This document summarizes efforts by the Pan American Health Organization to address noncommunicable diseases (NCDs) in the Americas from 2004 to 2012. It discusses commitments made at the UN High-Level Meeting on NCDs and advances made, including developing an NCD strategy and regional action plan with targets. It outlines objectives around multi-sector policies, risk factor reduction, health system response, and surveillance. The document also describes the CARMEN network of NCD surveillance sites and a meeting in Brasilia in 2012 around implementing the UN declaration on NCDs. It highlights policy advances, health promotion initiatives, and integrated management models to address NCDs in the Americas.

1. 2004
Noncommunicable diseases in
the Americas
post UN commitments & advances
Branka Legetic, MD, MPH, PhD
PAHO-WHO Regional Adviser on
Prevention and control of NCDs
Pan American
Health
Organization

2. FACING THE FACTS IN THE AMERICAS: disease burden
149 million smokers
Chronic respiratory disease 25% persons >15 years old obese
Other NCDs
Diabetes
TOTAL NCD DEATHS 2008 Cardiovascular
diseases
3,9 M
36% deaths are
Cancer below age 70 years
Approx. 200 million people living with an NCD in the Americas

3. Potential life expectancy gain in
the absence of selected risks to
global & regional health,

4. NCDs and Development Agenda

5. 2004
POST UN HLM and PAHO
NCD Regional Strategy 2012
Plan of Action with regional targets and
indicators
2. Technical cooperation with Member States
3. Continue advocacy in global forums: Social
Determinants, G8/G20, Summit of the Americas, etc.
4. Promote multi-sector partnerships
• Pan American Forum for Action on NCDs
5. Broader engagement in NCDs with other regional UN
agencies
Pan American
Health
Organization

6. 2004
2012
Pan American
Health
Organization

7. Regional Action Plan 2013 : 2004
OBJECTIVE 1: Multi sector policies and partnerships
1.1: To establish multi-sector partnerships and integration of
NCD prevention policies into sectors outside of health
OBJECTIVE 2: NCD risk factor reduction & protection
2.1: To reduce tobacco use and exposure to second-hand smoke[1].
2.2: To reduce the harmful use of alcohol[2].
2.3: To promote healthy eating and active living (salt, Trans fat)
OBJECTIVE 3: Health System Response to NCDs
3.1 To strengthening the capacity of primary health care providers
3.2 To implement a model of integrated management of NCDs
3.3. To secure supplies for NCD drugs.
3.4. To secure coverage of multi-drug therapy
OBJECTIVE 4: NCD surveillance and research
4.1.quality of NCD and risk factor surveillance systems, including
cancer registries
Pan American
4.2. improve utilization of NCD and risk factor surveillance systems to
Health
Organization
plan and monitor NCD program

8. CARMEN Network 2012
34 Members
Argentina, Anguilla, Aruba, Barbados
Bahamas, Bolivia, Brazil, Canada,
Colombia, Costa Rica, Cuba,
Curacao, Chile, Dominica,
Ecuador, El Salvador, Grenada,
Guatemala, Guyana,
Mexico, Nicaragua, Panama,
Paraguay, Peru, Puerto Rico,
St Kitts & Nevis, St Lucia,
Trin. & Tobago, Uruguay, Surinam,
Prospective Members
Venezuela, Bolivia
Collaborating members
SLU,USF,NHLBI,CDC,PHAC,
RAFA,ILSI,F&V, CI, HCC, IHF,
Special
• USA-Mexico (border)

9. B rasilia
2012
260 participants from:
Government officials from 36 countries
24 private sector/companies
45 CSOs & academic organizations
6 International Organizations

10. UN Declaration calls on Member States to:
– Advance the implementation of multisectoral, cost-
effective population-wide interventions in order to reduce
the impact of the common NCD risk factors -- tobacco use,
unhealthy diet, physical inactivity and harmful use of
alcohol
– Initiate the implementation of interventions to reduce salt,
sugar and saturated fats, and eliminate industrially
produced trans-fat.
– Promote increased access to cost-effective vaccinations to
prevent infections associated with cancers.
– Promote increased access to cost-effective screening
programmes as determined by national situations..
– Strengthen health systems to deliver cost-effective
treatment services.

11. 2004
Advances: policy
• NCD Policy Observatory: with Public Health
Agency, Canada
– Policy Monitoring (national capacity survey &
registry of laws for diabetes, obesity & CVD)
– Research: case studies: C Rica, Brazil; T&T,
Barbados
– Development/revision of National Action plans:
Belize, Ecuador,. Rica, Paragvay
– Policy dialogues/advocacy: e.g.,
• CARICOM Summit of Heads on chronic diseases
• CARMEN MERCOSUR, SICA, CAN
Pan American
Health
Organization

13. Advances: Promotion and Prevention
• Ratification and full implementation of FCTC
• Trans Fat Free Americas Initiative : Argentina,
Chile, Brazil, Ecuador, Mexico, Canada, Colombia,
Central America,
• Regional Salt reduction initiative : Argentina,
Barbados, Brazil, Canada, Chile, Colombia, C
Rica, Mexico, Paraguay, Uruguay, US.
• Urban Planning and development of public
transport to improve physical activity: 38 cities in
Americas; Ciclovia network, Active cities reward

15. winners
Pirapora, Brasil
(medio ambiente urbano)
Belo Horizonte, Brasil
(movilidad y transporte)
Ciclopaseo, Quito
(recreación y deporte) TransMilenio, Bogota
(mención especial)

16. Advances : Integrated Management
• Integrated Chronic Care model
• CAMDI – Central American Diabetes Intervention
• VIDA Project Mexico on integrated chronic care
• TATI project – Peru on cervical cancer screening
• TATI 2 Honduras, Bolivia, El Salvador
• CVD control through community workers Chile,
Guatemala, Argentina
• CVD risk assessment approach Argentina, Ecuador,
Jamaica,
• NCD drugs and basic technology in PAHO Strategic
fund to reduce cost of drugs ;
• HPV Vaccine in PAHO Revolving fund

17. Chronic care passport
Priorities for CVD

18. CARMEN School: continuous education on line

19. Monitoring changes toward 2025

20. www.paho.org/chronicdisease

21. Thank you!