WHO GLOBAL NCD ACTION PLAN:
Frameworks, priority actions and surveillance
for effective and sustainable NCD prevention
Chi...
Greetings from Finland
Pekka Puska, Director General22.08.13
10million
15million
20million
25million
High-income
countries
Upper
middle-income
Lower
middle-income
Low-income
countries...
22.08.13 4
UN high-level summit on NCDs
New York Sept 2011
• Preceded by Ministerial
Conference in Moscow
(April 2011).
• Political d...
WHO’s global NCD strategy, 2000
• NCD prevention and control is a global
health priority
• Comprehensive action is needed,...
Surveillance
Mapping the
epidemic of
NCDs
Management
Strengthen
health care
for people
with NCDs
Prevention
Reducing the
l...
Cornerstones of NCD prevention
and control (WHO global strategy)
• Attention to behavioural risk factors
– Tobacco use
– U...
INTEGRATED PREVENTION
22.08.13 9Pekka Puska, Director General
2000
2003
2004
2008
Global Strategy for the Prevention and
Control of Noncommunicable Diseases
Global Strategy on Diet,
Ph...
Key milestones: High-level Meeting on NCDs and beyond
High-level Meeting on
NCDs
(New York, September
2011)
Action Plan on...
22.08.13
Action Plan 2007-
2012
#
New Action Plan
for 2013-20
endorsed by
WHA 2013
12Pekka Puska, Director General
WHO global action plan 2013-20
1. International cooperation and advocacy
2. Strengthen national capacity, leadership,
gove...
22.08.13 Pekka Puska, Director General 14
Global targets (2010-2025)
1. 25 % reduction of avoidable mortality
2. 10 % reduction in harmful use of alcohol
3. 10 % re...
Ban Ki-Moon:
”We should all work to meet the targets to reduce NCDs”
22.08.13 16Pekka Puska, Director General
Global indicators
• Indicators of targets
• Additional indicators
–E.g. saturated fatty acids, fruits and
vegetables, bloo...
PRIORITY ACTIONS
• Should be feasible and affordable in
low-cost settings
• Evidence and/or expert opinion to
support
• Ad...
1. International cooperation and advocacy
• Raise public and political awareness on
NCDs
• Strengthen international collab...
22.08.13 20Pekka Puska, Director General
22.08.13 Pekka Puska, Director General 21
2. Strengthen national capacity,
leadership etc.
• Increase budgetary allocations for
NCD
• Strengthen national capacity,
...
Intersectoral work towards prevention
- ”Health in all policies”
• People’s lifestyles are influenced by decisions in
diff...
8th
Global WHO Conference on health promotion
- “Health in all policies”
From Ottawa to Helsinki (June 2013)
22.08.13 24Pe...
Comprehensive action and partnership
for national NCD prevention
• Health services
• Governments (national, local)
• Civil...
What are NPHIs?
 Institution or network that
provides leadership and
coordination for public
health systems at the
nation...
3a Reduce risk factors: tobacco
• Increase tobacco tax
• Completely smokefree indoor places
by law
• Effective health warn...
22.08.13 Pekka Puska, Director General 28
3b Reduce risk factors: alcohol
• Increase alcohol tax
• Comprehensive restrictions and bans
on adventising and promotion
...
22.08.13 Pekka Puska, Director General 30
3c Reduce risk factors: unhealthy
diet and physical inactivity
• Salt reduction through industry and
media campaigns
• Red...
22.08.13 Pekka Puska, Director General 32
4. Strengthen and reorient health systems
• Integrate effective NCD interventions in
universal primary health care
• Explo...
Redirection of health services
22.08.13 Pekka Puska, Director General 34
• Reorientation and strengthening of health syste...
5. Promote national reserch capacity
22.08.13 Pekka Puska, Director General 35
• Develop national research agenda
• Streng...
22.08.13 Pekka Puska, Director General 36
6. Monitor and evaluate
• Develop national targets and indicators
(based on the global ones)
• Develop national surveillan...
NCD FRAMEWORK FOR ACTION/MONITORING
22.08.13 38
GENETICS
Health
promotion
Prevention Treatment
SOCIETAL
RESPONSES
(HiAP)
H...
International/global action
• United Nations: New York 2011 Political
Declaration, Post 2015 targets
• UN agencies coordin...
22.08.13 Pekka Puska, Director General 40
NCD prevention is possible!
The potential is great
• Quite rapid impact
• Human impact on health and
wellbeing
• Impact on...
Change in age-adjusted mortality rates
Finland, males aged 35–64 (per 100 000 population)
extension of the Project
nationa...
The North Karelia/Finland
experience
• Supports and has interacted much with
the WHO NCD strategy:
–Integrated prevention
...
