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

13

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

21

• 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

23

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.

27

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.

29

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

31

Regional Plan of Action on

NCDs

32

• 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