UN Environment Programme - Environment for Development for MYANMAR-capacity4dev.eu
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UN Environment Programme - Environment for Development for MYANMAR The European Commission’s knowledge sharing platform for development cooperation -capacity4dev.eu for Myanmar (2017-18) https://europa.eu/capacity4dev/capacity-building-in-public-health-for-development/discussions/awareness-workshop-held-yangon-non-communicable-diseases-and-long-term-care-myanmar Awareness Workshop Held in Yangon on Non-communicable Diseases and Long Term Care - Myanmar https://europa.eu/capacity4dev/capacity-building-in-public-health-for-development/documents/icph-gmr-session-sphip-myanmar-experiences ICPH-GMR Session SPHIP Myanmar experiences https://europa.eu/capacity4dev/capacity-building-in-public-health-for-development/photo-albums/international-conference-public-health-gmr-countries-2017-myanmar-photo-impression International Conference Public Health GMR Countries, 2017 Myanmar, a photo impression https://europa.eu/capacity4dev/search?text=myanmar&f[0]=c4m_vocab_geo%3A111
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- 1. 2/2/2018 Awareness Workshop Held in Yangon on Non-communicable Diseases and Long Term Care - Myanmar | capacity4dev.eu https://europa.eu/capacity4dev/capacity-building-in-public-health-for-development/discussions/awareness-workshop-held-yangon-non-communicable-… 1/2 More info Information Awareness Workshop Held in Yangon on Non-communicable Diseases and Long Term Care - Myanmar 0 0 11 A one day workshop was organized in Yangon on 16 January 2018 by HelpAge International and University of Public Health under the European Union supported project ‘the strengthening public health capacity to Myanmar’s disease transition’ to raise awareness on NCDs and long term care. The workshop was attended by 70 participants including office bearers and members of Myanmar aging network, federation of older people’s self help groups, NGO representatives, government officials and other stakeholders from different states and regions of Myanmar. The workshop started with opening speech by Prof. Khay Mar Mya, Rector of the University of Public Health. She highlighted the need and importance of addressing NCDs and strengthening long term care. She said that it is high time for us to focus on addressing the NCDs and strengthening long term care by promoting healthy life styles for prevention of NCDs, improving screening services for early detection of NCDs as well as strengthening of health services and other mechanisms of community based and institutional long term care for older people in Myanmar.
- 3. Introduction • Myanmar is the second largest country in South-East Asia. • Population- 51,486,253 (Census 2014) • Ongoing epidemiological transition increasing the burden of NCDs. • 68% deaths due to NCDs (WHO- 2017). • 94% adults live with at least 1 risk factor of NCDs (STEPS 2014). • Limited capacities for research, policy, programming for prevention and control of NCDs.
- 4. Objectives of the Project • The University of Public Health Myanmar, University of Medicine 2, Help Age International and Thammassat University Thailand collaborating for public health capacity building project through triangular collaboration. • Supported by the European Union under strengthening public Health Institutions Programme. • The objectives of this project are: - To strengthen the University of Public Health for enhanced evidence based policy analysis and providing research evidence based on international scientific knowledge and supported by local research. - To build public health capacities of the larger health system for addressing disease transition specially through integration of NCD services at primary healthcare level.
- 5. Major Strategic Components of the Project Research - Assessment of research gaps and developing priority research agenda - Enhanced research to inform policy and programmatic response to address health transition Policy - Increased policy dialogue and consultation - Enhanced evidence based policy analysis - Developing National Strategic Action Plan on NCDs Capacity Building - Greater knowledge and skills among policy makers and public health implementers - Capacity building for PEN expansion - Stronger UPH to deliver high quality teaching and research Communication - Wider dissemination of research evidence through workshops, publications and different communication media for awareness and policy initiatives Strengthening Public Health Capacity to Respond to Myanmar’s Disease Transition
- 6. Activities • Conducted trainings for faculty and researchers on NCDs focussed research, policy development and policy analysis. • Assessed available research evidence on NCDs, identified the gaps and developed draft prioritized research agenda. • Conducted learning exchanges for UPH faculty, researchers and officials from MOHS to show first hand experiences. • Organized five advocacy workshops with concerned stakeholders. • Developed for the Ministry of Health and Sports a national strategic plan on prevention and control of NCDs (2017- 2021).
