Presentation on theme: "Non-communicable Diseases:"— Presentation transcript:
1Non-communicable Diseases: Realizing the commitments from Heads of State and Government made in the UN Political Declaration on NCDsلنتحد في مكافحة الأمراض غير الساريةUnidos 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 transmissiblesОбъединяйтесь в борьбе против НИЗ
2World Health Organization World Health Assembly in 2000:There is a strategic vision on how to address NCDs6 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
3World Health Organization Setting the agenda:Vision and a global road mapWorld Health Organization6 April 20172000Global Strategy for the Prevention and Control of Noncommunicable Diseases2003Global Strategy on Diet,Physical Activity and Health2004Action Plan on the Global Strategy for the Prevention and Control of NCDs2008Global Strategy to Reduce the Harmful Use of Alcohol2009WHO Global Status Report on NCDs20102011Political Declaration on NCDs2012+Realizing the commitments made in the Political Declaration
423 2013: 2012: 2011: Commitments from Heads of State and Government fact23The 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 Assembly2011:Commitments from Heads of State and GovernmentWorld Health Assembly2012:Adopt a global target of a 25% reduction in premature mortality from NCDs by 20252013:WHO Global NCD Action Plan , including 9 global targets and 25 indicatorsUN 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
5The WHO Global NCD Action Plan unites governments, international partners and WHO around a common agendaVision: 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
6country response for the prevention and control of NCDs The WHO Global NCD Action Plan has six objectiveswith recommended actions for Member States, international partners and WHOfactObjective 1To 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 goalsObjective 2To strengthen national capacity, leadership, governance, multisectoral action and partnerships to acceleratecountry response for the prevention and control of NCDsObjective 3To reduce exposure to modifiable risk factors for NCDs through creation of health-promoting environmentsObjective 4To strengthen and orient health systems to address the prevention and control of NCDs through people-centred primary health care and universal health coverageObjective 5To promote and support national capacity for high-quality research and development for the prevention andcontrol of NCDsObjective 6To monitor the trends and determinants of NCDs and evaluate progress in their preventionand control
7Nine 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 NCDsNine Global Targets and 25 Outcome Indicatorsلنتحد في مكافحة الأمراض غير الساريةUnidos 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 transmissiblesОбъединяйтесь в борьбе против НИЗ
8factAt 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
9At 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 indicatorsfact
10Non-communicable Diseases: Realizing the commitments from Heads of State and Government made in the UN Political Declaration on NCDs9 NCD Action Plan Indicators to inform reporting on progress made in the process of implementing the WHO Global NCD Action Planلنتحد في مكافحة الأمراض غير الساريةUnidos 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 transmissiblesОбъединяйтесь в борьбе против НИЗ
11WHO Discussion Paper (version dated 12 August 2013) Draft set of action plan indicators
12Immediate actions for Member States 2014-2015 What is next?Immediate actions for Member StatesSet national targets for 2025 in 2013, taking into account the 9 global targetsDevelop national multisectoral NCD policies and plans to attain national targets for 2025, by addressing the three major components of the NCD strategyAction AreaGovernanceRisk factorsHealth systemsSurveillance
13Action Area Risk factors What is next? Priority actions recommended for Member States to reduce the exposure of populations and individuals to risk factors for NCDsImplement interventions identified by WHO as "best buys" using WHO tools:Tobacco use:Tax increasesSmoke-free indoor work places and public placesHealth information and warnings about tobaccoBans on adverting and promotionHarmful use of alcohol:Tax increases on alcoholic beveragesComprehensive restrictions and bans on alcohol marketingRestrictions on the availability of alcoholUnhealthy diet and physical inactivity:Salt reduction through mass media campaigns and reduced salt content in processed foodsReplacement of trans-fats with polyunsaturated fatsPublic awareness programme about diet and physical activityMarketing of foods and non-alcoholic beverages to childrenAction AreaGovernanceRisk factorsHealth systemsSurveillance
14Action 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 NCDsfactImplement 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 immunizationPrevention of cervical cancer through screening and treatment of pre-cancerous lesionsMultidrug 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 yearsAction AreaGovernanceRisk factorsHealth systemsSurveillance
15Action Area Surveillance factWhat 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, coveringmonitoring of risk factors and determinants,outcomes (mortality and morbidity) andhealth system responseIntegrate into the national health information systemsDevelop national targets and indicators, based on the WHO recommendations and WHA ResolutionsAction AreaGovernanceRisk factorsHealth systemsSurveillance
16Action Area Surveillance The WHO Framework for NCD Surveillance quantifies and tracks exposures, outcomes and health systems responsefactAction AreaGovernanceRisk factorsHealth systemsSurveillanceA WHO Framework for NCD SurveillanceExposures:Behavioural risk factors: tobacco use, physical inactivity, harmful use of alcohol and unhealthy dietMetabolic risk factors: overweight/obesity, raised blood pressure, glucose & cholesterol.Social determinants: education, material well being, access to health careOutcomes:Mortality: NCD specific mortalityMorbidity: cancer incidence and typeHealth System Response:Interventions and health system capacity: infrastructure, policies and plans, access to key health care interventions and treatments, partnerships.
