WHO - Global and regional NCD commitments Peter Sousa Hoejskov, Technical Officer Food Safety & NCD WHO Division of Pacific Technical Support (DPS) 55.

WHO - Global and regional NCD commitments

Peter Sousa Hoejskov, Technical Officer Food Safety & NCDWHO Division of Pacific Technical Support (DPS)

55th PIHOA Board Meeting, Pohnpei, FSM 11-13 March 2014

*Surveillance*Mapping the epidemic of

NCDs and risk factors

*Management*Strengthen

health care for people with

NCDs

*Prevention*Reducing the

level of exposure to risk factors

World Health Assembly in 2000:There is a strategic vision on how to address NCDs

2000

2003

2004

2008

Global Strategy for the Prevention and Control of Noncommunicable Diseases

Global Strategy on Diet, Physical Activity and Health

Action Plan on the Global Strategy for the Prevention and Control of NCDs

2010

2009

2011

Global Strategy to Reduce the Harmful Use of Alcohol

WHO Global Status Report on NCDs

Political Declaration on NCDs

2012+ Realizing the commitments made in the Political Declaration

Setting the agenda:Vision and a global road map

Pacific political commitment   Pacific Health Leaders Multisectoral leaders Pacific Forum Leaders

1995 Yanuca Island declaration: ‘Healthy Islands’

2003 Tonga Commitment to Healthy Lifestyle and Supportive Environment

2010 PIHOA: NCD as a medical emergency in USAPI

Pacific Food Summit : Agriculture, Health and Trade on Food Security

2011 Honiara Communique on NCD Crisis declaration

Ministers of Sports supporting NCD

NCD Crisis Declaration

      UN High Level: Political Commitment on NCD

2013 Apia Communique on NCD Forum Trade and Economic Ministers : NCD Finance Roadmap

2014 Directors of Health: CRP endorsement

Ministers of Finance and Health Meeting

The UN High-level Meeting on NCDs was a defining moment for development cooperation: it sets a new global agenda that advances inclusive social and economic development.

UN

Gen

eral

Ass

embl

y

2011:Commitments from Heads of State and Government W

orld

Hea

lth A

ssem

bly

2012:Adopt a global target of a 25% reduction in premature mortality from NCDs by 2025 W

orld

Hea

lth A

ssem

bly

2013:WHO Global NCD Action Plan 2013-2020, including 9 global targets and 25 indicators

UN General Assembly NCD Review 2014:

Review and assessment of the United Nations General Assembly of the progress achieved in the prevention and control of NCDs

The WHO Global NCD Action Plan 2013-2020unites governments, international partners and WHO around a common agenda

Vision:A world free of the avoidable burden of NCDs

Goal:To reduce the preventable and avoidable burden of morbidity, mortality and disability due to NCDs by means of multisectoral collaboration and cooperation at national, regional and global levels

Objective 1To strengthen international

cooperation and advocacy to raise

the priority accorded to

prevention and control of NCDs

in the development agenda and in

internationally-agreed

development goals

Objective 4To strengthen

and orient health

systems to address the prevention

and control of NCDs through

people-centred

primary health care and universal

health coverage

Objective 4To strengthen

and orient health

systems to address the prevention

and control of NCDs through

people-centred

primary health care and universal

health coverage

Objective 5To promote and support

national capacity for high-quality research and development

for the prevention

and control of

NCDs

Objective 5To promote and support

national capacity for high-quality research and development

for the prevention

and control of

NCDs

Objective 2To strengthen

national capacity,

leadership, governance, multisectoral

action and partnerships to

accelerate country response

for the prevention and control of NCDs

Objective 3To reduce

exposure to modifiable risk

factors for NCDs through creation

of health-promoting

environments

Objective 6To monitor the

trends and determinants of

NCDs and evaluate

progress in their prevention and control

The WHO Global NCD Action Plan 2013-2020 has six objectives with recommended actions for Member States, international partners and WHO

Targets for NCD prevention and control

TOBACCO FREE

PACIFIC

At the World Health Assembly in May 2013, Member States adopted the Comprehensive Global Monitoring Framework for the Prevention and Control of NCDs, including a set of 25 indicators

Action AreaGovernanceRisk factors

Health systems

Surveillance

Set national targets for 2025 in 2013, taking into account the 9 global targets

Develop national multisectoral NCD policies and plans to attain national targets for 2025, by addressing the three major components of the NCD strategy

