Surveillance in Brief 4th issue - WHO · Surveillance in brief 4 GENERAL INFORMATION REGIONAL NCD CONTACTS & FOCAL POINTS AFRO: Dr Antonio Filipe, NCD Regional Adviser [email protected]

Update of Noncommunicable Diseases, Mental Health and Injury Surveillance activitiesMay 2003May 2003May 2003May 2003May 2003

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SurveillanceSurveillance in brief World Health Organization

SURVEILLANCE OF RISK FACTORS REPORT (SURF 1)

Until recently, risk factors such as raised blood pressure, cholesterol, tobacco use, excess alcoholconsumption, obesity, and the diseases linked to them, were more commonly associated with developedcountries. However, the World Health Report 2002: reducing risks, promoting healthy life, indicates that they arenow becoming more prevalent in developing nations.

These countries are being affected by a doubleburden of disease, the combination of long-established infectious diseases and the rapidlygrowing epidemic of chronic, noncommunicablediseases (NCDs). WHO has responded by givinghigher priority to NCD prevention, control andsurveillance in its programme of work. Nowmore than ever, standard methods and tools areneeded to enable countries to build andstrengthen their capacity to conduct surveillanceof NCDs and their risk factors. One such tool isthe WHO STEPwise approach toSurveillance (STEPS) of risk factors relatedto NCDs (See Surveillance in Brief issue 1).It is a simplified, stepwise approach providingstandardized materials and methods to helpcountries, especially those that lack resources,initiate NCD activities. The goal is to achievedata comparability between countries over time.The SuRF Report I introduces another tool, theWHO Global NCD InfoBase, whichassembles, for the first time in one place, NCDrisk factor data collected from WHO MemberStates. Data from the InfoBase is presented inthe country profiles of the SuRF report and itsassociated CD-ROM attachment. Displaying thecurrently available data is the first step towardsimproving NCD risk factor data collections. This

is an on-going process. In the next step (SuRF II), the available country data will be used to producecomparable estimates for risk factor prevalence in WHO Member States. This will result in an advocacytool with the power to transform health policy by highlighting the need for primary prevention and healthpromotion.

Launch of the WHO SuRFReport ........................................ 2Examples of country datain SuRF ...................................... 3General Information ............... 4STEPS Related

Documentation ........................ 4STEPS Regional contacts &Focal Points .............................. 4STEPS WHO/HQ Contacts . 4Acknowledgements ................. 4

ContentsFeature: Introduction to theWHO SuRF Report ................. 1Meet the WHO GlobalNCD InfoBase Team .............. 2Development of the WHOSuRF Report ............................. 2

Surveillance in brief2

MEET THE WHO GLOBAL NCD INFOBASE AND SURF TEAM

LAUNCH OF THE WHO SURF REPORTThe SuRF Report was launched in WHO Headquarters inMay 2003. The launch consisted of two separate events: avery successful international press conference was held on14 May at the United Nations Palais des Nationsintroducing the media to the report and how this newsurveillance tool captures key country risk factors to bringthe global chronic disease epidemic under control; a secondevent was held on 15 May for many WHO staff, selecteddonor country representatives and NongovernmentalOrganizations. Several “mini-launches” were also heldaround the globe by WHO Regional staff and otherpartners involved in the SuRF development process.The launch process has enabled the NCD InfoBase Teamto reach a maximum audience. Editorials will be releasedin the Lancet, the International Journal of Epidemiology,and the Journal of Social and Preventive Medicine.

Clockwise from back left:

Ms Tomoko Ono, Research AssistantMs Jacklynn Lippe, Research AssistantMs Carina Marquez, Research AssistantDr Kate Strong, Data Manager (seated)

Following the production and launch of the SuRF Report,Dr Kate Strong is taking maternity leave for a few months.We wish her all the very best in her new role.

