1. Assistant Director-General World Health Organization
An outline of the Global Strategy for the Prevention of Noncommunicable Diseases and its Action Plan
Dr Ala Alwan
Assistant Director-General
World Health Organization

2. Causative risk factors
Non-communicable 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
Non-communicable diseases
Heart disease and stroke 
Diabetes
Cancer
Chronic lung disease

3. WHO’s work is guided by the vision of the Global Strategy and its Action Plan, supported by the WHO FCTC and DPAS
2000
Global Strategy for the Prevention and Control of Noncommunicable Diseases
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

4. Key Components of the NCD Global Strategy

5. Surveillance

6. Gaps and Lessons Leaned
Good progress in risk factors surveillance over the last decade but NCD surveillance systems are still generally weak in member States
No consensus on key components of an NCD surveillance system and lack of standardized indicators to monitor NCD trends at national and global levels – duplication/inconsistencies
When it exists, NCD surveillance work is not institutionalized and rarely integrated into the national health information systems of LMICs
Limited capacity in epidemiology and surveillance in Member States
Limited capacity of WHO and partners

7. Prevention and Health Promotion

8. Prevention Reduction of Risk factors
Actions for:
Tobacco control
Promoting healthy diet
Promoting physical activity
Reducing the harmful use of alcohol
Cost effectiveness and best buys..

9. WHO Framework Convention on Tobacco Control (WHO FCTC)
Why are the poorest people in low- and middle-income countries affected the most?
Objective 3 – WHO's response to date
WHO Framework Convention on Tobacco Control (WHO FCTC)
First global health treaty negotiated under auspices of WHO
168 parties
Entry into force 27 Feb 2005
Creates international laws to:
Establish tobacco control as a priority on the public health agenda
Provide an evidence-based tool for adoption of sound tobacco control measures
Introduce a mechanism for firm country commitment and accountability 9

10. WHO Framework Convention on Tobacco Control: Evidence-based tool for adoption of tobacco control measures
Core package for interventions at the population level:
Price and tax measures to reduce the demand for tobacco (Article 6) and smuggling control (Article 15)
Protection from exposure to tobacco smoke (Article 8)
Packaging and labeling of tobacco products (Article 11)
Ban of tobacco advertising, promotion and sponsorship (Article 13)
Monitoring and evaluation (Articles 20, 21 and 22)
Core package for interventions at the individual level:
Tobacco dependence reduction and cessation (Article 14)

11. MPOWER: Six policies which build on the WHO FCTC
are an integral part of the NCD Global Strategy Action Plan
Monitor tobacco use and prevention policies
Protect people from tobacco smoke
Offer help to quit tobacco use
Warn about the dangers of tobacco
Enforce bans on tobacco advertising, promotion and sponsorship
Raise taxes on tobacco 11

12. Sustainable tobacco control programs including
The obstacles for tobacco control and implementation of WHO FCTC can be addressed by:
Sustainable tobacco control programs including
1. Sustainability
2. Comprehensive multi-sectoral tobacco control
3. Local, regional and nation wide activities
Strengthening human capacity in political, managerial and technical areas of tobacco control
key to a systematic multi-sectoral approach
Resources mobilization for capacity building

13. Example: Policies to promote healthy diet and prevent obesity
Reducing salt and trans fatty acids
Restricting availability of sugar sweetened beverages
Restricting availability of other high calorie snack foods: chips, chocolates and other sweets
Increasing availability of healthier foods
Protecting children from marketing and promotion practices
Reshaping industry supply and consumer demands
Labelling and calorie information
Pricing measures

14. Policies to promote physical activity and prevent obesity What works: Based on the Global Strategy on DPAS
Urban design and land use to encourage PA as part of transportation
Street design that make walking and biking safe and enjoyable (side lanes, bike lanes, improved lighting, public parks
Encourage use of stair (burn calories and not electricity)
Physical education as an important part of the school curriculum
Facilities for sports for adults including women

15. Management and Health Care

16. Underpinning principles for improving health care for people with NCDs
Universal coverage reforms:
Ensure availability and eliminate barriers to access
Service delivery reforms:
Organizing primary care networks accordingly
Leadership reforms:
Recognition of the key role and responsibilities of government
Matching growth in health expenditure with massive reinvestment in capacity for leading and governing the health sector
Public policy reforms:
Health systems
Public health
Cross-government: Health in All Policies