17Non-communicable Diseases: Realizing the commitments from Heads of State and Government made in the UN Political Declaration on NCDsWHO Global Coordination Mechanism on the Prevention and Control of NCDs (‘NCD GCM’)لنتحد في مكافحة الأمراض غير الساريةUnidos 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 transmissiblesОбъединяйтесь в борьбе против НИЗ
18UN INTERAGENCY TASK FORCE Non-communicable Diseases:Realizing the commitments from Heads of State and Government made in the UN Political Declaration on NCDsUN INTERAGENCY TASK FORCEلنتحد في مكافحة الأمراض غير الساريةUnidos 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 transmissiblesОбъединяйтесь в борьбе против НИЗ
19UN Interagency Task Force on NCDs What has happened since the UN Political Declaration on NCDs in 2011?UN Interagency Task Force on NCDsObjectives:Enhance and coordinate technical supportFacilitate information exchange about plans, strategies, programs and activitiesFacilitate information exchange about available resources to support national effortsStrengthen advocacyEnsure that tobacco control continues to be duly addressedStrengthen international cooperation“The Task Force will be convened and led by WHO. Accordingly, WHO shall provide the Secretariat of the Task Force”
20Fighting the global health burden through new technology: WHO ITU joint program on mHealth for NCDsmHealth as an example of interagency collaboration
21UN General Assembly NCD Review 2014 Non-communicable Diseases:Realizing the commitments from Heads of State and Government made in the UN Political Declaration on NCDsUN General Assembly NCD Review 2014لنتحد في مكافحة الأمراض غير الساريةUnidos 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 transmissiblesОбъединяйтесь в борьбе против НИЗ
22NCD progression and health economic burden Health and economic burdenHealthyPopulation to be coveredRisk factorsHigh riskNCDComplicationsRehabProgression of NCD
23Helping 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 risksThe environment where we live, study, play and work have a huge influence on our behaviours, lifestyles. The environments are often not underthe 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 issuesResponsibility 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 approachResponsibility 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.
25Very cost effective interventions Tobacco useReduce 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 sponsorshipHarmful alcohol useRegulating commercial and public availability of alcoholRestricting or banning alcohol advertising and promotionsUsing pricing policies such as excise tax increases on alcoholic beveragesUnhealthy diet and physical inactivityReduce salt intakeReplace trans-fats with unsaturated fats;Implement public awareness programmes on diet and physical activityCardiovascular disease and diabetesDrug 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 yearsAcetylsalicylic acid for acute myocardial infarction.CancerPrevention 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
26Win – Win approach for NCD prevention EducationImproved scholastic outcomeLess risk factorsAgricultureImproved production of fruits and vegetablesImproved consumption of fruits and vegetables in populationIndustriesImproved productivityLess expenses on sickness of employeesPrevention and control of NCDs in workersUrban planningBeautiful city, more tourists, more moneyMore physical activity, tobacco controlOther 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.
27Plain packaging- a path breaking approach in Australia Examples of best practices and effective approaches for MSA Tobacco ControlTobacco taxation and Health Promotion Foundations in Australia, Lao PDR, Korea, Malaysia, Mongolia, Tonga, Viet NamPlain packaging- a path breaking approach in AustraliaLet 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 AlcoholThe Mongolian President initiative in alcohol control, non- alcohol in government’s function and new alcohol legislationDevelopment of legislation: drinking and driving, use of helmet, blood testing: China, Cambodia, Philippines, VietnamRegulating informal alcohol control in VietnamHarmful 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.
29Healthier foods in Singapore-Hawker Fare Examples of best practices and effective approaches for MSA-- Promoting Healthy DietHealthier foods in Singapore-Hawker FareSalt reduction in China and MongoliaEat 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.
