douglas bettcher director prevention of ncds …douglas bettcher director prevention of ncds world...
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Douglas Bettcher Director
Prevention of NCDs WORLD HEALTH ORGANIZATION
SDG target 3.4: By 2030, reduce by one third premature mortality from NCDs
through prevention and treatment and promote mental health and well-being
Where do we stand today?
What progress has been made between 2000 and 2017? What are the plans until 2018?
Causative risk factors
Tobacco use
Unhealthy diets
Physical inactivity
Harmful use of
alcohol
No
nco
mm
un
icable
dise
ases
Heart disease and stroke Diabetes Cancer Chronic lung disease
2000: WHO Global Strategy on NCDs
Communicable, maternal, perinatal and nutritional conditions
NCDs Injuries
Source: WHO Global Health Estimates
-
5,000,000.00
10,000,000.00
15,000,000.00
20,000,000.00
25,000,000.00
0 to 29 30 to 69 70 and beyond
2015: 15 million people died from NCDs between the ages of 30 and 69
Pre
mat
ure
dea
ths
(30
-70
) in
mill
ion
s
Years
0
0.5
1
1.5
2
2.5
3
3.5
4
2000 2005 2010 2015
Low-income
Lower middle-income
Upper middle-income
High-income
2015: # of premature deaths (30-69) from NCDs among men , ex rich countries
Pre
mat
ure
dea
ths
(30
-70
) in
mill
ion
s
Years
0
0.5
1
1.5
2
2.5
3
2000 2005 2010 2015
Low-income
Lower middle-income
Upper middle-income
High-income
2015: # of premature deaths (30-69) from NCDs among women , ex rich countries
0
0.5
1
1.5
2
2.5
3
2000 2005 2010 2015
AFR
AMR
EMR
EUR
SEA
WPR
Pre
mat
ure
dea
ths
(30
-70
) in
mill
ion
s
Years
2015: # of premature deaths (30-69) from NCDs among men , except EUR
Pre
mat
ure
dea
ths
(30
-70
) in
mill
ion
s
Years
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
2
2000 2005 2010 2015
AFR
AMR
EMR
EUR
SEA
WPR
2015: # of premature deaths (30-69) from NCDs among women , except EUR
Pro
bab
ility
of
dyi
ng
(0-1
)
Years
0
0.05
0.1
0.15
0.2
0.25
0.3
2000 2005 2010 2015
Developed countries
Developing countries
2015: Probability of men dying from any major NCD between ages 30-70
Pro
bab
ility
of
dyi
ng
(0-1
)
Years
0
0.05
0.1
0.15
0.2
0.25
2000 2005 2010 2015
Developed countries
Developing countries
2015: Probability of women dying from any major NCD between ages 30-70
Probability of dying from any of cardiovascular disease, cancer, diabetes, chronic respiratory disease between the ages of 30 and 70
WHO estimates for 2015 (both sexes)
0%
5%
10%
15%
20%
25%
30%
35%
40%
AFR Algeria Cabo Verde, Gabon
15% 16%
AMR Canada Chile, Costa Rica
10% 11%
EMR Qatar Iran (IR)
14% 15%
EUR Iceland Italy, Israel, Sweden, Switzerland
8% 9%
SEAR Maldives Thailand
12% 16%
WPR Republic of Korea Australia, Japan
8% 9%
AFR Cote d'Ivoire Sierra Leone
28% 30%
AMR Trinidad and Tobago Guyana
26% 28%
EMR Sudan Afghanistan, Yemen
26% 31%
EUR Belarus, Kazakhstan, Russian Federation, Ukraine Turkmenistan
29% 35%
SEAR DPRK Indonesia
26% 27%
WPR Fiji Papua New Guinea
31% 36%
2015: Huge disparities between countries
Source: WHO Global Health Estimates
The most important question
Source: WHO Global Health Estimates
Globally, the probability of dying prematurely from these four main NCDs declined by 17% between 2000 and 2015. This rate of decline is insufficient to meet the SDG target 3.4 on NCDs (i.e. by 2030, reduce by one third premature mortality from NCDs)
2011 Political
Declaration
2014 Outcome
Document
2015 SDGs
2015 AAAA
2018 3rd HLM
Commitments made by world leaders to curb premature deaths from NCDs
2018
2009 ECOSOC Doha Declaration on NCDs
2007 CARICOM Port-of-Spain Declaration on NCDs
2011 Moscow
Declaration
Commits governments to develop national responses:
Target 3.4: By 2030, reduce by one third premature mortality from NCDs through prevention and treatment and promote mental health and wellbeing
Target 3.5: Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol
Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for al
2030 Agenda for Sustainable Development
Target 3.a: Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate
Target 3.b: Support the research and development of vaccines and medicines for the communicable and NCDs that primarily affect developing countries, provide access to affordable essential medicines and vaccines, in accordance with the Doha Declaration on the TRIPS Agreement and Public Health, which affirms the right of developing countries to use to the full the provisions in the Agreement on Trade-Related Aspects of Intellectual Property Rights regarding flexibilities to protect public health, and, in particular, provide access to medicines for all
