Dr Ruitai Shao
Programme Management Adviser
Department for the Management of NCDs
World Health Organization
Geneva
Volunta...
Outline
• NCDs and Their Determinants
• Global Responses
• Global Voluntary Targets, Action Plan
and Monitoring Framework ...
Tobacco use Unhealthy diet
Physical
inactivity
Harmful use of
alcohol
Heart disease
and stroke    
Diabetes    
Ca...
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 and
nutrit...
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-incom...
US$ 11B
is the average yearly cost for
all developing countries to
scale up action by
implementing a combined set
of cost-...
Key milestones: High-level Meeting on NCDs and beyond
High-level Meeting on NCDs
(New York, September 2011)
Action Plan on...
WHO Global Strategy for the Prevention and Control
of Noncommunicable Diseases
Surveillance
Mapping the
epidemic of
NCDs
M...
Reducing NCD's risk factors
 WHO Framework Convention on Tobacco
Control
 WHO Global Strategy for Diet, Physical
Activit...
Increasing health service coverage for people
at high risk and with established NCDs
– WHO technical support package of es...
Realizing the commitments made in the Political Declaration on NCDs
> Progress made by WHO
1 WHO Global NCD Action Plan 20...
Voluntary Global NCD Targets
1. Premature mortality from NCDs (25% reduction)
2. Harmful use of alcohol (10% reduction)
3....
Formal Meeting of Member States to conclude the
work on the comprehensive global monitoring framework including indicators...
Global NCD Action Plan 2013-20
1. To o raise the priority accorded to the prevention and control of NCDs
2. To strengthen ...
Agreement on the objectives:
• Advocate for the urgency to implement the
WHO Global NCD Action Plan 2013-2020
• Disseminat...
• Functions for the UN Interagency Task Force for NCDs
(see document EB134/14 for full text):
— Enhance and coordinate tec...
UN General Assembly NCD Review 2014
Possible elements for an outcome document: What we hear from Member States
Set nationa...
Number of countries with:
 At least one operational NCD plan
 A NCD unit
 Policy to reduce harmful use of alcohol
 Pol...
Moving from global initiatives
to local action
 Comprehensive assessment
 Build supportive environment for NCD preventio...
• Method of work for WHO to implement the actions for
the WHO Secretariat included in the WHO Global NCD
Action Plan 2013-...
Costa Rica
Ecuador
Paraguay
Morocco
Oman
Mozambique
Rwanda
Azerbaijan
Belarus
Uzbekistan
Nepal
Sri Lanka
China
Fiji
Mongol...
Comprehensive assessment
 Analyse NCD burden
 Examine evidence-based interventions
 Review experience and best practice...
Comprehensive assessment:
NCD burden
 Determining the magnitude of the NCD
problem
– Population and health indicators
– L...
Comprehensive assessment:
Evidence-based interventions
 Population-based interventions
– Communication
– Health intervent...
Examples of population-based
interventions
Tobacco use Harmful use of
alcohol
Unhealthy diet and
physical inactivity
• Hea...
Examples of individual interventions
Cardiovascular disease (CVD)
and diabetes
Cancer
• Counselling and multi-drug
therapy...
Comprehensive assessment:
Experiences and best practices
 Advocacy and Partnerships
 NCD policies, strategies, plans and...
Comprehensive assessment:
Assessment of country responses
 Health information systems
 Multisectoral action on NCDs
 He...
Data Sources
 National health information system database
 Mortality, risk factors, burden of diseases, health
expenditu...
Build supportive environment
for NCD prevention and control
 Advocacy for action
 Raise public and political awareness
...
Advocacy for action
 Analyse the situation and identify vision and priorities
 Define desired outcomes
 Know the target...
Multisectoral action
through effective partnerships
 Establish mechanisms and coordinate activities
 Exercise health sec...
Examples of cross-sectoral government
engagement to reduce NCD risk factors
Tobacco use Physical inactivity Harmful use of...
Examples of potential health effects of multisectoral action
Tobacco use Physical inactivity Harmful use of
alcohol
Unheal...
Logic Model
for Developing National NCD Action Plan
Goal and
objectives
(Examples)
Priority action areas
(Examples)
Activi...
Set national targets
and measure results
 Member States have committed themselves to "consider the
development of nationa...
Develop and implement
NCD action plan
 Develop NCD policies, plans and programmes
– Ensure stakeholder engagement
– Set a...
Monitoring and surveillance of NCD
and their determinants
• Mortality and morbidity
─ Mortality: NCD-specific mortality.
─...
Monitoring progress
• Engage key stakeholders
• Ensure common understanding of the process
• Agree on purpose of monitorin...
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Who shao ncd seminar2014_thl_10 march

  1. 1. 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
  2. 2. Outline • NCDs and Their Determinants • Global Responses • Global Voluntary Targets, Action Plan and Monitoring Framework for NCDs • Moving from global initiatives to local action
  3. 3. 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
  4. 4. 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 and nutritional conditions Noncommunicable diseases Injuries New data for 2011: Almost 14 million people died from NCDs between the ages of 30 and 70
  5. 5. 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-income countries Lower middle-income countries 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
  6. 6. 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
  7. 7. 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
  8. 8. 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
  9. 9. 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
  10. 10. 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)
  11. 11. 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
  12. 12. 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%)
  13. 13. 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)
  14. 14. 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
  15. 15. 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
  16. 16. • 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
  17. 17. 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.
  18. 18. 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)
  19. 19. 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
  20. 20. • 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
  21. 21. 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
  22. 22. Comprehensive assessment  Analyse NCD burden  Examine evidence-based interventions  Review experience and best practices  Assess country responses  Data Sources
  23. 23. 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
  24. 24. 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
  25. 25. 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
  26. 26. 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
  27. 27. 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
  28. 28. Comprehensive assessment: Assessment of country responses  Health information systems  Multisectoral action on NCDs  Health service  Community capacity  Financial resources  Research capacity
  29. 29. 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
  30. 30. 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)
  31. 31. 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
  32. 32. 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
  33. 33. 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 √ √ √ √ √
  34. 34. 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
  35. 35. 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
  36. 36. 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
  37. 37. 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
  38. 38. 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.
  39. 39. 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
  40. 40. Thank you
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