30Controls on advertisement EU television without frontiers directiveTV adverts shall not cause moral or physical detriments to minorsIreland-bans cartoon characters and celebrities to promote foodsFrance –mandatory health messages should accompany adverts on TV and radioSweden-total ban for adverts aimed at children less than 12 yrs
31Examples of best practices and effective approaches for MSA --- Promoting Physical ActivityExercise equipment in public parks in Lao PDR, China, KoreaWalk paths, and cycling tracks in Cambodia, Korea, China, MalaysiaCommunity physical exercise groups clubs in Seongbuk, Korea and Shanghai, ChinaWalking days in Dalin, Seongbuk, XiamenCreating 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.
32Examples of best practices and effective approaches for MSA - Healthy CitiesSmoke Free CitiesHarbin, QingDao, ChinaMakati and Marikina, PhilippinesLuangPrabang, in Lao PDR,Siem reap, CambodiaEnvironmentally sustainable healthy urban transport (ESHUT) in 5 Asian citiesPromote walking, cyclingpublic transport systemReduce use of private vehiclesSmokig banPromoting health and hygieneBarrier-free transport environmentsHealthy 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 AustraliaScaling up healthy cities for NCD prevention and control and promotion of healthy living is a theme that can be very beneficial for all sectors.
33Healthy workplaces - Shanghai, Hong Kong, China Examples of best practices and effective approaches for MS A----Healthy Settings:Health Promoting Schools and Work PlacesHealth Promoting schools for multiple health interventions- Singapore, Hong Kong, Macao (China)Healthy workplaces - Shanghai, Hong Kong, ChinaHealthy 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.
34Healthy Cities to Promote Healthy Living Promotion of Physical ActivityBicycle and pedestrian friendly urban landscape, Changwon,Community physical activity facilities, Hong Kong, Dalian, Beijing,Walk Paths in public parks-Shanghai, China
36Upstream interventions Policies/lack of it in other sectorsNCDs36
37Cross over All sectors to work for health Health in all policies TransportUrban planningFood processingTobacco/Alcohol sales andpromotionsEducationIndustry
38MSA-Entry Points National National multi-ministerial forum Subnational Effective only with commitment at the highest level, need a good driver, Health in All PoliciesCity/District/Village levelSubnationalMore feasible, leverage local government, collective voice of community, government closer to the community, local ordinancesTobacco/Alcohol/Physical ActivityRisk factorFacilitators-activism, pressure groups, champions, international agreements (FCTC), global reporting, more palpable interventions, common good /common enemyInter ministerialLocal GovernmentCross sector working groupsWe 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.
39Mechanisms , Tools and Instruments for MSA Inter-ministerial and inter-departmental committeesCommunity consultations and Citizens’ JuriesCross-sector action teamsPartnership platformsIntegrated budgets and accountingCross-cutting information and evaluation systemsImpact assessmentsJoined-up workforce developmentLegislative frameworksThe Adelaide statement also identified tools and instrumentsInter-ministerial and inter-departmental committeesCommunity consultations and Citizens’ JuriesCross-sector action teamsPartnership platformsIntegrated budgets and accountingHealth Lens AnalysisCross-cutting information and evaluation systemsImpact assessmentsJoined-up workforce developmentLegislative frameworks
40MSA-Accountability and Reporting Experiences from MDG 4 and 5 in accountability frameworkAgreed national targets and indicatorsSector-specific roles, responsibility, target, inputs and outputsJoint statement and joint planAcross sectors audit, evaluationPublic reportingOnce 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.
42NCD management: Defined package, coverage, follow-up What is good ?Desire for universal coverageGlobal push for universal health coveragePackage of Essential NCD interventions-Generic drugsWhat are the limitations?NCD services not defined adequately in PHCSystem limitations-concept of chronic care, human resourceMarket driven treatmentProfit sectorWhat is needed?NCD services to be defined and incorporatedIncrease resources in primary and secondary care-Human resource development
43Monitoring and evaluation Deaths-Cause Specific Mortality-ICD codingDisease burden-Registries (eg. Cancer, Stroke) Prevalence surveysRisk factors-Adult - WHO STEPS surveyChildren-Global school based student health surveyPolicy monitoringHealth Impact Assessment
44Healthier 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.