22.08.13 Pekka Puska, Director General
45
THE MAIN CHALLENGE FOR
SUCCESSFUL NCD
PREVENTION IS NOT WHAT
TO DO, BUT HOW TO
IMPLEMENT THE NEEDED
ACTIONS!
22.08.13 P...
During the last few years a great
number of strategies and plans for
evidence-based, effective prevention
and health promo...
Pekka Puska, Director General
IDENTIFYINGIDENTIFYING IMPLEMENTINGIMPLEMENTING
PRIORITIESPRIORITIES THEMTHEM
FROM PRIORITIE...
The WHO Global NCD Action Plan and
many other WHO and national strategies
give clear quidance on what to do
- But to achie...
Thank you
22.08.13 49Pekka Puska, Director General
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Who Global NCD Action Plan: Frameworks, priority actions and surveillance for effective and sustainable NCD prevention

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Pekka Puska
China Healthy Lifestyle Conference
Beijing 19.8.2013

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  • World Health Organization August 22, 2013 And what's drastic here – 90% of the premature death from NCDs occur in developing countries – countries that are already vulnerable and will also been hit heavily by global economic crisis and negative effects of climate changes. (Over the next decades, it is predicted that billions of people, particularly those in developing countries, face shortages of water and food and greater risks to health and life as a result of climate change 1 ) 1 Climate Change: Impacts, Vulnerabilities and adaptation in Developing Countries (2007) United Nations Framework Convention on Climate Change (UNFCCC).
  • Who Global NCD Action Plan: Frameworks, priority actions and surveillance for effective and sustainable NCD prevention

    1. 1. WHO GLOBAL NCD ACTION PLAN: Frameworks, priority actions and surveillance for effective and sustainable NCD prevention China Healthy Lifestyle Conference Beijing 19.8.2013 22.08.13 1 Pekka Puska Director General, National Institute for Health and Welfare (THL) President, Int. Association of National Public Health Institutes (IANPHI) Chair, Governing Council of WHO Cancer Research Agency (IARC) Past President, World Heart Federation (WHF)
    2. 2. Greetings from Finland Pekka Puska, Director General22.08.13
    3. 3. 10million 15million 20million 25million High-income countries Upper middle-income Lower middle-income Low-income countries 0.6M 0.5M 3.3M 2.3M 10.2M10.2M .3 3M .3 3M 3.0M 3.0M 3.0M 3.0M 5.9M 5.9M 2.3M .6 8M .6 8M 3.7M 13.6M 13.6M 1.1M0.9M Low-income countries Group III - Injuries Group II – Other deaths from noncommunicable diseases Group II – Premature deaths from noncommunicable diseases (below the age of 60), which are preventable Group I – Communicable diseases, maternal, perinatal and nutritional conditions Source: Total number of deaths in the world 90%of premature deaths from NCDs occur in developing countries 22.08.13 3Pekka Puska, Director General GLOBAL PUBLIC HEALTH CHANGING:
    4. 4. 22.08.13 4
    5. 5. UN high-level summit on NCDs New York Sept 2011 • Preceded by Ministerial Conference in Moscow (April 2011). • Political declaration • Action on global NCD prevention and control” • WHO’s leadership, intersectoral support 22.08.13 RECENT POLITICAL SUPPORT 5Pekka Puska, Director General
    6. 6. WHO’s global NCD strategy, 2000 • NCD prevention and control is a global health priority • Comprehensive action is needed, but from public health point of view population based prevention is the key (most cost- effective and sustainable) • Integrated prevention: targeting common, lifestyle related risk factors (tobacco, diet, physical activity, alcohol) 22.08.13 6Pekka Puska, Director General
    7. 7. Surveillance Mapping the epidemic of NCDs Management Strengthen health care for people with NCDs Prevention Reducing the level of exposure to risk factors Key Components of the global strategy
    8. 8. Cornerstones of NCD prevention and control (WHO global strategy) • Attention to behavioural risk factors – Tobacco use – Unhealthy diet – Physical inactivity – Harmful use of alcohol • Monitoring and surveillance of – Risk factors and diseases – Preventive actions • Redirection of health services – Prevention (esp. primary health care) – Chronic care model 22.08.13 8Pekka Puska, Director General
    9. 9. INTEGRATED PREVENTION 22.08.13 9Pekka Puska, Director General
    10. 10. 2000 2003 2004 2008 Global Strategy for the Prevention and Control of Noncommunicable Diseases Global Strategy on Diet, Physical Activity and Health Action Plan on the Global Strategy for the Prevention and Control of NCDs The journey to scale up global action 2010 2009 2011 Global Strategy to Reduce the Harmful Use of Alcohol WHO Global Status Report on NCDs UN Political Declaration on NCDs 22.08.13 10Pekka Puska, Director General
