WHO - Global and regional NCD commitments
Peter Sousa Hoejskov, Technical Officer Food Safety & NCD
WHO Division of Pacific Technical Support (DPS)
55th PIHOA Board Meeting, Pohnpei, FSM 11-13 March 2014
World Health Assembly in 2000:
There is a strategic vision on how to address NCDs
*Surveillance*
Mapping the
epidemic of
NCDs and risk
factors
*Prevention*
Reducing the
level of
exposure to
risk factors
*Management*
Strengthen
health care for
people with
NCDs
Setting the agenda:
Vision and a global road map
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
Global Strategy to Reduce
the Harmful Use of Alcohol
2009
WHO Global Status
Report on NCDs
2010
2011
Political Declaration on NCDs
2012+
Realizing the commitments made in the Political Declaration
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 Pacific Food Summit :
emergency in USAPI
Agriculture, Health and Trade
on Food Security
2011 Honiara Communique on Ministers of Sports
NCD Crisis Declaration
NCD Crisis declaration
supporting NCD
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
Ministers of Finance and
endorsement
Health Meeting
Commitments
from Heads of
State and
Government
2012:
Adopt a global
target of a 25%
reduction in
premature
mortality from
NCDs by 2025
World Health Assembly
2011:
World Health Assembly
UN General Assembly
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.
2013:
WHO Global
NCD Action
Plan 20132020, 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 2013-2020
unites 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
The WHO Global NCD Action Plan 2013-2020 has six objectives
with recommended actions for Member States, international partners and WHO
Objective 1
To strengthen
international
cooperation and
advocacy to raise
the priority
accorded to
prevention and
control of NCDs
in the
development
agenda and in
internationallyagreed
development
goals
Objective 2
To strengthen
national
capacity,
leadership,
governance,
multisectoral
action and
partnerships to
accelerate
country response
for the
prevention and
control of NCDs
Objective 3
To reduce
exposure to
modifiable risk
factors for NCDs
through creation
of healthpromoting
environments
Objective 4
To strengthen
and orient
health systems
to address the
prevention
and control of
NCDs through
peoplecentred
primary health
care and
universal
health
coverage
Objective 5
To promote
and support
national
capacity for
high-quality
research and
development
for the
prevention
and
control of
NCDs
Objective 6
To monitor the
trends and
determinants of
NCDs and
evaluate
progress in their
prevention
and control
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
What is next?
Immediate actions for Member States 2014-2015
Action Area
Governance
Risk 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? Priority actions recommended for Member States to
reduce the exposure of populations and individuals to risk factors for NCDs
Action Area
Implement interventions identified by WHO as
"best buys" using WHO tools:

–
–
–
–
Governance
Risk factors
Tobacco use:

Harmful use of alcohol:
–
–
Health systems
–
Surveillance

Tax increases
Smoke-free indoor work places and public places
Health information and warnings about tobacco
Bans on adverting and promotion
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
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:
Action Area
Governance
Risk factors
Health systems
Surveillance
 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
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)
Action Area

Governance
Risk factors
Health systems
Surveillance


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
The WHO Framework for NCD Surveillance quantifies and tracks exposures, outcomes and
health systems response
Action Area
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.
Governance
Risk factors
Health systems
Surveillance
Indicators
Vital Reg
with COD
Mortality from main NCDs

STEPS
GSHS
Harmful use of alcohol (3)


Low fruit and veg intake

Physical inactivity in adults

Cancer incidence by type
Cancer
Registry






Tobacco use in adolescents
Raised blood glucose/diabetes

Raised blood pressure

Overweight and obesity in adults


Overweight and obesity in
adolescents
Raised total cholesterol
GYTS

Saturated fat intake
Tobacco use in adults
GATS

Physical inactivity in adolescents
Salt intake
FF
Surveys


Indicator
Vital
Registration
Cancer
Registry
STEPS
SARA/
facility
data
NCD
Capacity
survey
Essential NCD meds and technologies


Hepatitis B vaccine

HPV vaccine

Cervical cancer screening

Drug therapy and counseling

Food
Freq
Surveys

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
Pacific Crisis Response Plans (CRP)
• 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!
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