Lecture 1, delivered at the "Strengthening Leadership & Advocacy for Non-Communicable Diseases in Malaysia" Workshop, 1 to 4 December 2014

1. Ministry of Health
Malaysia
Overview of
Non-Communicable Diseases
Feisul Idzwan Mustapha MBBS, MPH, AM(M)
Public Health Physician, NCD Section, Disease Control Division
Ministry of Health, Malaysia
LeAd-NCD-MAL Workshop
1 December 2014
Klang
dr.feisul@moh.gov.my

2. There are FourMajor Groups of Non-
Communicable Diseases;
Fourmajor lifestyles related risk factors
Modifiable causative risk factors
Tobacco use
Unhealthy
diets
Physical
inactivity
Harmful
use of
alcohol
Noncommunicable diseases
Heart disease
and stroke
   
Diabetes    
Cancers    
Chronic lung
disease
 2

3. 3
Global NCD
Targets
Source of icons: World Heart Federation Champion Advocates Programme

4. Proportional mortality, Malaysia
(% of total deaths, all ages, both sexes)
4

5. Premature mortality due to NCDs,
Malaysia
5
The probability of dying between ages 30 and 70 years
from the 4 main NCDs is 20%

6. DALYs attributable to risk factors
6
Poor Water & Sanitation
Underweight
Physical Inactivity
Alcohol
High Cholesterol
High BMI
Diabetes Mellitus
10.7%
10.8%
8.3%
9.0%
3.1%
4.3%
5.2%
0.1%
0.7%
12.1%
10.8%
0.1%
0.7%
11.4%
5.1%
0.9%
4.3%
0.7%
Tobacco
High BP
15.0% 10.0% 5.0% 0.0% 5.0% 10.0% 15.0%
Male Female
Burden of Disease Study Malaysia 2008, slide courtesy of Dr Mohd. Azahadi Omar, Institute for Public Health

7. Deaths attributable to risk factors
Poor Water & Sanitation
Underweight
Alcohol
Physical Inactivity
High BMI
High Cholesterol
Diabetes Mellitus
19.4%
15.7%
7.0%
7.3%
8.5%
5.0%
2.3%
0.1%
0.2%
22.8%
0.1%
0.2%
1.2%
7.1%
8.2%
8.1%
9.1%
0.3%
Tobacco
High BP
25% 20% 15% 10% 5% 0% 5% 10% 15% 20% 25%
Male Female
Burden of Disease Study Malaysia 2008, slide courtesy of Dr Mohd. Azahadi Omar, Institute for Public Health
7

8. Sub-analysis of NHMS 2011 data
• At least 15% (18 years and above) already with known NCD
risk factors (diabetes, hypertension or hypercholesterolemia).
• Undiagnosed high blood sugar, high blood pressure or high
cholesterol: 42.1% (18 years and above).
• Or, if include obesity: 48.3% (18 years and above).
• Therefore our high risk and at risk population: 63.3% (18
years and above)
8

9. 9
Global NCD
Targets
Source of icons: World Heart Federation Champion Advocates Programme

10. 10

11. 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.
11

12. Outcome Document of the 2014 UN
General Assembly High-level Meeting
on NCDs
First High-level Meeting on NCDs (New York,
19-20 September 2011)
2011
Second high-level Meeting on NCDs (New York, 10-11
July 2014) to take stock of the progress made since
2011
2014
Third High-level Meeting on NCDs
to report on progress achieved
since 2014
2018
12
Slide courtesy of Dr Shin Hai-rim, WHO Western Pacific Region Office

13. 2014 UN Outcome Document on NCDs
(resolution A/RES/68/300)
• Bottom line:
Governments committed themselves
to intensify their efforts towards a
world free of the avoidable burden of
NCDs
• Moving forward:
Maps out a set of concrete national
commitments to be implemented
between 2014 and 2018, and
provides 3 new global assignments
• Towards the world we want:
Next milestone in 2018
13
Slide courtesy of Dr Shin Hai-rim, WHO Western Pacific Region Office

14. National commitments included in the
2014 UN Outcome Document on NCDs
By 2015, consider setting national targets for NCDs
By 2015, consider developing national multisectoral
policies and plans
Integrate NCDs into health-planning and national
development plans
By 2016, implement "best buys" to reduce risk factors
for NCDs
By 2016, implement "best buys" to enable health
systems to respond
Strengthen national surveillance systems
14
Slide courtesy of Dr Shin Hai-rim, WHO Western Pacific Region Office

15. Global assignments included in the
2014 UN Outcome Document on NCDs
By 2015, WHO to develop an approach to register and
publish contributions of non-State actors towards the 9
global NCD targets
WHA68: Framework for country action to mobilize
sectors beyond health
OECD/DAC: Purpose code to track development
assistance for NCDs
By 2017, WHO to submit a progress report to UN
General Assembly
By 2018, UN General Assembly to convene a third High-level
Meeting
15
Slide courtesy of Dr Shin Hai-rim, WHO Western Pacific Region Office

16. Global accountability framework for NCDs:
Milestones during the next three years
• WHO publishes global baseline
• WHO conducts third survey on national capacities
• WHO generates data
2015
• Progress report to WHA on 25 outcome indicators
• Progress report to WHA on 9 progress indicators 2016
• Independent evaluation (Global Action Plan)
• Progress report to the UN General Assembly 2017 16
Slide courtesy of Dr Shin Hai-rim, WHO Western Pacific Region Office

