Who shao ncd seminar2014_thl_10 march

Dr Ruitai Shao

Programme Management Adviser

Department for the Management of NCDs

World Health Organization

Geneva

Voluntary Global Targets &

Global Monitoring Framework and

Global NCD Action Plan 2013-20

Outline

• NCDs and Their Determinants

• Global Responses

• Global Voluntary Targets, Action Plan

and Monitoring Framework for NCDs

• Moving from global initiatives to local

action

Tobacco use Unhealthy diet Physical inactivity

Harmful use of alcohol

Heart disease and stroke

Diabetes

Cancer

Chronic respiratory disease

UN Secretary-General

Focus on 4 NCDs and 4 risk factors for NCDs

10%

0

5 000 000

10 000 000

15 000 000

20 000 000

25 000 000

0-29 30-69 70-80+

Communicable,maternal, perinatal andnutritional conditions

Noncommunicablediseases

Injuries

New data for 2011: Almost 14 million people died from NCDs between the ages of 30 and 70

0

2 000 000

4 000 000

6 000 000

8 000 000

10 000 000

12 000 000

0-29 30-69 70-80+

High-income countries

Upper middle-incomecountries

Lower middle-incomecountries

Low-income countries

Deaths from NCDs

age groups

85% of people who die too young from NCDs live in developing countries, which resulted in 12 million premature deaths from NCDs in 2011

US$ 11B is the average yearly cost for

all developing countries to

scale up action by

implementing a combined set

of cost-effective NCD

interventions that have been

identified as priority actions

by WHO

US$ 7T is the cumulative

lost output in

developing

countries

associated with

NCDs between

2011-2025

The cost of inaction versus action

Key milestones: High-level Meeting on NCDs and beyond

High-level Meeting on NCDs

(New York, September 2011)

Action Plan on the Global Strategy for the

Prevention and Control of NCDs 2008-13

WHO Global Strategy for the Prevention and Control of Noncommunicable Diseases 2000

2008

2013

2011

Global NCD targets, Global NCD Action Plan 2013-20

and monitoring Framework, including indicators

World Conference on Social

Determinants on Health,

October 2011, Rio de Janeiro

2003 WHO Framework on Tobacco Convention

1997

First ministerial meeting on

NCDs in Moscow, April 2011)

The world health report 1997 - conquering suffering, enriching humanity

2004 WHO Global Strategy for diet, physical activity and health

2009 WHO Global Strategy to reduce the

harmful use of alcohol

WHO Global Strategy for the Prevention and Control

of Noncommunicable Diseases

Surveillance Mapping the epidemic of

NCDs

Management Strengthen

health care for people with

NCDs

Prevention Reducing the

level of exposure to risk factors

Reducing NCD's risk factors

WHO Framework Convention on Tobacco

Control

WHO Global Strategy for Diet, Physical

Activity and Health

WHO Global Strategy for the harmful use of

Alcohol

Increasing health service coverage for people

at high risk and with established NCDs

– WHO technical support package of essential

interventions to integrate NCD prevention and

control into primary care

– Add-on components for existing health initiatives

(polio, HIV/AIDS, TB)

Realizing the commitments made in the Political Declaration on NCDs > Progress made by WHO

1 WHO Global NCD Action Plan 2013-2020

2 Nine global targets for NCDs to be attained by 2025

3 25 outcome indicators for NCDs to measure progress towards the attainment of the nine global targets

4 9 NCD action plan indicators to inform reporting on progress made in the process of implementing the WHO Global NCD Action Plan 2013-2020

5 WHO Global Coordination Mechanism on the Prevention and Control of NCDs ("NCD-GCM")

6 UN Interagency Task Force on the Prevention and Control of NCDs

7 Report of the United Nations Secretary-General and the WHO Director-General on the progress made in realizing the commitments included in the UN Political Declaration on NCDs

8 WHO Country Capacity Assessment on NCDs

9 WHO Global Status Reports on NCDs in 2011 and 2014 (and 2010 global baseline)

10 Technical assistance to developing countries based on a One-WHO work plan on NCDs

Voluntary Global NCD Targets

1. Premature mortality from NCDs (25% reduction)

2. Harmful use of alcohol (10% reduction)

3. Physical inactivity (10% reduction)

4. Salt/sodium intake (10% reduction)

5. Tobacco use (30% reduction)

6. Raised blood pressure (25% reduction)

7. Diabetes/obesity( (0% change)

8. Essential medicines and technologies (80%)

9. Drug therapy and counseling (50%)

Formal Meeting of Member States to conclude the work on the comprehensive global monitoring framework including indicators and a set of

voluntary targets for the prevention and control of NCDs (Geneva, 5-7 November 2012)

Global NCD Action Plan 2013-20

1. To o raise the priority accorded to the prevention and control of NCDs

2. To strengthen national capacity, leadership, governance, multisectoral action and partnerships

3. To reduce modifiable risk factors

4. To strengthen and reorient health systems

5. To promote and support national capacity for high quality research and development

6. To monitor the trends and determinants of NCDs and evaluate progress

Agreement on the objectives: • Advocate for the urgency to implement the

WHO Global NCD Action Plan 2013-2020 • Disseminate knowledge on best practices • Provide a platform to identify barriers and

share innovate solutions • Advance multi-sectoral action • Share information on existing and potential

sources of finance and cooperation mechanism

Member States

Non-State Actors

UN organizations

Global Coordination Mechanism on NCDs What is the current status following discussions at the WHO Executive Board?

Further consultations of Member States in March or April 2014 on: – Responsibilities of participants – Working groups – WHO's role as the Secretariat – Work plan – Administrative arrangements – Accountability – Conflict of interest – Links with the UN Task Force on NCDs

• Functions for the UN Interagency Task Force for NCDs (see document EB134/14 for full text):

— Enhance and coordinate technical support

— Facilitate information exchange about plans, strategies, programmes and activities

— Facilitate information exchange about available resources to support national efforts

— Strengthen advocacy

— Ensure that tobacco control continues to be duly addressed

— Strengthen international cooperation

Terms of reference for the UN Interagency Task Force on NCDs

UN General Assembly NCD Review 2014 Possible elements for an outcome document: What we hear from Member States

Set national targets Member States to consider, by 2015, the development of national targets for 2025 based on national situations, taking into account the 9 voluntary global targets adopted by the 66th World Health Assembly (May 2013), and building on guidance provided by the World Health Organization, to focus on efforts to address the impacts of NCDs

Develop national plans Member States to develop, by 2015, multisectoral national policies and plans for the prevention and control of NCDs to attain national targets, taking into account the 2013-2020 WHO Global Action Plan for the Prevention and Control of NCDs.

Reduce exposure to risk factors Member States to implement, by 2015, as part of a national multisectoral plan, “best buys” and very cost-effective interventions to reduce the exposure to risk factors for NCDs as part of these national plans.

Enable health systems to respond Member States to implement, by 2015, as part of multisectoral national polices and plans, “best buys” and very cost-effective interventions to enable health systems to respond to the NCD challenge of epidemic proportions

Measure results Member States to implement, by 2015, the WHO Framework for NCD Surveillance covering (i) monitoring of risk factors and determinants; (ii) outcomes (mortality and morbidity) and (iii) health system response, as well as to integrate NCDs into the national health information systems, and develop national indicators taking into account the global ones.

Number of countries with: At least one operational NCD plan A NCD unit Policy to reduce harmful use of alcohol Policy to reduce physical inactivity Policy to reduce the burden of tobacco use Policy to reduce unhealthy diets National guidelines for management of NCDs National policy on NCD-related research National NCD surveillance system

Global NCD action plan (process) indicators What is the current status following discussions at the WHO Executive Board?

• Formal meeting of Member States (Geneva, 15 November 2013) reached consensus on 9 action plan (process indicators)

• WHO Executive Board endorsed the process indicators

•Next steps:

—67th World Health Assembly will consider the indicators (May 2014)

Moving from global initiatives

to local action

Comprehensive assessment

Build supportive environment for NCD prevention and

control

Multisectoral action through effective partnerships

Set national targets, develop and implement NCD action

plan and measure results

Monitoring trends of NCDs, determinants and progress in

NCD prevention and control

• Method of work for WHO to implement the actions for

the WHO Secretariat included in the WHO Global NCD

Action Plan 2013-2020 in a coordinated manner,

including:

– Across the three levels of WHO

(Country Offices, Regional Offices, Headquarters)

– Across the WHO Categories included in the WHO Programme

Budget 2014-2015 (e.g. communicable diseases, maternal

health, emergencies)

One-WHO Work Plan 2014-2015

Costa Rica Ecuador Paraguay

Morocco Oman

Mozambique Rwanda

Azerbaijan Belarus Uzbekistan

Nepal Sri Lanka

China Fiji Mongolia Vietnam

One-WHP plan: Working with Countries to develop national multisectoral action plan

