noncommunicable diseases: the who global...
TRANSCRIPT
Noncommunicable
Diseases:
the WHO Global
Context
Dr. Anselm Hennis, Director, NMH
Outline • Introduction: NCDs, Burden of Disease and background efforts
• Overview of the Global Context
• Outcomes of the UNGA NCD Review 2014
– PAHO NCD Plan of Action
– Alignment with PAHO Strategic Plan
– Resource Mobilization
• Pan American Forum on NCDs
• Next steps at Regional level
– UNGA Regional Tasks, roadmap
– NMH at country level: Next Steps
1
NCD burden: Global Context
2 WHO Global NCD Report 2010. Available at
http://www.who.int/nmh/publications/ncd_report2010/en/
Region of the Americas:
Main Causes of death (2010)
3 Source: PAHO Regional Observatory Database
Available at: http://www.paho.org/hq/index.php?option=com_content&view=article&id=5542&Itemid=2391&lang=es
78.19%
8.97%
9.37% 3.48%
45% Cardiovascular
diseases
Cancer
30%
Diabetes
8%
Other NCDs
7%
Chronic resp. disease
10%
THE FACTS IN THE AMERICAS: Disease Burden
149 million smokers 25% -30% adults with elevated blood pressure 25% persons >15 years old obese
Approx. 200 million people living with an NCD in the
Americas
36% deaths occur below age 70 years
TOTAL NCD DEATHS (2010) 3,9 M
MOST OF THIS PREMATURE MORTALITY IS PREVENTABLE IF WE ACT IN A TIMELY AND PROTECTIVE MANNER
The estimated global costs will multiply
almost exponentially
5 Source: Bloom et al. The Global Economic Burden of NCDs. Harvard, 2012
Health Spending Projections By Chronic Condition In Brazil, 2008–50.
Source: Glassman A et al. Health Affairs 2010;29:2142-2148
©2010 by Project HOPE - The People-to-People Health Foundation, Inc.
0 100 200 300 400 500
high blood pressure
overweight & obesity
alcohol use
smoking
high cholestero l
low fruit & vegetable
intake
physical inactivity
unsafe sex
unsafe water, sanitation &
hygiene
childhood underweight
indoor air pollution from
solid fuels
urban air pollution
attributable deaths (thousands)
male female
Attributable deaths for main NCD
Risk Factors in LAC 2010
NCDs have a significant impact on economies, health systems, and households
Economies
Reduced labor supply
Reduced labor outputs
(e.g., cost of absenteeism)
Additional costs to
employers (e.g.,
productivity, insurance)
Lower returns on human
capital investments
Lower tax revenues
Increased public health and
social welfare expenditures
Health systems
Increased consumption of
NCD-related healthcare
High medical treatment
costs (per episode and over
time)
Demand for more effective
treatments (e.g., cost of
technology and innovation)
Health system adaptation
(e.g., organization, service
delivery, financing) and
adaptation costs
Households and
individuals
Reduced well-being
Increased disabilities
Premature deaths
Household income
decrease, loss, or
impoverishment
Higher health
expenditures, including
catastrophic spending
Savings and assets loss
Reduced opportunities
Key
drivers
Country productivity
and
competitiveness
Fiscal
pressures
Health
outcomes
Poverty, inequity,
and
opportunity loss
Example impact areas
Source: World Bank analysis by the authors in “Chronic Emergency: Why NCDs Matter.” Health, Nutrition, and Population Discussion Paper. 2011. Washington DC: World Bank.
Global Context
– UN High level Political Declaration
– Processes:
• WHO NCD Plan of Action and One-
WHO action Plan
• UN Task Force
• Global Coordinating Mechanism
– Reporting: UNGA NCD Review 2014
11
Global Context: UN HLM 2011
12
2011:
Commitments
from Heads of
State and
Government UN
Gen
eral
Ass
emb
ly UN HLM Political Declaration calls on
Member States to:
• Respond to the challenge: a whole of
government and whole of society effort.
• Reduce risk factors and create health
promoting environments
• Strengthen national policies and health
systems
• International cooperation, including
collaborative partnerships
• Research and development
• Monitoring and evaluation
FOLLOW UP: UNGA NCD Review
2014
What have we gained from the UN
HLM?
UNHLM
Declaration
Political Commitment
Raise Awareness of the problem
Mobilization of Resources
Coordination of efforts
Inclusion of other sectors
Increased Accountability
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UNHLM: Main processes
14
NCD Review
2014
Subregional Consultations
UN
Po
litic
al
De
clar
atio
n
UN Task Force
GCM
WHO and PAHO NCD
Plans
… an
d Fu
ture U
NG
As o
n
NC
Ds
Outcome: Call to Action
WHO Global NCD Action Plan 2013-2020
The Global NCD Action plan was developed with the following objectives: • To raise the priority accorded to the prevention and
control of NCDs in global, regional and national agendas
• To strengthen national capacity, leadership, governance, multisectoral action and partnerships.
