1. NCDs: a global view
International Conference On Healthy Lifestyles And Non-communicable
Diseases (Ncds) In The Arab World And The Middle East, Riyadh, Kingdom
Of Saudi Arabia, 9-12 September 2012
Dr. Sania Nishtar
Founder and President
Heartfile Pakistan
Heartfile, 2012

2. Stocktaking
• Where do we stand?
• What needs to happen next?
• Does the EMR have capacity?
• What at the immediate next steps, at the
regional level?
Heartfile, 2012

3. NCDs: Where do we Stand
1
• On a positive note
– International consensus—Political declaration
– Normative clarity
• Evidence based best buys
• Strategies, tools and instruments
• Voluntary global targets
• Civil society mobilization and public private convergence
• Less auspicious
– Paucity of development resources
– NCDs are not (yet) fully part of domestic priorities
– Capacity to cascade policy into action is limited
Heartfile, 2012

4. NCDs and HIV and AIDS
Heartfile, 2012

5. NCDs: Where do we Stand
1
• On a positive note
– International consensus—Political declaration
– Normative clarity
• Evidence based best buys
• Strategies, tools and instruments
• Voluntary global targets
• Civil society mobilization and public private convergence
• Less auspicious
– Paucity of development resources
– NCDs are not (yet) fully part of domestic priorities
– Capacity to cascade policy into action is limited
Heartfile, 2012

6. US $ 22 Billion spent on health by International
AID agencies in in LMIC
Global mortality
From NCD
Overseas health aid
Source IDF

7. 2 What needs to happen next
Regionally
• Step up capacity to be responsive to country
needs
Domestically
1. Societal change
2. Next generation public health, action outside
health
3. Reorienting health from episodic to chronic care
Heartfile, 2012

8. Framework for action: NCDs 1
Nishtar S. Prevention of non-communicable diseases in Pakistan. Health Res Policy Syst. 2004
Heartfile, 2012

9. Framework of action: NCDs 2
Lifestyle risks
• Smoking
• Un healthy diet
• Lack of physical activity
• Stress
Biological risks
• Obesity
• Dyslipidaemia
• Diabetes
• High blood pressure
Disease conditions
• Cardiovascular disease
• Diabetes
• Lung conditions
• Some cancers
Heartfile, 2012

10. Framework of action: NCDs 3
Health
Systems for
Policy both acute
Societal
action at and chronic
change
all levels care
Heartfile, 2012

11. Societal choice
• The imperative for societal change in EMRO
– Six out of 10 countries with the highest prevalence
of diabetes
– Smoking amongst men ranges from 12-60%
– Grossly overweight population
• 50% women in the region overweight
• Escalating level of obesity in children
Policy action
– Trends in per-capita sale of
Behavior
manufactured food and fizzy drinks change
Market
shaping
Heartfile, 2012

12. Policy action by all levels of
government
• Multi-sectoral action
• Inter-sectoral action
• Opportunity for embedding NCDs in
– Medium term development frameworks
– Sustainable development goals?
– Universal coverage, the 21st century Health for all
– Social protection agendas
– Innovations dives (technological and design)
– The poverty reduction strategies
Heartfile, 2012

13. Pakistan: Composition of Shocks
categories of shocks

14. Health systems; from acute to chronic
3 care
• Health information systems
• Financing
• Service delivery
• Medicines and related products
• Governance
• Workforce Learning
• Technology
Innovations
Heartfile, 2012

15. Learning lessons
Leveraging innovations
Slide courtesy: Miriam Rabkin
Heartfile, 2012

16. © Alison Koler 2010
Heartfile, 2012

17. HIV—Lessons to be learnt for NCDs
Rabkin, and Nishtar. J Acquir Immune Defic Syndr 2011
Heartfile, 2012

18. Examples
Ethiopia Cambodia
Slide courtesy: Miriam Rabkin
Heartfile, 2012

19. Does the EMR have capacity to deliver
• Tier 1—capacity and resources exist
• Capacity constraints in Tier I and II
– Fiscal space
– International development priorities
– Health systems distortion
Heartfile, 2012

20. What will be the Riyadh
promise for NCDs ?
Heartfile, 2012