45NCD services in disasters WHY? WHAT? HOW? OUTCOMEWhat is MSA?Step 1. Sit. AnalysisNational MSA plan for NCD prevention and controlApproach paperGuiding principlesStep 2. Int stakeholder consultNCD MSA in UHCPrioritization of actions- country contextDraft planStep 3. Ext stakeholder consultHiAPUNDAF, city planning, urban development, sustainable development, legislative agendaFinal draftNCD services in disastersStep 4. Endorsement of MSANCD targets and indicators
46Current NCD plans/actions 1. Sit. AnalysisIRM 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 consultantsEpidemiological trendsHealth outcomesBurden and trendsCCS prioritiesUNDAFNational NCD plan- statusRelated plansCurrent NCD plans/actionsStakeholder mappingPolitical landscapeStakeholder analysisSourcesNCD country capacity surveyWHO CCSNCD global status reportRisk factors surveysHealth system assessmentVital registrationCancer registriesNutrition surveysToolsSpider gramsStakeholder analysisMulti votingBalance score cardsProblem solution treesPrioritization toolsProjection of national targetsProcess1 week IRM missionDay 1-engagementDay 2-3- Sit asssmntDay 4-PrioritizationDay 5-Draft planOutput of Step 1Approach paperSituational analysisPriority areasPotential national targetsSectors and stakeholdersNext steps
47Lead by WR, supported by team from IRM-RO and with external experts Step 2. Int stakeholder consultIRM mission 2 (One week)Lead by WR, supported by team from IRM-RO and with external expertsBased on the approach paper developed in Step 1Consultation within MOH-all programmes related to NCDInternal advocacy and buy inCurrent NCD servicesLimitationsOpportunitiesHealth insurance coverageHealth services for NCDHow can targets be monitoredNational NCD surveillance frameworkNCD surveillanceApproach paperToolsSpider gramsMulti votingProblem-solution treePrioritization toolsCapacity enhancementAdvocacyCommunicationSurveillanceLeadershipProcessThematic consultationsExternal technical supportOutput ofStep 2Draft MSA plan for NCD prevention and controlNCD in UHCNCD services in emergencies
483. 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 experts1 day consultation with ministries and departments in GovernmentOther government sectorsOne day consultation with NGOs, civil society organizationsCivil societyHalf day consultation with Donor and dev partners and UN agenciesDonor and development partnersUN agenciesHalf day consultation with professional associationsProfessional societiesDraft MSA planToolsSpider gramsMulti votingProblem-solution treePrioritization toolsProcessThematic consultationsExternal technical supportIdentification of specific actions in other sectors/domainsSynthesis and finalizationOutput of Step 3:Final MSA plan
49Lead by WR, supported by team from IRM (1 HQ, 1 RO) 4. Endorsement of MSAIRM 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.ConsultationsEndorsement from Ministry of Health and Other ministersEndorsementSupport expressed by UN agencies and partnersDonor and development partnersUN agenciesSupport expressed by professional associationsProfessional societiesPreparationsDesign and layout of MSA planForeword and messagesProcessEndorsementMedia activityOutcme of Step 4:Final endorsed national MSA plan for NCD prevention and control.
50Structure of a national multisectoral action plan for the prevention and control of NCDs PrefaceMessage from Head of State/Government, preface from Minister of health, messages from other key ministries, UN agencies and partners.IntroductionCountry context, CCS priority, NCD in national plans if any, concern and commitment from national leadersSituational analysisBurden, trends, current status of NCD plans/policies, partners, political landscape, capacity, challenges and opportunitiesApproach for MSA planProcess, inputs, global and regional mandates, national prioritiesNational Multisectoral planOverall framework, governanceVision, mission, national targets, objectives, actions, sectors responsible, milestonesHuman and financial resourcesSynergies with ongoing programmesMonitoring and reportingAnnexeList of participants and contributorsCopies of relevant WHO/UN documents
51Main barriers/risks identified and approaches to mitigate them PreparationLack of commitmentPerceived conflict of interestTerritorial issues among departmentsWho will fund?Who will lead?Advocacy using commitments made by the countryExamples from other countriesSupport for role delineation among sectorsDemonstrate ‘win-win’ optionsSteps 1-4Process constraintsLack of engagement from senior policy makersLack of firm commitments (only expression of interest)Participation by junior staff in consultationsInfluence of interested partiesNot reaching consensusIdentify an influential champion in the countryLobbying by minister of healthCivil society pressure, media reports on NCD burden and role of sectorsNGOs to highlight lack of enabling environment and role of other sectorsGet a directive from head of state/chief of cabinetWell prepared approach paper to offer optionsGood understanding of the roles by different sectorsImplementationWho will do what?Funds?Human resourcesCapacityLack of clearly identified bench marksLack of monitoringNo overall responsibilityLack of coordinationAnnual action plans with roles and responsibilityNational steering committee (with senior level representation from relevant sectors)Allocation of budgetClearly identified activities, indicators and targetsPublic reporting and reporting in the cabinet once a yearStage ofMSA NCD planBarriers and risksApproaches to mitigate
