Paper presented at the 2nd Public Health Seminar: Emerging public health issues, UNIMAS, 16 November 2015

1. Non-Communicable Diseases:
We know the answers, how
about the implementation?
Feisul Idzwan Mustapha MBBS, MPH, AM(M)
Public Health Physician
2nd Public Health Seminar 2015, UNIMAS
16 November 2015
Kota Samarahan, Sarawak

2. 2Source of icons: World Heart Federation Champion Advocates Programme
Global NCD
Targets
20%15%
23%15%
HED* <1.2%
35.2%30.0%
8.76.0gm
32.2%24.0%
<15.0%
Targets for
Malaysia
* Heavy episodic
drinking

3. 3
National Strategic Plan for
Non-Communicable
Diseases (NSP-NCD) 2010-
2014
 Presented and approved by the Cabinet on
17 December 2010.
 Provides the framework for strengthening
NCD prevention & control program in
Malaysia.
 Adopts the “whole-of-government” and
“whole-of-society approach”.
 Diabetes & obesity are used as the entry
points.
Seven Strategies:
1. Prevention and
Promotion
2. Clinical Management
3. Increasing Patient
Compliance
4. Action with NGOs,
Professional Bodies &
Other Stakeholders
5. Monitoring, Research
and Surveillance
6. Capacity Building
7. Policy and Regulatory
interventions

4. Where should our focus be 2015
onwards?
 Biggest contributor to DALY & deaths.
 Most cost-effective interventions (based on WHO
recommendations)
4

5. DALYs attributable to risk factors
5
10.8%
10.7%
9.0%
8.3%
5.2%
4.3%
3.1%
0.7%
0.1%
10.8%
0.7%
11.4%
12.1%
5.1%
0.9%
4.3%
0.7%
0.1%
15.0% 10.0% 5.0% 0.0% 5.0% 10.0% 15.0%
High BP
Tobacco
Diabetes Mellitus
High BMI
High Cholesterol
Alcohol
Physical Inactivity
Underweight
Poor Water & Sanitation
Male Female
Burden of Disease Study Malaysia 2008, slide courtesy of Dr Mohd. Azahadi Omar, Institute for Public Health

6. 19.4%
15.7%
8.5%
7.3%
7.0%
5.0%
2.3%
0.2%
0.1%
22.8%
1.2%
9.1%
8.1%
8.2%
7.1%
0.3%
0.2%
0.1%
25% 20% 15% 10% 5% 0% 5% 10% 15% 20% 25%
High BP
Tobacco
Diabetes Mellitus
High Cholesterol
High BMI
Physical Inactivity
Alcohol
Underweight
Poor Water & Sanitation
Male Female
Deaths attributable to risk factors
Burden of Disease Study Malaysia 2008, slide courtesy of Dr Mohd. Azahadi Omar, Institute for Public Health 6

7. Where should our focus be 2015
onwards?
1. Tobacco control and intensifying implementation of
FCTC
2. Salt reduction – health promotion
 NCD must take a leadership role in the multi-sectoral effort
3. Focus on community empowerment: using the KOSPEN
platform
4. Focus on the quality of management for hypertension
 However, not to introduce another program in silo
7

8. Proposed Framework for NSP-NCD
2015-2020 [based on the 9 voluntary global targets]
Proposal Status Division
1. Plan of Action for Prioritising Interventions
to fight Obesity in Malaysia 2015-2020
Work in
progress
Nutrition
2. Salt reduction strategy for Malaysia 2015-
2020
Work in
progress
Disease Control
3. National Strategic Plan for Tobacco Control Adopted Disease Control
4. Malaysia’s Alcohol Action Plan (MAAP)
2013-2020
Adopted Disease Control
5. National Action Plan for Physical Activity Work in
progress
Health
Education
6. Prioritising action for strengthening Chronic
Disease Management in Malaysia
Proposed Family Health
Development
7. National Plan of Action for Nutrition
Malaysia (NPANM) III 2016-2025
Work in
progress
Nutrition
8. National Cancer Blueprint Adopted Disease Control
8
The Overarching Framework for Prevention and Control of NCD in
Malaysia will be the proposed NSP-NCD 2015-2020 under which…

9. NCDs included in the 2030 Agenda for
Sustainable Development
9

10. NCDs included in the 2030 Agenda for
Sustainable Development
10

11. WHO NCD Progress Monitor 2015
11

12. 10 Progress Monitoring Indicators
12

13. 10 Progress Monitoring Indicators
13

14. NCD Progress Monitor 2015:
Malaysia
14

15. NCD Progress Monitor 2015:
Malaysia
15

16. So what is next?
 More soft policies?
 More hard policies?
 Are we clear on the causes of causes?
 Or is it the story of four people named Everybody,
Somebody, Anybody and Nobody?
16

17. Everybody, Somebody, Anybody and
Nobody?
There was an important job to be done and Everybody
was sure that Somebody would do it. Anybody could have
done it, but Nobody did. Somebody got angry about that,
because it was Everybody’s job. Everybody thought
Anybody could do it, but Nobody realized that Everybody
wouldn’t do it. It ended up that Everybody blamed
Somebody when Nobody did what Anybody could have.
17

18. Overview of Current Interventions for
NCD in Malaysia (from womb to tomb)
Pre-
conception
First 1,000 Days
To reduce obesity and NCDs-birth weight
Lifestyle during pregnancy – fetal health
Intervention
Package for young
couples at pre-
conception
Pregnancy
Infant/
Toddler
Pre-
School
School-
going Age
Guideline on Marketing of
unhealthy food & drinks to
Children
Guideline on Enforcement of
ban on sale of unhealthy food
& drinks outside of school
perimeters
Higher
Education
Adults Elderly
Komuniti Sihat, Perkasa
Negara (KOSPEN)
Healthy Workplace for a
Healthy Workforce
• School Canteen Guidelines
• BMI measurement twice
per year & reporting to
parents
• Involvement of PIBG / PTA
JOM MAMA
Initiative
MyBFF@school
• Healthy menu during meetings
• Healthy Cafeterias
• Healthy vending machine
policies
MyBFF@work
MyBFF@home
Kelab Doktor Muda
Program Siswa Sihat
(PROSIS)

19. 19Source of icons: World Heart Federation Champion Advocates Programme
Global NCD
Targets
20%15%
23%15%
HED* <1.2%
35.2%30.0%
8.76.0gm
32.2%24.0%
<15.0%
Targets for
Malaysia
* Heavy episodic
drinking

20. Thank you
20