Source: WHO Global Health Estimates 2014 (Year: 2012), Deaths by age group More than 14 million people died from NCDs in 2012 between the ages of 30 and 70 Communicable, maternal, perinatal and nutritional conditions NCDs Injuries These premature deaths could have largely been prevented

The percentage of people dying from NCDs before the age of 70 is the highest in the poorest countries Deaths from NCDs before the age of 70 as a percentage of total deaths from NCDs Source: WHO Global Health Estimates 2014 (Year: 2012), Deaths by age group

Development dimension: Poverty contributes to NCDs and NCDs contribute to poverty

Where do we stand today? Paragraph 43. Remarkable progress has been made since September Many countries, including some of the poorest, have aligned their policies and resources with the nine global targets and the WHO Global Action Plan for the Prevention and Control of NCDs to make unparalleled gains. Sizeable gains have occurred in even the poorest countries. Paragraph 44. However, progress has been insufficient and highly uneven. Bolder measures are urgent to accelerate efforts to address NCDs and mitigate their impacts. The political declaration has catalysed action and retains great power in engendering collective action for faster results. Note by the United Nations Secretary-General transmitting the report of the Director-General of WHO on the prevention and control of NCDs (10 December 2013)

Where do we stand today?

Countries with integrated operational NCD policies/plans with a dedicated budget 32%50% Where do we stand today?

Percentage of countries in 2013 with funding for NCD activities Low-incomeLow middle-incomeUpper middle-incomeHigh-income Primary prevention and health promotion Early detection and screening Health care and treatment Surveillance, monitoring and evaluation Capacity building Rehabilitation services 0% 100% % of countries

Taxation on tobacco and alcohol 85% of countries have taxes on tobacco 76% of countries have taxes on alcohol Taxation on foodstuffs and non-alcoholic beverages 11% of countries have taxes on high sugar content food and non-alcoholic beverages 3% of countries have taxes on high-fat foods Subsidies for healthy foods: 7% of countries have price subsidies for healthy foods Incentives to promote physical activity: 8% of countries have tax incentives to promote physical activity Motivation for fiscal interventions: 39% of countries use such interventions to raise general revenues 6% of countries use such interventions to raise funds for health Percentage of countries in 2013 with fiscal interventions to address NCDs

Taxation on alcohol Low-incomeLow middle-incomeUpper middle-incomeHigh-income Taxation on tobacco Taxation on high sugar content food and non-alcoholic beverages Taxation on high fat foods Price subsidies for healthy foods Taxation incentives to promote physical activity 0% 100% % of countries

Percentage of countries in 2013 with NCD components integrated into primary health care 0% 100% % of countries Low-incomeLow middle-incomeUpper middle-incomeHigh-income Primary prevention and health promotion Risk factor detection Risk factor and disease management Support for self help and self care Support for home-based care Rehabilitation services

Percentage of countries in 2013 with availability of NCD treatment procedures Low-incomeLow middle-incomeUpper middle-incomeHigh-income 0% 100% % of countries Retinal photocoagulation Renal replacement therapy by dialysis or transplant Radiotherapy Chemotherapy Coronary bypass or stenting

Tipping point

Road map of commitments included in the 2011 UN Political Declaration on NCDs 2011 Political Declaration 2014 Outcome Document 2018 First High-level Meeting on NCDs (World Leaders) Second High-level Meeting on NCDs (Ministers) Third High-level Meeting on NCDs

Road map of commitments included in the 2011 UN Political Declaration on NCDs 2011 UN Political Declaration on NCDs Roadmap of concrete national commitments, including one time- bound commitment: By 2013, consider developing national multisectoral policies and plans 2014 UN Outcome Document on NCDs Reiterated the same roadmap of national commitments, including four time-bound commitments: By 2015, consider setting national targets for NCDs By 2015, consider developing national multisectoral policies and plans By 2016, implement best buys to reduce risk factors for NCDs By 2016, implement best buys to enable health systems to respond

Best buys Tobacco Reduce 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 sponsorship Harmful use of alcohol Regulate commercial and public availability of alcohol Restrict or ban alcohol advertising and promotions Use pricing policies such as excise tax increases on alcoholic beverages Which NCD policies and programmes best drive progress?