52Prioritized activities within the national MSA plan for NCDs Considerations for selecting activities in MSA planCurrent risk factor burden and stage of the country in epidemiological transitionPolitical interestFeasibility (resources, infrastructure, governance mechanisms)Pressure groupsDonor and development community interestChampions to drive the actionsOngoing actionsWHO presence and support in countryInterests and activities of UN agencies and partnersSet of very cost effective interventions
53Potential prioritiesTobacco controlSalt reduction – policies, regulations, legislationReducing per capita alcohol consumptionControl of marketing of foods and non-alcoholic beverages to childrenFront of pack color coded labelsBan transfatsPA promotionCancer screeningHep B and HPV coverageQuality of health service indicatorsMonitoring of 25 indicatorsNCD is the main burden, good infrastructure, high political commitmentsSalt reduction-awareness, working with industryAlcohol harm reductionUrban planning for PA promotionFood labellingHealth promoting schools, work places, healthy cities and islandsPEN in primary careStrengthening referral careCervical cancer screeningHPV vaccinationSTEPS ad GSHS once in 5 yearsNational mortality registration and CODRapidly increasing NCD burden/moderate level of resources and capacity/increasing political commitmentSalt reduction-awareness, local food producers, caterersCancer palliative careHep B coverageSchool based approachesSTEPS and GSHS once in 5 yearsImprove death registration and COD reportingEarly in the epidemic/minimal resources
55Resources Advocacy materials Global and regional action plans and reportsNCD Global Action PlanNCD Regional Action PlanAction 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 DiseasesOne-WHO work plan for the prevention and control of NCDsActions 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 articlesTaxation of sugar sweetened beveragesEffect of food prices on the prevalence of obesityRegional NCD Meeting materialsIntercountry Workshop for NCD surveillance and monitoring, NCC, Republic of Korea, December 2012Workshop on Leadership and Capacity Building for Cancer Control (CanLEAD), NCC, Republic of Korea, June 2013Regional Workshop on Strengthening Leadership and Advocacy for the Prevention and Control of Noncommunicable Diseases (LeAd-NCD), Saitama, Japan, December 2013WorkbookMeeting reportsJapan-WHO Regional Consultation for Promoting Healthier Dietary Options for Children, Saitama, Japan, March 2012Regional Consultation on Strengthening Noncommunicable Diseases in Primary Health Care, Beijing, China, Apr 2012
56Multi-Sectoral Action in Australia A range of stakeholdersacross various federal government departments -health, education, family and community servicesacross various levels of government (federal, state/territory and local government)between the public and private sectors.A range of governance mechanisms:national committeesagreements with key stakeholdersAustralia 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); andbetween 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.
57National Preventative Health Taskforce (April 2008) obesity, tobacco and alcoholkey drivers of chronic disease, health system and social costsconsultations (40) and public submissions (397)Australia: the Healthiest Country by 2020 (Sept 2009)35 areas for action and 136 recommendationsfocus on social inclusion and integration with primary care
58National Partnership Agreement on Preventive Health National Partnership Agreements (NPAs) facilitate joint action between levels of Government in Australia - $872m over 6 years fromaims to prevent lifestyle risks that cause chronic illness and was one of the first of its kind in AustraliaDefines roles and responsibilities, and accountabilityThe 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; anddeveloping ‘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.
59National Partnership Agreement on Preventive Health supports setting-based interventions that lay the foundations for healthy behaviours in the daily lives of Australiansfocus on four risk factors and sustainable behaviour change11 initiatives, including Healthy Communitiessupported by social marketing messages and national infrastructureTook into account interim advice from Taskforce
60National Partnership Agreement on Preventive Health HEALTHY COMMUNITIESHEALTHY WORKERSState/Territoryquality framework, toolkits, web portal and statement of commitmentHEALTHY CHILDRENHealthy WorkersStates 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; andwith support, where possible, from peak employer groups such as chambers of commerce and industry.Healthy ChildrenStates 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; andincluding family based interventions, settings based initiatives, environmental strategies in and around schools, and breastfeeding support interventions.HEALTHY COMMUNITIES$71.8M commencingHEALTHY WORKERSState/Territory – up to $289.4M commencingNational ‘soft infrastructure’ - $5.2M for quality framework, toolkits, web portal and statement of commitmentHEALTHY CHILDRENState/Territory – up to $325.5M commencing
61Industry PartnershipFood and health dialogue aim is to assist consumers to make more healthy choicesWorking with food producers on voluntary reformulation of foods, portion sizingIndustry level action plans$1M commencingIn 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.
