Who shao ncd seminar2014_thl_10 march
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Transcript of Who shao ncd seminar2014_thl_10 march
Dr Ruitai Shao
Programme Management Adviser
Department for the Management of NCDs
World Health Organization
Geneva
Voluntary Global Targets &
Global Monitoring Framework and
Global NCD Action Plan 2013-20
Outline
• NCDs and Their Determinants
• Global Responses
• Global Voluntary Targets, Action Plan
and Monitoring Framework for NCDs
• Moving from global initiatives to local
action
Tobacco use Unhealthy diet Physical inactivity
Harmful use of alcohol
Heart disease and stroke
Diabetes
Cancer
Chronic respiratory disease
UN Secretary-General
Focus on 4 NCDs and 4 risk factors for NCDs
10%
0
5 000 000
10 000 000
15 000 000
20 000 000
25 000 000
0-29 30-69 70-80+
Communicable,maternal, perinatal andnutritional conditions
Noncommunicablediseases
Injuries
New data for 2011: Almost 14 million people died from NCDs between the ages of 30 and 70
0
2 000 000
4 000 000
6 000 000
8 000 000
10 000 000
12 000 000
0-29 30-69 70-80+
High-income countries
Upper middle-incomecountries
Lower middle-incomecountries
Low-income countries
Deaths from NCDs
age groups
85% of people who die too young from NCDs live in developing countries, which resulted in 12 million premature deaths from NCDs in 2011
US$ 11B is the average yearly cost for
all developing countries to
scale up action by
implementing a combined set
of cost-effective NCD
interventions that have been
identified as priority actions
by WHO
US$ 7T is the cumulative
lost output in
developing
countries
associated with
NCDs between
2011-2025
The cost of inaction versus action
Key milestones: High-level Meeting on NCDs and beyond
High-level Meeting on NCDs
(New York, September 2011)
Action Plan on the Global Strategy for the
Prevention and Control of NCDs 2008-13
WHO Global Strategy for the Prevention and Control of Noncommunicable Diseases 2000
2008
2013
2011
Global NCD targets, Global NCD Action Plan 2013-20
and monitoring Framework, including indicators
World Conference on Social
Determinants on Health,
October 2011, Rio de Janeiro
2003 WHO Framework on Tobacco Convention
1997
First ministerial meeting on
NCDs in Moscow, April 2011)
The world health report 1997 - conquering suffering, enriching humanity
2004 WHO Global Strategy for diet, physical activity and health
2009 WHO Global Strategy to reduce the
harmful use of alcohol
WHO Global Strategy for the Prevention and Control
of Noncommunicable Diseases
Surveillance Mapping the epidemic of
NCDs
Management Strengthen
health care for people with
NCDs
Prevention Reducing the
level of exposure to risk factors
Reducing NCD's risk factors
WHO Framework Convention on Tobacco
Control
WHO Global Strategy for Diet, Physical
Activity and Health
WHO Global Strategy for the harmful use of
Alcohol
Increasing health service coverage for people
at high risk and with established NCDs
– WHO technical support package of essential
interventions to integrate NCD prevention and
control into primary care
– Add-on components for existing health initiatives
(polio, HIV/AIDS, TB)
Realizing the commitments made in the Political Declaration on NCDs > Progress made by WHO
1 WHO Global NCD Action Plan 2013-2020
2 Nine global targets for NCDs to be attained by 2025
3 25 outcome indicators for NCDs to measure progress towards the attainment of the nine global targets
4 9 NCD action plan indicators to inform reporting on progress made in the process of implementing the WHO Global NCD Action Plan 2013-2020
5 WHO Global Coordination Mechanism on the Prevention and Control of NCDs ("NCD-GCM")
6 UN Interagency Task Force on the Prevention and Control of NCDs
7 Report of the United Nations Secretary-General and the WHO Director-General on the progress made in realizing the commitments included in the UN Political Declaration on NCDs
8 WHO Country Capacity Assessment on NCDs
9 WHO Global Status Reports on NCDs in 2011 and 2014 (and 2010 global baseline)
10 Technical assistance to developing countries based on a One-WHO work plan on NCDs
Voluntary Global NCD Targets
1. Premature mortality from NCDs (25% reduction)
2. Harmful use of alcohol (10% reduction)
3. Physical inactivity (10% reduction)
4. Salt/sodium intake (10% reduction)
5. Tobacco use (30% reduction)
6. Raised blood pressure (25% reduction)
7. Diabetes/obesity( (0% change)
8. Essential medicines and technologies (80%)
9. Drug therapy and counseling (50%)
Formal Meeting of Member States to conclude the work on the comprehensive global monitoring framework including indicators and a set of
voluntary targets for the prevention and control of NCDs (Geneva, 5-7 November 2012)
Global NCD Action Plan 2013-20
1. To o raise the priority accorded to the prevention and control of NCDs
2. To strengthen national capacity, leadership, governance, multisectoral action and partnerships
3. To reduce modifiable risk factors
4. To strengthen and reorient health systems
5. To promote and support national capacity for high quality research and development
6. To monitor the trends and determinants of NCDs and evaluate progress
Agreement on the objectives: • Advocate for the urgency to implement the
WHO Global NCD Action Plan 2013-2020 • Disseminate knowledge on best practices • Provide a platform to identify barriers and
share innovate solutions • Advance multi-sectoral action • Share information on existing and potential
sources of finance and cooperation mechanism
Member States
Non-State Actors
UN organizations
Global Coordination Mechanism on NCDs What is the current status following discussions at the WHO Executive Board?
