Noncommunicable Diseases Global Action Global Response Dr Nick

Noncommunicable Diseases: Global Action - Global Response Dr Nick Banatvala 6 th International WHO IUMSP NCD Managers Seminar May 2012

World Health Organization • Specialized agency within the United Nations • Established in 1948 • 194 Member States • World Health Assembly and Executive Board as Governing Bodies • Headquarters in Geneva, Switzerland • 6 Regional Offices; 6 Regional Committees • 150 country offices • 5, 431 professional staff

WHO’s Core Functions • providing leadership on matters critical to health; • shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge; • setting norms and standards; • articulating ethical and evidence-based policy options; • providing technical support and building sustainable institutional capacity; and • monitoring the health situation and assessing health trends.

2000 Global Strategy for the Prevention and Control of Noncommunicable Diseases Surveillance Mapping the epidemic of NCDs Prevention Reducing the level of exposure to risk factors Management Strengthen health care for people with NCDs

Lessons Learned From International Experience Strategies should: – Combine population and high risk approaches – To have an impact, interventions should be of appropriate intensity and sustained over extended periods of time – Include community participation, health care reforms, supportive policy decisions, legislation, and intersectoral action – More health gains are achieved by influencing public policies in other sectors • • Trade Education Agriculture food production, urban development and taxation

1. Surveillance: mapping the epidemic

Framework for national NCD surveillance • Exposure: – Behavioural risk factors: tobacco use, physical inactivity, harmful use of alcohol and unhealthy diet *Surveillance* Mapping the epidemic of NCDs – Metabolic risk factors: raised blood pressure, overweight/obesity, raised blood glucose, and raised cholesterol. – Social determinants: education, household income, access to health care • Outcome: – Mortality: NCD specific mortality – Morbidity: cancer incidence and type • Health System Response: – Interventions and health system capacity: infrastructure, policies and plans, access to key health care interventions and treatments, partnerships

• Good progress in risk factors surveillance over the last decade but NCD surveillance systems are still generally weak in member States • No consensus on key components of an NCD surveillance system and lack of standardized indicators to monitor NCD trends at national and global levels – duplication/inconsistencies • When it exists, NCD surveillance work is not institutionalized and rarely integrated into the national health information systems of LMICs • Limited capacity in epidemiology and surveillance in Member States • Limited capacity of WHO and partners

2. Primary prevention: reducing exposure to risk factors

Reduction of Risk factors • Actions for: – Tobacco control – Promoting healthy diet – Promoting physical activity – Reducing the harmful use of alcohol • Cost effective set of best buys. .

Why are the poorest people in low- and middle-income countries affected the most? Objective 3 – WHO's response to date WHO Framework Convention on Tobacco Control (WHO FCTC) • First global health treaty negotiated under auspices of WHO • 168 parties • Entry into force 27 February 2005 • Creates international laws for: – Establishing tobacco control as a priority on the public health agenda – The adoption of sound tobacco control measures – Introducing a mechanism for firm country commitment and accountability

WHO Framework Convention on Tobacco Control: Evidence-based tool for adoption of tobacco control measures Core package for interventions at the population level: • Price and tax measures to reduce the demand for tobacco (Article 6) and smuggling control (Article 15) • Protection from exposure to tobacco smoke (Article 8) • Packaging and labeling of tobacco products (Article 11) • Ban of tobacco advertising, promotion and sponsorship (Article 13) • Monitoring and evaluation (Articles 20, 21 and 22) Core package for interventions at the individual level: • Tobacco dependence reduction and cessation (Article 14)

MPOWER: Six policies which build on the WHO FCTC and are an integral part of the NCD Global Strategy Action Plan Monitor tobacco use and prevention policies Protect people from tobacco smoke Offer help to quit tobacco use Warn about the dangers of tobacco Enforce bans on tobacco advertising, promotion and sponsorship Raise taxes on tobacco

Policies to promote healthy diet and prevent obesity Reducing salt and trans fatty acids Restricting availability of sugar sweetened drinks Restricting availability of other high calorie snack foods: chips, chocolates and other sweets Increasing availability of healthier foods Protecting children from marketing/promotion Reshaping industry supply & consumer demands Labelling and calorie information Pricing measures

Policies to promote physical activity and prevent obesity Urban design and land use to encourage PA as part of transportation Street design that make walking and biking safe and enjoyable (side lanes, bike lanes, improved lighting, public parks Encourage use of stair (burn calories and not electricity) Physical education as an important part of the school curriculum Facilities for sports for adults including women

Global Strategy on Harmful Use of Alcohol Increase exercise taxes on alcoholic beverages Regulating availability, including minimal legal purchase age, restrictions on outlet density and time of sale and where appropriate government monopoly of retail sales Restricting exposure to marketing of alcoholic beverages through marketing regulations or advertising bans Drink-driving countermeasures, including random breath testing, blood alcohol limits at 0. 5 g/l, with zero tolerance for young drivers Treatment of alcohol use disorders and interventions for hazardous and harmful drinking Endorsed by the 2010 World Health Assembly

Risk factors: "Best buys" interventions to address NCDs Condition Interventions Tobacco use - Raise taxes on tobacco - Protect people from tobacco smoke - Warn about the dangers of tobacco - Enforce bans on tobacco advertising Alcohol use - Raise taxes on alcohol - Restrict access to retailed alcohol - Enforce bans on alcohol advertising Unhealthy diet &physical inactivity - Reduce salt intake in food - Replace trans fat with polyunsaturated fat - Promote public awareness about diet and physical activity - Hepatitis B vaccination Infections

3. Management: strengthening healthcare for those with NCDs

Improving health care for people with NCDs: principles Universal coverage • Ensure availability and eliminate barriers to access Service delivery reform • Organizing primary care networks accordingly Leadership • Recognition of the key role and responsibilities of government • Matching growth in health expenditure with massive reinvestment in capacity for leading and governing the health sector Public policy reform: • Public health • Cross-government: Health in All Policies • Health systems

Six building blocks to strengthen health systems for NCD

Prioritize NCD 'best buys' to improve health care for NCDs Condition Interventions CVD & diabetes – Provide counselling and multi-drug therapy (including blood sugar control for diabetes mellitus) for people with mediumhigh risk of developing heart attacks and strokes (including those who have established CVD) – Treat heart attacks ( myocardial infarction) with aspirin Cancer –Hepatitis B immunization beginning at birth to prevent liver cancer –Screening and treatment of pre-cancerous lesions to prevent cervical cancer

The NCD Global Strategy Action Plan Six objectives: 1. Raising the priority accorded to noncommunicable diseases in development work at global and national levels, and integrating prevention and control of non-communicable diseases into policies across all government departments 2. Establishing and strengthening national policies and programmes 3. Reducing and 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 Sets of actions for member states, WHO Secretariat and international partners.