Best buys Diet and physical activity Reduce salt intake Replace trans fats with unsaturated fats Implement public awareness programmes on diet and physical activity Promote and protect breastfeeding

Which NCD policies and programmes best drive progress? Best buys Cardiovascular diseases and diabetes Drug therapy (including glycaemic control for diabetes mellitus and control of hypertension 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 cardiovascular event in the next 10 years Acetylsalicylic acid (aspirin) for acute myocardial infarction Cancer Prevention of liver cancer through hepatitis B immunization Prevention of cervical cancer through screening (visual inspection with acetic acid (VIA) linked with timely treatment of pre-cancerous lesions

Halt the rise in diabetes and obesity A 10% relative reduction in prevalence of insufficient physical activity At least a 10% relative reduction in the harmful use of alcohol A 25% relative reduction in risk of premature mortality from cardiovascular disease, cancer, diabetes or chronic respiratory diseases An 80% availability of the affordable basic technologies and essential medicines, incl. generics, required to treat NCDs A 30% relative reduction in prevalence of current tobacco use A 30% relative reduction in mean population intake of salt/sodium A 25% relative reduction in prevalence of raised blood pressure or contain the prevalence of raised blood pressure At least 50% of eligible people receive drug therapy and counselling to prevent heart attacks and strokes Where to focus: 9 global NCD targets to be attained by 2025 (against a 2010 baseline)

Guidance provided through WHO tools Available at Updated every three months

WHA68 (2016) 2015 WHA73 (2021) 2020 WHA78 (2026) 2025 WHA68 (2016) 2015 WHA69 (2018) 2017 WHA73 (2021) 2020 Progress monitor 2015 Progress monitor 2016 UNGA (2017) 2017 What gets measured gets done 25 outcome indicators 9 process indicators 10 progress indicators

Country estimates of NCD mortality and selected risk factors (2010 baseline and latest available data) o Premature mortality o NCD mortality o Alcohol o Insufficient physical activity o Tobacco o Body mass index o Overweight and obesity o Raised blood glucose o Raised blood pressure Global baseline (2010) against which progress will be measured

The resource recession Significant additional investments are required to address NCDs in the post-2015 era: These need to rely on domestic public finance (the potential to increase taxation on tobacco and alcohol exists in many countries) Important role to improve the catalytic role of ODA to complement national NCD efforts Prevention must remain the cornerstone of any national response to NCDs Opportunity to integrate NCDs into existing fully-funded national public health programmes on unfinished business and UHC

NCD management remains important Management of NCDs will be critical to achieving the global target to reduce premature mortality from NCDs by 25% in 2025: Investment in health systems is critical for improving NCD outcomes Access to health technologies and essential medicines for NCDs has to be ensured Integrated programmes based on a total cardiovascular approach need to be strengthened in primary care (using hypertension, diabetes and other risk factors as an entry point) Global targets on coverage of people at risk for cardiovascular diseases and availability of essential medicines and technology can help to scale up NCD management

Target 3.4: By 2030, reduce by one third premature mortality from NCDs Target 3.5: Strengthen the prevention and treatment of substance abuse, including harmful use of alcohol Target 3.a Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate Target 3.b Support the research and development of vaccines and medicines for the communicable and NCDs that primarily affect developing countries Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all Most relevant NCD targets included in the proposed SDGs

WHO Programme Budget (proposed PB ) Outcome 2.1: Increased access to interventions to prevent and manage NCDs and their risk factors WHO Regional NCD Action Plans Number of countries that have established national multisectoral action plans for the prevention and control of NCDs Number of countries that have integrated work on NCDs into their UNDAFs Number of countries reporting on the 9 voluntary targets UN Task Force on NCDs WHO Global Coordination Mechanism on NCDs WHO Global NCD Action Plan How WHO is supporting domestic action on NCDs

Support provided by WHO Technical Departments, WHO Regional and WHO Country Offices is aimed at building national capacities to: Set targets and develop national plans Implement strategies to reduce risk factors Improve health care coverage for the management of NCDs Track the NCD epidemic and monitor progress

