1. Non-communicable Diseases:
Realizing the commitments from Heads of State and Government made in the UN Political Declaration on NCDs
لنتحد في مكافحة الأمراض غير السارية
Unidos contra las enfermedades no transmisibles
团结起来，抵抗非传染性疾病
Tous unis dans la lutte contre les maladies non transmissibles
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2. World Health Organization
World Health Assembly in 2000:
There is a strategic vision on how to address NCDs
6 April 2017
*Surveillance*
Mapping the epidemic of NCDs and risk factors
*Prevention*
Reducing the level of exposure to risk factors
*Management*
Strengthen health care for people with NCDs

3. World Health Organization
Setting the agenda:
Vision and a global road map
World Health Organization
6 April 2017
2000
Global Strategy for the Prevention and Control of Noncommunicable Diseases
2003
Global Strategy on Diet,
Physical Activity and Health
2004
Action Plan on the Global Strategy for the Prevention and Control of NCDs
2008
Global Strategy to Reduce the Harmful Use of Alcohol
2009
WHO Global Status Report on NCDs
2010
2011
Political Declaration on NCDs
2012+
Realizing the commitments made in the Political Declaration

4. 23 2013: 2012: 2011: Commitments from Heads of State and Government
fact 23
The UN High-level Meeting on NCDs was a defining moment for development cooperation: it sets a new global agenda that advances inclusive social and economic development.
UN General Assembly
2011:
Commitments from Heads of State and Government
World Health Assembly
2012:
Adopt a global target of a 25% reduction in premature mortality from NCDs by 2025
2013:
WHO Global NCD Action Plan , including 9 global targets and 25 indicators
UN General Assembly NCD Review 2014:
Review and assessment of the United Nations General Assembly of the progress achieved in the prevention and control of NCDs

5. The WHO Global NCD Action Plan unites governments, international partners and WHO around a common agenda
Vision: A world free of the avoidable burden of NCDs Goal: To reduce the preventable and avoidable burden of morbidity, mortality and disability due to NCDs by means of multisectoral collaboration and cooperation at national, regional and global levels

6. country response for the prevention and control of NCDs
The WHO Global NCD Action Plan has six objectives
with recommended actions for Member States, international partners and WHO
fact
Objective 1
To strengthen international cooperation and advocacy to raise the priority accorded to prevention and control of NCDs in the development agenda and in internationally-agreed development goals
Objective 2
To strengthen national capacity, leadership, governance, multisectoral action and partnerships to accelerate
country response for the prevention and control of NCDs
Objective 3
To reduce exposure to modifiable risk factors for NCDs through creation of health-promoting environments
Objective 4
To strengthen and orient health systems to address the prevention and control of NCDs through people-centred primary health care and universal health coverage
Objective 5
To promote and support national capacity for high-quality research and development for the prevention and
control of NCDs
Objective 6
To monitor the trends and determinants of NCDs and evaluate progress in their prevention
and control

7. Nine Global Targets and 25 Outcome Indicators
Non-communicable Diseases:
Realizing the commitments from Heads of State and Government made in the UN Political Declaration on NCDs
Nine Global Targets and 25 Outcome Indicators
لنتحد في مكافحة الأمراض غير السارية
Unidos contra las enfermedades no transmisibles
团结起来，抵抗非传染性疾病
Tous unis dans la lutte contre les maladies non transmissibles
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8. fact
At the World Health Assembly in May 2013, Member States adopted 9 voluntary global targets for the prevention and control of NCDs to be attained by 2025

9. At the World Health Assembly in May 2013, Member States adopted the Comprehensive Global Monitoring Framework for the Prevention and Control of NCDs, including a set of 25 indicators
fact

10. Non-communicable Diseases:
Realizing the commitments from Heads of State and Government made in the UN Political Declaration on NCDs
9 NCD Action Plan Indicators to inform reporting on progress made in the process of implementing the WHO Global NCD Action Plan
لنتحد في مكافحة الأمراض غير السارية
Unidos contra las enfermedades no transmisibles
团结起来，抵抗非传染性疾病
Tous unis dans la lutte contre les maladies non transmissibles
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11. WHO Discussion Paper (version dated 12 August 2013)
Draft set of action plan indicators

12. Immediate actions for Member States 2014-2015
What is next?
Immediate actions for Member States
Set national targets for 2025 in 2013, taking into account the 9 global targets
Develop national multisectoral NCD policies and plans to attain national targets for 2025, by addressing the three major components of the NCD strategy
Action Area
Governance
Risk factors
Health systems
Surveillance

13. Action Area Risk factors
What is next? Priority actions recommended for Member States to reduce the exposure of populations and individuals to risk factors for NCDs
Implement interventions identified by WHO as "best buys" using WHO tools:
Tobacco use:
Tax increases
Smoke-free indoor work places and public places
Health information and warnings about tobacco
Bans on adverting and promotion
Harmful use of alcohol:
Tax increases on alcoholic beverages
Comprehensive restrictions and bans on alcohol marketing
Restrictions on the availability of 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
Marketing of foods and non-alcoholic beverages to children
Action Area
Governance
Risk factors
Health systems
Surveillance