Comprehensive assessment

Analyse NCD burden

Examine evidence-based interventions

Review experience and best practices

Assess country responses

Data Sources

Comprehensive assessment:

NCD burden

Determining the magnitude of the NCD

problem – Population and health indicators

– Leading causes of death

– Prevalence of main risk factors

Determining the economic impact of the NCDs – Size of the problem: Demonstrating the Economic Burden of NCDs

– Possible solutions and their cost: Estimating a Global Price Tag for NCD

interventions

– The costs of scaling up a core intervention package

Comprehensive assessment:

Evidence-based interventions

Population-based interventions

– Communication

– Health interventions

– Economic measures

– Legislations/regulations

Individual interventions

– Early detection

– Health counselling and drug therapy

– Essential medicines and technologies

Examples of population-based

interventions

Tobacco use Harmful use of

alcohol

Unhealthy diet and

physical inactivity

• Health information

and warnings

• Tax increases

• Smoke-free indoor

workplaces and

public places

• Bans on tobacco

advertising,

promotion and

sponsorship

• Strengthening

awareness of

alcohol-attributable

burden

• Tax increases

• Restricted access

to retailed alcohol

• Bans on alcohol

advertising

• Public awareness

through mass media

on diet and physical

activity

• Reduced salt intake in

food

• Replacement of trans

fat with

polyunsaturated fat

Examples of individual interventions

Cardiovascular disease (CVD)

and diabetes

Cancer

• Counselling and multi-drug

therapy for people with a high risk

of developing heart attacks and

strokes (including those with

established CVD)

• Treatment of heart attacks with

aspirin

• Hepatitis B immunization to

prevent liver cancer (already

scaled up)

• Screening and treatment of pre-

cancerous lesions to prevent

cervical cancer

Comprehensive assessment:

Experiences and best practices

Advocacy and Partnerships

NCD policies, strategies, plans and

programmes

Community-based programmes

Health Information including NCDs and risk

factors

Comprehensive assessment:

Assessment of country responses

Health information systems

Multisectoral action on NCDs

Health service

Community capacity

Financial resources

Research capacity

Data Sources

National health information system database

Mortality, risk factors, burden of diseases, health

expenditure:

– WHOSIS

– National health accounts (NHA)

– Health programmes at WHO websites

Food safety and nutrition: The UN Food and

Agriculture Organization (FAO)

Economic arguments for NCDs: World Bank database

Build supportive environment

for NCD prevention and control

Advocacy for action

Raise public and political awareness

Integrate NCDs into the social and development

agenda and poverty alleviation strategies

Foster partnerships for NCDs

Strengthen international cooperation (e.g. UNDAF)

Advocacy for action

Analyse the situation and identify vision and priorities

Define desired outcomes

Know the target audience

Decide on key messages to influence target audiences

Choose appropriate approaches and planning activities

Engage the media

Build alliances

Build case for action

Multisectoral action

through effective partnerships

Establish mechanisms and coordinate activities

Exercise health sector's stewardship role with other

sectors and related United Nations organizations

Provide the health information, tools and advice

Share information and experience through various

platform, e.g. global, regional and national NCD Forum

or networks

Examples of cross-sectoral government

engagement to reduce NCD risk factors

Tobacco use Physical inactivity Harmful use of

alcohol

Unhealthy diet Other (eg.

Environment)

Health √ √ √ √ √

Education √ √ √ √

Finance √ √ √ √ √

Urban planning √ √ √ √

Agriculture √ √ √

Industry √ √ √ √

Transport √ √ √ √

Environment √ √ √

Housing √ √

Justice/Security √ √ √

Energy √ √

Social/Welfare √ √ √ √ √

Sports √ √ √ √

Communication √ √ √ √ √

Legislature √ √ √ √ √

Trade √ √ √ √ √

Youth affairs √ √ √ √ √

Examples of potential health effects of multisectoral action

Tobacco use Physical inactivity Harmful use of

alcohol

Unhealthy diet

Sectors

involved

(examples)