17. Improving NCD Health Care
Health system strengthening
Focus on developing and implementing a package of essential cost-effective interventions (best buys)
Actions to achieve short term gains in promoting access to the essential NCD interventions

18. Challenges addressed by the Global Strategy and its Action Plan
Strengthen understanding and capacity of NCD surveillance and integrating it into the national health information system
Promote Health in All Polices and intersectoral action to address risk factors
Improve access to appropriate and rational health care, particularly in LMICs

19. The NCD Global Strategy Action Plan
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
To translate the GS into concrete action the action plan was developed. The Action Plan is practically a road map for countries, for WHO and for international partners. It covers a six-year period, from 2008 until 2013, and contains sets of actions for Member States, for International Partners, and for the WHO Secretariat.
These sets of actions are grouped under six objectives.
The actions under the first objective aim to raise the priority accorded to NCDs in development work. There are also actions to be implemented by Member States to start integrating the prevention and control of NCDs into policies across all government departments. This is the so-called whole-of-government or health-in-all policies approach, without which we cannot achieve much in NCD prevention.
The second objective focuses on actions by Member States to establish and strengthen national policies and plans for the prevention and control of non-communicable diseases. It calls on international partners and the WHO Secretariat to provide technical support to low- and middle-income countries, so that they can build sustainable institutional capacities. The Action Plan identifies three priorities that all countries must address: (1) establishing a surveillance system as an integral part of the national health information system; (2) reducing exposure to risk level to prevent disease; (3) and improving health care with emphasis on primary health care.
The third objective calls on all parties to promote interventions to reduce the main shared modifiable risk factors for non-communicable diseases, which I mentioned earlier. These are: tobacco use, unhealthy diets, physical inactivity and the harmful use of alcohol.
The fourth objective requires the WHO Secretariat to develop a prioritized research agenda for non-communicable diseases, in close collaboration with international partners and Member States. This prioritized research agenda will generate knowledge and help to translate knowledge into action through innovative approaches in the context of low- and middle-income countries.
The fifth objective calls on the WHO Secretariat and international partners to promote partnerships and support a global network to raise awareness, mobilize resources and exchange successful approaches.
The sixth objective calls on all parties to monitor non-communicable diseases and their determinants and evaluate progress at national, regional and global levels.

20. Objective 1 - Raising the priority in development work
Meetings and a monograph on NCDs and development
Regional Ministerial Meeting on Health Literacy (Beijing, April 2009)
Regional Ministerial Meeting on Non-communicable Diseases and Injuries, Poverty and Development (Qatar, 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, 2009)
Current follow up work with the General Assembly – Several meetings with UN DESA and Member States
UNGA resolution on NCDs (May 2010) leading to a Summit on NCDs in 2011
GA resolution:
"Convene a High-level meeting of the UN General Assembly, with the participation of Heads of State and Government, on the Prevention and Control of NCDs in September 2011".
"Encourage Member States to include in their discussions in the 2010 MDG Review Meeting to be held in September 2010, the rising incidence and the socio-economic impact of the high prevalence of NCDs in developing countries"
"Request the UN Secretary-General to develop a global report on NCDs
We have been active in implementing this objective in 2008 and 9. NCDs are not part of the MDGs or any international initiative on development We had several consultations on translating the evidence linking NCDs to SED and poverty into convincing arguments for policy makers and we now have a mongraph finalized for dissemination to member States and other partners.
Several key activities were implemented in collaboration with the UN DESA. Two very successful events during the high level segment of the ECOSOC and this together with the Ministerial meeting hosted by the PM of Qatar resulted in increased awareness among policy makers of the need to integrate NCDs into the development agenda. We have the Doha declaration based on the suggestions of Member States on ways to raise priority and integration into international development initiatives and the ECOSOC declaration which calls for the implementation of the GS Action Plan.

21. Objective 1 – Intersectoral action
Mechanisms of strengthening intersectoral action for NCD prevention
ON ISA which is key for NCD prevention. Policies by non health sector have a direct influence on NCDs and unless we have health in all policies and non health sectors are accountable on the impact of their policies and actions on health, very little will be achieved. these are three key deliverables.