How WHO is supporting domestic action on NCDs Ongoing action by the WHO-led UN Task Force on NCDs: Joint country programming missions Global joint programme on m-health ("Be healthy, Be mobile") Products under development by the WHO Global Coordination Mechanism on NCDs: Recommendations on ways and means to help Member States in fulfilling their commitments to engage with the private sector on NCDs and increase financing for NCDs Recommendations on how to include NCDs in development cooperation and how to strengthen NCDs in North-South, South-South and triangular cooperation Communities of practice on NCDs and webinars Web-based platform that facilitates exchange of best practices in the areas of health-in-all-policies and whole-of-society approaches, legislation, regulation, health system strengthening and training of health personnel

The 3rd UN High-level Meeting on NCDs is only three years away … Time to scale up action

ANNEX

WHA68 (2016) 2015 WHA73 (2021) 2020 WHA78 (2026) 2025 WHA68 (2016) 2015 WHA69 (2018) 2017 WHA73 (2021) 2020 Progress monitor 2015 Progress monitor 2016 UNGA (2017) 2017 Holding governments accountable on fulfilling the commitments made 25 outcome indicators 9 process indicators 10 progress indicators

WHO Executive Board decision EB136(13) on 2 February 2015: The Executive Board decided to request the Director-General to publish a technical note in the coming months on how the Director-General will report in 2017 to the United Nations General Assembly on the national commitments included in the 2014 UN Outcome Document on NCDs and the 2011 UN Political Declaration on NCDs, using existing survey tools and taking into account existing indicators at the global and regional levels. What will WHO report to the UN General Assembly in 2017?

o Reviewed national commitments in both 2011 and 2014 o Considered existing indicators for monitoring at global and regional levels o Reviewed existing survey tools and data collection mechanisms o Widely consulted internally across all levels of WHO to select best mix of progress indicators Methodology used

How WHO will report progress to the UN General Assembly in 2017 WHO will report on 10 progress indicators related to the four time-bound national commitments included in the 2014 UN Outcome Document on NCDs related to: o Surveillance, monitoring and evaluation o Governance o Prevention and reduction of risk factors o Health care

1 indicator 4 indicators 3 indicators 2 indicators Governance Health care Prevention and reduction of risk factors Surveillance, monitoring and evaluation How WHO will report progress to the UN General Assembly in 2017

4.Operational multi- sectoral national strategy/action plan 5.Implement four key demand reduction measures of WHO FCTC 6.Implement three key measures to reduce the harmful use of alcohol 7.Implement four key measures to reduce unhealthy diet 8.Implement at least one public awareness programme on healthy diet / physical activity 1.Time-bound national targets and indicators 2.System for generating reliable cause specific mortality data 3.STEPS survey or a comprehensive health examination survey every 5 years 9.Evidence-based national guidelines/ protocols/ standards for the management of major NCDs 10.Provision of drug therapy and counselling for eligible persons Governance Health care Prevention and reduction of risk factors Surveillance, monitoring and evaluation How WHO will report progress to the UN General Assembly in 2017

Surveillance, monitoring and evaluation How WHO will report progress to the UN General Assembly in Member State has a STEPS survey or a comprehensive health examination survey every 5 years 1. Member State has set time-bound national targets and indicators based on WHO guidance 2. Member State has a functioning system for generating reliable cause-specific mortality data on a routine basis Time-bound commitment included in the 2014 UN Outcome Document on NCDs: By 2015, consider setting national targets for 2025 and process indicators based on national situations, taking into account the nine voluntary global targets for NCD, building on guidance provided by the World Health Organization, to focus on efforts to address the impacts of noncommunicable diseases and to assess the progress made in the prevention and control of NCDs and their risk factors and determinants

Governance How WHO will report progress to the UN General Assembly in 2017 Time-bound commitment included in the 2014 UN Outcome Document on NCDs: “By 2015, consider developing or strengthening national multisectoral policies and plans to achieve the national targets by 2025, taking into account the WHO Global NCD Action Plan 2013–2020 ” 4. Member State has an operational multisectoral national strategy/action plan that integrates the major NCDs and their shared risk factors

