Dr Ala Alwan Assistant DirectorGeneral Noncommunicable Diseases and

Dr Ala Alwan Assistant Director-General Noncommunicable Diseases and Mental Health World Health Organization Scope, Objectives and Agenda

Noncommunicable Diseases and Injuries Magnitude • • • Four major noncommunicable diseases (NCDs): – Cardiovascular diseases – Diabetes – Cancers – Chronic respiratory diseases Four shared modifiable risk factors: – Tobacco use – Unhealthy diet – Physical inactivity – Harmful use of alcohol 60% of deaths globally – 70% if injuries are included -80% in developing countries 40 -50% are premature Magnitude has a major socio-economic impact on developing countries Ø NCDs and injuries are still excluded from global discussions on development ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting Addressing noncommunicable diseases and injuries (Doha, Qatar, 10 -11 May 2009)

Injuries • Cause 10% of all deaths and 16% of all disability • Road traffic crashes alone are the leading cause of death for young people aged 1024 years ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting Addressing noncommunicable diseases and injuries (Doha, Qatar, 10 -11 May 2009)

Oil and gas price spike Retrenchment from globalization Asset price collapse NCDs Fiscal crisis Flu pandemic Food crisis Infectious disease ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting Addressing noncommunicable diseases and injuries (Doha, Qatar, 10 -11 May 2009) http: //www. weforum. org/pdf/globalrisks 09/global_risks_2009. pdf Global Risk Assessment 2009 World Economic Forum

Projected global deaths (2030) Cancers Ischaemic heart disease Stroke Acute respiratory infections Road traffic accidents Perinatal HIV/AIDS TB Malaria ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting Addressing noncommunicable diseases and injuries (Doha, Qatar, 10 -11 May 2009) www. who. int/healthinfo/global_burden_disease/2004_report_update/en/index. html Noncommunicable Diseases & Injuries

Noncommunicable Diseases Death trends (2015) Geographical regions (WHO classification) 2006 -2015 (cumulative) Total deaths (millions) NCD deaths (millions) Trend: Death from infectious disease Trend: Death from NCD Africa 10. 8 2. 5 28 +6% +27% Americas 6. 2 4. 8 53 -8% +17% Eastern Mediterranean 4. 3 2. 2 25 -10% +25% Europe 9. 8 8. 5 88 +7% +4% South-East Asia 14. 7 8. 0 89 -16% +21% Western Pacific 12. 4 9. 7 105 +1 +20% Total 58. 2 35. 7 388 -3% +17% WHO projects that over the next 10 years, the largest increase in deaths from cardiovascular disease, cancer, respiratory disease and diabetes will occur in low- and middle-income countries. ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting Addressing noncommunicable diseases and injuries (Doha, Qatar, 10 -11 May 2009) www. who. int/chp/chronic_disease_report/media/impact/en/index. html 2005

Noncommunicable Diseases The poorest people in developing countries are the ones who smoke the most Source: World Health Survey 2006 Range: from Q 1 = poorest quintile to Q 5 = Highest income quintile ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting Addressing noncommunicable diseases and injuries (Doha, Qatar, 10 -11 May 2009)

Noncommunicable Diseases Macro-economic impact 2005 2006 -2015 (cumulative) Lost national income (billions) Brazil 3 49 China 18 558 India 9 237 0. 4 8 Pakistan 1 31 Russian Federation 11 303 Tanzania 0. 1 3 Countries Nigeria WHO: "Heart disease, stroke and diabetes alone are estimated to reduce GDP between 1 to 5% per year in developing countries experiencing rapid economic growth" ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting Addressing noncommunicable diseases and injuries (Doha, Qatar, 10 -11 May 2009) (WHO Chronic Disease Report, 2005) Lost national income from premature deaths due to heart disease, stroke and diabetes

Noncommunicable Diseases The vicious cycle of poverty and NCDs ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting Addressing noncommunicable diseases and injuries (Doha, Qatar, 10 -11 May 2009)

NCDs are emerging as a serious threat to Arab countries and are undermining development ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting Addressing noncommunicable diseases and injuries (Doha, Qatar, 10 -11 May 2009)

