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Review of NCDs: Current Situation &Future Prospect

Review of NCDs: Current Situation &Future Prospect. Orratai Waleewong Health Promotion Policy Research Center (HPR) International Health Policy Program (IHPP), Thailand. Outline. Global Epidemic of NCDs NCDs and Socio-economic development Poverty and productivity MDGs

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Review of NCDs: Current Situation &Future Prospect

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  1. Review of NCDs:Current Situation &Future Prospect Orratai Waleewong Health Promotion Policy Research Center (HPR) International Health Policy Program (IHPP), Thailand

  2. Outline • Global Epidemic of NCDs • NCDs and Socio-economic development • Poverty and productivity • MDGs • Global movement on NCDs • Best Buy Intervention: Policy and intervention to prevent and control NCDs

  3. Global Risks Landscape 2013 (World Economic Forum) Impact if the risk were to occur The Dangers of Hubris on Human Health Likelihood to occur in the next

  4. Global Epidemic of NCDs • NCDs caused  36 million deaths (60 %) of global deaths (2008) •  80% of these occur in developing countries Annual number of deaths in the world 25 million 2.3M Injuries 6.8 M Other deaths from NCDs 20 million 2.3M Premature deaths from NCDs (below age of 60), which are preventable 3.7M 15 million 10.2M 13.6M 10 million Communicable diseases, maternal, perinatal and nutritional conditions 0.5M 5.9M 0.6M 3.3 M 3.3M 3.0M 3.0M 1.1M 0.9M Upper middle-income Low-income countries Lower middle-income High-income countries Source: The Global Burden of Disease 2004

  5. 10 leading diseases & injuries and 10 leading risk factors based on percentage of global deaths and DALYs, 2010. NCDs account for 65.5% of all deaths, 54% of DALYs Source: Institute for Health Metrics and Evaluation, ‘The Global Burden of Disease: Generating Evidence, Guiding Policy: 2012.

  6. NCDs mortality by countries (2008 estimates) World Health Organization - NCD Country Profiles , 2011.

  7. Poverty contributes to NCDs and NCDs contribute to poverty

  8. NCDs undercut the attainment of the MDGs • Poverty: Household income is spent on health care for NCDs, medicines, tobacco and alcohol use • Hunger: Underweight children and overweight adults are often found in the same households • Maternal health: Malnutrition increases the risk of gestational diabetes and poor maternal health, high prevalence of cervical cancer (300,000 a year) • Child health: Malnutrition in pregnancy is associated with a vulnerability to obesity, cardiovascular disease and diabetes later in life • Education: NCD-related costs displace household resources for education • HIV/AIDS:Increases the risk of cancers, and ARVs increase the risk of cardiovascular diseases • Tuberculosis: Tobacco and alcohol use, and diabetes are associated with TB deaths • Essential drugs: Cost-effective medicines to treat NCDs are available in low-cost generic forms, but remain inaccessible and unaffordable to most who need them

  9. Cost of inaction Vs Cost of action The average cost for LMICs to scale up action by implementing the “best buy interventions” US$ 170 billion for 2011-2025 US$ 11.4 billion per year US$1 per capita in LICs, 1.5 in LMICs & 3 in UMICs • The cumulative economic lost output in developing countries associated with NCDs • US$ 7 trillion • over 2011-2025 • US$ 500 billion per year • US$ 25 in LICs, 50 in LMICs & 139 in UMICs

  10. 4 NCDs X 4 common risk factors Tobacco use Chronic respiratory disease Harmful use of alcohol Cardiovascular disease 4 NCDs 4Risk factors Unhealthy diet Diabetes Physical inactivity Cancers

  11. What is driving the NCD epidemic? SocialDeterminants of Health

  12. Global action against NCDs UNGA High-level Meeting on the prevention and control of NCDs A/RES/66/2 ECOSOC • WHA61.14 Doha Declaration on NCD & Injuries Action Plan on the Global Strategy for the Prevention and Control of NCDs 2008-2013 Political Declaration on NCDs • WHA64.11 Moscow Declaration • WHA60.23 • WHA57.17 Implementation Global Strategy WHO Global Status Report on NCDs Global Strategy on Diet, Physical Activity and Health • WHA63.14 • WHA63.13 Marketing of food & non-alcoholic beverages to children Global Strategy to Reduce the Harmful Use of Alcohol • WHA66.10 A Comprehensive global monitoring framework • WHA56.1 • WHA53.17 Global Action Plan 2013-2020 Global Strategy for the Prevention and Control of NCDs Options & timeline for strengthening and facilitating multisectoral action 2007 2013 2003 2004 2009 2000 2008 2010 2011