5. Member State has implemented the following four demand-reduction measures of the WHO FCTC at the highest level of achievement: a.Reduce affordability of tobacco products by increasing tobacco excise taxes; b.Create by law completely smoke-free environments in all indoor workplaces, public places and public transport c.Warn people of the dangers of tobacco and tobacco smoke through effective health warnings and mass media campaigns d.Ban all forms of tobacco advertising, promotion and sponsorship Prevention and reduction of risk factors How WHO will report progress to the UN General Assembly in 2017 Risk factor: Tobacco Time-bound commitment included in the 2014 UN Outcome Document on NCDs: By 2016, as appropriate, reduce risk factors for NCDs and underlying social determinants through the implementation of interventions and policy options to create health- promoting environments, building on guidance set out in Appendix 3 to the WHO Global NCD Action Plan

6. Member State has implemented, as appropriate according to national circumstances, the following three measures to reduce the harmful use of alcohol as per the WHO Global Strategy to Reduce the Harmful Use of Alcohol: a.Regulations over commercial and public availability of alcohol b.Comprehensive restrictions or bans on alcohol advertising and promotions c.Pricing policies such as excise tax increases on alcoholic beverages Prevention and reduction of risk factors How WHO will report progress to the UN General Assembly in 2017 Risk factor: Alcohol Time-bound commitment included in the 2014 UN Outcome Document on NCDs: By 2016, as appropriate, reduce risk factors for NCDs and underlying social determinants through the implementation of interventions and policy options to create health- promoting environments, building on guidance set out in Appendix 3 to the WHO Global NCD Action Plan

How WHO will report progress to the UN General Assembly in 2017 Risk factor: Unhealthy diets 7. Member State has implemented the following four measures to reduce unhealthy diets: a.Adopted national policies to reduce population salt/sodium consumption b.Adopted national policies that limit saturated fatty acids and virtually eliminate industrially produced trans fatty acids in the food supply c.WHO set of recommendations on marketing of foods and non-alcoholic beverages to children d.Legislation /regulations fully implementing the International Code of Marketing of Breast-milk Substitutes Time-bound commitment included in the 2014 UN Outcome Document on NCDs: By 2016, as appropriate, reduce risk factors for NCDs and underlying social determinants through the implementation of interventions and policy options to create health- promoting environments, building on guidance set out in Appendix 3 to the WHO Global NCD Action Plan Prevention and reduction of risk factors

How WHO will report progress to the UN General Assembly in 2017 Risk factor: Physical Inactivity 8. Member State has implemented at least one recent national public awareness programme on diet and/or physical activity Time-bound commitment included in the 2014 UN Outcome Document on NCDs: By 2016, as appropriate, reduce risk factors for NCDs and underlying social determinants through the implementation of interventions and policy options to create health- promoting environments, building on guidance set out in Appendix 3 to the WHO Global NCD Action Plan

Health care How WHO will report progress to the UN General Assembly in 2017  By 2016, as appropriate, strengthen and orient health systems to address the prevention and control of NCDs and the underlying social determinants through people-centered primary health care and universal health coverage throughout the life cycle, building on guidance set out in Appendix 3 to the WHO Global NCD Action Plan ” 9. Member State has evidence- based national guidelines/ protocols/ standards for the management of major NCDs through a primary care approach, recognized/approved by government or competent authorities. 10. Member State has provision of drug therapy, including glycaemic control, and counselling for eligible persons at high risk to prevent heart attacks and strokes

Getting to 2018 o Jan 2015: WHO published global baseline o May 2015: WHO published a technical note on how WHO will report to the UN General Assembly in 2017 taking into account 10 progress monitor indicators o May 2015: WHO will conduct the fifth (2015) global survey on assessing national capacity for the prevention and control of NCDs o Sept 2015: WHO will publish an intermediate progress report taking into account 10 progress indicators and data collected in 2015 o May 2016: WHO will submit progress report to World Health Assembly on 25 outcome indicators and 9 process indicators o April 2017: WHO will conduct the sixth (2017) global survey on assessing national capacity on NCDs o Sept 2017: WHO will submit a progress report to the UN General Assembly, including a statistical annex with country data on the 10 progress indicators o 2018: Third High-level Meeting of the United Nations General Assembly on NCDs