2030 Agenda for Sustainable Development
Addis Ababa Action Agenda
The Addis Ababa Action Agenda defines the means of implementation for the 2030 Agenda for Sustainable Development
The Addis Ababa Action Agenda recognizes that price and tax measures on tobacco represent a revenue stream for financing for development in many countries
Governments already collect nearly US$270 billion in tobacco excise revenues each year
Tobacco taxation offers a win-win policy option for governments
2025 milestone: 9 voluntary global NCD targets
By 2030, reduce by one third premature mortality from NCDs
2030 milestone: NCD-related targets in the SDGs
2018 milestone: Four time-bound commitments
WHO Global NCD Action Plan 2013-
2020
2011 UN Political
Declaration on NCDs
2014 UN Outcome
Document on NCDs
Governance Risk factors Health systems Surveillance
Components of national NCD responses
WHO Regional NCD Action
Plans
Third High-level Meeting of the UN General Assembly on NCDs in 2018
Agenda for Sustainable
Development 2016-2030
Set national NCD targets for 2025 or 2030 and monitor results
Develop a national multisectoral action plan
Implement the "best buy" interventions to reduce NCD risk factors
Implement the "best buy" interventions to strengthen health systems to address NCDs
Four time-bound commitments in the 2014 UN Outcome Document on NCDs
WHA68 (2016) 2015
WHA73 (2021) 2020
WHA78 (2026) 2025
WHA68
(2016) 2015
WHA69 (2018) 2017
WHA73 (2021) 2020
2015 2016
UNGA (2017)
2017
Global accountability framework for NCDs
2018
UNGA 2016 UNGA 2017
25 outcome indicators
9 process
indicators
10 progress
indicators
2 indicators
2018
25 outcome indicators
9 process
indicators
10 progress
indicators
2 indicators
Where can we find these indicators?
Table 1 in Appendix 1 of document A66/8 (endorsed by resolution WHA66.10) http://apps.who.int/gb/e/e_wha66.html
Table in paragraph 2 in Annex 4 of document A67/14 (agreed by WHA67) http://apps.who.int/gb/e/e_wha67.html
Technical note published by the WHO Director-General on 1 May 2015 http://www.who.int/nmh/events/2015/getting-to-2018/en/
Report of the IAEG-SDGs to the 47 session of the UN Statistical Commission http://unstats.un.org/sdgs/iaeg-sdgs/
Progress towards the 9 global NCD targets for 2025 2010 2014 Trend
Unconditional probability of dying between ages of 30 and 70 from one of the mayor NCDs
20% 19%
Total alcohol per capita (aged 15+ years old) consumption within a calendar year (in litres of pure alcohol)
6.4 6.3
Prevalence of current tobacco smoking use among adults aged 18+
23.1% 21.8%
Age-standardized prevalence of raised blood pressure among persons aged 18+ years and mean systolic blood pressure
23% 22%
Age-standardized prevalence of raised blood glucose/diabetes among persons aged 18+ years
8% 9%
Age-standardized prevalence of overweight and obesity in persons aged 18+ years)
11% (obesity)
37% (overweight)
13% (obesity)
39% (overweight)
Outcome indicators (reported to the World Health Assembly in May 2016)
Number of countries 2010 2015 Trend
with at least one operational multisectoral national NCD action plan
30/166 (18%)
61/166 (37%)
that have operational NCD unit 88/166 (53%)
110/166 (66%)
with an operational policy to reduce the harmful use of alcohol 80/166 (48%)
111/166 (67%)
with an operational policy to reduce physical inactivity 91/166 (55%)
119/166 (72%)
with an operational policy to reduce the burden of tobacco use 109/166
(66%) 135/166
(81%)
with an operational policy to reduce unhealthy diet. 99/166 (60%)
123/166 (74%)
that have evidence-based national guidelines for the management of major NCDs through a primary care approach
125/166 (75%)
61/166 (37%) N/A
that have an operational national policy on NCD-related research NO DATA 60/166 (36%) N/A
with NCD surveillance and monitoring systems in place 60/166 (36%)
48/166 (29%) N/A
Process indicators (reported to the World Health Assembly in May 2016)
WHO NCD Progress Monitor for UN General Assembly: 2015 progress report card
0 5 10 15 20 25 30 35
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Number of Member States
Nu
mb
er
of
"fu
lly a
chie
ved
" In
dic
ato
rs
Is the world on track for 2030 to meet SDG target 3.4 (NCDs)?
Is the world on track for 2018 to meet the four time-bound commitments?
Are health outcomes for NCDs improving since 2011?
