Non-communicable Diseases: Realizing the commitments from Heads of State and Government made in the UN Political Decla

1. Non-communicable Diseases: Realizing the commitments from Heads of State and Government made in the UN Political Declaration on NCDs www.who.int/ncd ncdactionplan@who.int Объединяйтесь в борьбе против НИЗ Unidos contra las enfermedades no transmisibles لنتحد في مكافحة الأمراض غير السارية Tous unis dans la lutte contre les maladies non transmissibles 团结起来，抵抗非传染性疾病

2. World Health Assembly in 2000: There is a strategic vision on how to address NCDs *Surveillance* Mapping the epidemic of NCDs and risk factors *Prevention* Reducing the level of exposure to risk factors *Management* Strengthen health care for people with NCDs

3. Setting the agenda: Vision and a global road map 2000 Global Strategy for the Prevention and Control of Noncommunicable Diseases 2003 Global Strategy on Diet, Physical Activity and Health 2004 Action Plan on the Global Strategy for the Prevention and Control of NCDs 2008 Global Strategy to Reduce the Harmful Use of Alcohol 2009 WHO Global Status Report on NCDs 2010 2011 Political Declaration on NCDs 2012+ Realizing the commitments made in the Political Declaration

4. fact 23 The UN High-level Meeting on NCDs was a defining moment for development cooperation: it sets a new global agenda that advances inclusive social and economic development. UN General Assembly NCD Review 2014: Review and assessment of the United Nations General Assembly of the progress achieved in the prevention and control of NCDs

5. The WHO Global NCD Action Plan 2013-2020unites governments, international partners and WHO around a common agenda Vision:A world free of the avoidable burden of NCDsGoal:To reduce the preventable and avoidable burden of morbidity, mortality and disability due to NCDs by means of multisectoral collaboration and cooperation at national, regional and global levels

6. fact The WHO Global NCD Action Plan 2013-2020 has six objectives with recommended actions for Member States, international partners and WHO Objective 4 To strengthen and orient health systems to address the prevention and control of NCDs through people-centred primary health care and universal health coverage Objective 5 To promote and support national capacity for high-quality research and development for the prevention and control of NCDs Objective 1 To strengthen international cooperation and advocacy to raise the priority accorded to prevention and control of NCDs in the development agenda and in internationally-agreed development goals Objective 2 To strengthen national capacity, leadership, governance, multisectoral action and partnerships to accelerate country response for the prevention and control of NCDs Objective 6 To monitor the trends and determinants of NCDs and evaluate progress in their prevention and control Objective 3 To reduce exposure to modifiable risk factors for NCDs through creation of health-promoting environments

7. Non-communicable Diseases: Realizing the commitments from Heads of State and Government made in the UN Political Declaration on NCDs Nine Global Targets and 25 Outcome Indicators Объединяйтесь в борьбе против НИЗ Unidos contra las enfermedades no transmisibles لنتحد في مكافحة الأمراض غير السارية Tous unis dans la lutte contre les maladies non transmissibles 团结起来，抵抗非传染性疾病

8. fact At the World Health Assembly in May 2013, Member States adopted 9 voluntary global targets for the prevention and control of NCDs to be attained by 2025

9. At the World Health Assembly in May 2013, Member States adopted the Comprehensive Global Monitoring Framework for the Prevention and Control of NCDs, including a set of 25 indicators fact

10. Non-communicable Diseases: Realizing the commitments from Heads of State and Government made in the UN Political Declaration on NCDs 9 NCD Action Plan Indicators to inform reporting on progress made in the process of implementing the WHO Global NCD Action Plan 2013-2020 Объединяйтесь в борьбе против НИЗ Unidos contra las enfermedades no transmisibles لنتحد في مكافحة الأمراض غير السارية Tous unis dans la lutte contre les maladies non transmissibles 团结起来，抵抗非传染性疾病

11. WHO Discussion Paper (version dated 12 August 2013) Draft set of action plan indicators

12. What is next? Immediate actions for Member States 2014-2015 • Set national targetsfor 2025 in 2013, taking into account the 9 global targets • Develop national multisectoral NCD policies and plans to attain national targets for 2025, by addressing the three major components of the NCD strategy

13. fact What is next? Priority actions recommended for Member States to reduce the exposure of populations and individuals to risk factors for NCDs • Implement interventions identified by WHO as "best buys" using WHO tools: • Tobacco use: • Tax increases • Smoke-free indoor work placesand public places • Health information and warnings about tobacco • Bans on adverting and promotion • Harmful use of alcohol: • Tax increases on alcoholic beverages • Comprehensive restrictions and bans on alcohol marketing • Restrictions on the availability of alcohol • Unhealthy diet and physical inactivity: • Salt reduction through mass media campaigns and reduced salt content in processed foods • Replacement of trans-fats with polyunsaturated fats • Public awareness programme about diet and physical activity • Marketing of foods and non-alcoholic beverages to children

14. fact What is next? Priority actions recommended for Member States to enable health systemsto respond more effectively and equitably to the health-care needs of people with NCDs • Implement interventions identified by WHO as "best buys" into the basic primary health care: • Health system strengthening is key: • Prevention of liver cancer through hepatitis B immunization • Prevention of cervical cancer through screening and treatment of pre-cancerous lesions • Multidrug therapy to individuals who have had a heart attack or stroke and to persons with a high risk of a cardiovascular event in the next 10 years

15. fact What is next? Priority actions recommended for Member States to quantify and track NCDs and their determinants (as it provides the foundation for advocacy, national policy and action) • Implement the WHO Framework for NCD Surveillance, covering • monitoring of risk factors and determinants, • outcomes (mortality and morbidity) and • health system response • Integrate into the national health information systems • Develop national targets and indicators, based on the WHO recommendations and WHA Resolutions

16. fact The WHO Framework for NCD Surveillance quantifies and tracks exposures, outcomes and health systems response A WHO Framework for NCD Surveillance • Exposures: • Behavioural risk factors: tobacco use, physical inactivity, harmful use of alcohol and unhealthy diet • Metabolic risk factors: overweight/obesity, raised blood pressure, glucose & cholesterol. • Social determinants: education, material well being, access to health care • Outcomes: • 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.

17. Non-communicable Diseases: Realizing the commitments from Heads of State and Government made in the UN Political Declaration on NCDs WHO Global Coordination Mechanism on the Prevention and Control of NCDs (‘NCD GCM’) Объединяйтесь в борьбе против НИЗ Unidos contra las enfermedades no transmisibles لنتحد في مكافحة الأمراض غير السارية Tous unis dans la lutte contre les maladies non transmissibles 团结起来，抵抗非传染性疾病

18. Non-communicable Diseases: Realizing the commitments from Heads of State and Government made in the UN Political Declaration on NCDs UN INTERAGENCY TASK FORCE Объединяйтесь в борьбе против НИЗ Unidos contra las enfermedades no transmisibles لنتحد في مكافحة الأمراض غير السارية Tous unis dans la lutte contre les maladies non transmissibles 团结起来，抵抗非传染性疾病

19. What has happened since the UN Political Declaration on NCDs in 2011? UN Interagency Task Force on NCDs • Objectives: • Enhance and coordinate technical support • Facilitate information exchange about plans, strategies, programs and activities • Facilitate information exchange about available resources to support national efforts • Strengthen advocacy • Ensure that tobacco control continues to be duly addressed • Strengthen international cooperation “The Task Force will be convened and led by WHO. Accordingly, WHO shall provide the Secretariat of the Task Force”

20. Fighting the global health burden through new technology: • WHO ITU joint program on mHealth for NCDs mHealth as an example of interagency collaboration

21. Non-communicable Diseases: Realizing the commitments from Heads of State and Government made in the UN Political Declaration on NCDs UN General Assembly NCD Review 2014 Объединяйтесь в борьбе против НИЗ Unidos contra las enfermedades no transmisibles لنتحد في مكافحة الأمراض غير السارية Tous unis dans la lutte contre les maladies non transmissibles 团结起来，抵抗非传染性疾病

22. NCD progression and health economic burden Health and economic burden Population to be covered Healthy Risk factors High risk NCD Complications Rehab Progression of NCD

23. Helping to improve health

24. ‘Whole-of-Government’ and ‘Whole- of-Society’ approach • ‘Whole-of-Government’ denotes public service agencies working across portfolio boundaries to achieve a shared goal and an integrated government response to particular issues • Responsibility for health and its social determinants rests with the whole society, and health is produced in new ways between society and government.

25. Very cost effective interventions

26. Win – Win approach for NCD prevention

27. Tobacco taxation and Health Promotion Foundations in Australia, Lao PDR, Korea, Malaysia, Mongolia, Tonga, Viet Nam Plain packaging- a path breaking approach in Australia Examples of best practices and effective approaches for MSA - Tobacco Control

28. The Mongolian President initiative in alcohol control, non- alcohol in government’s function and new alcohol legislation Development of legislation: drinking and driving, use of helmet, blood testing: China, Cambodia, Philippines, Vietnam Regulating informal alcohol control in Vietnam Examples of best practices and effective approaches for MSA - Tobacco Control -- Reducing Harm from Alcohol

29. Healthier foods in Singapore-Hawker Fare Salt reduction in China and Mongolia Eat smart restaurants (700+), Hong Kong (China) Eat smart @ school (400), Hong Kong (China) Examples of best practices and effective approaches for MSA -- Promoting Healthy Diet

30. Controls on advertisement • EU television without frontiers directive • TV adverts shall not cause moral or physical detriments to minors • Ireland-bans cartoon characters and celebrities to promote foods • France –mandatory health messages should accompany adverts on TV and radio • Sweden-total ban for adverts aimed at children less than 12 yrs

31. Exercise equipment in public parksin Lao PDR, China, Korea Walk paths, and cycling tracks in Cambodia, Korea, China, Malaysia Community physical exercise groupsclubs in Seongbuk, Korea and Shanghai, China Walking days in Dalin, Seongbuk, Xiamen Examples of best practices and effective approaches for MSA --- Promoting Physical Activity

32. Examples of best practices and effective approaches for MSA - Healthy Cities • Smoke Free Cities Harbin, QingDao, China Makati and Marikina, Philippines LuangPrabang, in Lao PDR, Siem reap, Cambodia • Environmentally sustainable healthy urban transport (ESHUT) in 5 Asian cities Promote walking, cycling public transport system Reduce use of private vehicles Smokig ban Promoting health and hygiene Barrier-free transport environments

33. Health Promoting schools for multiple health interventions- Singapore, Hong Kong, Macao (China) Healthy workplaces - Shanghai, Hong Kong, China Examples of best practices and effective approaches for MS A----Healthy Settings: Health Promoting Schools and Work Places

34. Healthy Cities to Promote Healthy Living • Promotion of Physical Activity • Bicycle and pedestrian friendly urban landscape, Changwon, • Community physical activity facilities, Hong Kong, Dalian, Beijing, • Walk Paths in public parks-Shanghai, China

36. Upstream interventions Policies/ lack of it in other sectors NCDs

37. Cross over All sectors to work for health Health in all policies Transport Urban planning Food processing Tobacco/Alcohol sales and promotions Education Industry

38. MSA-Entry Points Inter ministerial Local Government Cross sector working groups

39. Mechanisms , Tools and Instruments for MSA • Inter-ministerial and inter-departmental committees • Community consultations and Citizens’ Juries • Cross-sector action teams • Partnership platforms • Integrated budgets and accounting • Cross-cutting information and evaluation systems • Impact assessments • Joined-up workforce development • Legislative frameworks

40. MSA-Accountability and Reporting • Experiences from MDG 4 and 5 in accountability framework • Agreed national targets and indicators • Sector-specific roles, responsibility, target, inputs and outputs • Joint statement and joint plan • Across sectors audit, evaluation • Public reporting

41. NCD Management

42. NCD management: Defined package, coverage, follow-up

43. Monitoring and evaluation Deaths-Cause Specific Mortality-ICD coding Disease burden-Registries (eg. Cancer, Stroke) Prevalence surveys Risk factors- Adult - WHO STEPS survey Children-Global school based student health survey Policy monitoring Health Impact Assessment

44. Healthier people making healthier decisions. An operational manual for WHO IRM/QRT to support countries in the development of a national multisectoral plans for prevention and control of NCDs.

45. WHY? WHAT? HOW? OUTCOME What is MSA? Step 1. Sit. Analysis National MSA plan for NCD prevention and control Approach paper Guiding principles Step 2. Int stakeholder consult NCDMSA in UHC Prioritization of actions- country context Draft plan Step 3. Ext stakeholder consult HiAP UNDAF, city planning, urban development, sustainable development, legislative agenda Final draft NCD services in disasters Step 4. Endorsement of MSA NCD targets and indicators

46. 1. Sit. Analysis IRM mission 1 (One week) to assign a 3 member team for the country (1 HQ, 1 RO, 1 from another region)- within WR office team led by WR, MOH focal points and national consultants • Sources • NCD country capacity survey • WHO CCS • NCD global status report • Risk factors surveys • Health system assessment • Vital registration • Cancer registries • Nutrition surveys • Tools • Spider grams • Stakeholder analysis • Multi voting • Balance score cards • Problem solution trees • Prioritization tools • Projection of national targets Process 1 week IRM mission Day 1-engagement Day 2-3- Sit asssmnt Day 4-Prioritization Day 5-Draft plan • Output of Step 1 • Approach paper • Situational analysis • Priority areas • Potential national targets • Sectors and stakeholders • Next steps

47. Step 2. Int stakeholder consult IRM mission 2 (One week) Lead by WR, supported by team from IRM-RO and with external experts Based on the approach paper developed in Step 1 Approach paper Tools Spider grams Multi voting Problem-solution tree Prioritization tools Capacity enhancement Advocacy Communication Surveillance Leadership Process Thematic consultations External technical support Output of Step 2 Draft MSA plan for NCD prevention and control NCD in UHC NCD services in emergencies

48. 3. Ext stakeholder consult IRM mission 3 (One week) Lead by WR, supported by team from IRM (1 from HQ, 1 RO and 1 from another region) with external experts Draft MSA plan Tools Spider grams Multi voting Problem-solution tree Prioritization tools Process Thematic consultations External technical support Identification of specific actions in other sectors/domains Synthesis and finalization Output of Step 3: Final MSA plan

49. 4. Endorsement of MSA IRM mission 4 (2 days) Lead by WR, supported by team from IRM (1 HQ, 1 RO) Preparations Design and layout of MSA plan Foreword and messages Process Endorsement Media activity Outcme of Step 4: Final endorsed national MSA plan for NCD prevention and control.

50. Structure of a national multisectoral action plan for the prevention and control of NCDs