Noncommunicable Diseases www. who. int/healthinfo/global_burden_disease/estimates_regional/en/index. html Magnitude in the Middle East Diabetes (2%) Neuropsychiatric disorders (2%) Digestive diseases (4%) Total deaths: 4. 3 million • Noncommunicable conditions: 50% • Communicable diseases*: 39% • Injuries: 11% Cardiovascular diseases (27%) Intentional injuries (4%) Respiratory diseases (4%) Malignant neoplasms (7%) Unintentional injuries (7%) Perinatal conditions (10%) Infectious and parasitic diseases (17%) Respiratory infections (10%) * Including maternal and perinatal conditions and nutritional deficiencies ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting Addressing noncommunicable diseases and injuries (Doha, Qatar, 10 -11 May 2009)

Top-10 countries in diabetes prevalence in the world (2007) Rank and country Age- adjusted prevalence of diabetes in 20 -79 yr age group (%) 1. Nauru 30. 7 2. United Arab Emirates 19. 5 3. Saudi Arabia 16. 7 4. Bahrain 15. 2 5. Kuwait 14. 4 6. Oman 13. 1 7. Tonga 12. 9 8. Mauritius 11. 1 9. Egypt 11. 0 10. Mexico 10. 6 ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting Addressing noncommunicable diseases and injuries (Doha, Qatar, 10 -11 May 2009)

NCDs and injuries are preventable We know what works We have cost-effective interventions: • Tobacco control interventions • Measures to improve healthy dietary and physical activity patterns • Early detection and effective treatment of cancer • Treatment of hypertension, diabetes • Treatment of heart disease and stroke • Intersectoral injury prevention measures ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting Addressing noncommunicable diseases and injuries (Doha, Qatar, 10 -11 May 2009)

The global response to address noncommunicable diseases ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting Addressing noncommunicable diseases and injuries (Doha, Qatar, 10 -11 May 2009)

2008 -2013 Action Plan for the Global Strategy Six Objectives of the Action Plan 1. Integrating NCD prevention into the development agenda, and into policies across all government departments 2. Establishing/strengthening national policies and programmes 3. Reducing/preventing risk factors 4. Prioritizing research on prevention and health care 5. Strengthening partnerships 6. Monitoring NCD trends and assessing progress made at country level Under each of the 6 objectives, there are sets of actions for member states, WHO Secretariat and international partners. ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting Addressing noncommunicable diseases and injuries (Doha, Qatar, 10 -11 May 2009)

The NCD gap in the development agenda (Health ODA* Commitments 2006 by major subsector) US$ Billions Total = $20. 9 billion ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting Addressing noncommunicable diseases and injuries (Doha, Qatar, 10 -11 May 2009) * ODA = Official Development Assistance provided by 24 OECD/DAC donor countries, as well as the EC Noncommunicable Diseases

President of the 61 st World Health Assembly … … MDGs … failed to identify noncommunicable conditions, in spite of the fact that these diseases account for fully 70% of the global mortality… most of the morbidity and mortality caused are preventable … a serious omission … I propose we seriously consider an MDG+, which would set goals for the ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting NCCs, as. Addressing we have done for other … challenges. noncommunicable diseases and injuries (Doha, Qatar, 10 -11 May 2009)

Global NCD Action Plan 2008 -2013 Milestones Objective 1: To raise the priority accorded to noncommunicable diseases in development work at global and national level • Regional Ministerial Meeting on Health Literacy (Beijing, 2930 April 2009) • Regional Ministerial Meeting on NCDs, Poverty and Development (Qatar, 10 -11 May 2009) • ECOSOC High Level Segment on Global Health (Geneva, 68 July 2009) ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting Addressing noncommunicable diseases and injuries (Doha, Qatar, 10 -11 May 2009)

What do we want to achieve from this meeting? • Review the magnitude and trends of NCDs and injuries with special emphasis on socio-economic impact • Discuss successful approaches and interventions to address NCDs and injuries and identify costeffective measures to improve access of the poor and vulnerable populations to proper health care • Discuss ways and means of integrating the prevention of NCDs and injuries into national, regional and global development initiatives ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting Addressing noncommunicable diseases and injuries (Doha, Qatar, 10 -11 May 2009)

What do we want to achieve from this meeting? . . . • Recommend key actions for countries to incorporate NCD prevention into poverty reduction strategies and relevant social and economic policies • Recommend mechanisms to involve all government departments to ensure that NCD and injury prevention receives a cross-sectoral response A Call for action by the international community and development agencies to respond to the needs of countries in scaling up action against NCDs and injuries ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting Addressing noncommunicable diseases and injuries (Doha, Qatar, 10 -11 May 2009)