Further consultations of Member States in March or April 2014 on: – Responsibilities of participants – Working groups – WHO's role as the Secretariat – Work plan – Administrative arrangements – Accountability – Conflict of interest – Links with the UN Task Force on NCDs
• Functions for the UN Interagency Task Force for NCDs (see document EB134/14 for full text):
— Enhance and coordinate technical support
— Facilitate information exchange about plans, strategies, programmes and activities
— Facilitate information exchange about available resources to support national efforts
— Strengthen advocacy
— Ensure that tobacco control continues to be duly addressed
— Strengthen international cooperation
Terms of reference for the UN Interagency Task Force on NCDs
UN General Assembly NCD Review 2014 Possible elements for an outcome document: What we hear from Member States
Set national targets Member States to consider, by 2015, the development of national targets for 2025 based on national situations, taking into account the 9 voluntary global targets adopted by the 66th World Health Assembly (May 2013), and building on guidance provided by the World Health Organization, to focus on efforts to address the impacts of NCDs
Develop national plans Member States to develop, by 2015, multisectoral national policies and plans for the prevention and control of NCDs to attain national targets, taking into account the 2013-2020 WHO Global Action Plan for the Prevention and Control of NCDs.
Reduce exposure to risk factors Member States to implement, by 2015, as part of a national multisectoral plan, “best buys” and very cost-effective interventions to reduce the exposure to risk factors for NCDs as part of these national plans.
Enable health systems to respond Member States to implement, by 2015, as part of multisectoral national polices and plans, “best buys” and very cost-effective interventions to enable health systems to respond to the NCD challenge of epidemic proportions
Measure results Member States to implement, by 2015, the WHO Framework for NCD Surveillance covering (i) monitoring of risk factors and determinants; (ii) outcomes (mortality and morbidity) and (iii) health system response, as well as to integrate NCDs into the national health information systems, and develop national indicators taking into account the global ones.
Number of countries with: At least one operational NCD plan A NCD unit Policy to reduce harmful use of alcohol Policy to reduce physical inactivity Policy to reduce the burden of tobacco use Policy to reduce unhealthy diets National guidelines for management of NCDs National policy on NCD-related research National NCD surveillance system
Global NCD action plan (process) indicators What is the current status following discussions at the WHO Executive Board?
