NCD Program in Malaysia, overview

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Overview presented to group of undergraduate and postgraduate students from UPM on 9 December 2013 in Putrajaya

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NCD Program in Malaysia, overview

  1. 1. Ministry of Health Malaysia NCDs in Malaysia: Issues & Challenges Feisul Idzwan Mustapha MBBS, MPH, AM(M) Public Health Specialist Disease Control Division Ministry of Health, Malaysia 9 December 2013 dr.feisul@moh.gov.my
  2. 2. Non-Communicable Diseases Section • Headed by a Deputy Director • Consists of three main sectors: • NCD-Cancer-FCTC • Occupational & Environmental Health • Mental health, Substance Abuse, Violence and Injury Program (MESVIP) • Two main functions: • Policy and Program Development for the prevention and control of NCD in Malaysia • Monitoring and Evaluation 2
  3. 3. There are Four Major Groups of NonCommunicable Diseases; Four major lifestyles related risk factors Modifiable causative risk factors Noncommunicable diseases Tobacco use Unhealthy diets Physical inactivity Harmful use of alcohol Heart disease and stroke     Diabetes     Cancers     Chronic lung disease  3
  4. 4. Prevalence of Diabetes, ≥30 years (1996, 2006 & 2011) 25 20.8 Prevalence (%) 20 14.9 Total diabetes 15 8.3 10 5 0 10.7 9.5 6.5 4.3 4.7 5.4 NHMS III (2006) NHMS 2011 Prevalence of Hypercholesterolaemia, ≥18 years (2006 & 2011) 40 32.7 35.1 35 25 19.8 20 Total HPT 15 Known 10 Undiagnosed 12.8 Prevalence (%) 30 Prevalence (%) IFG 5.3 Prevalence of Hypertension, ≥18 years (2006 & 2011) 32.2 Undiagnosed 1.8 NHMS II (1996) 35 Known 10.1 26.6 30 25 20.6 Total HChol 20 Known 15 Undiagnosed 10 5 5 0 0 NHMS III (2006) NHMS 2011 Source: National Health & Morbidity Surveys (NHMS) 8.4 4 NHMS III (2006) NHMS 2011
  5. 5. Prevalence of Overweight & Obesity, ≥18 years (1996, 2006 & 2011) 35 Prevalence of Abdominal Obesity, ≥18 years (2006 & 2011) MALES 29.4 29.1 60 54.1 16.6 20 15.1 14.0 15 Overweight Obesity 10 4.4 5 PREVALENCE (%) 25 47.1 50 37.1 40 30.1 30 0 NHMS II (1996) NHMS III (2006)NHMS 2011 20 NHMS 2006 70 63.2 62.8 50 44.7 40 33.6 28.6 30 48.0 61.4 NHMS 2011 63.2 56.2 55.7 60 PREVALENCE (%) Prevalence (%) 30 FEMALES 51.0 50.4 Prevalence of Abdominal Obesity by age groups (NHMS 2011) 19.6 20 5 10 18-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+ AGE GROUPS (years)
  6. 6. Overweight in adults, ASEAN Region, 2010 50.0 45.0 40.0 Prevalence % 35.0 30.0 25.0 20.0 15.0 Male Female 10.0 5.0 0.0 6
  7. 7. Obesity in adults, ASEAN Region, 2010 18.0 16.0 14.0 Prevalence % 12.0 10.0 8.0 Male 6.0 Female 4.0 2.0 0.0 7
  8. 8. High Blood Sugars in Adults, ASEAN Region, 2010 12.0 10.0 Prevalence % 8.0 6.0 Male 4.0 Female 2.0 0.0 8
  9. 9. Burden of Diabetes in Malaysia: Trends & Projections by 2020 (Adults age 18 years and above) 25 5,000,000 Current projection 4,500,000 4,000,000 Prevalence (%) 3,500,000 15 3,000,000 2,500,000 10 2,000,000 1,500,000 5 Estimated population 20 1,000,000 500,000 0 0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Year Est. population, 2006 Est. population, 2011 Prevalence projection, 2006 Prevalence projection, 2011 9
  10. 10. UN Secretary-General: NCDs in developing countries are hidden, misunderstood and underrecorded A rapidly rising epidemic in developed and developing countries… … with serious socio-economic impacts, particularly in developing countries. Workable solutions exist to prevent most premature deaths from NCDs and mitigate the negative impact on development. The way forward: These solutions need to be mainstreamed into socio-economic development programmes and poverty alleviation strategies. 10
  11. 11. 11
  12. 12. 65th World Health Assembly (May 2012): Decided to adopt a global target of a 25% reduction in premature mortality from NCD by 2025. 66th World Health Assembly (May 2013): Adoption of the Global Action plan for the Prevention and Control of NCDs (2013-2020), including 25 NCD indicators with 9 voluntary global targets. 12
  13. 13. Global Monitoring Framework for NCDs Indicator Targets 1. Premature mortality from NCD 25% relative reduction in risk of dying 2. Harmful use of alcohol 10% relative reduction 3. Physical inactivity 10% relative reduction 4. Salt intake 30% relative reduction in mean population intake 5. Tobacco use 30% relative reduction 6. Hypertension Contain the prevalence 7. Diabetes & obesity Contain the prevalence 8. Drug therapy to prevent heart attacks & strokes At least 50% of eligible people receive therapy 9. Essential NCD medicines & basic technologies to treat major NCDs Availability & affordability 13 Note: Targets for year 2025, against baseline of year 2010. Reporting to the United Nations every five years (next will be in 2015)
  14. 14. Overarching principles & approaches in the GAP for NCD 14
  15. 15. Seven Strategies: 1. 2. 3. National Strategic Plan for Non-Communicable Diseases (NSP-NCD) 2010-2014 • • • 4. 5. 6. 7. 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-ofsociety approach” Prevention and Promotion Clinical Management Increasing Patient Compliance Action with NGOs, Professional Bodies & Other Stakeholders Monitoring, Research and Surveillance Capacity Building Policy and Regulatory interventions 15
  16. 16. Multi-Sectoral Approach: What & Why? • Working together across sectors to improve health and influence its determinant • Forging new collaborations and partnerships are critical in making progress in addressing the NCD epidemic. • Partnership occurs at different levels: • Individuals, families and communities. • Government, communities and NGOs. • Government, development partners (within countries), civil society and, as appropriate, the private sector. 16
  17. 17. ‘Whole-of-Government’ and ‘Whole- of-Society’ approach • ‘Whole-of-Government’ denotes public service agencies working across portfolio boundaries to achieve a shared goal and an integrated government response to particular issues. • Responsibility for health and its social determinants rests with the whole society, and health is produced in new ways between society and government. 17
  18. 18. Social Determinants of Health 18
  19. 19. Cost effective interventions to address NCDs Populationbased interventions addressing NCD risk factors - Excise tax increases Smoke-free indoor workplaces and public places Health information and warnings about tobacco Bans on advertising and promotion Harmful use of alcohol - Excise tax increases on alcoholic beverages Comprehensive restrictions and bans on alcohol marketing Restrictions on the availability of retailed alcohol Unhealthy diet and physical inactivity Individualbased interventions addressing NCDs in primary care Tobacco use - Salt reduction through mass media campaigns and reduced salt content in processed foods Replacement of trans-fats with polyunsaturated fats Public awareness programme about diet and physical activity Cancer - Prevention of liver cancer through hepatitis B immunization Prevention of cervical cancer through screening (visual inspection with acetic acid [VIA]) and treatment of precancerous lesions CVD and diabetes - Multi-drug therapy (including glycaemic control for diabetes mellitus) for individuals who have had a heart attack or stroke, and to persons at high risk (> 30%) of a cardiovascular event within 10 years Providing aspirin to people having an acute heart attack - - 19
  20. 20. Interventions & Multi-Sectoral Action ADVOCACY, HEALTH IMPACT ASSESSMENT  HEALTH IN ALL POLICIES Tobacco use Harmful use of alcohol • Excise tax increases on alcoholic beverages • Comprehensive restrictions and bans on alcohol marketing • Restrictions on the availability of retailed alcohol Unhealthy diet and physical inactivity MINISTRIES Excise tax increases Smoke-free indoor workplaces and public places Health warnings Bans on advertising and promotion • • • • • Salt reduction through mass media campaigns and reduced salt content in processed foods • Replacement of trans-fats with polyunsaturated fats • Public awareness programme about diet and physical activity MSA  Health, Ministries including Agriculture, • Health • Agriculture Finance, • Finance Transport, •Transport  Trade and Industry • Trade and Industry Education, • Education • Labour Labour, • Urban planning Urban planning, • Justice Justice OTHER STAKEHOLDERS  Other stakeholders including Civil society, • Industry • Civil society NGOs, • NGOs Academia, • Academiasector, Private  Donor, development partners 20 “Healthy” Settings such as Cities, Towns, Schools, Workplaces etc.