Are counties strengthening their capacities for NCDs since 2011?
Are countries implementing the WHO Global NCD Action Plan?
No
No
The NCD community needs an electric shock to its semi-
comatose soul. But who has the courage
to deliver it?
Yes Yes
Yes, but …
Remarkable progress, even in some of the poorest countries, but bolder
measures are needed.
What can WHO report to the UN General Assembly in November 2017?
Successes to date are still outstripped by illness,
disability, human suffering, and premature deaths from
NCDs
Why is progress so slow?
A lack of adequate commitment and policy expertise to integrate measures to address NCDs into national SDGs responses
Unmet demands for technical assistance to be provided through bilateral and multilateral channels to strengthen national capacity
Slow progress in engaging the whole-of-government and key sectors beyond health, which is a prerequisite in developing national multisectoral NCD responses, including the implementation of the “best buys” for NCDs
Lack of action to allocate funding to implement NCD control priorities, in developing countries, by domestic mobilization of resources or external aid
Weak health systems and inadequate national capacity in public health
Insufficient analytical, legal and tax administrative capacity to reduce risk factors and support the implementation of the best buys
Actions of opposing forces, including industry interference, that blocks the implementation of certain key measures.
Are countries requesting assistance to overcome these bottlenecks?
Governance Risk factors Health systems Surveillance
UN Agencies (coordinated through the WHO-led UN Task Force on
NCDs)
WHO Secretariat
(through WHO Programme
Budget)
Non-State actors
(coordinated through the
WHO GCM/NCD)
Development and implementation of national NCD responses
• Normative work • Technical assistance
• Technical assistance (beyond the health sector)
• Advocacy • Network • Forum
Components of national NCD responses
How is WHO helping countries to build national NCD responses?
May 2017: Updated set of good and best buys for NCDs
Endorsed by the World Health Assembly in May 2017: 16 best buys 86 good buys
http://apps.who.int/gb/e/e_wha70.html Two years process Methodology endorsed by the World Health
Assembly in May 2016 Additional information published to
understand the underlying analysis related to interventions included in the updated set
Additional technical briefings published on the evidence underlying the interventions presented in the updated set
http://www.who.int/ncds/governance/appendix3-update/en/
1) Increase excise taxes and prices on tobacco products
2) Implement plain/standardized packaging and/or large graphic health warnings on all tobacco packages
3) Enact and enforce comprehensive bans on tobacco advertising, promotion and sponsorship
4) Eliminate exposure to second-hand tobacco smoke in all indoor workplaces, public places, public transport
5) Implement effective mass media campaigns that educate the public about the harms of smoking/tobacco use and second hand smoke
6) Increase excise taxes on alcoholic beverages
7) Enact and enforce bans or comprehensive restrictions on exposure to alcohol advertising (across multiple types of media)
8) Enact and enforce restrictions on the physical availability of retailed alcohol (via reduced hours of sale)
9) Reduce salt intake through the reformulation of food products to contain less salt and the setting of target levels for the amount of salt in foods and meals
10) Reduce salt intake through the establishment of a supportive environment in public institutions such as hospitals, schools, workplaces and nursing homes, to enable lower sodium options to be provided
11) Reduce salt intake through a behaviour change communication and mass media campaign
12) Reduce salt intake through the implementation of front-of-pack labelling
13) Implement public awareness and motivational communications for physical activity, including mass media campaigns for physical activity behavioural change
14) Drug therapy (including glycaemic control for diabetes mellitus and control of hypertension using a total risk approach) and counselling to individuals who have had a heart attack or stroke and to persons with moderate to high risk of a fatal and non-fatal cardiovascular event in the next 10 years
15) Vaccination against human papillomavirus (2 doses) of 9–13 year old girls
16) Prevention of cervical cancer by screening women aged 30–49
May 2017: Updated set of 16 best buys for NCDs
Available at www.who.int/ncds
Updated quarterly
WHO tools
WHO Global Conference on NCDs (Montevideo, 18-20 October 2017)
Focus: How to develop NCD policies to
implement the (updated) “best buys” for NCDs to reach SDG target 3.4?
How to influence public policies in sectors beyond health to reach SDG target 3.4?
How to enhance policy coherence between public health, trade and other sectors to reach SDG target 3.4?
Outcome: NCD Roadmap 2018-2030 for
SDG target 3.4 on NCDs www.who.int/montevideo2017
Key take away
In 2011 and 2014, Heads of State and Government made commitments to reduce premature mortality from NCDs
In 2015, Heads of State and Government committed to develop ambitious national responses to the SDGs, including SDG target 3.4 to, by 2030, reduce by one third premature mortality from NCDs
Despite these commitments, progress to date has been insufficient and highly uneven.
Bolder measures are urgent to focus efforts.
Our task at hand: Which bolder measures do we recommend?