    11. 11. 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 Global Strategy for the Prevention and Control of Noncommunicable Diseases Global Strategy for the Prevention and Control of Noncommunicable Diseases 2000 2008 2013 2011 2011 8th Global Conference on Health Promotion, 10-14 June 2013, Helsinki, Finland 8th Global Conference on Health Promotion, 10-14 June 2013, Helsinki, Finland World Conference on Social Determinants on Health, October 2011, Rio de Janeiro World Conference on Social Determinants on Health, October 2011, Rio de Janeiro
    12. 12. 22.08.13 Action Plan 2007- 2012 # New Action Plan for 2013-20 endorsed by WHA 2013 12Pekka Puska, Director General
    13. 13. WHO global action plan 2013-20 1. International cooperation and advocacy 2. Strengthen national capacity, leadership, governance, multisectoral action and partnership 3. Reduce risk factors through health-promoting environments 4. Strengthen and reorient health systems for prevention and control of NCDs 5. Promote national capacity for research for prevention and control of NCDs 6. Monitor trends and determinants of NCD and evaluate progress 22.08.13 Pekka Puska, Director General 13
    14. 14. 22.08.13 Pekka Puska, Director General 14
    15. 15. Global targets (2010-2025) 1. 25 % reduction of avoidable mortality 2. 10 % reduction in harmful use of alcohol 3. 10 % reduction in insufficient physical activity 4. 30 % reduction in mean population salt intake 5. 30 % reduction in tobacco use 6. 25 % reduction in raised blood pressure 7. Halt the raise in diabetes and obesity 8. At least 50 % of eligible (=high risk) people receive drug treatment and councelling to prevent heart attack and stroke 9. In 80 % availability of affordable basic technologies and essential medicines for NCD 22.08.13 Pekka Puska, Director General 15
    16. 16. Ban Ki-Moon: ”We should all work to meet the targets to reduce NCDs” 22.08.13 16Pekka Puska, Director General
    17. 17. Global indicators • Indicators of targets • Additional indicators –E.g. saturated fatty acids, fruits and vegetables, blood cholesterol, cervical cancer screening, HPV vaccination, policies of narcotics, advertizing of foods and non-alcoholic beverages to children, national policies to limit saturated fats and eliminate trans fats in food supply 22.08.13 Pekka Puska, Director General 17
    18. 18. PRIORITY ACTIONS • Should be feasible and affordable in low-cost settings • Evidence and/or expert opinion to support • Adapt to local conditions and stage of process • Supported by many documents 22.08.13 Pekka Puska, Director General 18
    19. 19. 1. International cooperation and advocacy • Raise public and political awareness on NCDs • Strengthen international collaboration for training • Integrate NCDs into development strategies 22.08.13 Pekka Puska, Director General 19
    20. 20. 22.08.13 20Pekka Puska, Director General
    21. 21. 22.08.13 Pekka Puska, Director General 21
    22. 22. 2. Strengthen national capacity, leadership etc. • Increase budgetary allocations for NCD • Strengthen national capacity, including institutional capacity for prevention and control of NCDs • Develop national multisectoral policy and plan 22.08.13 Pekka Puska, Director General 22
    23. 23. Intersectoral work towards prevention - ”Health in all policies” • People’s lifestyles are influenced by decisions in different sectors of society (much of them beyond the health sector) • Health in general and NCD prevention in particular should be taken into account in decisions made by different sectors (health impact assessment) • Social change process combining government policies, expert guidance, broad health promotion and mobilization of people Pekka Puska, Director General22.08.13
    24. 24. 8th Global WHO Conference on health promotion - “Health in all policies” From Ottawa to Helsinki (June 2013) 22.08.13 24Pekka Puska, Director General HELSINKI STATEMENT
    25. 25. Comprehensive action and partnership for national NCD prevention • Health services • Governments (national, local) • Civil society (NGOs) • Private sector • Media • International collaboration 22.08.13 25Pekka Puska, Director General
    26. 26. What are NPHIs?  Institution or network that provides leadership and coordination for public health systems at the national level  Often part of the government (usually under MOH) or closely attached to it. Scope & size vary.  Promotes evidence-based decisions, policies, and programs MEXICO INSP MOROCCO NETHERLANDS RIVM U.S. CDC ETHIOPIA EHNRI CHINA CDC Finland THL
    27. 27. 3a Reduce risk factors: tobacco • Increase tobacco tax • Completely smokefree indoor places by law • Effective health warnings and media campaigns • Ban all tobacco advertising, promotion and sponsorship (all FCTC provisions should be implemented) 22.08.13 Pekka Puska, Director General 27