• Formal meeting of Member States (Geneva, 15 November 2013) reached consensus on 9 action plan (process indicators)
• WHO Executive Board endorsed the process indicators
•Next steps:
—67th World Health Assembly will consider the indicators (May 2014)
Moving from global initiatives
to local action
Comprehensive assessment
Build supportive environment for NCD prevention and
control
Multisectoral action through effective partnerships
Set national targets, develop and implement NCD action
plan and measure results
Monitoring trends of NCDs, determinants and progress in
NCD prevention and control
• Method of work for WHO to implement the actions for
the WHO Secretariat included in the WHO Global NCD
Action Plan 2013-2020 in a coordinated manner,
including:
– Across the three levels of WHO
(Country Offices, Regional Offices, Headquarters)
– Across the WHO Categories included in the WHO Programme
Budget 2014-2015 (e.g. communicable diseases, maternal
health, emergencies)
One-WHO Work Plan 2014-2015
Costa Rica Ecuador Paraguay
Morocco Oman
Mozambique Rwanda
Azerbaijan Belarus Uzbekistan
Nepal Sri Lanka
China Fiji Mongolia Vietnam
One-WHP plan: Working with Countries to develop national multisectoral action plan
Comprehensive assessment
Analyse NCD burden
Examine evidence-based interventions
Review experience and best practices
Assess country responses
Data Sources
Comprehensive assessment:
NCD burden
Determining the magnitude of the NCD
problem – Population and health indicators
– Leading causes of death
– Prevalence of main risk factors
Determining the economic impact of the NCDs – Size of the problem: Demonstrating the Economic Burden of NCDs
– Possible solutions and their cost: Estimating a Global Price Tag for NCD
interventions
– The costs of scaling up a core intervention package
Comprehensive assessment:
Evidence-based interventions
Population-based interventions
– Communication
– Health interventions
– Economic measures
– Legislations/regulations
Individual interventions
– Early detection
– Health counselling and drug therapy
– Essential medicines and technologies
Examples of population-based
interventions
Tobacco use Harmful use of
alcohol
Unhealthy diet and
physical inactivity
• Health information
and warnings
• Tax increases
• Smoke-free indoor
workplaces and
public places
• Bans on tobacco
advertising,
promotion and
sponsorship
• Strengthening
awareness of
alcohol-attributable
burden
• Tax increases
• Restricted access
to retailed alcohol
• Bans on alcohol
advertising
• Public awareness
through mass media
on diet and physical
activity
• Reduced salt intake in
food
• Replacement of trans
fat with
polyunsaturated fat
Examples of individual interventions
Cardiovascular disease (CVD)
and diabetes
Cancer
• Counselling and multi-drug
therapy for people with a high risk
of developing heart attacks and
strokes (including those with
established CVD)
• Treatment of heart attacks with
aspirin
• Hepatitis B immunization to
prevent liver cancer (already
scaled up)
• Screening and treatment of pre-
cancerous lesions to prevent
cervical cancer
Comprehensive assessment:
Experiences and best practices
Advocacy and Partnerships
NCD policies, strategies, plans and
programmes
Community-based programmes
Health Information including NCDs and risk
factors
Comprehensive assessment:
Assessment of country responses
Health information systems
Multisectoral action on NCDs
Health service
Community capacity
Financial resources
Research capacity
Data Sources
National health information system database
Mortality, risk factors, burden of diseases, health
expenditure:
– WHOSIS
– National health accounts (NHA)
– Health programmes at WHO websites
Food safety and nutrition: The UN Food and
Agriculture Organization (FAO)
Economic arguments for NCDs: World Bank database
Build supportive environment
for NCD prevention and control
Advocacy for action
Raise public and political awareness
Integrate NCDs into the social and development
agenda and poverty alleviation strategies
Foster partnerships for NCDs
Strengthen international cooperation (e.g. UNDAF)
Advocacy for action
Analyse the situation and identify vision and priorities
Define desired outcomes
Know the target audience
Decide on key messages to influence target audiences
Choose appropriate approaches and planning activities
Engage the media
Build alliances
Build case for action
Multisectoral action
through effective partnerships
Establish mechanisms and coordinate activities
Exercise health sector's stewardship role with other
sectors and related United Nations organizations
Provide the health information, tools and advice
Share information and experience through various
platform, e.g. global, regional and national NCD Forum
or networks
Examples of cross-sectoral government
engagement to reduce NCD risk factors
Tobacco use Physical inactivity Harmful use of
alcohol
Unhealthy diet Other (eg.