- 12. Activities • Developed, pre-tested and finalized two training manuals for training of lower and medium-level health care providers in prevention and integration of NCD services into primary healthcare. • Conducted training for central training team and regional training teams. • Conducting training of township medical officers and other medical/public health officers on PEN interventions (990 TMOs/MOs from 330 townships) • Training of basic health staff on PEN interventions by TMOs/MOs. • Developing health information system for NCDs prog. • Conducting action research during the roll-out of the training.
- 14. Indicator Framework • Indicator framework for progress monitoring and impact measurement of NCD prevention and control Inputs - Number of training manuals developed - Number of healthcare providers trained - Number of supportive supervision visits conducted Outputs - % improvement in knowledge and skills of trained providers - % of health facilities with trained providers, medicines - Number of consultations held - Number of preventive activities held - Number of patients diagnosed for NCDs - Number of patients treated/referred Outcomes - % reduction in prevalence of NCD risk factors - % reduction in prevalence of morbidity and mortality due to NCDs
- 15. Tools and Processes • Patient registries, individual patient screening and treatment records • Referral records • Facility registers with daily summary reports, • Monthly summary reports • Quarterly summary reports • Data entry in electronic formats • Data processing, report generation and feedback
- 30. Monitoring and Data Validation Mechanism • Supportive supervision visits • Scoring of facilities based on performance • Periodic review meetings and feedback • Studies on preparedness and responsiveness of health facilities • Conducting studies on barriers and facilitators of NCD service utilization • Studies on service utilization, quality of services and patient satisfaction
- 31. Monitoring and Data Validation Mechanism • Study on NCD morbidity and mortality • Comparison with STEPS survey on NCD risk factors • Establishing community based feedback mechanisms on NCD services • Triangulation of data from monthly/quarterly reports from facilities, supportive supervisions visits and independent studies/surveys
- 32. [Thanks.Acknowledgements: - Thanks to the European Union for funding this project in Myanmar. - Thanks to University of Public Health Myanmar, University of Medicine 2, Help Age International and Thammassat University Thailand for collaborative work and Age International and World Diabetes Foundation for co-funding. - Thanks to Ministry of Health and Sports, the Government of Republic of the Union of Myanmar for full cooperation. - For more information please visit: Project Website: www.sphcmyanmar.org Facebook Page: https://www.facebook.com/SPHCMyanmar/
- 34. Myanmar: Overview • Population- 51,486,253 (Census 2014) • Ongoing epidemiological transition increasing the burden of NCDs. • 94% adults live with at least 1 risk factor of NCDs (STEPS 2014). • 68% deaths due to NCDs (WHO- 2017). • Limited capacities for research, policy, programming for prevention and control of NCDs.
- 35. About the Project • Objectives- To strengthen the UPH and wider health stakeholders for evidence-based policy development and policy analysis on NCDs and to improve institutional capacities for managing the transition towards NCDs in Myanmar. • 5 year project, 3.5 Million Euro- Funded by European Union, co-funded by Age International and World Diabetes Foundation. • Partners: HelpAge International, University of Public Health, University of Medicine 2 and Thammasat University. • Working very closely with NCD Unit of Ministry of Health and Sports, Government of Myanmar.