22. Objective 2 – National policies and plans
Global Survey on Assessment of National capacity for NCD Prevention
Guidelines on national surveillance systems- development of core indicators
Framework for country action
Strengthening health care for people with noncommunicable diseases:
WHO technical support package of essential interventions in primary care
Strengthening national cancer control in collaboration with international partners
International seminar for managers of national NCD programmes
Benin
Bhutan
Eritrea
Sri Lanka
Sudan
Syria
Vietnam
Albania
Nicaragua
Sri Lanka
Tanzania
Vietnam
Yemen
Key activities implemented during the first 18 months since the endorsement of the action plan

23. Objective 3 – Reducing and preventing risks
WHO Framework Convention on Tobacco Control (WHO FCTC)
First global health treaty negotiated under auspices of WHO
169 parties
Entry into force 27 Feb 2005
Creates international laws to:
Establish tobacco control as a priority on the public health agenda
Provide an evidence-based tool for adoption of sound tobacco control measures
Introduce a mechanism for firm country commitment and accountability
The world has very clear directions on tobacco control- celebrated the 5th anniversay last month- we now have 169 parties to the convention 23

24. Objective 3 – Reducing and preventing risks
Six proven interventions building on WHO FCTC measures for reducing demand Global Report on the Tobacco Epidemic & Economics on Tobacco Control- innovative financing

25. Objective 3 – Reducing and preventing risks
A key product is the second Report on the Global Tobacco Epidemic which focuses on smoke free environment but also contains inforrmation onthge progress of implementationof the 6 mpower measures. We are working on the third one (warnings)

26. Objective 3 – Reducing and preventing risks
Reducing the level of exposure of individuals and populations to unhealthy diets and physical inactivity:
Population salt reduction platforms & strategies
Population prevention strategies for childhood obesity
Recommendations on the marketing of foods and non-alcoholic beverages to children
Global Recommendations on physical activity and health
IER/NMH work on cost-effectiveness
NCD Prevention through Diet and Physical Activity in Schools and Worksites
Benin
Cape Verde
China
Fiji
India
Lebanon
Mali
Mauritania
Mauritius
Pakistan
Tunisia
Uganda
Vietnam
Yemen
Key projects in implementing the DPAS

27. Global Strategy on Harmful Use of Alcohol
Endorsed by the 63rd World Health Assembly

28. Objective 4 – Prioritizing research
WHO
Advisory Committee on Health Research
WHO Meeting on A Prioritized Research Agenda Geneva, August 2008)
Ministerial Forum on Research for Health, Bamako, November 2008
Jan-July 2010:
Consultations with international partners and development of the first public version
October 2009:
Second draft
A Prioritized NCD Research Agenda

29. What has WHO been doing to mobilize a global response?
Six objectives:
1. Raising the priority accorded to NCDs in development work at global and national levels and promote intersectoral action
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

30. Objective 5 – Promoting partnerships
NCDnet: a new network to combat NCDs in developing countries
Mission of NCDnet:
Help implement the Global Strategy Action Plan
Goals of NCDnet:
Raising awareness through advocacy
Increase resource availability
Catalyze country-level implementation
During the ECOSOC High-level Segment in July 2009, WHO established a new network to combat non-communicable diseases, entitled NCDnet. The mission of NCDnet is to help Member States, International Partners and WHO to implement the Action Plan. NCDnet is focusing on three goals: (1) to increase the focus on NCDs through collective advocacy; (2) to increase resource availability through innovative resourcing mechanisms and (3) promote exchange of successful approaches to accelerate country-level implementation. A first planning meeting took place on 15 October We will share additional details later this morning.

31. Objective 6 – Monitoring and evaluating progress
Surveillance tool (2009):
Country capacity assessment
WHO Global status report on noncommunicable diseases
Data collection in
193 Member States
(2009/2010)
Data analysis
(2010)
2010
Assessing trends in mortality, morbidity and risk factors
Assessing the progress made by countries in addressing NCDs

32. Main implementation challenges (to be discussed at the upcoming World Health Assembly)
Moving forward on NCD surveillance
"Health in All Policies": prevention and intersectoral action
Health care financing