• Legislature

• Stakeholder ministries across

government, including

ministries of agriculture,

customs /revenue, economy,

education, finance, health,

foreign affairs, labour,

planning, social welfare, state

media, statistics, and Trade

• Ministries of education,

finance, labour, planning,

transport, urban planning,

sports, and youth

• Local government

• Legislature

• Ministries of trade,

industry, education,

finance, justice

• Local Government

• Legislature

• Ministries of trade agriculture,

industry, education, urban

planning, energy, transport,

social welfare, Environment

Examples of

multisectoral

action

• Full implementation of WHO

Framework Convention on

Tobacco Control obligations

through coordination

committees at the national and

subnational levels

• Urban planning /re-

engineering for active

transport and walkable cities

• School-based programmes

to support physical activity

• Incentives for work site

healthy lifestyle programmes

• Increased availability of safe

environments recreational

spaces

• Mass media campaigns

• Economic interventions to

promote physical activity

(taxes on motorized

transport, subsidies on

bicycles and sports

equipment)

• Tax increases

• Bans on alcohol

advertising

• Restricted access to

retailed alcohol

• Reduced drunk

driving

• Reduced amounts of salt,

saturated fat and sugars in

processed foods

• Eliminate industrially produced

trans-fats in foods

• Controlled advertising of

unhealthy food to children

• Increase availability and

affordability of fruit and

vegetables to promote intake

• Offer of healthy food in schools

and other public institutions

and through social support

programmes

• Economic interventions to

drive food consumption (taxes,

subsidies)

• Food security

Desired

outcome

• Reduced tobacco use and

consumption, including

secondhand smoke exposure

and reduced production of

tobacco and tobacco products

• Decreased physical inactivity

• Reduced harmful use

of alcohol

• Substitution of healthy foods

for energy-dense

micronutrient-poor food

• Reduced use of salt, saturated

fat and sugars

Logic Model

for Developing National NCD Action Plan

Goal and

objectives

(Examples)

Priority action areas

(Examples)

Activities

(examples)

Outputs

(examples)

Outcomes/impact (examples)

Short-term Long-term

General goal:

to reduce premature

mortality from NCDs

Specific Objectives:

1. To reduce prevalence

of risk factors

2. To increase coverage

of people with Main

NCDs

• To Build supportive

environment for NCDs

• to reduce the exposure

of populations and

individuals to the risk

factors for NCDs

• to improve health care

for people with the

selected main NCDs

• To strengthen

Monitoring NCD and

their risk factors

• to advance

multisectoral action

• To strengthen national

capacity

• to promote

international

cooperation and

coordination

Health campaign for

increasing

awareness of NCDs

and their risk

factors

place NCD in

development

agenda

incorporate NCD

into poverty

reduction strategy

financing NCD

set priorities of

NCD prevention and

control

set national targets

for NCD prevention

and control

Implementation of

FCTC and DPAS

awareness of

NCD increased

(KAP)

NCDs in

development

agenda and

poverty reduction

strategy

Budget increased

for NCDs

Priorities and

targets set

Changed in

coverage of NCD

management

Capacity

improved

Multisectoral

actions

implemented

Prevalence of risk

factors reduced

Mortality of

NCDs reduced

Quality of life

improved

Input Indicators Process Indicators Outcome Indicators

Monitoring & Evaluation

Set national targets

and measure results

Member States have committed themselves to "consider the development of national targets based on national situations", building on the 9 voluntary global targets

National targets can be more or less ambitious than the global ones

National adaptation of global targets should be guided by: Current performance, Current level of exposure 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

Develop and implement

NCD action plan Develop NCD policies, plans and programmes

– Ensure stakeholder engagement

– Set appropriate vision, goals, objectives

– Determine priority areas for action

– Define roles and responsibilities of stakeholders

– Determine timeframe

– Prepare budget

Implement NCD policies, plans and programmes

– Gaining and maintaining political and public support

– Dedicated unit and operational team

– Strengthen capacity to implement policies and plans

– Scale-up existing programmes or establish pilot projects

Monitoring and surveillance of NCD

and their determinants

• Mortality and morbidity ─ Mortality: NCD-specific mortality.

─ Morbidity: Cancer incidence and type (as core).

• Risk factors • Behavioural risk factors: tobacco use, physical inactivity, the harmful use of alcohol

and unhealthy diet

• Physiological and metabolic risk factors: raised blood pressure, overweight/obesity,

raised blood glucose, and raised cholesterol.

• National system response • Interventions and health system capacity: infrastructure, policies and

plans, access to key health-care interventions and treatments,

partnerships.

Monitoring progress

• Engage key stakeholders

• Ensure common understanding of the process

• Agree on purpose of monitoring and evaluation

activity

• Focus monitoring and evaluation activity

• Analyse data

• Use monitoring and evaluation information

Thank you