62Australian National Preventive Health Agency First dedicated national organisation to gather, analyse and disseminate evidenceHelping to progress taskforce recommendationsFocus on obesity, alcohol, tobaccoANPHA will support COAG and the Australian Health Ministers:providing evidence-based advicesupporting the development of evidence and data on preventive health and the effectiveness of interventionsnational guidelines and standards to guide preventive health activitiesResponsible for some initiatives under the National Partnership:social marketing campaignspreventive health research fund focusing on translational researchdevelopment of a preventive health workforce strategyANPHA 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.
64Performance 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 - reduceMeasured in 2013 and 2015Performance benchmarks and indicators15.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 JuneTo 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.
65Current intersectoral mechanisms- MOH participation Policy AgendaDepartment of HealthDirector of Health co-chaired Steering Committee and all working groupsActively take role on deliberating and overseeing strategy, setting up working groups and giving advice on specific priority areas.NCDD, CHPVice-Chairman- Director of HealthVice Chairman- Director of Health65
66Current intersectoral mechanisms- Coordination committee Policy AgendaChair – Secretary for Food & Health BureauChair – Secretary for Food and HealthCo-chair – Director of HealthMemberships – Representatives from the Government, public and private sectors, academia, professional bodies, industry and other key partnersThe 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.6666
67Current intersectoral mechanisms- Coordination committee Policy AgendaWorking groupsHeld meeting regularlyWGDPA1 meeting in 2008 and 3 meetings in 2009WGAH3 meetings in 2009 and 2 meetings in 2010WGI1 meeting in 2012Formulated Action Plans and held events regularly67
68Steering Committee Composition Chaired by the Secretary for Food and HealthCo-chaired by Director of HealthMembership include representatives from the Government, public and private sectors, academia, professional bodies, industry and other key partners6868
69Working Groups (WGs) WG on Diet and Physical Activity Established in December 2008To tackle imminent problems caused by obesity, unhealthy diet and physical inactivityWG on Alcohol and HealthEstablished in June 2009To focus on the reduction of alcohol-related harmWG on InjuriesEstablished in February 2012To focus on the prevention of injuriesFrequency of meetingEvery 2 – 3 months for each working group6969
70Republic of Korea: Health Plan 2010 History 1995 People’s Health Promotion Law1997 Provision of People’s Health Promotion Fund2008 Health Plan 2010Establishment of operation plan2002Establishment of Health Plan20102005New 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
71The National Plan for NCD Prevention and Control (2012-2015) was issued by 15 Ministries and Commissions.MOHNational development and Reform CommissionMinistry of EducationMinistry of Science & TechnologyMinistry of industry and information technologyMinistry of Civil AffairsMinistry of financeMinistry of human resources and social securityMinistry of environmental protectionMinistry of AgricultureMinistry of CommerceThe State Administration of Radio Film and TelevisionGeneral Administration of Press and PublicationGeneral Administration of sportState Food and Drug AdministrationTotal 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.
72Support for Behavioral Changes Health Japan 21Health Japan 21 Plan④Evidence-based planning②Support system③Coordination of programs①PRPrograms forthe ElderlyPrograms by InsurersHealth Insuranceof the UniversalOccupational HealthSchool HealthLocal PlansSupport for Behavioral Changes
73BruMAP-NCD National multisectoral plan Commitment from highest levels Leadership by Minister of Health and Permanent SecretaryDedicated groupSeries of consultationsRealistic set of actions
74Mongolia MSA Plan Commitment from senior level Leadership by NCD programme managerSubgroup formedConsultation with MOH sectorsConsultation with other sectorsIdentified actions which are of interest to other sectors
75What 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 controlBruMAP-NCD (national multisectoral action plan for the prevention and control of NCDs in Brunei Darussalam)
76Launch NMSAP-NCDArrange a launch of the plan with ministers from other sectors and other high profile personalitiesDevelop a media planPrepare media notesOrganize a media briefingUse TV talk shows and other avenues for discussion