- 37. Major Strategic Components Research - Assessment of research gaps and developing priority research agenda - Enhanced research to inform policy and programmatic response to address health transition Policy - Increased policy dialogue and consultation - Enhanced evidence based policy analysis - Developing National Strategic Action Plan on NCDs Capacity Building - Greater knowledge and skills among policy makers and public health implementers - Capacity building for PEN expansion - Stronger UPH to deliver high quality teaching and research Communication - Wider dissemination of research evidence through workshops, publications and different communication media for awareness and policy initiatives Strengthening Public Health Capacity to Respond to Myanmar’s Disease Transition
- 38. Progress and Achievements Research Component • Completed assessment of research gaps on NCDs (literature review and qualitative interviews ) • Conducted KAP survey on mental health (Mental Health Literacy in Community) • Formed Research Advisory Committee, organized two meeting of RAC to discuss on the findings of research gap assessment and to develop priority research agenda on NCDs • Developed priority research agenda on NCDs • Started work on developing study design on NCD morbidity • Started work on developing study design for qualitative study on mental health
- 39. Progress and Achievements Policy Component • Organized a policy introductory meeting by TU and Consultants- Yangon, October 2015 • Experience Sharing Workshop on Health Care System and Policy Development in NCDs, Experiences and Lessons learned from Thailand- Yangon, January 2016 • Workshop on Policy Analysis and Policy Development Process with focus on NCDs- Nay Pyi Taw- October 2016 • Developed and formally released (MOHS) the National Strategic Action Plan for prevention & control of NCDs in Myanmar: 2017-21
- 40. Progress and Achievements Policy Component • Health policy workshop for faculty and researchers from UPH, other universities and NCD unit, Yangon, 25-27 April 2017 • Health policy workshop for faculty and researchers from UPH, Yangon, 6-8 September 2017 • Workshop on health policy and systems research, 24-26 October 2017 • Meeting of NCD stakeholders for establishing national NCD network including non-health actors
- 45. Progress and Achievements Capacity Building Component Learning Exchange with Thammasat University: - Learning Exchange Program (1) on Primary Care Services and Counseling on NCDs (14-18, September 2015) Bangkok, Thailand - Learning Exchange Program (2) on PEN site health center and planning on health policy at UPH (29-30 October 2015), Yangon - Learning Exchange Program (3) Primary Care Services & Service delivery (2-6 Nov 2015), Bangkok, Thailand - Learning Exchange Program (4) on health care system and policy development in NCDs: experience sharing from Thailand (12th Jan 2016), Yangon, Union of Myanmar
- 46. Progress and Achievements Capacity Building Component Learning Exchange with Thammasat University: - Learning Exchange (5) Monitoring & Evaluation of NCDs Programmes (23rd -27th May 2016), Bangkok, Thailand - Learning Exchange 6: NCD - Surveillance and Services, (17th -20th January 2017), Bangkok, Thailand - Learning Exchange 7: NCDs prevention programs under Universal Health Care Coverage, (11-13 September 2017), Bangkok, Thailand
- 48. Progress and Achievements Capacity Building Component • Capacity building and advocacy for PEN Expansion - Meeting on formulation of Strategic Plan for Scaling Up of PEN in Myanmar (18th Feb 2016), Yangon - Workshop on development of plan for scaling up of PEN in Myanmar (1st March 2016), Nay Pyi Taw - PEN Scaling up Meeting, Yangon (29th July 2016) - Meeting for initiation of PEN expansion & Development of National Strategic Plan on NCDs meeting- UM 2, Yangon, 28th October, 2016
- 49. Progress and Achievements Capacity Building Component • Advocacy Workshops on NCDs and PEN Expansion in 5 States and Regions State/Region Date Number of Participants Yangon 09 August 2016 100 Bago 12 August 2016 153 Nay Pyi Taw 16 August 2016 60 Mandalay 19 August 2016 120 Mawlamyaing 24 August 2016 70
- 52. Progress and Achievements Capacity Building Component • Developed two manuals for PEN Scaling-up training • Central team training for PEN scaling-up (1st and 2nd Feb 2017), Yangon (23 participants) • Refresher course for TOT of PEN Manual guideline for Central Team , UPH, Yangon, 7th March 2017 • Package of Essential Non-communicable Diseases Interventions (PEN) Training of Township Level Medical and Public Health Officials (First batch)- 14th-16th March 2017, Nay Pyi Taw (50 participants), (Second batch)- 28th-30th March 2017, Yangon (41 participants), (Third batch- 62 Participants), 25-27 October, Nay Pyi Taw • 9 supervision visits conducted • Training on trends, prevention & control of NCDs for University of Community Health, Magway- June 2017 (128 participants)
- 54. Progress and Achievements Capacity Building Component • Supported for public health curriculum review for UPH and 5 medical universities • Organized two day national seminar on public health curriculum review : 3-4 May 2017 • Organized stakeholder consultative workshop on mental health- 27 June 2017 • Strengthened physical facilities for training/learning at: - UPH, UM2 and PEN Site (Myaungdagar RHC)