17. NCDs in the post-2015 development
agenda: Towards the world we want
• 10 September 2014: Member States
welcomed the report of the Open Working
Group of the UN General Assembly on
Sustainable Development Goals
• Next 12 months: Proposal shall be the
main basis for integrating sustainable
development goals into the post-2015
development agenda
• Target 3.4: By 2030 reduce by one-third
pre-mature mortality from NCDs through
prevention and treatment, and promote
mental health and well-being
17
Slide courtesy of Dr Shin Hai-rim, WHO Western Pacific Region Office

18. 18

19. Cost effective interventions to address
NCDs
Population-based
interventions
addressing
NCD
risk factors
Tobacco use - 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
- 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
Individual-based
interventions
addressing
NCDs in
primary care
Cancer - Prevention of liver cancer through hepatitis B immunization
- Prevention of cervical cancer through screening (visual
inspection with acetic acid [VIA]) and treatment of pre-cancerous
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. Cost effective NCD interventions…
• What works, what can we afford, and what should we
adopt?
• The challenge? Identify interventions that:
• are effective;
• can lead to measurable declines in NCD death rates
quickly (e.g. over 10 years);
• are affordable; and
• can easily be implemented and sustained.
The Lancet. December 8, 2007 Volume 370:
Gaziano T, Galea G and Reddy K. Scaling up interventions for chronic disease prevention: the evidence.
pp 1939-1946.
The Lancet. December 15, 2007. Volume 370:
Asaria P, Crisholm D, Mathers C, Ezzati M, Beaglehole R. Chronic disease prevention: health effects and
financial costs of strategies to reduce salt intake and control tobacco use. pp 2044-2053.
Lim S, et. al. Prevention of cardiovascular disease in high-risk individuals in low-income and middle-income
countries: health effects and costs. pp 2054-2061.
20

21. WHO Regional Response
2000
2001-03
2004-06
2008
2009-11
Healthy Islands Initiative
WPDD
Call for Action on Obesity Control
Regional plan for integrated CVD and
Diabetes Prevention 1998-2003
Regional Tobacco action plan
FCTC implementation
Regional NCD STEP Surveys
Healthy Cities Initiatives
addressing NCD and tobacco
NCD & Poverty: Pro-Poor Strategy 2006
Regional Action plans for NCD
Regional Strategy to Reduce
Alcohol related harm
Regional Initiative on multi-sectoral
intervention for NCD prevention: Obesity
Strategy & programme: Breast/cervical
cancer control
2012
National multisectoral plans
Marketing of foods/ NCD and
PHC/Surveillance
2013 Cancer Leadership and LeAd-NCD
Regional action plan (2014-2020)
2014
NCD knowledge net work
2nd Lead NCD
NCD surveillance
21
Slide courtesy of Dr Shin Hai-rim, WHO Western Pacific Region Office

22. 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
22

23. 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
Behavioural
Change
Supportive living
environment
Health promotion & educations
Policies & regulations
23

24. 24

25. The Great Prevention Debate
Personal choice
versus
government responsibility
25

26. Personal Choice is Important
26

27. BUT …
If we want people to make healthy choices we
have to make healthy choices available,
accessible and affordable
27

28. Prevention is BOTH a personal and
government responsibility
28

29. Social Determinants of Health
29

30. National Systems Response to NCDs –
ASEAN Countries
BRN
CAM
IND
LAO
MAL
MYN
PHI
SIN
THA
VIET
Has an operational NCD unit/branch or department
within MOH ✓ ✓ ✓ ✗ ✓ ✗ ✓ ✓ ✓ ✗
Has an operational multisectoral & integrated national
policy, strategy or action plan ✗ ✗ ✓ ✗ ✓ ✓ ✗ ✗ ✗ ✗
Has an operational policy, strategy or action plan to
reduce the harmful use of alcohol ✓ ✓ ✓ ✗ ✗ ✓ ✓ ✗ ✓ ✗
Has an operational policy, strategy or action plan to
reduce physical inactivity ✗ ✓ ✓ ✗ ✓ ✓ ✓ ✓ ✓ ✗
Has an operational policy, strategy or action plan to
reduce the burden of tobacco use ✗ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
Has an operational policy, strategy or action plan to
reduce unhealthy diet and/or promote healthy diets ✗ ✓ ✓ ✗ ✓ ✓ ✓ ✓ ✓ ✓
Has evidence-based national guidelines for the Mx of
major NCDs through a primary care approach ✓ ✗ ✓ ✗ ✓ ✓ ✗ ✓ ✓ ✗
Has an NCD surveillance and monitoring system in
place to enable reporting for the GMF ✗ ✓ ✗ ✗ ✓ ✗ ✗ ✓ ✓ ✓
Has a national, population-based cancer registry ✓ ✗ ✗ ✗ ✗ ✗ ✗ ✓ ✗ ✗
30

31. Summary
• Preventing and controlling NCD is an urgent priority for all
countries.
• NCD is a global issue – affecting not just developed countries,
but more so in developing countries.
• Most of the drivers of NCDs and their risk factors lie outside
the control of the health sector.
• Multi-Sectoral Approach (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.
• The burden of NCD in Malaysia continues to increase.
• Prevention and control of NCDs is both the responsibility of
government as well as individuals. 31

32. 32
Summary

33. Thank you
dr.feisul@moh.gov.my
Facebook: Feisul Mustapha
33