Dr alwan NCD


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  • To be more specific in terms of concrete work, each member states have to consider a set of action: under governance,
  • I agree it is an enormous agenda and it is difficult but these are exactly what every country has to do to strengthen health systems. We know there are gaps in all countries, irrespective of stage of development and income and these gaps have to be addressed
  • Dr alwan NCD

    1. 1. KEY QUESTIONS •Can we realistically reduce the NCD burden? •What is the way forward ? What are the commitments of member States • What do countries need to implement the commitments?International Conference on Healthy lifestyles and NCD prevention in the Arab World and Middle East
    2. 2. Four Major Groups of Noncommunicable Diseases Four major lifestyles related risk factors Modifiable causative risk factors Unhealthy Physical Harmful use Tobacco use diets inactivity of alcohol Heart disease and stroke    Noncommunicable diseases Diabetes     Cancer     Chronic lung disease 
    3. 3. Deaths in the Eastern Mediterranean Region (Millions of deaths in 2008) 4.5 M 4.0 M 11% 3.5 M 3.0 M 36% 2.5 M 2.0 M 1.5 M 1.0 M 0.5 M 53% 0.0 M Communicable, maternal, perinatal and nutritional conditions NCDs InjuriesInternational Conference on Healthy lifestyles and NCD prevention in the Arab World and Middle East
    4. 4. Projections• NCD mortality will increase by 15% worldwide by 2020. The greatest increase will occur in Africa followed by the Eastern Mediterranean Region
    5. 5. Deaths from NCDs before 60 in the EMR (Percentage of total NCD deaths in 2008) Qatar Somalia Kuwait Yemen Djibouti Bahrain Saudi Arabia Oman Sudan Syrian Arab Republic Iraq Pakistan Libyan Arab Jamahiriya Egypt Jordan Morocco Iran (Islamic Republic of) Lebanon Tunisia 0% 10% 20% 30% 40% 50% 60% 70%International Conference on Healthy lifestyles and NCD prevention in the Arab World and Middle East
    6. 6. Can we realistically reduce the burden? There is a strategic vision on how to address NCDs*Surveillance* *Prevention* *Management* Mapping the Reducing the Strengthen epidemic of level of health care for NCDs exposure to people with risk factors NCDs
    7. 7. Can we realistically reduce the NCD burden? WHO Global Status Report on NCDs (launched April 2011): Solutions • A national surveillance framework and monitoring scheme integrated into health information systems • Best buys interventions to prevent NCDs by reducing risk factors, implemented through a multisectoral approach • Practical approaches to improve management of NCDs, particularly at the PHC levelInternational Conference on Healthy lifestyles and NCD prevention in the Arab World and Middle East
    8. 8. How is the region doing? Key messagesWHO Country Profiles (launched in September 2011):  The NCD crisis is far advanced in most countries  Some encouraging responses in some countries, but not comprehensive and there are major gaps  Reliable data is scarce. Surveillance is generally weak  Proportion of countries implementing the core interventions is small  Some progress to improve health care at PHC but there are major inequities, monitoring is weak and training of health workforce is inadequate  There are large disparities in national capacities among countries, particularly in policy development and implementation
    9. 9. A framework for NCD surveillance• Exposures – Behavioural risk factors: tobacco use, physical inactivity, harmful use of alcohol and unhealthy diet – Metabolic risk factors: overweight/obesity, raised blood pressure, glucose & cholesterol. – Social determinants: education, material well being, access to health care• Outcomes – Mortality: NCD specific mortality – Morbidity: cancer incidence and type• Health System cCapacity and Response – Interventions and health system capacity: infrastructure, policies and plans, access to key health care interventions and treatments, partnerships.