- 55. Progress and Achievements Capacity Building Component • Training on Project Cycle Management - Administrative Staff: 30 Sept. to 2 Oct. 2015 (15 participants) - Academic Staff- 11 to 13 Nov. 2015 (20 participants) • Training for administrative staff on financial management- 29 – 30 March 2016 (15 participants)
- 56. Progress and Achievements Capacity Building Component • Established E-library at UPH , 2017 • Participation in course on systematic reviews, Australia, October, 2017 • Participation in strategic meetings and conferences on NCDs and ageing • Conducted one in-country learning exchange an sharing on cervical cancer guidelines, October 2017 • Arranged one meeting with University of Hong Kong for developing linkages and south-south collaboration, September 2017
- 58. Progress and Achievements Communication Component • Knowledge and evidence dissemination workshops: - Two dissemination workshops for STEPS NCD risk factors survey (Nay Pyi Taw - 4th February 2016 and Yangon - 17th March 2016) - Experience Sharing Workshop on Tobacco Control in Myanmar (Yangon- UPH 11 July 2016) - Dissemination Seminar on findings of Mental Health assessment (7th July 2016)
- 59. Progress and Achievements Communication Component • IEC Material Developed and Distributed: - STEPS Survey report - STEPS Fact Sheets (English and Myanmar Version) - STEPS Data Sheet - Project brochures - Booklets on overview of NCDs in Myanmar - Research gap assessment report
- 60. Progress and Achievements Communication Component IEC Material Developed and Distributed: - First policy brief on overview of NCDs - Second policy brief on PEN implementation in Myanmar - Third policy brief on mental health under progress - Poster on NCDs developed - Pamphlet on NCDs prevention developed
- 61. Progress and Achievements Communication Component • Electronic and Social Media - Project website (2017) www.sphcmyanmar.org - Created (2016) and regular updating a Facebook page for the project for sharing new updates and awareness raising https://www.facebook.com/SPHCMyanmar/?ref=aymt _homepage_panel - Short film on the project (2017) http://sphcmyanmar.org/audio-and-video-resources/
- 62. Progress and Achievements Communication Component - Highlighting our work and NCD related issues in print and electronic media in Myanmar - Contributing news items regularly for SPHIP newsletter for larger visibility - Contributing news items regularly for HelpAge regional newsletter for larger visibility - Presenting our work in different conferences for knowledge sharing
- 63. Thanks.
- 64. Khin Thiri Maung, MPH Deputy Project Manager HelpAge International
- 65. National Health Plan (2011-2016), priorities actions Chronic non-communicable diseases *Cardiovascular disease *Diabetes Mellitus *Cancer *Chronic respiratory disorders Non-communicable diseases/conditions of public health importance *Accidents and injuries *Disabling conditions (Blindness, Deafness, Community based rehabilitation) *Mental Health *Substance abuse *Snake bite
- 68. Steps for NCD research agenda • Review of available evidence on NCDs and risk factors • Discussion of key findings on gaps • Framework for priority research agenda • Prioritization of research to address key evidence needs • Support program managers, institutions, researchers and decision makers for policy
- 69. Aims • Focus on key research issues that are likely to have the greatest potential to impact prevention and control of NCDs • Generate knowledge where there are gaps • Help translate available knowledge into policy and practice through innovative approaches
- 70. Initial Review of research on NCDs 1. Research gaps were identified through a literature review of the research conducted in Myanmar plus country-specific research from outside Myanmar • Keyword searches of electronic databases • Manual searching of papers within Myanmar academic and government institutions. • A range of publication types were included in the search: Published studies, Conference proceedings and abstracts, unpublished research and other reports/documents, systematic search and collections 2. Ethics Review Committee inquiry 3. Key informant interviews of leaders from the health sector
- 71. 1. Literature Review Methods • Research activities on NCDs from 2000 to 2015 • 230 papers identified in review • Included studies of prevalence, risk factors, knowledge and behaviours, interventions • Included 145 papers • Prevalence: 58 • Risk factors: 55 • Interventions: 26 • Care: 6
- 72. 2. Ethics Review Inquiry Methods • Met with Seven Ethics Review Committees • 5 Medical Universities • Dept. of Medical Research of Ministry of Health • University of Public Health • Criteria • On-going research on NCDs: prevalence, risk factors, knowledge and behaviours, interventions
- 73. Sr. No. Organizations/Institutions/Department M F Total 1 NGO/INGO 2 1 3 2 Ministry of Health 1 1 2 3 Medical Universities 2 4 6 4 Department of Public Health 5 6 11 5 Agencies 1 0 1 6 Co-Investigators 2 4 6 Total 13 16 29 3. Key Informant Interviews Method: 9 question tool, all open ended - Opinions of the key NCDs research gaps in Myanmar - Opinion of highest priority research needs for NCDs Participants: Heads of universities, government departments, etc.