14. Action Area Governance Risk factors Health systems Surveillance fact
What is next? Priority actions recommended for Member States to enable health systems to respond more effectively and equitably to the health-care needs of people with NCDs
fact
Implement interventions identified by WHO as "best buys" into the basic primary health care:
Health system strengthening is key:
Prevention of liver cancer through hepatitis B immunization
Prevention of cervical cancer through screening and treatment of pre-cancerous lesions
Multidrug therapy to individuals who have had a heart attack or stroke and to persons with a high risk of a cardiovascular event in the next 10 years
Action Area
Governance
Risk factors
Health systems
Surveillance

15. Action Area Surveillance
fact
What is next? Priority actions recommended for Member States to quantify and track NCDs and their determinants (as it provides the foundation for advocacy, national policy and action)
Implement the WHO Framework for NCD Surveillance, covering
monitoring of risk factors and determinants,
outcomes (mortality and morbidity) and
health system response
Integrate into the national health information systems
Develop national targets and indicators, based on the WHO recommendations and WHA Resolutions
Action Area
Governance
Risk factors
Health systems
Surveillance

16. Action Area Surveillance
The WHO Framework for NCD Surveillance quantifies and tracks exposures, outcomes and health systems response
fact
Action Area
Governance
Risk factors
Health systems
Surveillance
A WHO 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 Response:
Interventions and health system capacity: infrastructure, policies and plans, access to key health care interventions and treatments, partnerships.

17. Non-communicable Diseases:
Realizing the commitments from Heads of State and Government made in the UN Political Declaration on NCDs
WHO Global Coordination Mechanism on the Prevention and Control of NCDs (‘NCD GCM’)
لنتحد في مكافحة الأمراض غير السارية
Unidos contra las enfermedades no transmisibles
团结起来，抵抗非传染性疾病
Tous unis dans la lutte contre les maladies non transmissibles
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18. UN INTERAGENCY TASK FORCE
Non-communicable Diseases:
Realizing the commitments from Heads of State and Government made in the UN Political Declaration on NCDs
UN INTERAGENCY TASK FORCE
لنتحد في مكافحة الأمراض غير السارية
Unidos contra las enfermedades no transmisibles
团结起来，抵抗非传染性疾病
Tous unis dans la lutte contre les maladies non transmissibles
Объединяйтесь в борьбе против НИЗ

19. UN Interagency Task Force on NCDs
What has happened since the UN Political Declaration on NCDs in 2011?
UN Interagency Task Force on NCDs
Objectives:
Enhance and coordinate technical support
Facilitate information exchange about plans, strategies, programs and activities
Facilitate information exchange about available resources to support national efforts
Strengthen advocacy
Ensure that tobacco control continues to be duly addressed
Strengthen international cooperation
“The Task Force will be convened and led by WHO. Accordingly, WHO shall provide the Secretariat of the Task Force”

20. Fighting the global health burden through new technology:
WHO ITU joint program on mHealth for NCDs
mHealth as an example of interagency collaboration

21. UN General Assembly NCD Review 2014
Non-communicable Diseases:
Realizing the commitments from Heads of State and Government made in the UN Political Declaration on NCDs
UN General Assembly NCD Review 2014
لنتحد في مكافحة الأمراض غير السارية
Unidos contra las enfermedades no transmisibles
团结起来，抵抗非传染性疾病
Tous unis dans la lutte contre les maladies non transmissibles
Объединяйтесь в борьбе против НИЗ

22. NCD progression and health economic burden
Health and economic burden
Healthy
Population to be covered
Risk factors
High risk
NCD
Complications
Rehab
Progression of NCD

23. Helping to improve health
This is a picture often presented and shows the importance of social determinants which are in the domain of other sectors in reducing health risks
The environment where we live, study, play and work have a huge influence on our behaviours, lifestyles. The environments are often not under
the health sector. They are under different government ministries – such as urban planning, education, industry, commerce and agriculture  
This is the basis for 'whole-of government' and 'whole-of-society' approach

24. ‘Whole-of-Government’ and ‘Whole- of-Society’ approach
‘Whole-of-Government’ denotes public service agencies working across portfolio boundaries to achieve a shared goal and an integrated government response to particular issues
Responsibility for health and its social determinants rests with the whole society, and health is produced in new ways between society and government.
Whole of government approach refers to
“…whole-of-government denotes public service agencies working across portfolio boundaries to achieve a shared goal and an integrated government response to particular issues. Approaches can be formal and informal. They can focus on policy development, program management and service delivery.”
Whole of society approach
Responsibility for health and its social determinants rests with the whole society, and health is produced in new ways between society and government. A wide variety of agencies and individuals (private companies, independent agencies, academia, expert bodies and informed citizens) increasingly play a critical role in governance for health. New communication technologies, including the social media, enable new forms of participation, transparency and accountability.

25. Very cost effective interventions
Tobacco use
Reduce affordability of tobacco products by increasing tobacco excise taxes;
Create by law completely smoke-free environments in all indoor workplaces, public places and public transport;
Warn people of the dangers of tobacco and tobacco smoke through effective health warnings and mass media campaigns;
Ban all forms of tobacco advertising, promotion and sponsorship
Harmful alcohol use
Regulating commercial and public availability of alcohol
Restricting or banning alcohol advertising and promotions
Using pricing policies such as excise tax increases on alcoholic beverages
Unhealthy diet and physical inactivity
Reduce salt intake
Replace trans-fats with unsaturated fats;
Implement public awareness programmes on diet and physical activity
Cardiovascular disease and diabetes
Drug therapy (including glycaemic control for diabetes mellitus and control of hypertenstion using a total risk approach) and counselling to individuals who have had a heart attack or stroke, and to persons with high risk (≥ 30%) of a fatal and nonfatal CVD event in the next 10 years
Acetylsalicylic acid for acute myocardial infarction.
Cancer
Prevention of liver cancer through hepatitis B immunization;
Prevention of cervical cancer through screening (visual inspection with acetic acid [VIA]) or Pap smear (cervical cytology), if very cost effective), linked with timely treatment of pre-cancerous lesions

26. Win – Win approach for NCD prevention
Education
Improved scholastic outcome
Less risk factors
Agriculture
Improved production of fruits and vegetables
Improved consumption of fruits and vegetables in population
Industries
Improved productivity
Less expenses on sickness of employees
Prevention and control of NCDs in workers
Urban planning
Beautiful city, more tourists, more money
More physical activity, tobacco control
Other sectors can benefit by taking actions which will also impact ncd prevention and control. Healthy children in schools will help to improve their scholastic achievement and will help to reduce ncd risk factors.

27. Plain packaging- a path breaking approach in Australia
Examples of best practices and effective approaches for MSA Tobacco Control
Tobacco taxation and Health Promotion Foundations in Australia, Lao PDR, Korea, Malaysia, Mongolia, Tonga, Viet Nam
Plain packaging- a path breaking approach in Australia
Let us look at some of the good practices of MSA in the Region.
Tobacco control is a good example in many of the countries. Smoke-free public places are possible only if many sectors come together. Hong Kong and Singapore has demonstrated this. Plain packaging by Australia is a path-breaking approach.
Raising taxes for tobacco is one of the most powerful ways t reduce consumption and many countries have done this already and others are being supported.

28. -- Reducing Harm from Alcohol
Examples of best practices and effective approaches for MSA - Tobacco Control
-- Reducing Harm from Alcohol
The Mongolian President initiative in alcohol control, non- alcohol in government’s function and new alcohol legislation
Development of legislation: drinking and driving, use of helmet, blood testing: China, Cambodia, Philippines, Vietnam
Regulating informal alcohol control in Vietnam
Harmful use of alcohol is one of the risk factors for NCD and it leads to many other health and socio-economic consequences.
Political commitment is critical and the best example is that of Mongolia, where the President toasted the new year with a glass of milk signifying a major change.

29. Healthier foods in Singapore-Hawker Fare
Examples of best practices and effective approaches for MSA
-- Promoting Healthy Diet
Healthier foods in Singapore-Hawker Fare
Salt reduction in China and Mongolia
Eat smart restaurants (700+), Hong Kong (China)
Eat school (400), Hong Kong (China)
There are many good examples in the Region. The ‘hawker fare’ in Singapore is the work of Health Promotion Board with many other sectors to make 'street food' healthy and safe. Hong Kong has more than 700 healthy eating restaurants offering healthier options in the Menu. They also have eat school.
Republic of Korea has legislated to restrict marketing of junk food to children, while Mongolia and China has salt reduction programmes.

30. Controls on advertisement
EU television without frontiers directive
TV adverts shall not cause moral or physical detriments to minors
Ireland-bans cartoon characters and celebrities to promote foods
France –mandatory health messages should accompany adverts on TV and radio
Sweden-total ban for adverts aimed at children less than 12 yrs

31. Examples of best practices and effective approaches for MSA
--- Promoting Physical Activity
Exercise equipment in public parks in Lao PDR, China, Korea
Walk paths, and cycling tracks in Cambodia, Korea, China, Malaysia
Community physical exercise groups clubs in Seongbuk, Korea and Shanghai, China
Walking days in Dalin, Seongbuk, Xiamen
Creating awareness and improving environments can influence people’s behaviour. There are good examples from Shanghai, China and Seoul, Republic of Korea, and Marikina in Philippines, which made infrastructure changes, public parks, cycling tracks etc.

32. Examples of best practices and effective approaches for MSA
- Healthy Cities
Smoke Free Cities
Harbin, QingDao, China
Makati and Marikina, Philippines
LuangPrabang, in Lao PDR,
Siem reap, Cambodia
Environmentally sustainable healthy urban transport (ESHUT) in 5 Asian cities
Promote walking, cycling
public transport system
Reduce use of private vehicles
Smokig ban
Promoting health and hygiene
Barrier-free transport environments
Healthy Cities are a priority for the region. This region has one of the fastest urbanization. Healthy city development can introduce policy interventions and the Environmentally Sustainable and Healthy Urban Transport is a good example of multiple sectors coming together in Phnom Penh, Marikina, Ichikawa.
Many cities are becoming smoke-free like Davao in the Philippines, and Sydney and Melbourne in Australia
Scaling up healthy cities for NCD prevention and control and promotion of healthy living is a theme that can be very beneficial for all sectors.