    10. 10. A package of low-cost "best buy" solutions exist: but the implementation in the EMR is weakInterventions NCDs and risk factor Best buysPopulation-based Tobacco use  Tax increasesinterventions addressing  smoke-free indoor workplaces and public placesNCD risk factors  health information  and warnings about tobacco  bans on advertising and promotion Harmful use of alcohol  Tax increases on alcoholic beverages;  Comprehensive restrictions and bans on alcohol marketing;  Restrictions on the availability of retailed alcohol Unhealthy diet and  Salt reduction through mass media campaigns and reduced physical inactivity salt content in processed foods;  Replacement of trans-fats with polyunsaturated fats  Public awareness programme about diet and physical activityIndividual-based Cancer  Prevention of liver cancer through hepatitis B immunizationinterventions addressing  Prevention of cervical cancer through screening andNCDs in primary care treatment of pre-cancerous lesions Cardiovascular disease  Multi-drug therapy (including glycaemic control for diabetes and diabetes mellitus) to individuals who have had a heart attack or stroke, and to persons with a high risk of a heart attack or stroke in the next 10 years  Providing aspirin to people having an acute heart attack
    11. 11. Political Declaration of the High-level Meeting (United Nations General Assembly resolution 66/2) Strategic areas for Member States: • To recognize NCDs as a challenge of epidemic proportions in developed and developing countries • To promotes health-in-all-policies and whole-of-government approaches • To prioritizes actions and expand national capacity to: – Reduce risk factors for NCDs – Improve health care within the context of health system strengthening – Monitor NCDs and evaluate progressInternational Conference on Healthy lifestyles and NCD prevention in the Arab World and Middle East
    12. 12. What are the commitments of Member States?In the area of governance , countries are expected to:• assess their NCD situation and capacity and put in place comprehensive multisectoral plans by 22013• integrate NCDs into health planning processes.• Strengthen intersectoral action• explore sustainable resources to Increase and prioritize budgetary allocations to NCDs
    13. 13. What are the commitments of Member States? (Progress will be assessed during the UNGA in 2014)In the area of prevention and risk factors reduction , countriesare expected to:• Accelerate the implementation of the WHO FCTC, particularly the 6 demand reduction measures• Implement interventions to reduce salt, trans fat and sugar• Implement the WHA recommendations on marketing of foods and non-alcoholic beverages to children• Promote mass media campaigns on diet and physical activity• Promote breast feeding and implement the international code of marketing of breast milk substitutes• Consider vaccinations to prevent certain cancers
    14. 14. What are the commitments of Member States?In the area of health care , countries are expected to:• Review health systems, identify gaps and weaknesses and integrate NCD interventions into PHC• Prioritise effective interventions for early detection and treatment• Improve access to essential diagnostics and medicines• Explore viable health financing mechanisms like innovative approaches like tobacco taxation to increase coverage• Promote the production, training and retention of health workers
    15. 15. What are the commitments of Member States?In the area of surveillance and monitoring , countries areexpected to:• Develop national targets and indicators based on WHO guidance• Strengthen surveillance and integrate into national health information systems ( monitoring of risks and determinants, cause specific mortality, and health system capacity and response)
    16. 16. EXAMPLES OF AREAS REQUIRING FURTHER POLICY GUIDANCE AND ACTION … Strengthening surveillance aspects , developing guidance on health information systems and identifying effective approaches to address existing gaps Developing guidance on implementing the best buys, based on experience and best practices Refining evidence and summarising lessons learned for best buys e.g taxation, other forms of sin tax, removal of subsidies from certain food items Developing guidance on multisectoral action Establishing effective approaches to build capacity in cost/effectiveness analysis for policy making in the region Developing evidence/based clinical guidelines for common NCD conditionsInternational Conference on Healthy lifestyles and NCD prevention in the Arab World and Middle East
    17. 17. "This is the second health issue ever to be addressed at a special meeting of the United Nations General Assembly. We should all work to meet targets to reduce NCDs. WHOs best buys serve as excellent guidance" Ban Ki-moon • UN Secretary-General • 19 September 2011NCDs will remain on the UNGA agenda…2012. Progress will be assessed in 2113, 214 , and beyond….International Conference on Healthy lifestyles and NCD prevention in the Arab World and Middle East