- 74. Methods *This prioritized research agenda is consistent with international standards. *The agenda uses the same definition of research as the WHO Strategy on Research for Health *It divides the gaps in information found in Myanmar into four research domains agreed to by a consortium of countries and advocated by WHO, including (i) social and economic determinants (ii) (ii) behavioral risk factors (tobacco use, physical inactivity, obesity, unhealthy diet and harmful use of alcohol); (iii)(iii) prevention, detection and care of major NCDs (CVD, cancer, chronic respiratory disease and diabetes) (iv)(iv) relevant health policy, health equity and health systems issues.
- 75. Methods *The Research Advisory Committee (RAC) consists of active members of Myanmar’s public health research, academic and program community. The members come from various schools and centers to ensure that the committee is balanced and that decisions are well informed and impartial. *Using their differing perspectives and areas of expertise, they apply their own expertise to ensure high quality research recommendations. *The findings from An Assessment of Available Evidence on NCDs and their Risk Factors in Myanmar *The RAC members reviewed and discussed each research program, and they were edited to reflect their recommendations.
- 76. Global Priority Areas for NCD Research *Research on social & economic determinants *Behavioral risk factors (tobacco use, physical inactivity, obesity, unhealthy diet & harmful use of alcohol) *Prevention, detection & care of major NCDs (CVD, cancer, chronic respiratory disease, & diabetes) *Relevant health policy, health equity, & health systems issues
- 77. Social & Economic Determinants *Causes of common NCD risk factor distributions *Assess & monitor socioeconomic & environmental factors/underlying drivers over time *Influence of urbanization on lifestyles *Health impacts of urban & rural development programs
- 78. Behavioral Risk Factors (tobacco use, physical inactivity, obesity, unhealthy diet & harmful alcohol use) *Additional information needed to monitor behavioral risks beyond those included in STEPS *Intervention studies to change behavioral risks *Developing & promoting healthier models of food production, marketing, & consumption *Exploratory & mixed methods behavioral influences
- 79. Prevention, detection & care of major NCDs (CVD, cancer, chronic respiratory disease & diabetes) *Strengthen vital registration & HMIS *Cost-effectiveness studies of intervention implementation *Monitoring & evaluation of PEN utilization in Primary Health Care *Identify & deliver national interventions based on global “best buy” interventions *Task-shifting, family & self-care, & eHealth for NCD prevention & care *Use of health technology assessment & audit to improve quality of health care *Community-based assessments of quality, & satisfaction
- 80. Health Policy, Health Equity & Health Systems *Cost-effectiveness policy studies of fiscal & legal means of health protection *Monitor national targets & health policy enforcement *Evaluate health impacts of public policies on food security, trade, agriculture, *& rural/urban development *Examine facilitators & barriers for cross-sectoral working for health *Sustainable development *strengthen the prevention & treatment of substance abuse *reduce deaths from Road Traffic Accidents *reduce deaths from hazardous chemicals, air pollution, & soil contamination
- 81. Key Gaps in Myanmar Research of NCDs *Mortality from NCDs & monitoring of mortality over time *Morbidity from NCDs & monitoring over time *Metabolic/physiological risk factors within the population & monitoring of risk factors over time *Information for decisions on priority interventions to address key risk factors *Current levels of behavioral risk factors & monitoring of these risk factors over time *Information for the development of campaigns to address key behavioral risk factors
- 82. Key Gaps in Myanmar Research of NCDs *Assessment of key health (and other) system responses to NCD prevention & control *Information for decisions on key health (and other) system responses to address the NCD burden *Assessment of socio-economic & other underlying drivers that impact on NCD burden *Assessment of key environmental factors impacting on NCDs & general health *Information for decisions on key interventions to address environmental challenges *Information for monitoring changing environmental & other factors impacting on the burden of NCDs
- 83. Prioritizing *A survey was created for each member of the RAC to rate the research programs on three parameters (urgency, feasibility, and impact). *The ratings were scored by summing the responses in each parameter: high = 3, medium = 2, and low = 1, producing a total (between 3 and 9) for each research program. *The mean represented a final score for each research program, and these final scores were rank-ordered. In addition, participants were encouraged to designate sources of potential funding, and the responses were collected in the form of textual data. *Two research advisory committee meetings were held to prioritize the research agenda. *A total of 24 research priorities were identified by 36 members of RAC.