33. Healthy workplaces - Shanghai, Hong Kong, China
Examples of best practices and effective approaches for MS A----Healthy Settings:
Health Promoting Schools and Work Places
Health Promoting schools for multiple health interventions- Singapore, Hong Kong, Macao (China)
Healthy workplaces - Shanghai, Hong Kong, China
Healthy settings such as schools and work places are well-suited for multiple risk factor interventions. Singapore, Macao and Hong Kong (China) and other cities have developed health promoting schools. Health promoting work places in Shanghai offers healthier diet and facilities for physical activity in the workplace.

34. Healthy Cities to Promote Healthy Living
Promotion of Physical Activity
Bicycle and pedestrian friendly urban landscape, Changwon,
Community physical activity facilities, Hong Kong, Dalian, Beijing,
Walk Paths in public parks-Shanghai, China

36. Upstream interventions
Policies/
lack of it in other sectors
NCDs 36

37. Cross over All sectors to work for health Health in all policies
Transport
Urban planning
Food processing
Tobacco/Alcohol sales and
promotions
Education
Industry

38. MSA-Entry Points National National multi-ministerial forum Subnational
Effective only with commitment at the highest level, need a good driver, Health in All Policies
City/District/Village level
Subnational
More feasible, leverage local government, collective voice of community, government closer to the community, local ordinances
Tobacco/Alcohol/Physical Activity
Risk factor
Facilitators-activism, pressure groups, champions, international agreements (FCTC), global reporting, more palpable interventions, common good /common enemy
Inter ministerial
Local Government
Cross sector working groups
We can consider different entry points. It can be at the national level with an institutional mechanism, such as an interministerial committee or working group.
At the subnational level this can be through local governments and healthy cities is a good example.
MSA can also be issue-based such as around tobacco control or salt reduction. These approaches need a working group or task force with relevant partners.

39. Mechanisms , Tools and Instruments for MSA
Inter-ministerial and inter-departmental committees
Community consultations and Citizens’ Juries
Cross-sector action teams
Partnership platforms
Integrated budgets and accounting
Cross-cutting information and evaluation systems
Impact assessments
Joined-up workforce development
Legislative frameworks
The Adelaide statement also identified tools and instruments
Inter-ministerial and inter-departmental committees
Community consultations and Citizens’ Juries
Cross-sector action teams
Partnership platforms
Integrated budgets and accounting
Health Lens Analysis
Cross-cutting information and evaluation systems
Impact assessments
Joined-up workforce development
Legislative frameworks

40. MSA-Accountability and Reporting
Experiences from MDG 4 and 5 in accountability framework
Agreed national targets and indicators
Sector-specific roles, responsibility, target, inputs and outputs
Joint statement and joint plan
Across sectors audit, evaluation
Public reporting
Once the country sets up the national targets and indicators, sector specific inputs, outputs and targets have to be identified.
Joint statement and agreed plans with formal endorsements can be powerful instruments.
Audit and evaluation is needed across different sectors.
Public reporting will enhance the accountability.

41. NCD Management

42. NCD management: Defined package, coverage, follow-up
What is good ?
Desire for universal coverage
Global push for universal health coverage
Package of Essential NCD interventions-Generic drugs
What are the limitations?
NCD services not defined adequately in PHC
System limitations-concept of chronic care, human resource
Market driven treatment
Profit sector
What is needed?
NCD services to be defined and incorporated
Increase resources in primary and secondary care-
Human resource development

43. Monitoring and evaluation
Deaths-Cause Specific Mortality-ICD coding
Disease burden-Registries (eg. Cancer, Stroke) Prevalence surveys
Risk factors-
Adult - WHO STEPS survey
Children-Global school based student health survey
Policy monitoring
Health Impact Assessment

44. Healthier people making healthier decisions.
An operational manual for WHO IRM/QRT to support countries in the development of a national multisectoral plans for prevention and control of NCDs.

45. NCD services in disasters
WHY? WHAT? HOW? OUTCOME
What is MSA?
Step 1. Sit. Analysis
National MSA plan for NCD prevention and control
Approach paper
Guiding principles
Step 2. Int stakeholder consult
NCD MSA in UHC
Prioritization of actions- country context
Draft plan
Step 3. Ext stakeholder consult
HiAP
UNDAF, city planning, urban development, sustainable development, legislative agenda
Final draft
NCD services in disasters
Step 4. Endorsement of MSA
NCD targets and indicators

46. Current NCD plans/actions
1. Sit. Analysis
IRM mission 1 (One week)
to assign a 3 member team for the country (1 HQ, 1 RO, 1 from another region)-
within WR office team led by WR, MOH focal points and national consultants
Epidemiological trends
Health outcomes
Burden and trends
CCS priorities
UNDAF
National NCD plan- status
Related plans
Current NCD plans/actions
Stakeholder mapping
Political landscape
Stakeholder analysis
Sources
NCD country capacity survey
WHO CCS
NCD global status report
Risk factors surveys
Health system assessment
Vital registration
Cancer registries
Nutrition surveys
Tools
Spider grams
Stakeholder analysis
Multi voting
Balance score cards
Problem solution trees
Prioritization tools
Projection of national targets
Process
1 week IRM mission
Day 1-engagement
Day 2-3- Sit asssmnt
Day 4-Prioritization
Day 5-Draft plan
Output of Step 1
Approach paper
Situational analysis
Priority areas
Potential national targets
Sectors and stakeholders
Next steps

