Raising the priority of noncommunicable diseases in development work at global and national levels Presentation for discussion (Not an official document)

Causative risk factors Four types of noncommunicable diseases are largely preventable by means of effective interventions that tackle shared modifiable risk factors Causative risk factors Tobacco use Unhealthy diets Physical inactivity Harmful use of alcohol Noncommunicable diseases Heart disease and stroke  Diabetes Cancer Chronic lung disease

Total number of deaths in the world (2004) fact 60% of the world's annual deaths are due to noncommunicable diseases. Approximately 25% of these deaths are premature and could be prevented 10% 70 million 60 million 5.8 M 50 million 26.0 M (above the age of 60) 40 million 35 million (60% of all deaths) Source: 30 million 9.0 M (below the age of 60) 25% of 35 million 20 million 18.0 M 10 million Total number of deaths in the world (2004) Group III - Injuries Low-income countries Group II – Other deaths from noncommunicable diseases Group II – Premature deaths from noncommunicable diseases (below the age of 60), which are preventable Group I – Communicable diseases, maternal, perinatal and nutritional conditions

Estimated deaths from cardiovascular diseases (2004) fact More people die from heart diseases and strokes in the poorest developing countries than in the richest industrialized countries 8.2 m 2030 9.0 m 2.6 m 3.8 m 6.1 m 7.3 m 2015 2.6 m 3.4 m Source: Low income countries 5.1 m Lower middle-income countries 6.5 m 2004 Upper middle-income countries 2.4 m High income countries 3.0 m 2 million 4 million 6 million 8 million 10 million Estimated deaths from cardiovascular diseases (2004)

The top-10 leading causes of death In all developing countries, premature deaths from noncommunicable diseases account for a large enough share of the disease burden to merit a serious policy response fact The top-10 leading causes of death Low-income countries Middle-income countries High-income countries Lower respiratory infections (11.2%) Coronary heart disease (9.4%) Diarrhoeal diseases (6.9%) HIV/AIDS (5.7%) Stroke and other cerebrovascular diseases (5.6%) Chronic obstructive pulmonary disease (3.6%) Tuberculosis (3.5%) Neonatal infections (3.4%) Malaria (3.3%) Premature and low birth weight (3.2%) Stroke and other cerebrovascular disease (14.2%) Coronary heart disease (13.9%) Chronic obstructionary pulmonary disease (7.4%) Lower respiratory infection (3.8%) Trachea, bronchus, lung cancers (2.9%) Road traffic accidents (2.8%) Hypertensive heart disease (2.5%) Stomach cancer (2.2%) Tuberculosis (2.2%) Diabetes mellitus (2.1%) Coronary heart disease (16.3%) Stroke and other cerebrovascular diseases (9.3%) Trachea, bronchus, lung cancers (5.9%) Chronic obstructive pulmonary disease (3.5%) Alzheimer and other dementias (3.4%) Colon and rectum cancers (3.3%) Diabetes mellitus (2.8%) Breast cancer (2.0%) Stomach cancer (1.8%) Source:

Attributable deaths in developing countries by risk factor Unsafe water, sanitation, hygiene Indoor smoke from solid fuels Tobacco use High blood glucose Low fruit and vegetable intake Overweight and obesity Physical inactivity Sub-optimal breastfeeding High cholesterol Urban outdoor air pollution Underweight Unsafe health care injections Unsafe sex Alcohol use Unmet contraceptive need Vitamin A deficiency Occupational risks Global climate change High blood pressure Child sexual abuse Zinc deficiency Lead exposure Illicit drug use Iron deficiency fact The risk of dying in developing countries from causes attributable to high-blood pressure, tobacco use, high blood glucose or physical inactivity Attributable deaths in developing countries by risk factor 7 million 6 million 5 million 4 million 3 million 2 million 1 million

Without action, Africa will witness the largest increase in deaths from noncommunicable diseases in 2015 (vs 2004) fact 2.5 million 30% 25% 2.0 million 20% 1.5 million 15% 1.0 million 10% 5% 0% Africa Americas East. Med Europe South- East Asia Western Pacific Africa Americas East. Med Europe South- East Asia Western Pacific

10 leading causes of deaths in females (2004) fact Noncommunicable diseases are among the leading causes of death among women in developing countries, as well as high-income countries 10 leading causes of deaths in females (2004) Source: WHO's report on "Women and Health: today's evidence, tomorrow's agenda"

Populations in low- and middle-income countries At household level, noncommunicable diseases are affecting the poorest people in developing countries disproportionally fact Poverty at household level Populations in low- and middle-income countries Globalization Urbanization Population ageing Increased exposure to common modifiable risk factors: Unhealthy diets Physical inactivity Tobacco use Harmful use of alcohol Noncommunicable diseases: Cardiovascular diseases Cancers Diabetes Chronic respiratory diseases Loss of household income from unhealthy behaviours Loss of household income from poor physical status Limited access to effective and equitable health-care services which respond to the needs of people with noncommunicable diseases Loss of household income from high cost of health care 14 million people die prematurely each year in developing countries from noncommunicable diseases Poverty contributes to noncommunicable diseases and noncommunicable diseases contribute to poverty

fact Noncommunicable diseases are the third largest global risk in terms of likelihood and the fourth largest global risk in terms of economic severity Oil spikes Retrenching from globalization Asset price collapse Food price volatility Noncommunicable diseases Financial crisis "A problem neither the developed world nor the developing world can afford" "Declining development assistance has already led to a significant reduction of public spending on health in many countries. When funds are limited, governments tend to focus on basic health services, in line with the MDGs, at the expense of the prevention and treatment of noncommunicable diseases." (WEF Global Risk 2010 Report) Infectious diseases World Economic Forum: Global Risk 2010 Report