• To reduce modifiable risk factors for NCDs and underlying social determinants through creation of health-promoting environments
• To strengthen and orient health systems to address the prevention and control of NCDs
• To promote and support national capacity for high-quality research and development for the prevention and control of NCDs
• To monitor the trends and determinants of NCDs and evaluate progress in their prevention and control
9 global voluntary targets by 2025
WHO Global NCD Action Plan 2013-2020 > 25 outcome indicators (to measure outcomes in 2015, 2020 and 2025)
Number of countries with: At least one operational NCD plan A NCD unit Policy to reduce harmful use of alcohol Policy to reduce physical inactivity Policy to reduce the burden of tobacco use Policy to reduce unhealthy diets National guidelines for management of NCDs National policy on NCD-related research National NCD surveillance system
WHO Global NCD Action Plan 2013-2020 > 9 process indicators (to measure progress in 2015, 2017 and 2020)
UN Interagency Task Force on
NCDs • Terms of Reference agreed during EB134 in WHO in January
• Purpose:
– Coordinate activities of the relevant UN funds, programmes and
specialized agencies and other intergovernmental organizations to
support work on commitments from the UN HLM, in particular through
the implementation of the WHO NCD Plan of Action.
• Objectives:
– Enhance and coordinate systematic support to Member States on NCD
efforts
– Facilitate systematic and timely information exchange
– Facilitate information on available resources to support national efforts
on ncds
– Strengthen advocacy for NCDs
– Incorporate work of the Ad Hoc Interagency Task Force on Tobacco
Control
– Strengthen international cooperation to support national, regional and
global plans on NCDs through exchange of best practices. 19
Partnerships with UN Agencies
20
Joint letter from the UNDP coordinator
and WHO DG
• Accelerate the development of
multisectoral joint programmes
• Support governments to develop
national targets
• Development, implementation and
monitoring of national, multisectoral policies
and plans
WHO Global Coordinating
Mechanism • Part of the Mandate of the UN HLM (2011), WHO and PAHO
NCD Action Plans
• Mandate: an intersectoral, participatory approach
• Terms of Reference approved in WHA 2014
• Actors
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• GOVERNMENTAL: • Non-Health • Other Levels (state, municipal) • Other Powers (parliament, judicial)
• UN-AGENCIES • NON – STATE ACTORS
• Academia • NGOs (representing social and private interests) • Some Private Actors (without conflict of interest)
UNGA NCD Review 2014:
Relevance for Member States
22
Identifies progress made by
Member States
Extracts lessons learnt from the
process
Establishes Member States
and Regional positions at global level
Identifies gaps and priority
actions
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NCD Review 2014
Dr. Margaret Chan noted that “Eighty-five per
cent of premature deaths from NCDs occur in
developing countries,”
“risk factors for NCDs are becoming part of the
very fabric of modern society. The obesity epidemic has been getting worse, not
better, for more than three decades.”
In reference to NCDs, she noted a “seismic shift that calls for sweeping changes in
the very mindset of public health’’
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NCD Review 2014
• Helen Clarke, UNDP Administrator, noted
that, “sustainable development calls for
integrated policy-making across the economic,
social, and environmental spheres. To make
progress we will need to revisit patterns of
trade, consumption, governance, and urbanization – and not only to treat and
manage disease through medical interventions.”
NCDS ‘’must not be seen as a health challenge alone,
but also, more broadly, as a human development challenge’’
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NCD Review 2014
• Recognition that progress on NCDs has been ‘’insufficient and highly uneven’’
since 2011,
– call for specific measurable and time bound national commitments,
including governments called upon to set national NCD targets, national
multisectoral plans, and national multisectoral mechanisms by 2015
• Recognition that NCDs are a major challenge for development in the 21st
century,
– call to governments to integrate NCDs into national health and development
planning and processes, as well as the inclusion of NCDs in the post-2015
development agenda
26
NCD Review 2014 • Acknowledgement of commitments to reduce risk factors and underlying social
determinants, as well as strengthening and orienting health systems to respond to
NCDs over the life-course.
– Governments to implement interventions and policy options for the prevention
and control of NCDs (Global Action Plan 2013-2020) by 2016
• Acknowledgement of linkages between NCDs and other health issues, including
communicable diseases (such as HIV/AIDS), and reproductive, maternal, and
newborn child health issues;
– Governments to integrate NCDs into existing services, especially at the Primary
Health Care level.
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NCD Review 2014
• Acknowledgement of the need to strengthen national surveillance and
monitoring systems, including social disparities in NCDs to address
inequalities, and also pursue gender-based approaches based on
available data.
