1. Hypertension Prevention
Dr Temo Waqanivalu
Program Officer
Surveillance and Population-based Prevention Unit
Department of Prevention of Noncommunicable Diseases

2. Burden of NCD
- In million deaths were due to NCD
10%
Deaths in 2011
Age groups
Source: WHO Global Burden of Disease (2011)

3. Burden of NCD

4. Prevalence of Raised Blood Pressure

5. Prevalence of Raised Blood Pressure

6. Causative or Contributing Factors

7. Leading risk factors for global mortality
Source: WHO's report on "Global health risks"
60% of global death are due to non communicable diseases;
That includes 15% of the total number of deaths with occurs before the age of 60, and 27% of the total number which occurs before the age of 70.
High blood pressure is ranked 1th on global level
Physical inactivity is ranked 4th on global level (5.5%) – overweight/obesity 4.8% - unsafe sex 7th with 4 %.

8. Strong evidence for the link between salt and health
Primarily linked with CVD
Sodium consumption increases BP
BP increases CVD risk
Age, sex and baseline BP specific effects
. Source: He et al. J Human Hypertension, 2008

9. Dose Response: Meta-analysis (1 month or longer)
Change in Systolic BP (mmHg)
Normotensives
b=0.04, P<0.001
Hypertensives
b=0.07, P<0.001
Change in Urinary Sodium (mmol/24h)
\ A 6 g/day reduction in salt intake predicts a fall in SBP of:
 7 mmHg in Hypertensives (p<0.001)
 Avg. 5 mmHg
 4 mmHg in Normotensives (p<0.01)
J Human Hypertens 2002;16:761

10. Salt Consumption Average 10g/day 80% from processed foods
Mean Sodium Intake in persons 20 yrs and over 2010
Average 10g/day
80% from processed foods

11.  Salt intake 5-6g/day
 Stroke 24%
 CHD 18%
600,000 (approx) Stroke & heart attack deaths prevented / year
Western Pacific
Worldwide 2.0 million (approx) deaths prevented / year
He & MacGregor. Hypertension 2003;42:

12. The Political Declaration of the High Level Meeting
Article 43 12

13. Outcomes: mortality and morbidity
Exposures: biological and behavioural risk factors
National systems response
Member States have committed themselves to "consider the development of national targets based on national situations", building on the 9 voluntary global targets.
National targets can be more or less ambitious than the global ones and should be guided by:
- Current performance;
- Current level of exposure;
- Programmes planned and in place.
WHO is developing a Toolkit on NCD Surveillance, which will include a module on setting national targets and measuring results

14. WHO supports countries in addressing NCDs
2000
WHO Global Strategy for the Prevention and Control of NCDs
WHO Framework Convention on Tobacco Control
2003
WHO Global Strategy on Diet, Physical Activity and Health
2004
WHO Global NCD Action Plan
2008
WHO Global Strategy to Reduce the Harmful Use of Alcohol
2009
First WHO Global Status Report on NCDs
2010
Moscow Declaration
UN Task Force on NCDs
2011
2011 UN Political Declaration on NCDs
2013
2013
WHO Global NCD Action Plan , including 9 global targets
2014
2014 UN Outcome Document on NCDs
2015
2015
Country Framework for Action to engage sectors beyond health on NCDs
Adoption of the post-2015 development agenda
2025
World Health Assembly
Attainment of the 9 global targets for NCDs by 2025
UN General Assembly
2030
Attainment of the global target for NCDs by (as part of the Sustainable Development Goals)
ECOSOC

15. The WHO Global NCD Action Plan 2013-2020 – six objectives

16. The Approach 16

17. High risk and Population-based approaches
High-Risk Approach
Population Approach
Benefit is high for…
The whole population
The individual
Source: Rose G. “Sick Individuals and Sick Populations” IJE 2001;30:
Subject motivation
Low
High
Doctor motivation
Benefit-risk ratio
“Worrisome”
“Favourable”
Screening costs
No screening costs
High
Depth of solution
Radical
Palliative, temporary
Behaviour-Context fit
“Appropriate”
“Inappropriate”

