1. WHO - Global and regional NCD commitments
Peter Sousa Hoejskov, Technical Officer Food Safety & NCD
WHO Division of Pacific Technical Support (DPS)
55th PIHOA Board Meeting, Pohnpei, FSM March 2014

2. World Health Organization
World Health Assembly in 2000:
There is a strategic vision on how to address NCDs
21 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
21 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. Pacific political commitment
Pacific Health Leaders
Multisectoral leaders
Pacific Forum Leaders
1995
Yanuca Island declaration: ‘Healthy Islands’
2003
Tonga Commitment to Healthy Lifestyle and Supportive Environment
2010
PIHOA: NCD as a medical emergency in USAPI
Pacific Food Summit : Agriculture, Health and Trade on Food Security
2011
Honiara Communique on NCD Crisis declaration
Ministers of Sports supporting NCD
NCD Crisis Declaration
UN High Level: Political Commitment on NCD
2013
Apia Communique on NCD
Forum Trade and Economic Ministers : NCD Finance Roadmap
2014
Directors of Health: CRP endorsement
Ministers of Finance and Health Meeting

5. Commitments from Heads of State and Government 2012: 2013:
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

6. 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

7. 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
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

8. Targets for NCD prevention and control
TOBACCO FREE PACIFIC

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

10. 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
Finalize and endorse Crisis Response Plans (CRP)
Action Area
Governance
Risk factors
Health systems
Surveillance

11. 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

12. Action Area Governance Risk factors Health systems Surveillance
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
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

13. Action Area Surveillance
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)
Action Area
Governance
Risk factors
Health systems
Surveillance
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 Pacific targets, the WHO recommendations and WHA Resolutions

14. Action Area Surveillance
The WHO Framework for NCD Surveillance quantifies and tracks exposures, outcomes and health systems response
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.

15.  Indicators Vital Reg with COD Cancer Registry STEPS GSHS FF Surveys
GATS
GYTS
Mortality from main NCDs 
Cancer incidence by type
Harmful use of alcohol (3)
Low fruit and veg intake
Physical inactivity in adults
Physical inactivity in adolescents
Salt intake
Saturated fat intake
Tobacco use in adults
Tobacco use in adolescents
Raised blood glucose/diabetes
Raised blood pressure
Overweight and obesity in adults
Overweight and obesity in adolescents
Raised total cholesterol

16.  Indicator Vital Registration Cancer Registry STEPS Food Freq Surveys
SARA/
facility data
NCD Capacity survey
Cervical cancer screening 
Drug therapy and counseling
Essential NCD meds and technologies
Hepatitis B vaccine
HPV vaccine
Marketing to children
Access to palliative care
Policies to limit saturated fats and eliminate trans fat

17. Set national targets and measure results
Member States are encouraged to adopt the global and Pacific voluntary targets as national targets
National adaptation should be guided by:
Current performance,
Current level of exposure
Programmes planned and in place
WHO is developing a Toolkit on NCD Surveillance, which will include a module on setting national targets and measuring results

18. Pacific Crisis Response Plans (CRP)
A framework to prioritize action in the short run (1-2 years)
Based on very cost-effective interventions (“Best Buys”)
Helps development partners focus support and technical assistance
CRPs are not additional NCD plans!

19. CRISIS RESPONSE PLANS (CRP) in PICs
Tobacco Control Tobacco Free Pacific
Healthy Diet
– Salt reduction & Fruits and Vegetables
CVD Risk Management & Counselling
- Package of Essential NCD (PEN) Services

20. 3 Areas; 15 Strategies and 15+ Milestones

21. Summary
NCD is not only a threat to public health, but also to socio-economic development and prosperity
Targets and the way forward are clear – Countries need to scale up action individually and collectively
Surveillance, prevention and management of NCDs go hand-in-hand
CRPs help countries prioritize and progress towards the long-term goal of 25x25

22. Thank you