    28. 28. 22.08.13 Pekka Puska, Director General 28
    29. 29. 3b Reduce risk factors: alcohol • Increase alcohol tax • Comprehensive restrictions and bans on adventising and promotion • Restrictions in the availability of retailed alcohol 22.08.13 Pekka Puska, Director General 29
    30. 30. 22.08.13 Pekka Puska, Director General 30
    31. 31. 3c Reduce risk factors: unhealthy diet and physical inactivity • Salt reduction through industry and media campaigns • Reduction of saturated fat and replacement of transfats • Public awareness campaigns on diet and physical activity 22.08.13 Pekka Puska, Director General 31
    32. 32. 22.08.13 Pekka Puska, Director General 32
    33. 33. 4. Strengthen and reorient health systems • Integrate effective NCD interventions in universal primary health care • Explore innovative financing approaches to expand health coverage and prioritize very cost effective interventions • Multidrug preventive therapy to high risk of CVD individuals • Aspirin in acute heart attack • Liver cancer prevention through hepatitis B immunization • Cervical cancer prevention through screening 22.08.13 Pekka Puska, Director General 33
    34. 34. Redirection of health services 22.08.13 Pekka Puska, Director General 34 • Reorientation and strengthening of health systems • Primary health care: ”Now more than ever” (WHR 2008) • Special emphasis for NCDs • Chronic care model • Preventive practices
    35. 35. 5. Promote national reserch capacity 22.08.13 Pekka Puska, Director General 35 • Develop national research agenda • Strengthen national capacity through national health and research institutes
    36. 36. 22.08.13 Pekka Puska, Director General 36
    37. 37. 6. Monitor and evaluate • Develop national targets and indicators (based on the global ones) • Develop national surveillance monitoring system –Cause of deaths register –Cancer register –Periodic population risk factor surveys –Monitoring of national actions 22.08.13 Pekka Puska, Director General 37
    38. 38. NCD FRAMEWORK FOR ACTION/MONITORING 22.08.13 38 GENETICS Health promotion Prevention Treatment SOCIETAL RESPONSES (HiAP) HEALTH SERVICES Pekka Puska, Director General
    39. 39. International/global action • United Nations: New York 2011 Political Declaration, Post 2015 targets • UN agencies coordination • WHO leadership –UN coordination –International collaborative mechanism –Global Action Plan 2013-20 –Global monitoring and reporting (UN, WHA) 22.08.13 Pekka Puska, Director General 39
    40. 40. 22.08.13 Pekka Puska, Director General 40
    41. 41. NCD prevention is possible! The potential is great • Quite rapid impact • Human impact on health and wellbeing • Impact on health service costs and socioeconomic development EXPERIENCE FROM FINLAND 22.08.13 41Pekka Puska, Director General
    42. 42. Change in age-adjusted mortality rates Finland, males aged 35–64 (per 100 000 population) extension of the Project nationally start of the North Karelia Project North Karelia -85% All Finland -80% Rate per 100 000 1969- 1971 2006 Change from 1969-1971 to 2006 All causes 1328 583 -56% All cardiovascular 680 172 -75% Coronary heart disease 489 103 -79% All cancers 262 124 -53% Coronary heart disease Gain of some 10 healthy years in Finnish population 22.08.13 42Pekka Puska, Director General
    43. 43. The North Karelia/Finland experience • Supports and has interacted much with the WHO NCD strategy: –Integrated prevention –FCTC, Diet & physical activity strategy • Happy about the recent political support to upgrading of NCD prevention –UN NCD Summit in September 2011 in New York –Follow up work under WHO leadership 22.08.13 Pekka Puska, Director General
    44. 44. 22.08.13 Pekka Puska, Director General
    45. 45. 45 THE MAIN CHALLENGE FOR SUCCESSFUL NCD PREVENTION IS NOT WHAT TO DO, BUT HOW TO IMPLEMENT THE NEEDED ACTIONS! 22.08.13 Pekka Puska, Director General
    46. 46. During the last few years a great number of strategies and plans for evidence-based, effective prevention and health promotion have been produced 22.08.13 Pekka Puska, Director General 46 Many important priorities have been identified
    47. 47. Pekka Puska, Director General IDENTIFYINGIDENTIFYING IMPLEMENTINGIMPLEMENTING PRIORITIESPRIORITIES THEMTHEM FROM PRIORITIES TO IMPLEMENTATION 08/22/13 Implementation gap
    48. 48. The WHO Global NCD Action Plan and many other WHO and national strategies give clear quidance on what to do - But to achieve good results a lot of practical work in the communities and in the country is needed! 22.08.13 Pekka Puska, Director General 48
    49. 49. Thank you 22.08.13 49Pekka Puska, Director General

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