Dr Timothy Armstrong Coordinator Surveillance and Population-based Prevention Department of Chronic Diseases and Health Promotion World Health Organization

Why is surveillance important?

Political Declaration on NCDs 61. Call upon WHO, with the full participation of Member States, informed by their national situations, through its existing structures, and in collaboration with United Nations agencies, funds and programmes, and other relevant regional and international organizations, as appropriate, building on continuing efforts to develop before the end of 2012, a comprehensive global monitoring framework, including a set of indicators, capable of application across regional and country settings, including through multisectoral approaches, to monitor trends and to assess progress made in the implementation of national strategies and plans on NCDs. Let's have a look at the text included in the Political Declaration on NCDs that relates to the topic we are discussing today. Paragraph 61 of the Political Declaration calls upon WHO, with the full participation of Member States, informed by their national situations, through its existing structures, and in collaboration with United Nations agencies, funds and programmes, and other relevant regional and international organizations, as appropriate, building on continuing efforts to develop before the end of 2012, a comprehensive global monitoring framework, including a set of indicators, capable of application across regional and country settings, including through multisectoral approaches, to monitor trends and to assess progress made in the implementation of national strategies and plans on NCDs.

Political Declaration on NCDs 62. Call upon WHO, in collaboration with Member States through the governing bodies of WHO, and in collaboration with United Nations agencies, and other relevant regional and international organizations, as appropriate, building on the work already under way, to prepare recommendations for a set of voluntary global targets for the prevention and control of NCDs, before the end of 2012. Paragraph 62 calls upon WHO, in collaboration with Member States through the governing bodies of WHO, and in collaboration with United Nations agencies, and other relevant regional and international organizations, as appropriate, building on the work already under way, to prepare recommendations for a set of voluntary global targets for the prevention and control of NCDs, before the end of 2012

Political Declaration on NCDs 63. Consider the development of national targets and indicators based on national situations, building on guidance provided by WHO, to focus on efforts to address the impacts of non-communicable diseases and their risk factors and determinants. Paragraph 63 commits Member States to consider the development of national targets and indicators based on national situations, building on guidance provided by WHO.

Framework for national NCD surveillance Outcomes Mortality: NCD specific mortality Morbidity: cancer incidence and type Exposures Behavioural risk factors: tobacco use, physical inactivity, harmful use of alcohol and unhealthy diet Metabolic risk factors: raised blood pressure, overweight/obesity, raised blood glucose, and raised cholesterol. Social determinants: education, material well being, access to health care Health System Response Interventions and health system capacity: infrastructure, policies and plans, access to key health care interventions and treatments, partnerships.

Monitoring framework and indicators for NCDs Outcomes Cancer incidence by type Mortality between ages 30 – 70 due to CVD, cancer, diabetes, or CRD Exposures Adult alcohol per capita consumption Heavy drinking occasions Insufficient physical activity Low fruit and vegetable consumption Overweight/obesity Raised blood glucose/diabetes Raised blood pressure Raised total cholesterol Salt/sodium intake Tobacco smoking Health systems response Access to palliative care Availability of basic diagnostics and medicines Cervical cancer screening Multidrug therapy for CVD risk reduction Policies to eliminate trans fats Policies to reduce marketing of unhealthy foods to children Vaccination for Hepatitis B Vaccination for HPV

Criteria recommended for selection of indicators and targets High epidemiological and public health relevance Coherence with major strategies and priorities Evidence driven targets and indicators Availability of evidence-based effective and feasible public health interventions Evidence of achievability at the country level Existence of unambiguous data collection instruments and potential to set a baseline and monitor changes over time.

Relationship between global and national targets National targets should be consistent with the global target. Targets may be adapted nationally, based on the country's situation. Adaptations would reflect what might be achievable in a specific country based on their performance, current exposure and what actions can be achieved. National adapted targets may be more or less ambitious than the global target.

"What gets measured, gets done!" Core indicators Few "tracer" targets Focuses national attention Major contribution to achievements in NCD prevention and control

NCD Country Profiles