Total number of deaths in low- and middle-income countries (2004) fact In developing countries, more than 8 million premature deaths from noncommunicable diseases per year are omitted from the MDGs 60 million 50 million 5.3 M 20.0 M 8.1 M 17.4 M 40 million 14.2 M 30 million Source: 20 million 10 million Not covered by the MDGs: More than 8 million premature deaths from noncommunicable diseases 0 million Total number of deaths in low- and middle-income countries (2004) Group III - Injuries Low-income countries Group II – Other deaths from noncommunicable diseases Group II – Premature deaths from noncommunicable diseases (below the age of 60), which are preventable Group I – Communicable diseases, maternal, perinatal and nutritional conditions

Health ODA Commitments (2007) in US$ billions fact International development agencies have been slow in responding to the call to raise the priority accorded to noncommunicable diseases in development work Health ODA Commitments (2007) in US$ billions HIV/AIDS & STDs $7.40 Health Policy & Admin. Management $1.65 Infectious Disease Control $1.33 Reproductive Health $1.16 Basic Health Care $1.14 Total Health ODA: $22.1 billion Health ODA for noncommunicable diseases: 503 million (~2%) There is no OECD/DAC Creditor Reporting System code yet to track health commitments for the prevention and control of noncommunicable diseases Malaria Control $0.80 Family Planning $0.53 Tuberculosis Control $0.45 Basic Nutrition $0.33 Medical Services $0.24 Basic Health Infrastructure $0.23 Medical Research $0.22 Medical Education/Training $0.21 Health Education $0.06 Water Supply/Sanitation - Large Systems $3.90 Water resources policy/admin. mgmt $0.93 Basic Drinking Water Supply & Sanitation $0.92 Waste Management/Disposal $0.42 River Development $0.10 Water Resources Protection $0.06 Water Education/Training $0.01 Source: Kaiser Family Foundation (www.kff.org/globalhealth) (Based on analysis of data obtained via online query of the OECD Development Assistance Committee (DAC) Database and Creditor Reporting System (CRS) on 31 May 2009)

fact In May 2008, WHO Member States started to mobilize a global response to address noncommunicable diseases, with a particular focus on developing countries 2000 Global Strategy for the Prevention and Control of Noncommunicable Diseases Global Strategy on Infant and Young Child Feeding 2002 WHO Framework Convention on Tobacco Control 2003 2004 Global Strategy on Diet, Physical Activity and Health 2008 Action Plan on the Global Strategy for the Prevention and Control of Noncommunicable Diseases

2. Establishing and strengthening national policies and programmes The 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases was endorsed by the World Health Assembly in May 2008 fact Six objectives: 1. Raising the priority accorded to noncommunicable diseases in development work at global and national levels, and integrating prevention and control of non-communicable diseases into policies across all government departments 2. Establishing and strengthening national policies and programmes 3. Reducing and preventing risk factors 4. Prioritizing research on prevention and health care 5. Strengthening partnerships 6. Monitoring NCD trends and assessing progress made at country level Under each of the six objectives, there are sets of actions for Member States, the WHO Secretariat and international partners

ECOSOC High-level Segment on Global Health (Geneva, 6-9 July 2009) fact Many public health leaders are calling on global development initiatives to take into account the prevention and control of noncommunicable diseases Regional Ministerial Meeting on Health Literacy (Beijing, 29-30 April 2009) Regional Ministerial Meeting on Noncommunicable Diseases and Injuries, Poverty and Development (Qatar, 10-11 May 2009) ECOSOC High-level Segment on Global Health (Geneva, 6-9 July 2009) ECOSOC Ministerial Roundtable Meeting on Non-communicable Diseases and Injuries (Geneva, 8 July 2009) Doha Declaration on Noncommunicable Diseases ECOSOC Ministerial Declaration Continuing discussions at the UN General Assembly

High-level forums are starting to call for the inclusion of noncommunicable diseases into discussions on development fact

Increase resource availability (both financial and human capital) fact At the occasion of the 2009 ECOSOC High-level Segment, WHO launched a new global network to combat noncommunicable diseases (NCDnet) on 8 July 2009 Mission of NCDnet: Help implement the Action Plan by catalyzing a multi-sectoral, multi-level response, with a particular focus on developing countries Goals of NCDnet: Increase focus on prevention and control of noncommunicable diseases through collective advocacy Increase resource availability (both financial and human capital) Catalyze effective multi-stakeholder action with a focus on country-level implementation

International Advisory Council Global/Regional Forum Meetings NCDnet is composed of the WHO Secretariat staff, an International Advisory Council, NCDnet Global and Regional Forum meetings and functional Working Groups fact WHO International Advisory Council Funding/Resourcing Mechanisms Global/Regional Forum Meetings Working groups Advocacy and Communications Innovative Resourcing Mechanisms Monitoring and evaluation Partnership capacity building