ECOSOC Western Asia Ministerial Meeting
“Addressing noncommunicable diseases and injuries:
major challenges to sustainable development
in the 21st century”
Addressing common, modifiable risk factors for
noncommunicable diseases
Dr Fiona Adshead
Director, Chronic Diseases and Health Promotion
World Health Organization
10-11 May 2009
Doha, Qatar
Noncommunicable Diseases and their shared risk factors
 Four diseases:
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Cardiovascular diseases
Diabetes
Cancers
Chronic respiratory diseases
 Four risk factors:
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Tobacco use
Unhealthy diet
Physical inactivity
Harmful use of alcohol
 These diseases predominantly affect poor people in developing
countries, but they are preventable through action on four risk factors.
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ECOSOC Western Asia Ministerial Meeting, Doha, Qatar | 10-11 May 2009
Addressing noncommunicable diseases and injuries:
major challenges to sustainable development in the 21st century
Know your risk:
Countries with STEPS surveys
STEPS survey
completed
Survey or data
analysis under way
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ECOSOC Western Asia Ministerial Meeting, Doha, Qatar | 10-11 May 2009
Addressing noncommunicable diseases and injuries:
major challenges to sustainable development in the 21st century
STEPwise approach to surveillance
(STEPS)
 A simple, standardized method for collecting, analysing
and disseminating risk factor data in countries.
 Three different "steps" of risk factor
assessment:
– Questionnaire,
– Physical measurements,
– Biochemical measurements.
 Multiple modules on different topics.
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ECOSOC Western Asia Ministerial Meeting, Doha, Qatar | 10-11 May 2009
Addressing noncommunicable diseases and injuries:
major challenges to sustainable development in the 21st century
From data to policy
 Using the STEPS data for programs:
– To target your audience,
– To target your intervention,
– To target your location,
– To monitor progress.
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ECOSOC Western Asia Ministerial Meeting, Doha, Qatar | 10-11 May 2009
Addressing noncommunicable diseases and injuries:
major challenges to sustainable development in the 21st century
 Modelling work has shown the need to:
– anticipate and prepare for change,
– aim for impact at a societal level.
 Combined approaches to tackle multiple risk factors
can be effective:
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involve all stakeholders,
create enabling environments,
improve health literacy,
use "daily life" interventions where people live and work:
• improving urban or rural "walkability" or "cyclability",
• school or worksite based health promotion programmes.
ECOSOC Western Asia Ministerial Meeting, Doha, Qatar | 10-11 May 2009
Addressing noncommunicable diseases and injuries:
major challenges to sustainable development in the 21st century
UK Foresight – Tackling Obesities: Future Choices 2007
Tackling obesity: how we respond to challenges
Nizwa Healthy Lifestyle Project – Oman
 Goal: to improve the health of people in Nizwa through
community based projects for primary prevention of NCDs
(2004-2009).
Interventions tackle
following risk factors:
- physical inactivity,
- unhealthy diet,
- unhealthy environment,
- smoking,
- traffic accidents.
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ECOSOC Western Asia Ministerial Meeting, Doha, Qatar | 10-11 May 2009
Addressing noncommunicable diseases and injuries:
major challenges to sustainable development in the 21st century
School based interventions:
"Know Your Body" – Crete, Greece
Intervention:
 Know Your Body: 6-year programme (grades 1 to 6),
Characteristics:



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Comprehensive, multi-component, school-based, focus on diet and PA,
Constructs from social learning theory,
Curricula offered by trained teachers,
Strong parental focus,
Outcomes:
 significant improvements in knowledge and food choices,
 substantive reductions in intake of dietary fat, particularly saturated fat,
and four- to five-fold increases in self-reported leisure-time activity.
Source: WHO, What Works, 2009
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ECOSOC Western Asia Ministerial Meeting, Doha, Qatar | 10-11 May 2009
Addressing noncommunicable diseases and injuries:
major challenges to sustainable development in the 21st century
Improving health at work: shared benefits
Workplace health promotion can
achieve a 25-30% reduction in
medical and absenteeism costs.
 ≈ 27% reduction in sick leave
absenteeism,
 ≈ 26% reduction in healthcare costs,
 ≈ return on investment: $1 invested
results in $3 savings.
Source: Chapman LS, 2003
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ECOSOC Western Asia Ministerial Meeting, Doha, Qatar | 10-11 May 2009
Addressing noncommunicable diseases and injuries:
major challenges to sustainable development in the 21st century
Community intervention – Pasos Adelante
The programme:
Pasos Adelante, or "Steps Forward", is a community-participation
campaign for chronic NCD prevention, targeting border counties
between USA and Mexico.
The basis for the intervention:
Individuals received culturally appropriate educational
classes and participated in a walking club.