- 84. Sorted Research Priorities within Domain I: Social and Economic Determinants Research Priorities Rank Causes of common NCD risk factor distributions 7.92 Occupational exposures & NCDs 7.16 Influence of urbanization & joblessness on lifestyles (youth & adult) 6.68 Assess & monitor socioeconomic & environmental factors/underlying drivers over time 6.68 Health impacts of urban & rural development programs 6.36 Mean 6.96
- 85. Sorted Research Priorities within Domain II: Behavioral Risk Factors Research Priorities Rank Developing & promoting healthier models of food production, marketing, & consumption 7.72 Intervention studies to change behavioral risks 7.60 Additional information needed to monitor behavioral risks beyond those included in STEPS 6.72 Exploratory, community-based, & mixed methods behavioral influences 6.40 Mean 7.11
- 86. Sorted Research Priorities within Domain III: prevention, detection and care of major NCDs Research Priorities Rank Strengthen vital, cancer registry, registration & HMIS 7.75 Monitoring & evaluation of PEN utilization in Primary Health Care 7.38 Task-shifting, family & self-care, & eHealth for NCD prevention & care 7.33 Identify & deliver national interventions based on global “best buy” interventions 7.08 Community-based assessments of quality, & satisfaction 7.04 Cost-effectiveness studies of intervention implementation and training programs 7.00 Use of health technology assessment & audit to improve quality of health care 6.42 Mean 6.97
- 87. Sorted Research Priorities within Domain IV: Relevant health policy, health equity & health systems issues Research Priorities Rank Sustainable development: reduce deaths from Road Traffic Accidents 8.17 Evaluate health impacts of public policies on food security, trade, agriculture, & rural/urban development 7.29 Cost-effectiveness policy studies of fiscal & legal means of health protection, economic burden, & insurance 7.21 Monitor national targets and health policy enforcement 7.21 Sustainable development: strengthen the prevention & treatment of substance abuse 7.00 Sustainable development: reduce deaths from hazardous chemicals, air pollution, & soil contamination 6.88 Examine facilitators & barriers for cross-sectional working for health (community support) 6.33 Health impacts of urban & rural development programs 6.33 Mean 6.75
- 88. Discussion *Income inequalities and poverty levels are main drivers of NCD risks which is further exacerbated by poor information about different population groups. *One of the areas of research prioritized under behavioral risk factors by the RAC is the development and promotion of food production, marketing, & consumption. *Under the prevention, detection, and care of major NCDs, Myanmar's health system has a working registry and has implemented PEN. *National policies on road traffic accidents, food security, and catastrophic health insurance for families can increase the health and reduce exposure to risk for the general population. Cost- benefit studies will assist policy-makers develop the appropriate legislation. *The research prioritized in this report does not represent an exhaustive list therefore over time more areas requiring urgent attention will emerge.
- 89. Discussion The RAC discussed issues for research in Myanmar. There is a divergence between the rising NCD burden and the research capacity and output of Myanmar. The reasons for this low output of research include: *inadequate training of professionals and poor infrastructure for research; *shortage of funds for research; *absence of effective leadership and peer support in research; *absence of a tradition of research; *research is often funded from external sources and addresses donor-driven research priorities that may not be appropriate for the context; *lack of economic impact and cost-effectiveness studies.