For additional information or to contact the team pleasesend an email to: [email protected]

Development of the WHO Global NCD InfoBase hasbeen a huge effort involving• a small dedicated and hardworking team at HQ• all six of the WHO Regional Offices and• well over 200 individuals.The current version includes over 47,000 data points fromover 1,400 sources. At least one piece of data is availablefor over 170 countries of the 192 Member States. A uniquefeature is that each record can be linked back to its surveyinformation, including primary source. This is importantwhen the collection of such data involves so many differentprotocols, definitions, and age groups.The Global NCD InfoBase and the resulting SuRF reportfully reflect the STEPwise approach to Surveillance. SuRFreport 1 is the first step and presents the current globalstatus of country data for the major chronic disease riskfactors. It also shows the lack of comparable data. Thewide variety of methods, age groups, and definitions usedby country-level surveys means that risk factor prevalenceinformation is not directly comparable either within acountry or between countries.The second step, SuRFReport 2, will follow later in the year providing comparableestimates on risk factor prevalence from country data. Thethird step is to use this comparable data to advocate forhealth policy that targets primary intervention strategies to

DEVELOPMENT OF THE WHO GLOBAL NCD INFOBASE AND SURF REPORT

Hard copies of the SuRF Report can beobtained from WHO Marketing andDissemination on email: [email protected]

We would like to thank all of those who have participatedin launches and assisted in advocacy activities for the SuRFreport.

Left to Right:Dr Ruth Bonita,Director, NMH/CCSDr Kate Strong, DataManager, NMH/CCSDr Janet Voute, ChiefExecutive Officer,World Heart Federation

prevent chronic disease.Eight risk factors have been identified that fit the criteriarelating to the STEPS methodology. These are: tobaccoand alcohol use, patterns of physical inactivity, low fruit/vegetable intake, obesity (as measured by BMI), bloodpressure, cholesterol and diabetes (measured by bloodglucose). Of principal importance to the data collectionis the need to display prevalence data for these eight riskfactors by age group(s) and sex and with some measureof the uncertainty of the estimate for each Member State.NCD risk factor information included in the SuRF reportcomes from a variety of sources, ranging from peer-reviewed journal articles to reports and unpublished datafrom Ministries of Health. All of this information is heldin the WHO Global NCD InfoBase, designed as a “onestop” resource for data needs and will be available on theinternet.The NCD InfoBase team is continuing to collect data onthese eight risk factors from countries. Contact us [email protected] if you have additional information/data to contribute.

Surveillance in brief3

EXAMPLES OF COUNTRY DATA IN SURF

PROBLEMS AND SOLUTIONSThe NCD InfoBase represents the first step inbuilding better quality NCD risk factor data bydisplaying the country-level data that currently exists.However, there are several limitations to currentexisting NCD risk factor data collections. It is difficultto compare survey data across countries. Evenwithin a country, when data from different years areavailable, this data may not be comparable becauseof different survey instruments, resulting in differentmeasurement methods and different criteria forclinical events. These problems can be solved tosome extent by using standardized surveyinstruments.

Harmonising survey instruments and collecting dataon a small set of core indicators may go a long wayto providing better data in the future, but valid,existing data should not be ignored. The second stepin the SuRF project is to use country data to developestimates of national prevalence for each risk factor.Member States with national health statisticsreporting systems (that include risk factorinformation) have already produced these estimatesfor their countries. For other countries with sub-national surveys, and sometimes more than onesurvey, a data harmonization process can be used toproduce a national estimate.

The above pages are taken from the Japan countryprofile as an example of the layout, graphics anddetailed content provided in the SuRF Report.The advantage of the SuRF report is that it displaysthese country risk factor profiles on CD-ROM tomake the data more accessible. The CD-ROM formatenables direct access to the data on a computerinstead of an unwieldy paper copy. The formatdisplays the following information for each MemberState:♦ all recent risk factor data;♦ age-specific prevalence rates or mean values;

♦ survey sample sizes;♦ 95% confidence intervals;♦ risk factor definitions; and♦ complete source information.

In many cases, study authors or Ministries of Healthhave been contacted for additional, unpublishedinformation about their risk factor surveys. Notesattached to the source reference indicate whereadditional information has been provided andidentifies the provider.