47. Lead by WR, supported by team from IRM-RO and with external experts
Step 2. Int stakeholder consult
IRM mission 2 (One week)
Lead by WR, supported by team from IRM-RO and with external experts
Based on the approach paper developed in Step 1
Consultation within MOH-all programmes related to NCD
Internal advocacy and buy in
Current NCD services
Limitations
Opportunities
Health insurance coverage
Health services for NCD
How can targets be monitored
National NCD surveillance framework
NCD surveillance
Approach paper
Tools
Spider grams
Multi voting
Problem-solution tree
Prioritization tools
Capacity enhancement
Advocacy
Communication
Surveillance
Leadership
Process
Thematic consultations
External technical support
Output of
Step 2
Draft MSA plan for NCD prevention and control
NCD in UHC
NCD services in emergencies

48. 3. Ext stakeholder consult
IRM mission 3 (One week)
Lead by WR, supported by team from IRM (1 from HQ, 1 RO and 1 from another region) with external experts
1 day consultation with ministries and departments in Government
Other government sectors
One day consultation with NGOs, civil society organizations
Civil society
Half day consultation with Donor and dev partners and UN agencies
Donor and development partners
UN agencies
Half day consultation with professional associations
Professional societies
Draft MSA plan
Tools
Spider grams
Multi voting
Problem-solution tree
Prioritization tools
Process
Thematic consultations
External technical support
Identification of specific actions in other sectors/domains
Synthesis and finalization
Output of Step 3:
Final MSA plan

49. Lead by WR, supported by team from IRM (1 HQ, 1 RO)
4. Endorsement of MSA
IRM mission 4 (2 days)
Lead by WR, supported by team from IRM (1 HQ, 1 RO)
Prior to mission 4, WR and MOH team to share the final draft and to have engagement with all stakeholders to get endorsement.
Consultations
Endorsement from Ministry of Health and Other ministers
Endorsement
Support expressed by UN agencies and partners
Donor and development partners
UN agencies
Support expressed by professional associations
Professional societies
Preparations
Design and layout of MSA plan
Foreword and messages
Process
Endorsement
Media activity
Outcme of Step 4:
Final endorsed national MSA plan for NCD prevention and control.

50. Structure of a national multisectoral action plan for the prevention and control of NCDs
Preface
Message from Head of State/Government, preface from Minister of health, messages from other key ministries, UN agencies and partners.
Introduction
Country context, CCS priority, NCD in national plans if any, concern and commitment from national leaders
Situational analysis
Burden, trends, current status of NCD plans/policies, partners, political landscape, capacity, challenges and opportunities
Approach for MSA plan
Process, inputs, global and regional mandates, national priorities
National Multisectoral plan
Overall framework, governance
Vision, mission, national targets, objectives, actions, sectors responsible, milestones
Human and financial resources
Synergies with ongoing programmes
Monitoring and reporting
Annexe
List of participants and contributors
Copies of relevant WHO/UN documents

51. Main barriers/risks identified and approaches to mitigate them
Preparation
Lack of commitment
Perceived conflict of interest
Territorial issues among departments
Who will fund?
Who will lead?
Advocacy using commitments made by the country
Examples from other countries
Support for role delineation among sectors
Demonstrate ‘win-win’ options
Steps 1-4
Process constraints
Lack of engagement from senior policy makers
Lack of firm commitments (only expression of interest)
Participation by junior staff in consultations
Influence of interested parties
Not reaching consensus
Identify an influential champion in the country
Lobbying by minister of health
Civil society pressure, media reports on NCD burden and role of sectors
NGOs to highlight lack of enabling environment and role of other sectors
Get a directive from head of state/chief of cabinet
Well prepared approach paper to offer options
Good understanding of the roles by different sectors
Implementation
Who will do what?
Funds?
Human resources
Capacity
Lack of clearly identified bench marks
Lack of monitoring
No overall responsibility
Lack of coordination
Annual action plans with roles and responsibility
National steering committee (with senior level representation from relevant sectors)
Allocation of budget
Clearly identified activities, indicators and targets
Public reporting and reporting in the cabinet once a year
Stage of
MSA NCD plan
Barriers and risks
Approaches to mitigate

52. Prioritized activities within the national MSA plan for NCDs
Considerations for selecting activities in MSA plan
Current risk factor burden and stage of the country in epidemiological transition
Political interest
Feasibility (resources, infrastructure, governance mechanisms)
Pressure groups
Donor and development community interest
Champions to drive the actions
Ongoing actions
WHO presence and support in country
Interests and activities of UN agencies and partners
Set of very cost effective interventions

53. Potential priorities
Tobacco control
Salt reduction – policies, regulations, legislation
Reducing per capita alcohol consumption
Control of marketing of foods and non-alcoholic beverages to children
Front of pack color coded labels
Ban transfats
PA promotion
Cancer screening
Hep B and HPV coverage
Quality of health service indicators
Monitoring of 25 indicators
NCD is the main burden, good infrastructure, high political commitments
Salt reduction-awareness, working with industry
Alcohol harm reduction
Urban planning for PA promotion
Food labelling
Health promoting schools, work places, healthy cities and islands
PEN in primary care
Strengthening referral care
Cervical cancer screening
HPV vaccination
STEPS ad GSHS once in 5 years
National mortality registration and COD
Rapidly increasing NCD burden/moderate level of resources and capacity/increasing political commitment
Salt reduction-awareness, local food producers, caterers
Cancer palliative care
Hep B coverage
School based approaches
STEPS and GSHS once in 5 years
Improve death registration and COD reporting
Early in the epidemic/
minimal resources

