who global ncd action plan: frameworks, priority actions and surveillance for effective and...

WHO GLOBAL NCD ACTION PLAN:Frameworks, priority actions and surveillance for effective and sustainable NCD prevention

China Healthy Lifestyle Conference

Beijing 19.8.2013

13.04.23 1

Pekka PuskaDirector General, National Institute for Health and Welfare (THL)President, Int. Association of National Public Health Institutes (IANPHI)Chair, Governing Council of WHO Cancer Research Agency (IARC)Past President, World Heart Federation (WHF)

Greetings from Finland

Pekka Puska, Director General13.04.23

10 million

15 million

20 million

25 million

High-income countries

Upper middle-income

Lower middle-income

Low-income countries

0.6M

0.5M

3.3M

2.3M

10.2M10.2M

3.3 M3.3 M3.0M

3.0M3.0M

3.0M

5.9M5.9M

2.3M

6.8 M6.8 M

3.7M13.6M

13.6M

1.1M0.9M

Low-income countriesGroup III - InjuriesGroup II – Other deaths from noncommunicable diseasesGroup II – Premature deaths from noncommunicable diseases (below the age of 60), which are preventableGroup I – Communicable diseases, maternal, perinatal and nutritional conditions

So

urce

:

Total number of deaths in the world

90% of premature deaths from NCDs occur in developing countries

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GLOBAL PUBLIC HEALTH CHANGING:

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UN high-level summit on NCDsNew York Sept 2011

• Preceded by Ministerial Conference in Moscow (April 2011).

• Political declaration• Action on global NCD

prevention and control”• WHO’s leadership,

intersectoral support

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RECENT POLITICAL SUPPORT

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WHO’s global NCD strategy, 2000

• NCD prevention and control is a global health priority

• Comprehensive action is needed, but from public health point of view population based prevention is the key (most cost-effective and sustainable)

• Integrated prevention: targeting common, lifestyle related risk factors (tobacco, diet, physical activity, alcohol)

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SurveillanceMapping the epidemic of

NCDs

ManagementStrengthen health care for people with NCDs

PreventionReducing the

level of exposure to risk factors

Key Components of the global strategy

Cornerstones of NCD prevention and control (WHO global strategy)• Attention to behavioural risk factors

– Tobacco use– Unhealthy diet– Physical inactivity– Harmful use of alcohol

• Monitoring and surveillance of – Risk factors and diseases– Preventive actions

• Redirection of health services– Prevention (esp. primary health care)– Chronic care model

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INTEGRATED PREVENTION

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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

The journey to scale up global action

2010

2009

2011

Global Strategy to Reduce the Harmful Use of Alcohol

WHO Global Status Report on NCDs

UN Political Declaration on NCDs13.04.23 10Pekka Puska, Director General

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

Global Strategy for the Prevention and Control of Noncommunicable

Diseases

Global Strategy for the Prevention and Control of Noncommunicable

Diseases2000

2008

2013

2011

2011

8th Global Conference on Health Promotion,

10-14 June 2013, Helsinki, Finland

8th Global Conference on Health Promotion,

10-14 June 2013, Helsinki, Finland

World Conference on Social Determinants on Health, October 2011, Rio de Janeiro

World Conference on Social Determinants on Health, October 2011, Rio de Janeiro

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Action Plan 2007-2012

#New Action Plan

for 2013-20endorsed by WHA 2013

12Pekka Puska, Director General

WHO global action plan 2013-201. International cooperation and advocacy

2. Strengthen national capacity, leadership, governance, multisectoral action and partnership

3. Reduce risk factors through health-promoting environments

4. Strengthen and reorient health systems for prevention and control of NCDs

5. Promote national capacity for research for prevention and control of NCDs

6. Monitor trends and determinants of NCD and evaluate progress

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Global targets (2010-2025)1. 25 % reduction of avoidable mortality

2. 10 % reduction in harmful use of alcohol

3. 10 % reduction in insufficient physical activity

4. 30 % reduction in mean population salt intake

5. 30 % reduction in tobacco use

6. 25 % reduction in raised blood pressure

7. Halt the raise in diabetes and obesity

8. At least 50 % of eligible (=high risk) people receive drug treatment and councelling to prevent heart attack and stroke

9. In 80 % availability of affordable basic technologies and essential medicines for NCD

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Ban Ki-Moon:”We should all work to meet the targets to reduce NCDs”

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Global indicators

• Indicators of targets

• Additional indicators–E.g. saturated fatty acids, fruits and

vegetables, blood cholesterol, cervical cancer screening, HPV vaccination, policies of narcotics, advertizing of foods and non-alcoholic beverages to children, national policies to limit saturated fats and eliminate trans fats in food supply

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PRIORITY ACTIONS

• Should be feasible and affordable in low-cost settings

• Evidence and/or expert opinion to support

• Adapt to local conditions and stage of process

• Supported by many documents

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1. International cooperation and advocacy

• Raise public and political awareness on NCDs

• Strengthen international collaboration for training

• Integrate NCDs into development strategies

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2. Strengthen national capacity, leadership etc.