– Governments to assess national progress towards the GMF’s 9
voluntary targets and 25 indicators.
• Recognition of the need to strengthen international cooperation,
resource mobilization, and improve tracking
– specific call to the Organization for Economic Cooperation and
Development (OECD) to develop a mechanism to improve tracking
of official development assistance on NCDs.
28
NCD Review 2014
• Future review of NCDS: WHO has been called upon to submit through the UN
SG a progress report in 2017, to be followed by a UN HLM Review on NCDs in
2018, to ensure the continued recognition of NCDs at the highest political level,
and not only as a health issue.
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Challenges of the
Global processes on NCDs
• Definitions of 9 voluntary targets and 25 indicators
• Coordination among UN agencies
• Country capacity
• Surveillance/monitoring systems: availability and quality
• Resources
• Full participation of the Region in the process
• Regional influence on UNGA NCD Review 2014
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Regional Context
• PAHO NCD Plan of Action
• Alignment with Strategic Plan
• Resource Mobilization
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Regional Plan of Action on
NCDs
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• Aligned with WHO Global Plan of Action • Includes:
• Implementation of the 9 global targets in the Region
• Regional monitoring of the 25 indicators* • Introduces 11 Region Specific Indicators
• Four lines of action, aligned with Global Framework and Political Declaration on NCDs:
• Multisectoral policies and Partnerships (all regional indicators)
• Risk factors and protective factors (all global indicators)
• Health system response (5 regional indicators added to the global indicators)
• Surveillance and Research (3 regional and 2 global indicators)
* Some of the regional indicators consolidate indicators of the Global Monitoring Framework
Focus of PAHO’s NCD POA
2013-19
4 Diseases: CVD, Cancer, Diabetes, CRD
4 Risk Factors: Tobacco, Diet, Alcohol, Physical Inactivity
Other regional issues: Obesity, Mental Health, CKD
NCDs as Development Issue
Whole of government, whole of
society approach
NCDs in social protection schemes
and UHC
Protective factors and determinants of health
Change of model of care within PHC
Access to technology and
medicines
Monitor advances
Challenges of the PAHO NCD Action
Plan • Competing national priorities.
• Insufficient investment in prevention and control
of NCDs.
• Low regulatory capacity at the national level.
• Interference from big economic corporations.
• The complexity of monitoring and reporting
systems reduces country capacity to report
progress on NCDs and risk factors.
• Failure to comply with international mandates
such as WHO FCTC.
34
Resource Mobilization Efforts
35
Insert NMH in PAHO’s Resource
Mobilization Umbrellas
Earmarked resource
mobilization from WHO
Renew, expand, strengthen
external funding partners
Alternative funding
mechanisms
Organizational funds
$1.4M
RB
CIDA
?
AECI
?
WHO:
Tobacco, Road Safety,
Mental Health
NCDs
BRAZIL
Contribution**
Future directions
• Best Buys
• Challenges
• NCDs – a shared
responsibility
36
NCD Recommended “Best Buys” Risk factor /
disease Interventions
Tobacco use
• Raise taxes on tobacco • Protect people from tobacco smoke • Warn about the dangers of tobacco • Enforce bans on tobacco advertising
Harmful use of alcohol
• Raise taxes on alcohol • Restrict access to retailed alcohol • Enforce bans on alcohol advertising
Unhealthy diet and physical inactivity
• Reduce salt intake in food • Replace trans fat with polyunsaturated fat • Promote public awareness about diet and physical
Cardiovascular disease (CVD) and diabetes
• Provide counselling and multi-drug therapy (including blood sugar control for diabetes mellitus) for people with medium-high risk of developing heart attacks and strokes (including those who have established CVD)
• Treat heart attacks ( myocardial infarction) with aspirin
Cancer • Hepatitis B immunization beginning at birth to prevent liver cancer • Screening* and treatment of pre-cancerous lesions to prevent
cervical cancer 37
- - - - -
http://www.who.int/nmh/publications/who_bestbuys_to_prevent_ncds.pdf
MARKETING and Risk Factors of
NCDs
MARKETING and Risk Factors of
NCDs
“Coming Together” “Be OK”
PAHO, technical guidelines
40
CONCLUSION: NCDs, a shared
responsibility
• The fight against NCDs is not only about individual
choices
• Best-buys already working on tobacco control, can be
adapted to the food, beverage and alcohol industries. At
the end, it is all the same.
• The marketing industry shares a moral responsibility due
to the big influence they have on the general population
and on the governments.
CONCLUSION: NCDs, a shared responsibility
• There is also a role of mass media in
“translating” the knowledge produced
by sound, honest science to the
population, and in informing with
evidence on individual, family,
community and political decisions.
Thank you!
Title of the Presentation 43