54. Framing a national MSA plan

55. Resources Advocacy materials
Global and regional action plans and reports
NCD Global Action Plan
NCD Regional Action Plan
Action Plan on Reducing the Double Burden of Malnutrition in the Western Pacific Region ( )
EB134/14 Follow-up to the Political Declaration of the High-level Meeting of the United Nations General Assembly on the Prevention and Control of Non-communicable Diseases
One-WHO work plan for the prevention and control of NCDs
Actions that Make a Difference (Report on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region )
Health in All Policies (HiAP) Framework for Country Action (January 2014)
Journal articles
Taxation of sugar sweetened beverages
Effect of food prices on the prevalence of obesity
Regional NCD Meeting materials
Intercountry Workshop for NCD surveillance and monitoring, NCC, Republic of Korea, December 2012
Workshop on Leadership and Capacity Building for Cancer Control (CanLEAD), NCC, Republic of Korea, June 2013
Regional Workshop on Strengthening Leadership and Advocacy for the Prevention and Control of Noncommunicable Diseases (LeAd-NCD), Saitama, Japan, December 2013
Workbook
Meeting reports
Japan-WHO Regional Consultation for Promoting Healthier Dietary Options for Children, Saitama, Japan, March 2012
Regional Consultation on Strengthening Noncommunicable Diseases in Primary Health Care, Beijing, China, Apr 2012

56. Multi-Sectoral Action in Australia
A range of stakeholders
across various federal government departments -health, education, family and community services
across various levels of government (federal, state/territory and local government)
between the public and private sectors.
A range of governance mechanisms:
national committees
agreements with key stakeholders
Australia has a federal system of government. The Federal Government has a leadership role in policy making and is primarily responsible for funding various health services including medical services and pharmaceuticals outside of hospitals. The Federal Government also makes a substantial contribution to funding hospital costs and it has a role in aged care, Indigenous health care and veterans’ health. The Federal Government funds around 43% of health expenditure. The States and Territories deliver almost all public hospital services and a wide range of community and public health services, including school health, dental health, maternal and child health and environmental health programs. The State and Territory Governments fund around 27% of health expenditure. The private sector delivers many health services and accounts for about 30% of health expenditure.
This splitting of responsibility for health between government levels has meant multi-sectoral arrangements to address non-communicable diseases have been a feature of the Australian health system over many years and have by necessity occurred:
across federal government departments;
across levels of government (federal, state/territory and local government); and
between the public and private sectors.
Through a multi-sectoral approach, the Australian Government has implemented a range of programs and activities that promote healthy outcomes in the daily lives of Australians through non-health settings, such as communities, early childhood education and care environments, schools and workplaces.

57. National Preventative Health Taskforce (April 2008)
obesity, tobacco and alcohol
key drivers of chronic disease, health system and social costs
consultations (40) and public submissions (397)
Australia: the Healthiest Country by 2020 (Sept 2009)
35 areas for action and 136 recommendations
focus on social inclusion and integration with primary care

58. National Partnership Agreement on Preventive Health
National Partnership Agreements (NPAs) facilitate joint action between levels of Government in Australia - $872m over 6 years from
aims to prevent lifestyle risks that cause chronic illness and was one of the first of its kind in Australia
Defines roles and responsibilities, and accountability
The main mechanism through which the federal and state and territory governments coordinate multi-sectoral action are National Partnership Agreements. National Partnership Agreements are agreements between the Australian Commonwealth and state and territory governments to support or facilitate the delivery of specific outputs. This presentation will focus on three National Partnerships, in particular, the National Partnership Agreement on Preventive Health, the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes, and the National Partnership Agreement on Indigenous Early Childhood Development.
To begin with, the National Partnership Agreement on Preventive Health aims to address the rising prevalence of lifestyle related chronic disease by laying the foundations for healthy behaviours in the daily lives of Australians through settings such as communities, early childhood education and care environments, schools and workplaces, supported by national social marketing campaigns (MeasureUp and an anti-smoking campaign). It seeks to do this by:
funding states/territories/other organisations to deliver programs;
developing partnerships with industry and NGOs to encourage changes in practices;
raising awareness of public health issues through social marketing campaigns; and
developing ‘enablers’ such as surveys, research, a workforce strategy and a preventive health agency to provide assistance to all sectors to promote health and reduce health risk and inequalities in the Australian community.
The Australian Government has committed $872 million to support this agreement.

