dr alwan ncd

International Conference on Healthy lifestyles and NCD prevention in the Arab World and Middle East

KEY QUESTIONS

•Can we realistically reduce the NCD burden?

•What is the way forward ? What are the commitments of member States

• What do countries need to implement the commitments?

Modifiable causative risk factors

Tobacco use Unhealthy diets

Physical inactivity

Harmful use of alcohol

Noncommunicable diseases

Heart disease and stroke

Diabetes

Cancer Chronic lung disease

Four Major Groups of Noncommunicable Diseases Four major lifestyles related risk factors


Communicable, maternal, perinatal and nutritional conditions NCDs Injuries

0.5 M

1.0 M

1.5 M

2.0 M

2.5 M

3.0 M

3.5 M

4.0 M

4.5 M

0.0 M

36%

53%

11%

Deaths in the Eastern Mediterranean Region

(Millions of deaths in 2008)

Projections

• NCD mortality will increase by 15% worldwide by 2020. The greatest increase will occur in Africa followed by the Eastern Mediterranean Region


0% 10% 20% 30% 40% 50% 60% 70%

QatarSomalia

KuwaitYemenDjiboutiBahrain

Saudi ArabiaOmanSudan

Syrian Arab RepublicIraq

PakistanLibyan Arab Jamahiriya

EgyptJordan

MoroccoIran (Islamic Republic of)

LebanonTunisia

Deaths from NCDs before 60 in the EMR(Percentage of total NCD deaths in 2008)

*Surveillance*Mapping the epidemic of

NCDs

*Management*Strengthen

health care for people with

NCDs

*Prevention*Reducing the

level of exposure to risk factors

Can we realistically reduce the burden? There is a strategic vision on how to address NCDs


Solutions• A national surveillance framework and

monitoring scheme integrated into health information systems

• Best buys interventions to prevent NCDs by reducing risk factors, implemented through a multisectoral approach

• Practical approaches to improve management of NCDs, particularly at the PHC level

Can we realistically reduce the NCD burden?WHO Global Status Report on NCDs (launched April 2011):

The NCD crisis is far advanced in most countries Some encouraging responses in some countries,

but not comprehensive and there are major gaps Reliable data is scarce. Surveillance is generally

weak Proportion of countries implementing the core

interventions is small Some progress to improve health care at PHC but

there are major inequities, monitoring is weak and training of health workforce is inadequate

There are large disparities in national capacities among countries, particularly in policy development and implementation

How is the region doing? Key messages WHO Country Profiles (launched in September 2011):

A 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 cCapacity and Response

– Interventions and health system capacity: infrastructure, policies and plans, access to key health care interventions and treatments, partnerships.

A package of low-cost "best buy" solutions exist:but the implementation in the EMR is weak

Interventions NCDs and risk factor Best buys

Population-based interventions addressing NCD risk factors

Tobacco use Tax increases smoke-free indoor workplaces and public places health information and warnings about tobacco bans on advertising and promotion

Harmful use of alcohol Tax increases on alcoholic beverages; Comprehensive restrictions and bans on alcohol marketing; Restrictions on the availability of retailed 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

Individual-based interventions addressing NCDs in primary care

Cancer Prevention of liver cancer through hepatitis B immunization Prevention of cervical cancer through screening and

treatment of pre-cancerous lesions

Cardiovascular disease and diabetes

Multi-drug therapy (including glycaemic control for diabetes mellitus) to individuals who have had a heart attack or stroke, and to persons with a high risk of a heart attack or stroke in the next 10 years

Providing aspirin to people having an acute heart attack


Political Declaration of the High-level Meeting(United Nations General Assembly resolution 66/2)

Strategic areas for Member States:

• To recognize NCDs as a challenge of epidemic proportions in developed and developing countries

• To promotes health-in-all-policies and whole-of-government approaches

• To prioritizes actions and expand national capacity to:– Reduce risk factors for NCDs– Improve health care within the context of health

system strengthening– Monitor NCDs and evaluate progress

What are the commitments of Member States?

In the area of governance , countries are expected to:

• assess their NCD situation and capacity and put in place comprehensive multisectoral plans by 22013

• integrate NCDs into health planning processes.• Strengthen intersectoral action• explore sustainable resources to Increase and prioritize

budgetary allocations to NCDs

What are the commitments of Member States?(Progress will be assessed during the UNGA in 2014)

In the area of prevention and risk factors reduction , countries are expected to:• Accelerate the implementation of the WHO FCTC, particularly

the 6 demand reduction measures• Implement interventions to reduce salt, trans fat and sugar• Implement the WHA recommendations on marketing of foods

and non-alcoholic beverages to children• Promote mass media campaigns on diet and physical activity • Promote breast feeding and implement the international code

of marketing of breast milk substitutes • Consider vaccinations to prevent certain cancers


In the area of health care , countries are expected to:

• Review health systems, identify gaps and weaknesses and integrate NCD interventions into PHC

• Prioritise effective interventions for early detection and treatment

• Improve access to essential diagnostics and medicines• Explore viable health financing mechanisms like innovative

approaches like tobacco taxation to increase coverage• Promote the production, training and retention of health

workers


In the area of surveillance and monitoring , countries are expected to:

• Develop national targets and indicators based on WHO guidance

• Strengthen surveillance and integrate into national health information systems ( monitoring of risks and determinants, cause specific mortality, and health system capacity and response)


EXAMPLES OF AREAS REQUIRING FURTHER POLICY GUIDANCE AND ACTION …Strengthening surveillance aspects , developing guidance on health information systems and identifying effective approaches to address existing gapsDeveloping guidance on implementing the best buys, based on experience and best practicesRefining evidence and summarising lessons learned for best buys e.g taxation, other forms of sin tax, removal of subsidies from certain food itemsDeveloping guidance on multisectoral actionEstablishing effective approaches to build capacity in cost/effectiveness analysis for policy making in the region Developing evidence/based clinical guidelines for common NCD conditions


"This is the second health issue ever to be addressed at a special meeting of the United Nations General Assembly. We should all work to meet targets to reduce NCDs. WHO's best buys serve as excellent guidance"

Ban Ki-moon • UN Secretary-General • 19 September 2011

NCDs will remain on the UNGA agenda…2012. Progress will be assessed in 2113, 214 , and beyond….

dr alwan ncd

Health & Medicine

ncd prevention

ncd burden

ncd crisis

key health care interventions

management of ncds

high risk

health system capacity

health care outcomes