Environment)
Health √ √ √ √ √
Education √ √ √ √
Finance √ √ √ √ √
Urban planning √ √ √ √
Agriculture √ √ √
Industry √ √ √ √
Transport √ √ √ √
Environment √ √ √
Housing √ √
Justice/Security √ √ √
Energy √ √
Social/Welfare √ √ √ √ √
Sports √ √ √ √
Communication √ √ √ √ √
Legislature √ √ √ √ √
Trade √ √ √ √ √
Youth affairs √ √ √ √ √
Examples of potential health effects of multisectoral action
Tobacco use Physical inactivity Harmful use of
alcohol
Unhealthy diet
Sectors
involved
(examples)
• Legislature
• Stakeholder ministries across
government, including
ministries of agriculture,
customs /revenue, economy,
education, finance, health,
foreign affairs, labour,
planning, social welfare, state
media, statistics, and Trade
• Ministries of education,
finance, labour, planning,
transport, urban planning,
sports, and youth
• Local government
• Legislature
• Ministries of trade,
industry, education,
finance, justice
• Local Government
• Legislature
• Ministries of trade agriculture,
industry, education, urban
planning, energy, transport,
social welfare, Environment
Examples of
multisectoral
action
• Full implementation of WHO
Framework Convention on
Tobacco Control obligations
through coordination
committees at the national and
subnational levels
• Urban planning /re-
engineering for active
transport and walkable cities
• School-based programmes
to support physical activity
• Incentives for work site
healthy lifestyle programmes
• Increased availability of safe
environments recreational
spaces
• Mass media campaigns
• Economic interventions to
promote physical activity
(taxes on motorized
transport, subsidies on
bicycles and sports
equipment)
• Tax increases
• Bans on alcohol
advertising
• Restricted access to
retailed alcohol
• Reduced drunk
driving
• Reduced amounts of salt,
saturated fat and sugars in
processed foods
• Eliminate industrially produced
trans-fats in foods
• Controlled advertising of
unhealthy food to children
• Increase availability and
affordability of fruit and
vegetables to promote intake
• Offer of healthy food in schools
and other public institutions
and through social support
programmes
• Economic interventions to
drive food consumption (taxes,
subsidies)
• Food security
Desired
outcome
• Reduced tobacco use and
consumption, including
secondhand smoke exposure
and reduced production of
tobacco and tobacco products
• Decreased physical inactivity
• Reduced harmful use
of alcohol
• Substitution of healthy foods
for energy-dense
micronutrient-poor food
• Reduced use of salt, saturated
fat and sugars
Logic Model
for Developing National NCD Action Plan
Goal and
objectives
(Examples)
Priority action areas
(Examples)
Activities
(examples)
Outputs
(examples)
Outcomes/impact (examples)
Short-term Long-term
General goal:
to reduce premature
mortality from NCDs
Specific Objectives:
1. To reduce prevalence
of risk factors
2. To increase coverage
of people with Main
NCDs
• To Build supportive
environment for NCDs
• to reduce the exposure
of populations and
individuals to the risk
factors for NCDs
• to improve health care
for people with the
selected main NCDs
• To strengthen
Monitoring NCD and
their risk factors
• to advance
multisectoral action
• To strengthen national
capacity
• to promote
international
cooperation and
coordination
Health campaign for
increasing
awareness of NCDs
and their risk
factors
place NCD in
development
agenda
incorporate NCD
into poverty
reduction strategy
financing NCD
set priorities of
NCD prevention and
control
set national targets
for NCD prevention
and control
Implementation of
FCTC and DPAS
awareness of
NCD increased
(KAP)
NCDs in
development
agenda and
poverty reduction
strategy
Budget increased
for NCDs
Priorities and
targets set
Changed in
coverage of NCD
management
Capacity
improved
Multisectoral
actions
implemented
Prevalence of risk
factors reduced
Mortality of
NCDs reduced
Quality of life
improved
Input Indicators Process Indicators Outcome Indicators
Monitoring & Evaluation
Set national targets
and measure results
Member States have committed themselves to "consider the development of national targets based on national situations", building on the 9 voluntary global targets
National targets can be more or less ambitious than the global ones
National adaptation of global targets should be guided by: Current performance, Current level of exposure Programmes planned and in place
WHO is developing a Toolkit on NCD Surveillance, which will include a module on setting national targets and measuring results
Develop and implement
NCD action plan Develop NCD policies, plans and programmes
– Ensure stakeholder engagement
– Set appropriate vision, goals, objectives
– Determine priority areas for action
– Define roles and responsibilities of stakeholders
– Determine timeframe
– Prepare budget
Implement NCD policies, plans and programmes
– Gaining and maintaining political and public support
– Dedicated unit and operational team
– Strengthen capacity to implement policies and plans
– Scale-up existing programmes or establish pilot projects
Monitoring and surveillance of NCD
and their determinants
• Mortality and morbidity ─ Mortality: NCD-specific mortality.
─ Morbidity: Cancer incidence and type (as core).
• Risk factors • Behavioural risk factors: tobacco use, physical inactivity, the harmful use of alcohol
and unhealthy diet
• Physiological and metabolic risk factors: raised blood pressure, overweight/obesity,
raised blood glucose, and raised cholesterol.
• National system response • Interventions and health system capacity: infrastructure, policies and
plans, access to key health-care interventions and treatments,
partnerships.
Monitoring progress
• Engage key stakeholders
• Ensure common understanding of the process
• Agree on purpose of monitoring and evaluation
activity
• Focus monitoring and evaluation activity
• Analyse data
• Use monitoring and evaluation information
Thank you