59. National Partnership Agreement on Preventive Health
supports setting-based interventions that lay the foundations for healthy behaviours in the daily lives of Australians
focus on four risk factors and sustainable behaviour change
11 initiatives, including Healthy Communities
supported by social marketing messages and national infrastructure
Took into account interim advice from Taskforce

60. National Partnership Agreement on Preventive Health
HEALTHY COMMUNITIES
HEALTHY WORKERS
State/Territory
quality framework, toolkits, web portal and statement of commitment
HEALTHY CHILDREN
Healthy Workers
States and Territories will be funded to facilitate delivery of healthy living programs in workplaces:
focusing on healthy living and covering topics such as physical activity, healthy eating, the harmful/hazardous consumption of alcohol and smoking cessation;
meeting nationally agreed guidelines for these topics, and including support for risk assessment and the provision of education and information which could include the provision of incentives either directly or indirectly to employers;
including small and medium enterprises, who may require support from roving teams of program providers; and
with support, where possible, from peak employer groups such as chambers of commerce and industry.
Healthy Children
States and Territories will be funded to deliver a range of programs:
building on existing efforts currently in place, while adapting them to suit demographic and other factors in play at various sites;
covering physical activity, healthy eating, and primary and secondary prevention;
in settings such as child care centres, pre-schools, schools, multi-disciplinary service sites, and children and family centres; and
including family based interventions, settings based initiatives, environmental strategies in and around schools, and breastfeeding support interventions.
HEALTHY COMMUNITIES
$71.8M commencing
HEALTHY WORKERS
State/Territory – up to $289.4M commencing
National ‘soft infrastructure’ - $5.2M for quality framework, toolkits, web portal and statement of commitment
HEALTHY CHILDREN
State/Territory – up to $325.5M commencing

61. Industry Partnership
Food and health dialogue aim is to assist consumers to make more healthy choices
Working with food producers on voluntary reformulation of foods, portion sizing
Industry level action plans
$1M commencing
In the area of food policy, the Australian Government has established a mechanism called the Food and Health Dialogue (the Dialogue) where it works collaboratively with the food industry to improve dietary intakes. A voluntary food reformulation program has been established under the Dialogue to target the reduction of risk-associated nutrients, including sodium, sugar and saturated fat, in commonly consumed foods. To date, reformulation targets have been reached for bread, breakfast cereal, simmer sauces, processed meats, soup and savory pie sectors. More work will be done in 2012 with the sector which deals with processed foods.

62. Australian National Preventive Health Agency
First dedicated national organisation to gather, analyse and disseminate evidence
Helping to progress taskforce recommendations
Focus on obesity, alcohol, tobacco
ANPHA will support COAG and the Australian Health Ministers:
providing evidence-based advice
supporting the development of evidence and data on preventive health and the effectiveness of interventions
national guidelines and standards to guide preventive health activities
Responsible for some initiatives under the National Partnership:
social marketing campaigns
preventive health research fund focusing on translational research
development of a preventive health workforce strategy
ANPHA received $17.6 million for agency functions and $13.1 million for the research fund and is responsible for social marketing campaigns ($102.0m) and a workforce audit ($0.6m totaling $133.2m under the NPAPH.
The Workforce Strategy building on an audit which will identify and quantify the workforce required to deliver the settings‑based initiatives funded through the prevention NP (Healthy Workers, Healthy Children and Healthy Communities) and propose options to ensure there is sufficient capacity within the sector to support the roll out of activities and programs, leading to a long term strategy for improving the preventive health workforce in Australia.

63. Social Marketing
healthy eating
tobacco

64. Performance benchmarks
(a) children at unhealthy weight - hold levels and reduce
(b) fruits and vegetables consumed by children - increase
(c) children participating in at least 60 minutes of moderate physical activity - increase
(d) adults at unhealthy weight - hold levels and reduce
(e) fruits and vegetables consumed by adults - increase
(f) adults participating in at least 30 minutes of moderate physical activity on five or more days of the week -increase
(g) adults smoking daily - reduce
Measured in 2013 and 2015
Performance benchmarks and indicators
15.The Commonwealth, the States and Territories agree to meet the following performance benchmarks:
(a)increase in proportion of children at unhealthy weight held at less than five per cent from baseline for each state by 2013; proportion of children at healthy weight returned to baseline level by 2015.
(b)increase in mean number of daily serves of fruits and vegetables consumed by children by at least 0.2 for fruits and 0.5 for vegetables from baseline for each State by 2013; 0.6 for fruits and 1.5 for vegetables by 2015.
(c)increase in proportion of children participating in at least 60 minutes of moderate physical activity every day from baseline for each State by five per cent by 2013; by 15 per cent by 2015.
(d)increase in proportion of adults at unhealthy weight held at less than five per cent from baseline for each state by 2013; proportion of adults at healthy weight returned to baseline level by 2015.
(e)increase in mean number of daily serves of fruits and vegetables consumed by adults by at least 0.2 for fruits and 0.5 for vegetables from baseline for each state by 2013; 0.6 for fruits and 1.5 for vegetables from baseline by 2015.
(f)increase in proportion of adults participating in at least 30 minutes of moderate physical activity on five or more days of the week of 5% from baseline for each state by 2013; 15 per cent from baseline by 2015.
(g)reduction in state baseline for proportion of adults smoking daily commensurate with a two percentage point reduction in smoking from 2007 national baseline by 2011; 3.5 percentage point reduction from 2007 national baseline by 2013.
(h)performance against benchmarks will be assessed at two time points: June 2013 and December The baseline for these benchmarks will be the last available data at June
To the extent they contribute to the achievement of objectives and outcomes under the National Healthcare Agreement or contribute to the aggregate pace of activity in progressing COAG agreed reform agenda, these performance benchmarks may be subject to analysis and reporting for each State and Territory by the COAG Reform Council with reference to the following performance indicators, being the proportion of:
(a)children and adults at healthy bodyweight;
(b)children and adults meeting the national guidelines for fruit and vegetable consumption;
(c)children and adults meeting the national guidelines for physical activity; and
(d)Australians smoking daily.

