Empowerandstrengthenthecapacityofcivilsociety:synergieswithothersocialmovemente.g.climatechangeandenvironment

–PublicPrivatePartnershipsmustengagetherightmembersfromthestartandmanageofCOIi.e.MOH,MOF,civilsocietyetc.

d. A whole of society approach(cont.)

• Publicawarenessandimprovehealthliteracy– RaiseawarenessaboutthepublichealthburdencausedbyNCDs&therelationshipbetweenNCDs,povertyandsocialandeconomicdevelopment

• Changingenvironmentsincludingphysical,economic,digitalandsocialisthemostpromiseforchangingbehaviorinthepopulations.

Source:PairojS.

e. Information system• Addressevidenceandinformationgaps,highlightcaseNCDhealthandeconomicburden

• Supportevidencedbasedsocialmovementandpolicyadvocacy

• De-normalizationandcorrectingmisinformationthroughinvolvementofhealth,non-healthsectors,publicmedia,civilsociety

• Investinginimplementationresearchanduseofinformationforpolicymonitoring

4.3 Actions by Community

• Civilengagement&socialmobilizationtodrivepoliticalactions.

• EngagingpeoplelivingwithNCDintheresponses• BuildingalliancesandcoalitionforNCDatthecommunitylevele.g.Healthycitymovement

• SriLanka:establishcommunityinfrastructuresformanagementandcontrolofNCDs– EstablishHealthyLifestyleCentresin2011– Launchofwellwomenclinicsin1996

4.4 Actions by Individual

• UKexperiencesonChangeforlife—App,empoweringconsumers

• ApplicationofNUDGEtheoryincombinationwithCHOICEarchitecturetoinfluenceindividualbehaviourinfavourofhealthychoices

PMAC2019–healthymeeting• SetglobalandnationalnormandstandardofhealthyandactivemeetingHealthierFoodand

Nutrition• Varietyofgrains• Fruitsandvegetables• Waterasdefault• Alcohol-andtobacco

free• Lessuseofplastic

Physicallyactive

• Standingzoneduringmeeting

• Activebreaks• Activezone

Mentalpleasantenvironment

• Massage• Meditation

Lead Rapporteur and Rapporteur Coordinator

Dr.KatieDainNCDAlliance

Prof.TeoYikYingNationalUniversityofSingapore

Dr.TeaCollinsWorldHealthOrganization

Dr.VirojTangcharoensathienInternationalHealthPolicyProgram

RAPPORTEURCOORDINATOR

Dr.WalaipornPatcharanarumol

Dr.WarisaPanichkriangkai

OranaChandrasiri PayaoPhonsuk

LEADRAPPORTEUR

PMAC2019 Session RapporteursAbdelJamal Disangcopan Abila DerrickBary Akiko Fukui Alia Luz Anond Kulthanmanusorn Ayodele Akinnawo BawiMang Lian Bhurinud Salakij Biniam Getachew Carmeneza DosSantosMonteiro Charuttaporn Jitpeera Chayanis KositamongkolChen Cynthia Chhorvann Chhea Elisabeth Listyani Fonthip WatcharapornHathairat Kosiyaporn Jaruayporn Srisasalux Jessica Beagley Jin Xu Jintana Jankhotkaew Jiraluck Nontarak Jurairat Phromjai Kamolthip Chanvised Kaori Oohara Khanitta Seaiew Khanuengnij Yueayai Khunjira Udomaksorn Korapat MayurasakornKrittiya Sasipuminrit

Milin Sakornsin Nanoot Mathurapote Naoki Yanagisawa Napat Pattawattananon Nattadhanai Rajatanavin Nattanicha Pangkariya Nichakul Pisitpayat Nicolas Rosemberg Nimali Widanapathirana Niyadar Impetch Nootchawon Boonruangkitinandha Noppakun Thammatacharee Noppawan Piaseu Nucharapon LiangruenromNurKhaulah Fadzil Nutkamon Luesomboon NyiNyi Zayar Ong Suan Orratai Waleewong Panupong Tantirat Patinya Srisai Patiphak Namahoot Pawena Narasri Pensom Jumriangrit PhatthanawilaiInmai Pitikhun Setapura Piyawan Kanan Quinten Lataire RachaneekornManeesiri Rachel Archer

Ratchaporn Congprasert Rui Liu Rungsun Munkong Sarayuth Khuntha Shaheda Viriyathorn Shiqi Wang Sigit Arifwidodo Silvana PerezLeonQuinoso Sininard Wangdee Sirinard Nipaphorn Sopit Nasueb Suchunya Aungkulanon Sumithra KrishnamurthyReddiar Suphanat Wongsanuphat Suphanna Krongthaeo Taishi Matsumoto Takuya Nakashima Tharani Loganathan Thitiporn Sukeaw Thitirat Wongkeaw ThuyenHoangMyNguyen Voramon Agrasuta Wakako Takeda Waraporn Suwanwela Watinee Kunpuek Wattana Masunglong Wilailak Saengsri Woranan Witthayapipopsakul Ye YuShwe Yuki Inoue Yumiko Miyashita Yun Wang