Finalize and endorse Crisis Response Plans (CRP)

What is next?Immediate actions for Member States 2014-2015

What is next? Priority actions recommended for Member States to reduce the exposure of populations and individuals to risk factors for NCDs

Implement interventions identified by WHO as "best buys" using WHO tools: Tobacco use:

– Tax increases– Smoke-free indoor work places and public places– Health information and warnings about tobacco– Bans on adverting and promotion

Harmful use of alcohol:– Tax increases on alcoholic beverages– Comprehensive restrictions and bans on alcohol

marketing– Restrictions on the availability of 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– Marketing of foods and non-alcoholic beverages to

children

Action AreaGovernanceRisk factors

Health systemsSurveillance

What is next? Priority actions recommended for Member States to enable health systems to respond more effectively and equitably to the health-care needs of people with NCDs

Implement interventions identified by WHO as "best buys" into the basic primary health care:

Health system strengthening is key:– Prevention of liver cancer through hepatitis

B immunization– Prevention of cervical cancer through

screening and treatment of pre-cancerous lesions

– Multidrug therapy to individuals who have had a heart attack or stroke and to persons with a high risk of a cardiovascular event in the next 10 years

Action Area

Governance

Risk factors

Health systems

Surveillance

What is next? Priority actions recommended for Member States to quantify and track NCDs and their determinants (as it provides the foundation for advocacy, national policy and action)

Implement the WHO Framework for NCD Surveillance, covering – monitoring of risk factors and determinants, – outcomes (mortality and morbidity) and – health system response

Integrate into the national health information systems

Develop national targets and indicators, based on Pacific targets, the WHO recommendations and WHA Resolutions

Action Area

Governance

Risk factors

Health systems

Surveillance

The WHO Framework for NCD Surveillance quantifies and tracks exposures, outcomes and health systems response

A WHO Framework for NCD Surveillance

Exposures:– Behavioural risk factors: tobacco use, physical

inactivity, harmful use of alcohol and unhealthy diet

– Metabolic risk factors: overweight/obesity, raised blood pressure, glucose & cholesterol.

– Social determinants: education, material well being, access to health care

Outcomes:

– 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.

Action AreaGovernanceRisk factors

Health systemsSurveillance

Indicators Vital Reg with COD

Cancer Registry

STEPS GSHS FFSurveys

GATS GYTS

Mortality from main NCDs Cancer incidence by type Harmful use of alcohol (3) Low fruit and veg intake Physical inactivity in adults Physical inactivity in adolescents Salt intake Saturated fat intake Tobacco use in adults Tobacco use in adolescents Raised blood glucose/diabetes Raised blood pressure Overweight and obesity in adults Overweight and obesity in adolescents

Raised total cholesterol

Indicator VitalRegistration

Cancer Registry

STEPS FoodFreq Surveys

SARA/facility data

NCD Capacity survey

Cervical cancer screening

Drug therapy and counseling

Essential NCD meds and technologies

Hepatitis B vaccine

HPV vaccine

Marketing to children

Access to palliative care

Policies to limit saturated fats and eliminate trans fat

Set national targets and measure results

Member States are encouraged to adopt the global and Pacific voluntary targets as national targets

National adaptation should be guided by:o Current performance, o Current level of exposure o Programmes planned and in place

WHO is developing a Toolkit on NCD Surveillance, which will include a module on setting national targets and measuring results

• A framework to prioritize action in the short run (1-2 years)

• Based on very cost-effective interventions (“Best Buys”)

• Helps development partners focus support and technical assistance

• CRPs are not additional NCD plans!

Pacific Crisis Response Plans (CRP)

CRISIS RESPONSE PLANS (CRP) in PICs

Tobacco Control - Tobacco Free Pacific

Healthy Diet – Salt reduction & Fruits and Vegetables

CVD Risk Management & Counselling- Package of Essential NCD (PEN) Services

3 Areas; 15 Strategies and 15+ Milestones

Summary• NCD is not only a threat to public health, but also

to socio-economic development and prosperity • Targets and the way forward are clear –

Countries need to scale up action individually and collectively

• Surveillance, prevention and management of NCDs go hand-in-hand

• CRPs help countries prioritize and progress towards the long-term goal of 25x25

Thank you