1. Noncommunicable Diseases: Global Action - Global Response
Dr Nick Banatvala
6th International WHO IUMSP NCD Managers Seminar
May 2012

2. World Health Organization
Specialized agency within the United Nations
Established in 1948
194 Member States
World Health Assembly and Executive Board as Governing Bodies
Headquarters in Geneva, Switzerland
6 Regional Offices; 6 Regional Committees
150 country offices
5,431 professional staff
Let me start with a brief introduction of WHO. The WHO is a United nations specialized agency . It is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health mattersEstablished in 1948
193 Member States
The World Health Assembly and Executive Board consisting of ministries of health of member states are the Governing Bodies
Headquarters is based in Geneva, Switzerland
And there are 6 Regional Offices; 6 Regional Committees, each consisting of ministries of health from all member states in the region
WHO has an extensive presence in countries. It has 150 country offices

3. WHO’s Core Functions
providing leadership on matters critical to health;
shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge;
setting norms and standards;
articulating ethical and evidence-based policy options;
providing technical support and building sustainable institutional capacity; and
monitoring the health situation and assessing health trends.
WHO fulfils its objectives through its core functions:
providing leadership on matters critical to health and engaging in partnerships where joint action is needed;
shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge;
setting norms and standards and promoting and monitoring their implementation;
articulating ethical and evidence-based policy options;
providing technical support, catalysing change, and building sustainable institutional capacity; and
monitoring the health situation and assessing health trends.
These core functions are set out in a General Programme of Work, which provides the framework for organization-wide programme of work, budget, resources and results.

4. Mapping the epidemic of NCDs Management
Global Strategy for the Prevention and Control of Noncommunicable Diseases
2000
Surveillance
Mapping the epidemic of NCDs
Management
Strengthen health care for people with NCDs
Prevention
Reducing the level of exposure to risk factors

5. Lessons Learned From International Experience
Strategies should:
Combine population and high risk approaches
To have an impact, interventions should be of appropriate intensity and sustained over extended periods of time
Include community participation, health care reforms, supportive policy decisions, legislation, and intersectoral action
More health gains are achieved by influencing public policies in other sectors
Trade
Education
Agriculture
food production, urban development and taxation
Fifth: Experience indicates that
Trade, food, agric, urban development, finance, and taxation policies

6. 1. Surveillance: mapping the epidemic

7. Mapping the epidemic of NCDs
Framework for national NCD surveillance
Exposure:
Behavioural risk factors: tobacco use, physical inactivity, harmful use of alcohol and unhealthy diet
Metabolic risk factors: raised blood pressure, overweight/obesity, raised blood glucose, and raised cholesterol.
Social determinants: education, household income, access to health care
Outcome:
Mortality: NCD specific mortality
Morbidity: cancer incidence and type
Health System Response:
Interventions and health system capacity: infrastructure, policies and plans, access to key health care interventions and treatments, partnerships
*Surveillance*
Mapping the epidemic of NCDs

8. 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

9. 2. Primary prevention: reducing exposure to risk factors

10. Reduction of Risk factors
Actions for:
Tobacco control
Promoting healthy diet
Promoting physical activity
Reducing the harmful use of alcohol
Cost effective set of best buys..

11. 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 February 2005
Creates international laws for:
Establishing tobacco control as a priority on the public health agenda
The adoption of sound tobacco control measures
Introducing a mechanism for firm country commitment and accountability 11

12. 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)

13. MPOWER: Six policies which build on the WHO FCTC
and 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 13

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

15. Policies to promote physical activity and prevent obesity
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

16. Global Strategy on Harmful Use of Alcohol
Increase exercise taxes on alcoholic beverages
Regulating availability, including minimal legal purchase age, restrictions on outlet density and time of sale and where appropriate government monopoly of retail sales
Restricting exposure to marketing of alcoholic beverages through marketing regulations or advertising bans
Drink-driving countermeasures, including random breath testing, blood alcohol limits at 0.5g/l, with zero tolerance for young drivers
Treatment of alcohol use disorders and interventions for hazardous and harmful drinking
Endorsed by the 2010 World Health Assembly

17. Risk factors: "Best buys" interventions to address NCDs
15/09/2018
Interventions
Condition
- Raise taxes on tobacco
- Protect people from tobacco smoke
- Warn about the dangers of tobacco
- Enforce bans on tobacco advertising
Tobacco use
- Raise taxes on alcohol
- Restrict access to retailed alcohol
- Enforce bans on alcohol advertising
Alcohol use
- Reduce salt intake in food
- Replace trans fat with polyunsaturated fat
Promote public awareness about diet and physical activity
Hepatitis B vaccination
Unhealthy diet &physical inactivity
Infections 17

18. 3. Management: strengthening healthcare for those with NCDs

19. Improving health care for people with NCDs: principles
Universal coverage
Ensure availability and eliminate barriers to access
Service delivery reform
Organizing primary care networks accordingly
Leadership
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 reform:
Public health
Cross-government: Health in All Policies
Health systems

20. Six building blocks to strengthen health systems for NCDs

21. Prioritize NCD 'best buys' to improve health care for NCDs
15/09/2018
Prioritize NCD 'best buys' to improve health care for NCDs
Interventions
Condition
Provide counselling and multi-drug therapy (including blood sugar control for diabetes mellitus) for people with medium-high risk of developing heart attacks and strokes (including those who have established CVD)
Treat heart attacks ( myocardial infarction) with aspirin
CVD & diabetes
Hepatitis B immunization beginning at birth to prevent liver cancer
Screening and treatment of pre-cancerous lesions to prevent cervical cancer
Cancer 21

22. 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
Sets of actions for member states, WHO Secretariat and international partners.