- 90. Thank you
- 91. 2/2/2018 International Conference Public Health GMR Countries, 2017 Myanmar, a photo impression | capacity4dev.eu https://europa.eu/capacity4dev/capacity-building-in-public-health-for-development/photo-albums/international-conference-public-health-gmr-countries-… 1/2 More info Photo Album International Conference Public Health GMR Countries, 2017 Myanmar, a photo impression 0 24 The 9th International Conference Public Health GMR Countries in 2017 Myanmar, was hosted by the University of Public Health in Yangon and supported by HelpAge International, together principal implementers of the NCD transition project under the Support to Public Health Institutes Programme. The theme of the conference was Adopting Healthy Lifestyles: Combating NCDs. This theme enabled the SPHIP programme to share its knowledge and experiences in plenary sessions and parallel sessions. The SPHIP programme organised a session, sharing the developments in Myanmar, Laos and Bangladesh. The presentations are also on this webpage. One of the highlights was the very inspiring speech by the Myanmar Union Minister of Health, who is a public health expert, and who called for action and government commitment to fight NCDs. There were vivid debates and discussions on how to approach the determinants of NCDs, and link to intersectoral work on education, nutrition, law enforcement, environmental protection, etc. international_conferenc… international_conferenc… international_conferenc… international_conferenc… international_conferenc… international_conferenc…
- 97. Healthy Lifestyle, a neoliberal concept? • Approach in Western countries: • The healthy choice is the responsibility of the individual, not the society • Budget for prevention around 3% of health care budgets • Focus is on clinical care NCDs with 90% of health budget
- 98. Healthcare costs explode in High-Income countries due to failing NCD prevention • Cost increased from US$ 2,300 in 1995 to US$ 5,200 per capita in High Income Countries • Demographic changes small contribution • People live longer with chronic diseases • Average 1 disease 50+ years • Average 2 diseases 65+ years Where is the healthy lifestyle?
- 99. What is the healthy choice if fast food is cheaper than healthy food? • Fast food chains expand all over the world • In many urban slums in low- and middle income countries healthy food is not affordable anymore
- 100. What is the healthy choice, if air pollution in mega-cities slowly kills the population? • COPD is number 3 killer in urban areas in the world • Urban population over 50% of the world population • Most unhealthy cities in low- and middle-income countries
- 102. What is the healthy choice if clean water becomes inaccessible for the poor? • Water stress increasing worldwide • Most water stress in low and middle-income countries • Economic due to privatisation of supply • Physical due to drought or water pollution
- 103. What is the free choice if tobacco industries can target the Asian population with advertisements?
- 104. Public health experts have to look beyond the individual lifestyle factors Due to neo-liberal approach • Western healthcare ignores social determinants of health • No health measures are promoted that could affect economic growth • No investment in health promotion
- 105. Lessons to be learned from NCD approach dominated by Western world until now • Addressing NCDs by curative care only is disastrous • Cost explosion and no increase of quality of life for the poor • Healthy choice is a myth • Especially for poor countries • Addressing NCDs requires socio-economical and political action to address determinants
- 106. Key Points for Action • Reinvigorate political action: coherent multisectoral policies • Enable health systems to respond more effectively to NCDs: effective prevention and control of NCDs • Increase significantly the financing of national NCD responses and international cooperation: investing in health has economic benefits • Increase efforts to engage sectors beyond health: interconnectedness between NCDs and the achievement of the SDGs • Seek measures to address the negative impact of products and environmental factors harmful for health
- 107. And the good news is…. • These recommendations come from Montevideo Roadmap on NCDs • Input into the 71st World Health Assembly • Input into the third High-level Meeting of the United General Assembly on NCDs in 2018 • We have many governments on our side for a radical change in approach • We must continue lobby Montevideo Roadmap 2018- 2030 on NCDs as a Sustainable Development Priority. WHO conference 18- 20 October 2017 confirmed that NCDs are part of SDGs.