65. Current intersectoral mechanisms- MOH participation
Policy Agenda
Department of Health
Director of Health co-chaired Steering Committee and all working groups
Actively take role on deliberating and overseeing strategy, setting up working groups and giving advice on specific priority areas.
NCDD, CHP
Vice-Chairman
- Director of Health
Vice Chairman
- Director of Health 65

66. Current intersectoral mechanisms- Coordination committee
Policy Agenda
Chair – Secretary for Food & Health Bureau
Chair – Secretary for Food and Health
Co-chair – Director of Health
Memberships – Representatives from the Government, public and private sectors, academia, professional bodies, industry and other key partners
The Food and Health Bureau (FHB) is responsible for forming policies and allocating resources for the running of Hong Kong’s health services. It also ensures these policies are carried out effectively to protect and promote public health, provide lifelong holistic health care to every citizen of Hong Kong, and ensure that no one is denied adequate medical treatment due to lack of means. 66 66

67. Current intersectoral mechanisms- Coordination committee
Policy Agenda
Working groups
Held meeting regularly
WGDPA
1 meeting in 2008 and 3 meetings in 2009
WGAH
3 meetings in 2009 and 2 meetings in 2010
WGI
1 meeting in 2012
Formulated Action Plans and held events regularly 67

68. Steering Committee Composition
Chaired by the Secretary for Food and Health
Co-chaired by Director of Health
Membership include representatives from the Government, public and private sectors, academia, professional bodies, industry and other key partners 68 68

69. Working Groups (WGs) WG on Diet and Physical Activity
Established in December 2008
To tackle imminent problems caused by obesity, unhealthy diet and physical inactivity
WG on Alcohol and Health
Established in June 2009
To focus on the reduction of alcohol-related harm
WG on Injuries
Established in February 2012
To focus on the prevention of injuries
Frequency of meeting
Every 2 – 3 months for each working group 69 69

70. Republic of Korea: Health Plan 2010 History
1995 People’s Health Promotion Law
1997 Provision of People’s Health Promotion Fund
2008 Health Plan 2010
Establishment of operation plan
2002
Establishment of Health Plan2010
2005
New Health Plan 2010
* 4 Categories, 24 Main Tasks, 108 programs
[국민건강증진법]이 1995년에 제정되었고, 이 법이 국민건강증진 종합계획의 근거입니다.
2002년에 처음으로 이 종합계획이 수립되었고 2005년에 보완개정되었습니다.
중간평가 결과 추진이 미흡한 것으로 판단되었습니다.
후반부(2006~2010) 성과를 끌어 올리기 위한 개입으로서 2008년에 실행계획을 수립하였습니다.
이 실행계획을 추진하는 한편 Health Plan 2020도 준비하고 있습니다.
Increase of tobacco price

71. The National Plan for NCD Prevention and Control (2012-2015)
was issued by 15 Ministries and Commissions.
MOH
National development and Reform Commission
Ministry of Education
Ministry of Science & Technology
Ministry of industry and information technology
Ministry of Civil Affairs
Ministry of finance
Ministry of human resources and social security
Ministry of environmental protection
Ministry of Agriculture
Ministry of Commerce
The State Administration of Radio Film and Television
General Administration of Press and Publication
General Administration of sport
State Food and Drug Administration
Total 15 ministries and administrations, including the MOH, National Development and Reform Commission, the Ministry of Finance, the Ministry of Human Resources and Social Security and the Ministry of Environmental Protection, jointly issued China National Plan for NCD Prevention and Control ( ) in this May, this is the document.

72. Support for Behavioral Changes
Health Japan 21
Health Japan 21 Plan
④Evidence-based planning
②Support system
③Coordination of programs
①PR
Programs for
the Elderly
Programs by Insurers
Health Insurance
of the Universal
Occupational Health
School Health
Local Plans
Support for Behavioral Changes

73. BruMAP-NCD National multisectoral plan Commitment from highest levels
Leadership by Minister of Health and Permanent Secretary
Dedicated group
Series of consultations
Realistic set of actions

74. Mongolia MSA Plan Commitment from senior level
Leadership by NCD programme manager
Subgroup formed
Consultation with MOH sectors
Consultation with other sectors
Identified actions which are of interest to other sectors

75. What does it look like?
MSA-NCD plan is the national roadmap for activities by all relevant ministries/sectors in the country for NCD prevention and control
BruMAP-NCD (national multisectoral action plan for the prevention and control of NCDs in Brunei Darussalam)

76. Launch NMSAP-NCD
Arrange a launch of the plan with ministers from other sectors and other high profile personalities
Develop a media plan
Prepare media notes
Organize a media briefing
Use TV talk shows and other avenues for discussion

77. Thank you