• Increase budgetary allocations for NCD

• Strengthen national capacity, including institutional capacity for prevention and control of NCDs

• Develop national multisectoral policy and plan

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Intersectoral work towards prevention- ”Health in all policies”

• People’s lifestyles are influenced by decisions in different sectors of society (much of them beyond the health sector)

• Health in general and NCD prevention in particular should be taken into account in decisions made by different sectors (health impact assessment)

• Social change process combining government policies, expert guidance, broad health promotion and mobilization of people

Pekka Puska, Director General13.04.23

8th Global WHO Conference on health promotion - “Health in all policies”

From Ottawa to Helsinki (June 2013)

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HELSINKI STATEMENT

Comprehensive action and partnership for national NCD prevention

• Health services

• Governments (national, local)

• Civil society (NGOs)

• Private sector

• Media

• International collaboration

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What are NPHIs?

Institution or network that provides leadership and coordination for public health systems at the national level

Often part of the government (usually under

MOH) or closely attached to it. Scope & size vary.

Promotes evidence-based decisions, policies, and programs

MEXICO INSP

MOROCCO

NETHERLANDS RIVM

U.S. CDC

ETHIOPIA EHNRI

CHINA CDC

Finland THL

3a Reduce risk factors: tobacco• Increase tobacco tax

• Completely smokefree indoor places by law

• Effective health warnings and media campaigns

• Ban all tobacco advertising, promotion and sponsorship

(all FCTC provisions should be implemented)

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3b Reduce risk factors: alcohol

• Increase alcohol tax

• Comprehensive restrictions and bans on adventising and promotion

• Restrictions in the availability of retailed alcohol

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3c Reduce risk factors: unhealthy diet and physical inactivity

• Salt reduction through industry and media campaigns

• Reduction of saturated fat and replacement of transfats

• Public awareness campaigns on diet and physical activity

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4. Strengthen and reorient health systems• Integrate effective NCD interventions in universal

primary health care

• Explore innovative financing approaches to expand health coverage and prioritize very cost effective interventions

• Multidrug preventive therapy to high risk of CVD individuals

• Aspirin in acute heart attack

• Liver cancer prevention through hepatitis B immunization

• Cervical cancer prevention through screening

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Redirection of health services

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• Reorientation and strengthening of health systems• Primary health care:

”Now more than ever” (WHR 2008)

• Special emphasis for NCDs• Chronic care model• Preventive practices

5. Promote national reserch capacity

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• Develop national research agenda• Strengthen national capacity

through national health and research institutes

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6. Monitor and evaluate• Develop national targets and indicators

(based on the global ones)

• Develop national surveillance monitoring system–Cause of deaths register–Cancer register–Periodic population risk factor surveys–Monitoring of national actions

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NCD FRAMEWORK FOR ACTION/MONITORING

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GENETICS

Health promotion

Prevention Treatment

SOCIETAL RESPONSES(HiAP)

HEALTH SERVICES

Pekka Puska, Director General

International/global action

• United Nations: New York 2011 Political Declaration, Post 2015 targets

• UN agencies coordination

• WHO leadership–UN coordination– International collaborative mechanism–Global Action Plan 2013-20–Global monitoring and reporting (UN,

WHA)

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NCD prevention is possible!

The potential is great• Quite rapid impact• Human impact on health and

wellbeing• Impact on health service costs and

socioeconomic developmentEXPERIENCE FROM FINLAND

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Change in age-adjusted mortality rates Finland, males aged 35–64 (per 100 000 population)

extension of the Project nationally

start of the North Karelia Project

North Karelia -85%

All Finland -80%

Rate per 100 000

1969-1971

2006 Change from 1969-1971 to 2006

All causes 1328 583 -56%

All cardiovascular

680 172 -75%

Coronary heart disease

489 103 -79%

All cancers 262 124 -53%

Coronary heart diseaseCoronary heart disease

Gain of some 10 healthy years in Finnish populationGain of some 10 healthy years in Finnish population

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The North Karelia/Finland experience• Supports and has interacted much with

the WHO NCD strategy:– Integrated prevention–FCTC, Diet & physical activity strategy

• Happy about the recent political support to upgrading of NCD prevention–UN NCD Summit in September 2011

in New York–Follow up work under WHO leadership

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45

THE MAIN CHALLENGE FOR

SUCCESSFUL NCD

PREVENTION IS NOT WHAT

TO DO, BUT HOW TO

IMPLEMENT THE NEEDED

ACTIONS!

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During the last few years a great number of strategies and plans for evidence-based, effective prevention and health promotion have been produced

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Many important priorities have been identified

Pekka Puska, Director General

IDENTIFYINGIDENTIFYING IMPLEMENTINGIMPLEMENTING

PRIORITIESPRIORITIES THEMTHEM

FROM PRIORITIES TO IMPLEMENTATION

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Implementation gap

The WHO Global NCD Action Plan and many other WHO and national strategies give clear quidance on what to do

- But to achieve good results a lot of practical work in the communities and in the country is needed!

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Thank you

13.04.23 49Pekka Puska, Director General