18. Very Cost Effective (Best Buy) Intervention

19. Causes of Causes/Determinants Development?
ENVIRONMENTAL
Socio-cultural
Economic & Trade
Physical
5000yrs ago average world intake of salt 0.1g/day
To preserve food and clean bad ones
Development result in refrigeration and chemicals
Now 9-12 g/day

20. Guidelines

21. SALT (Sodium) Guidelines
For adults: WHO recommends that adults consume less than 5 g (just under a teaspoon) of salt per day.
For children: WHO recommends that the recommended maximum intake of salt for adults be adjusted downward for children aged two to 15 years based on their energy requirements relative to those of adults.
All salt that is consumed should be iodized or “fortified” with iodine

22. Population Salt Reduction Strategies
INDUSTRY ACTION
Product Reformulation
Food Regulations
Reduction of salt
in processed foods
Industry Commitment
Food Targets/Standards
Proper labeling
Fiscal Measures
WHAT
HOW
OUTCOME
Local Policies
Catering Guidelines
Marketing & Mobilization
Consumer Education
Reduction of use and
consumption of salt
Public Awareness and
education campaign
Behavior Change campaign
Health Literacy
Reduction of use of
salt
Food outlets
Events and functions
Settings (Schools, Health
Care Facilities) 1
EMPOWER
CONSUMERS 2
SUPPORTIVE
SETTINGS 3

23. Hidden Salt in food ↓ BP Food industry slowly reduce
e.g. processed, fast, takeaway, restaurant food
Food industry slowly reduce
- No rejection by public
Fantastic for Public Health
Very little cost
↓ BP
No need to change diet

24. How not to ↓ salt ! No effect on salt intake
Give choice of reduced salt products
No effect on salt intake
Allow industry to claim no one wants it
Does not target most deprived
Allow some health charities to get money from food industry!

25. M&E Framework

26. Population Based Prevention in country
Establish Baseline level of risk and set national targets
Develop national multisectoral plans with other sectors including private and CSOs
Implement equitable actions focused on poor and vulnerable
Monitor implementation and trends
Networking

27. Progress so far ..
All regions except Africa are conducting surveys and initiating salt reduction measures
All regions are progressing Physical activity promotion since the global target set
Marketing Restrictions and dietary fiscal policies poorly implemented by all
Fruits and vegetable promotion to be strengthened through Nutrition Decade of Action (ICN2)
MORE NEEDS TO BE DONE

28. The WHO Global NCD Action Plan – six objectives with recommended actions for Member States, international partners and WHO
Action for Secretariat (WHO)
LEADING & CONVENING: Work with the United Nations funds, programs and agencies to reduce modifiable risk factors at the country level
POLICY ADVICE & DIALOGUE: Publish and disseminate guidance (“toolkits”) on the implementation and evaluation of interventions at the country level for reducing the prevalence of tobacco use, promoting a health diet and physical activity and reducing the harmful use of alcohol
NORMS & STANDARDS: continue to build on existing efforts and develop normative guidance and technical tools to support the implementation of WHO’s global strategies for addressing modifiable risk factors;
KNOWLEDGE GENERATION: Strengthen the evidence base and disseminate evidence to support policy interventions at the country level for reducing the prevalence of tobacco use, promoting a healthy diet and physical activity and reducing the harmful use
TECHNICAL COOPERATION: Provide technical assistance to reduce modifiable risk factors including through implementing the WHO guidelines and global strategies for addressing modifiable risk factors and other health-promoting policy options.
Bolding the bit that EMRO is doing through the Call for Action and this meeting -= to be emphasised

29. S A L T Toolkit trategy development ction to reduce salt
ink to Iodine Fortification
racking progress

30. Population Salt Reduction Strategies
INDUSTRY ACTION
Product Reformulation
Food Regulations
Reduction of salt
in processed foods
Industry Commitment
Food Targets/Standards
Proper labeling
Fiscal Measures
WHAT
HOW
OUTCOME
Local Policies
Catering Guidelines
Marketing & Mobilization
Consumer Education
Reduction of use and
consumption of salt
Public Awareness and
education campaign
Behavior Change campaign
Health Literacy
Reduction of use of
salt
Food outlets
Events and functions
Settings (Schools, Health
Care Facilities) 1
EMPOWER
CONSUMERS 2
SUPPORTIVE
SETTINGS 3

31. Thank You
mail: