Ueda2016 the agenda for ncd prevention and control - samer jabbour

1. The agenda for NCD
prevention and control
Samer Jabbour
Associate Professor, Faculty of Health Sciences, American University of
Beirut
The Public Health in the Arab World initiative

2. Burden of NCDs in the EMR
2Source: 2014 WHO estimates (for the year 2012)
28%
9%
4%
3%
13%
13%
30%
Cardiovascular diseases
Cancers
Chronic Respiratory
Diseases
Diabetes
Other noncommunicable
diseases
Injuries
Communicable, maternal,
perinatal/child, and
nutritional conditions
• Over 2.2 million
deaths annually
• Over 57% of all
deaths
• Over half of NCD
deaths are premature
(below age 70)

3. NCD mortality in the Eastern Mediterranean
Region (2012)
12%
12%
13%
14%
17%
17%
17%
17%
18%
18%
19%
19%
19%
19%
20%
21%
23%
23%
24%
25%
31%
0% 5% 10% 15% 20% 25% 30% 35%
Kuwait
Lebanon
Bahrain
Qatar
Saudi Arabia
Tunisia
Iran (Islamic Republic of)
Sudan
Libya
Oman
Djibouti
United Arab Emirates
Somalia
Syrian Arab Republic
Jordan
Pakistan
Morocco
Yemen
Iraq
Egypt
Afghanistan
Probability of dying from any of cardiovascular diseases, cancer,
diabetes, or chronic respiratory diseases between age 30 & exact
age 70
Source: 2014 WHO estimates (for the year 2012)

4. Premature NCD mortality in the EMR (2012)
70.5%
81.4%
51.9%
61.4%
49.9%
40.5%
50.6%
53.2%
50.2%
31.0%
41.8%
48.2% 50.0%
52.6%
71.0%
45.9%
65.9%
71.7%
46.8%
40.3%
67.4%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
NCD deaths under 70 (% of all NCD death)
All ages, both sexes
Source: 2014 WHO estimates (for the year 2012)

5. Surveillance
Monitoring NCDs
and their
determinants
Management
Strengthening
health care for
people with NCDs
Prevention
Reducing the level
of exposure to risk
factors
2000 WHO Global Strategy for prevention and
control of NCDs (WHA53)
Governance

6. First High-level Meeting on NCDs (New York, 19-20 September 2011)
NCDs @ United Nations General Assembly
2011
Second high-level Meeting on NCDs (New York, 10-11 July 2014)
to take stock of the progress made since 20112014
NCDs adopted as part of sustainable development goals (SDGs)2015
6

8. Global Monitoring Framework
9 voluntary global targets for 2025

11. UPDATED REGIONAL FRAMEWORK FOR ACTION
GOVERNANCE
Strategic interventions Process indicators
Each country is expected to: Country has:
• Integrate noncommunicable diseases into national
policies and development plans
• Establish a multisectoral strategy/plan and a set of
national targets and indicators for 2025 based on
national situation and WHO guidance
• Increase budgetary allocations for
noncommunicable disease prevention and control
including through innovative financing
mechanisms, such as taxation of tobacco, alcohol
and other unhealthy products
• Periodically assess national capacity for prevention
and control of noncommunicable diseases using
WHO tools
• An operational multisectoral national strategy/action
plan that integrates the major noncommunicable diseases
and their shared risk factors
• Set time-bound national targets and indicators based on
WHO guidance
• A high-level national multisectoral commission, agency
or mechanism to oversee engagement, policy coherence
and accountability of sectors beyond health
• Increased budgetary allocations measured by tracking
and reporting on health expenditures on prevention and
control of major noncommunicable diseases, by source,
per capita

12. UPDATED REGIONAL FRAMEWORK FOR ACTION
PREVENTION AND REDUCTION OF RISK FACTORS
Strategic interventions Process indicators
Each country is expected to: Country is implementing:
• Accelerate implementation of the WHO Framework
Convention on Tobacco Control (WHO FCTC) and
ratify Protocol to Eliminate Illicit Trade in Tobacco
Products
• Ensure healthy nutrition in early life and childhood
including breastfeeding promotion and regulating
marketing of foods and non-alcoholic beverages to
children
• Reduce average population salt intake per WHO
recommendations
• Virtually eliminate trans-fat intake and reduce
intake of saturated fatty acids
• Promote physical activity through a life-course
approach
• Implement the best buys to reduce the harmful use
of alcohol
• Four demand-reduction measures of the WHO FCTC at
the highest level of attainment
• Four measures to reduce unhealthy diet
• At least one recent national public awareness programme
on diet and/or physical activity
• As appropriate, according to national circumstances, three
measures to reduce the harmful use of alcohol, in line
with WHO global strategy to

13. UPDATED REGIONAL FRAMEWORK FOR ACTION
SURVEILLANCE, MONITORING & EVALUATION
Strategic interventions Process indicators
Each country is expected to: Country has:
• Implement/strengthen the WHO surveillance
framework that monitors mortality and
morbidity, risk factors and determinants, and
health system capacity and response
• Integrate the three components of the
surveillance framework into the national
health information system
• Strengthen human resources and
institutional capacity for surveillance,
monitoring and evaluation
• A functioning system for generating reliable cause-
specific mortality data on a routine basis
• An operational population-based cancer registry
• A STEPS survey or a comprehensive health
examination survey every 5 years
• A framework to monitor effective coverage of
hypertension and diabetes treatment

14. UPDATED REGIONAL FRAMEWORK FOR ACTION
HEALTH CARE
Strategic interventions Process indicators
Each country is expected to: Country has:
• Implement the best buys in health care
• Improve access to early detection and
management of major noncommunicable
diseases and risk factors by including them in the
essential primary health care package
• Improve access to safe, affordable and quality
essential medicines and technologies for major
noncommunicable diseases
• Improve access to essential palliative care
services
• Evidence-based national
guidelines/protocols/standards for management of
major noncommunicable diseases through a primary
care approach, recognized/approved by the government
or competent authority
• Provision of drug therapy, including glycaemic control,
and counselling for eligible persons at high risk to
prevent heart attacks and strokes, with an emphasis on
the primary care level

15. Trends in the probability of dying from the four main NCDs
under different scenarios
Source: Professor Majid Ezzati et al 2014
(unpublished data)

16. Deaths prevented or delayed between 2010 and 2025
if risk factor targets are met
Source: Professor Majid Ezzati et al 2014 (unpublished data)

17. Which risk factors would contribute the most to achieving the
25 x 25 target?

18. 2/3 + 1/3
 Cost-effective population interventions that reduce
exposure to risk factors for NCDs will contribute up to
two-thirds of the reduction in premature mortality.
 Health systems that respond more effectively and
equitably to the health-care needs of people with NCDs
can reduce premature mortality by another one-third up
to one-half.
Both population-based interventions and individual-
based interventions

19. Source: NEJM 2007 356 2388 updated
Both NCD population and individual based
interventions are important
24
23
24
36
39
43
47
38
35
35
43
40
40
74
72
76
55
60
49
44
53
60
55
50
60
54
2
5
9
1
8
9
11
5
10
7
6
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
IMPACT Iceland 1981-2006
IMPACT Finland 1982 -1997
BMJ Finland 1972-1992
IMPACT Sweden 1986-2002
IMPACT Czech 1985-2007
IMPACT Poland 1991-2005
IMPACT USA 1980-2000
IMPACT England & Wales 1981-2000
IMPACT New Zealand 1982-1993
IMPACT Scotland 1975-1994
Hunink USA 1980-1990
Beaglehole New Zealand 1974-1981
Goldman USA 1968-1976
% attribution of global CHD mortality reduction
Treatments Risk factors Unexplained

21. The way forward
21
Vision: Global Strategy, UN Political Declaration, SDGs
Roadmap: Updated framework & process indicators
WHO Tools: Covering all areas
Governance
National targets and indicators
Operational multisectoral action plans
Surveillance
Implement
WHO
framework on
surveillance
Prevention
Implement
WHO “best
buys”
Health care
Implement
WHO “best
buys”;
strengthen
PHC

22. Thank you!
sj22@aub.edu.lb