The outcomes:
The programme has an 87% completion rate, with a
120-minute median increase in physical activity, and
a four-serving increase in fruit and vegetables per
person per week.
Source: Staten LK et al, 2005
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ECOSOC Western Asia Ministerial Meeting, Doha, Qatar | 10-11 May 2009
Addressing noncommunicable diseases and injuries:
major challenges to sustainable development in the 21st century
Risk factor reduction:
at the heart of NCD prevention and control
 Prevent NCDs through four key risk factors:
tobacco, unhealthy diet, physical inactivity,
harmful use of alcohol,
 Target action based on risk factors,
 Target action where people live their lives,
 Multistakeholder and community-level
approaches are best.
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ECOSOC Western Asia Ministerial Meeting, Doha, Qatar | 10-11 May 2009
Addressing noncommunicable diseases and injuries:
major challenges to sustainable development in the 21st century
Background material
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ECOSOC Western Asia Ministerial Meeting, Doha, Qatar | 10-11 May 2009
Addressing noncommunicable diseases and injuries:
major challenges to sustainable development in the 21st century
Physical inactivity
Sudan (Khartoum State, 2005, 25-64)
Iraq (STEPS 2006, 25-65)
Saudi Arabia (STEPS 2005, 15-64)
Kuwait (STEPS 2006, 20-64)
Egypt (STEPS 2005, 15-65)
United Arab Emirates (WHS 2003, 18-69)
Pakistan (WHS 2003, 18-69)
% inactive* females
% inactive* males
Tunisia (WHS 2003, 18-69)
0
10
20
30
40
50
60
70
80
90
100
* <600 MET-mins/week (=5x30 minutes of moderate activity
Data collected using WHO STEPS surveillance tools
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ECOSOC Western Asia Ministerial Meeting, Doha, Qatar | 10-11 May 2009
Addressing noncommunicable diseases and injuries:
major challenges to sustainable development in the 21st century
% <5 servings of fruits and vegetables
Syrian Arab Republic
(STEPS 2003, 15-64)
Saudi Arabia (STEPS
2005, 15-64)
Iraq (STEPS 2006, 2565)
Kuwait (STEPS 2006,
20-64)
Egypt (STEPS 2005, 1565)
United Arab Emirates
(WHS 2003, 18-69)
0
10
20
30
40
50
60
70
80
90
100
Data collected using WHO STEPS surveillance tools
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ECOSOC Western Asia Ministerial Meeting, Doha, Qatar | 10-11 May 2009
Addressing noncommunicable diseases and injuries:
major challenges to sustainable development in the 21st century
% with elevated blood pressure
Iraq (STEPS 2006, 25-65)
Syrian Arab Republic (STEPS
2003, 15-64)*
Egypt (STEPS 2005, 15-65)
Saudi Arabia (STEPS 2005,
15-64)
Sudan (Khartoum State, 2005,
25-64)
Kuwait (STEPS 2006, 20-64)
0
5
10
15
20
25
30
35
40
45
(>=SBP 140 and/or DBP >=90)
*note: For Syria: labeled as 'high blood pressure', actual definition unknown
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ECOSOC Western Asia Ministerial Meeting, Doha, Qatar | 10-11 May 2009
Addressing noncommunicable diseases and injuries:
major challenges to sustainable development in the 21st century
Data collected using WHO STEPS surveillance tools
% with elevated cholesterol
Kuwait (STEPS 2006, 20-64)
Iraq (STEPS 2006, 25-65)
Syrian Arab Republic (STEPS
2003, 15-64)
Saudi Arabia (STEPS 2005, 1564)
Sudan (Khartoum State, 2005,
25-64)
Egypt (STEPS 2005, 15-65)
0
5
10
15
(Plasma Cholesterol >= 5.2 mmol/L)
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ECOSOC Western Asia Ministerial Meeting, Doha, Qatar | 10-11 May 2009
Addressing noncommunicable diseases and injuries:
major challenges to sustainable development in the 21st century
20
25
30
35
40
Data collected using WHO STEPS surveillance tools
% with elevated fasting blood glucose
Sudan (Khartoum State, 2005,
25-64)
Saudi Arabia (STEPS 2005, 1564)
Kuwait (STEPS 2006, 20-64)
Iraq (STEPS 2006, 25-65)
Egypt (STEPS 2005, 15-65)
0
2
4
6
8
10
12
14
16
18
20
(capillary blood glucose >=7.0 mmol/L)
Data collected using WHO STEPS surveillance tools
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ECOSOC Western Asia Ministerial Meeting, Doha, Qatar | 10-11 May 2009
Addressing noncommunicable diseases and injuries:
major challenges to sustainable development in the 21st century