  13. UN High-level Meeting on NCDs (19-20 September 2011, New York) It was only the 2nd time in history that the UN General Assembly discussed a health issue • 113 Member States • 34 Presidents &Prime-Ministers • 3 Vice-Presidents & Deputy Prime-Ministers • 51 Ministers of Foreign Affairs and Health • 11 Heads of UN Agencies 100s of NGOs Political Declaration on NCDs (A66/RES/2)

  14. UNGA High-level Meeting on the prevention and control of NCDs Political Declaration on NCDs (A66/RES/2) • Establish multisectoral national plans by 2013 • Integrate NCDs into health-planning processes and the national development agenda • Promote multisectoral action through whole-of-government approaches • Set national targets and measure results • Increase domestic resources • Head quarter • WHO Regional Offices • Member states • Develop a global monitoring framework and targets • Develop a global implementation plan 2013-2020 • Provide technical support to developing countries • Identify options for multisectoral actions • Coordinate work with other UN Agencies • Measure results and report

  15. World Health Organization (WHO) Vision: The promotion of equity, universal access, and self-reliance in health development • Strategies to deliver on this vision: • Health systems and capacity building • NCDs, mental health & disabilities • Health security • Health development for poverty reduction (by • accelerating MDGs) • Improving access to medical products • Improving performance through reform

  16. WHO reform: Global Programme of Work (Draft 12th)

  17. Rio+20United Nations Conference on Sustainable Development [June 2012] “ We understand the goals of sustainable development can only be achieved in the absence of a high prevalence of debilitating communicable and NCDs, and where populations can reach a state of physical, mental and social well-being. ” (paragraph 138) “ We acknowledge that the global burden and threat of NCDs constitutes one of the major challenges for sustainable development in the 21st century. ” (paragraph 141)

  18. UN Task Team on the post-2015 UN development agenda [June 2012] “ The MDGs did not adequately address … increase in NCDs . ” (paragraph 19) “ Priorities for social development and investments in people would include: … NCDs. Access to sufficient nutritious food and promotion of healthy life styles with universal access to preventive health services will be essential to reduce the high incidence of NCDs diseases in both developed and developing countries” (paragraph 67)

  19. Global Action Plan for the Prevention and Control of NCDs 2013–2020 Objectives • To raise the priority accorded to the prevention & control of NCDs in global, regional and national agendas and internationally agreed development goals, through strengthened international cooperation and advocacy • To strengthen national capacity, leadership, governance, multisectoral action and partnerships to accelerate country response for the prevention & control of NCDs • To reduce modifiable risk factors for NCDs and underlying social determinants through creation of health-promoting environments • To strengthen and orient health systems to address the prevention & control of NCDs and the underlying social determinants through people-centred primary health care and universal health coverage • To promote and support national capacity for high-quality research and development for the prevention & control of NCDs • To monitor the trends and determinants of NCDs and evaluate progress in their prevention & control

  20. NCDs is preventable ! Thepackage of low-cost "best buys" interventions exist , but implementation in developing countries is still weak

  21. Implementing low-cost workable solutions in developing countries could prevent most premature deaths from NCDs • 2/3 + 1/3 • Implementing cost-effective interventions that reduce exposure to NCDs risk factors of populations will contribute up to 2/3 of the reduction in premature mortality. • In addition, health systems that respond more effectively and equitably to the health-care needs of people with NCDs can reduce premature mortality by another 1/3 up to 1/2.

  22. Population-based interventions addressing NCD risk factors: “Best buy” & “Good buy” interventions

  23. Individual-based (Health care) interventions addressing NCD risk factors: “Best buys” Early detection & care, using cost-effective & sustainable health-care interventions >> integrate into primary health care

  24. Orratai Waleewong, B.Pharm, MSc Health Promotion Policy Research Center (HPR) International Health Policy Program (IHPP) orratai@ihpp.thaigov.net

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