Surveillance in brief4

GENERAL INFORMATION REGIONAL NCD CONTACTS & FOCAL POINTSAFRO: Dr Antonio Filipe, NCD Regional Adviser

[email protected] Djohar HannounSTEPS Regional Focal [email protected]

PAHO/:Dr Sylvia Robles, HCP/HCNAMRO Programme Coordinator

[email protected] Pedro Ordunez, NCD Data Focal [email protected]

EURO: Dr Aushra ShatchkuteNCD Regional [email protected]

EMRO: Dr Oussama Khatib, NCD Regional [email protected]

SEARO:Dr Jerzy Leowski, NCD Regional [email protected] Anand KrishnanSTEPS Regional Focal [email protected]

WPRO: Dr Gauden Galea, NCD Regional [email protected] Maximilian de CourtenWHO South PacificSTEPS Regional Focal [email protected] Elaine Chung, WHO South PacificData Management [email protected]

Technical Support Centre:Dr Rob Granger, Focal Point, Menzies Centrefor Population Health Research, [email protected] Jan Pryor, Focal Point,Fiji School of [email protected]

These documents can be accessed through the Surveil-lance web site: http://www.who.int/ncd/surveillance/surveillance_publications.htm1. THE WHO STEPS Approach to NCD risk factor

surveillance - Summary (WHO/NMH/CCS/01.01)- available in Arabic, Chinese, English, French,Russian, Spanish

2. The WHO STEPS Instrument:formatted Core and Core & Expanded (Version 1.3)

3. The WHO STEPS Framework4. The WHO STEPS Planning & Implementation

Manual5. The WHO STEPS Field Manual6. Rapid Assessment Protocols for Surveillance (RAPS)

STEPS RELATED DOCUMENTATION

© World Health Organization, 2003 - All rights reserved

SURVEILLANCE CONTACTS IN WHO/HQ

SURVEILLANCE IN BRIEF CONTACT:If you would like to provide information for futureeditions of “Surveillance in Brief”, please send your submissionto: Rachel Pedersen, Editor, NMH/CCS:[email protected]; Fax: +41 22 791 4769Previous editions of Surveillance in Brief are availableon the web site: http://www.who.int/ncd/surveillance/surveillance_publications.htm

DONOR SUPPORTWHO would like to acknowledge the AustralianAgency for International Development (AusAID),Sida/Sarec (Sweden), the Government of theNetherlands, the Government of New Zealand andthe Government of the United Kingdom for theircontributions towards the development andimplementation of the WHO STEPS project.

A Public Health Action Plan ToPrevent Heart Disease and Stroke

Dr Ruth Bonita, Director, Surveillance (CCS),Noncommunicable Diseases and Mental Health (NMH),World Health Organization, CH-1211, Geneva,Switzerland

Dr Timothy Armstrong, STEPS Coordinator, orMs Lydia Bendib, NMH/CCS:[email protected] or Fax: +4122 791 4769

Dr Kate Strong, Data Manager and NCD InfoBase Team,NMH/CCS: [email protected]

The Centers for Disease Control and Prevention (CDC)in Atlanta, in collaboration with the American HeartAssociation (AHA), the American Stroke Association(ASA), the Association of State and Territorial HealthOfficials (ASTHO) and other national associations, hasrecently released a new report entitled “A Public HealthAction Plan to Prevent Heart Disease and Stroke: Steps toa Healthier US”. This is a practical and comprehensiveevidence-based approach and many of the principles andprocesses detailed in the Plan are relevant globally.This Strategic Plan provides health practitioners and policymakers with a framework for developing a health caresystem that will address both treatment and preventionof heart disease and stroke, the respective first and thirdleading causes of death and disability in the United States.It also provides a guide for the nation in reaching the goalsof Healthy People 2010, the national prevention agenda ofthe Department of Health and Human Services (HHS).The Plan is in line with the new national initiative “Stepsto a Healthier US” which proposes to “put preventionfirst” in solving America’s health care crisis.For additional information, please contact CDC on email:[email protected] or visit www.cdc.gov/cvh