International and Canadian Perspectives on Integrated Chronic Disease Prevention Dr. Sylvie Stachenko Director General, Centre for Chronic Disease Prevention and Control

2 Global NCD Picture

3 Global NCD Burden

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5 Risk Factors and Global Burden of Disease Selected Risk Factor % E.U. DALY’s % Global DALY’s Tobacco9%3% Alcohol8.4%3.5% HypertensionNA1.4% Physical Inactivity1.4%1% Ref: Global Burden of Disease 1990; Murray and Lopez

6 Key Issues Burden: large and increasing Risks: few and modifiable communicated globally cluster in time among the poor Interventions: effective but underused Health Systems: transform to meet new challenges

7 Milestones for World Health Assembly Resolution of 2000 Building the Evidence-base Comprehensive Community Cardiovascular Control Programs (CCCCP) – 1974 MONICA (CVD prevention initiative, 1980’s) INTERHEALTH + CINDI (1985)

8 Good Health (reducing NCD) PromotionPreventionHealth Care - Determinants of Health - Lifestyle programmes - Mental Health - Models of Chronic Care Bridging Agent - CINDI Monitoring and Evaluation

9 The CINDI Approach Integration Commonality of risk factors for major NCD Systems approach to delivery Partnerships Demonstrations Focal point for development of know-how Dissemination... Canadian Heart Health Initiative (CHHI – 1987)

10 The Global NCD Strategy Focus on Integration WHA endorsed framework for the integrated prevention and control of NCD’s – May 2000 However…Member State capacities pose challenges for supporting an integrated NCD agenda

11 Ref: Assessment of National Capacity for Noncommunicable Disease Prevention and Control. WHO 2002

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14 Ref: Assessment of National Capacity for Noncommunicable Disease Prevention and Control. WHO 2002

15 Impetus for Integration International Level Networks of national programmes and integrated community based NCD prevention and control initiatives CINDI (Euro), CARMEN (Amro), NANDI (Afro), INDRIA (Searo), EMEN (Emro), WPRO Global Forum of community based networks Focus on 4 priority NCD CVD, cancer, diabetes, chronic respiratory disease Taking stock of existing integrated comprehensive programs across the world Research and training in policy

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17 Impetus for Integration National Assets Canadian Heart Health Initiative Observatory of community-based comprehensive programs 311 projects in 10 provinces, 35 community level programs Development of tools and methodologies Process evaluation Partnership and linkage model International, national, provincial, and community Public, private, and voluntary sector

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20 Canadian Heart Health Initiative Lessons Learned Long time-frame and sustainable funding needed…visible output requires visible input ‘Preventive dose’ not achieved…’scaling up’ Focus mainly on community mobilization, public health - health care system not fully mobilized…sustainability Link up with other targeted prevention initiatives and combine strategies whenever possible (CHHI, Diabetes, Canadian Strategy on Cancer Control…)

21 Impetus for Integration National Assets National Alliances Chronic Disease Prevention Alliance Coalition on Enhancing Preventive Practices of Health Professionals Provincial Alliances Several provinces moving toward integrated NCD strategy (MB, BC, NS, AB)

22 Strategic Opportunities  Romanow Commission: “What relative share of governments’ investments in health should be focused on prevention of illness and injury, promotion of good health habits, treatment of illnesses or “healthy” public policy to address the socio-economic and other inequalities that lead to ill health?”  Large funding streams: Tobacco, Diabetes, Primary Care Fund Research (CIHR) Federal provincial advisory committees ACPH ACHI

23 CCDPC Role 1. Knowledge Generation and Dissemination 2. Policy development 3. Surveillance expertise 4. International (CINDI Canada and WHO Collaborating Centre on NCD policy)

24 Towards Integration - Challenges Need to create an Observatory function and database of best practices for integrated approaches Integrated evaluation framework Dissemination through effective usage of IT and other mechanisms (e.g. G-8 Heart Health Telematics Project) Intersectoral collaboration New alliances between public health and clinicians Comprehensive approach to chronic disease across the continuum of care Integrate in the population health agenda... A National Strategy for integrated chronic disease prevention…