  21. 21. MSA-Entry Points National National multi-ministerial forum • Effective only with commitment at the highest level, need a good driver, Health in All Policies Inter ministerial Subnational City/District/Village level • More feasible, leverage local government, collective voice of community, government closer to the community, local ordinances Local Government Risk factor Tobacco/Alcohol/Physical Activity • Facilitators-activism, pressure groups, champions, international agreements (FCTC), global reporting, more palpable interventions, common good /common enemy Cross sector working groups 21
  22. 22. Current inter-sectoral mechanisms: MOH participation • Cabinet Committee for a Health-Promoting Environment. • Established under NSP-NCD. • Chaired by the Deputy Prime Minister, members consist of 10 Ministers • National Council on Food Safety and Nutrition • Established under the National Plan of Action for Nutrition. • MOH is also a permanent member of various interministerial committees under several ministries e.g. • • • • Ministry of Education; Ministry of Youth and Sports; Ministry of Housing & Local Governments; Ministry of Women, Family and Social Affair. 22
  23. 23. Current inter-sectoral mechanisms Cabinet Committee for A Health Promoting Environment Chaired by the Deputy Prime Minister 1. Minister of Health 2. Minister of Education 3. Minister of Information, Communications, Arts & Culture 4. Minister of Rural & Regional Development 5. Minister of Agriculture and Agro-based Industry 6. Minister of Youth & Sports 7. Minister of Human Resource 8. Minister of Domestic Trade, Co-operatives and Consumerism 9. Minister of Housing and Local Governments 10. Minister of Women, Family and Social Affairs Main TOR: To determine policies that creates a living environment which supports positive behavioural changes of the population towards healthy eating and active living 23
  24. 24. Strategy 7 NSP-NCD: Policy & Regulatory Interventions • Main thrust of NSP-NCD • Health promotion and education will increase awareness and knowledge • However changes in behaviour is strongly influenced by our living environment Awareness Knowledge Health promotion & educations Behavioural Change Supportive living environment 24 Policies & regulations
  25. 25. 25
  26. 26. Strategy 7: Policy & Regulatory Interventions, Progress thus far… • Guideline on marketing of foods and non-alcoholic beverages to children (Self-regulatory, August 2013). • Strengthening implementation of the Framework Convention for Tobacco Control (FCTC). • Guideline on food and beverages sold in school canteens (revised guideline, January 2012). • Banning of sale of food & beverages by mobile vendors outside of school perimeters (2012) • Health-promoting workplaces in the public sector • Healthy menus during meetings • Healthy vending machines • Healthy cafeterias There is still much that needs to be done…. 26
  27. 27. Lessons learned from the past and current attempts to work with other sectors • Go for the path of least resistance. • Perhaps less impact, but at least establish the link and develop trust. • Compromise, find the “middle path” • You cannot force the other sectors to go 100% your way. • Be creative – think “out-of-the-box” • Use other existing mechanisms not previously used to move the NCD prevention agenda forward. • Be sensitive to current global/national trends. • Use any opportunity to move the NCD prevention agenda forward. 27
  28. 28. Meet their primary interestNCD prevention can be a Co-Benefit Education Improved scholastic outcome Improved health of children Agriculture Improved production of fruits and vegetables Improved consumption of f&v in population Industries Urban planning Improved productivity Less expenses on sickness of employees Beautiful city, more tourists, more money Healthier people More physical activity 28
  29. 29. Strategy 5, Research • What’s new? • Currently developing a research framework for developing and evaluating behaviour change interventions in combating obesity among Malaysians. • JOM MAMA – a pre-pregnancy intervention for the future prevention of obesity, diabetes and CVD. • SEACO Demographic Surveillance Site. • HOPE-4: Hypertension Outcomes Prevention and Evaluation 4; cluster randomised trial of a model hypertension and CVD risk assessment, detection, treatment and control programme. 29
  30. 30. Challenges for Malaysia • The main challenge in policy and regulatory interventions remain that they are mostly under the responsibilities of ministries and departments other than Ministry of Health • Ministry of Health needs to take leadership role. • Need to find a win-win solution – “mutuality of interest”. • Economic and “political” consideration remains paramount and needs to be acknowledged. • The health sector needs to play a strong advocacy role. 30
  31. 31. Summary • Preventing and controlling NCD is an urgent priority for all countries. • Most of the drivers of NCDs and their risk factors lie outside the control of the health sector. • Specific for NCDs: • MSA is required to create enabling environments, so that healthy choices are the easy choices. • MSA is also required to break the cycle of poverty and NCDs. • The prevention and control of NCDs and their risk factors have a positive impact not only on health, but also on productivity and economic and social development. 31
  32. 32. Health promotion champions • Public health personnel are most suited to become health promotion champions • Health knowledge • Clinical skills • Communication skills • Right attitude • Confidence among people • Friendly 32
  33. 33. Thank you dr.feisul@moh.gov.my Facebook: Feisul Mustapha 33

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