Regional Strategy & Plan of Action on an Integrated Approach to the Prevention and Control of Chronic Diseases Line

1. . . Regional Strategy & Plan of Action on an Integrated Approach to the Prevention and Control of Chronic Diseases Line of Action:Surveillance of CNCDs and RFs

2. The Growing Epidemic of Chronic Diseases, Driving Factors, and What They Contributed to • Driving factors • Urbanization • Globalization • Technology • Aging • Behavioral risk factors • Unhealthy diet • Physical inactivity • Tobacco and alcohol use • Social and economic burden • Disproportionate burden of chronic diseases on the poor

3. WHO and PAHO Resolutions Supporting Integrated CNCD and RF Prevention and Control • WHO Resolution on Integrated prevention and control of non communicable diseases (2000) • Framework convention for Tobacco control ( 2003) • Global Strategy on Diet Physical activity and health (2004) • Global Resolution on Alcohol (2005) • Global Resolution on prevention on cancer ( 2005) • PAHO Resolution on Cardiovascular diseases and Hypertension (2 000) • PAHO resolution on “Public Health response to chronic diseases” (2002)

4. Type of information Related to Health • Environment • Socioeconomic and political • Health situation • Health services • Health determinants • Health-promotion strategies • Health-related policy info Adapted from Parrish y MC Donnell

5. Scenarios • Information systemsdisconnected and undeveloped • Mortality • Programs • Routine surveillance • CD • Analysis poor and fragmented • Decision-making regardless to available information • Integrated information systems • Mortality • Morbidity • Health services (PHC and hospital) • Programs • Other sectors • Public Health Surveillance • CD and CNCD • Sentinel sites • Population Health studies • Developed units for analysis of health situation • Use of GIS • Information used for decision-making

6. Situation Today in LAC Related to Surveillance Systems and CNCDs

7. National Health Reporting System, Survey and Surveillance • Health Information System: 25 • Chronic diseases included: 17 • Risk factors included: 17 • Mortality included: 25 • Morbidity included: 20 • Routine surveillance system: 8

8. Brazil: CNCD Surveillance System Information Risk factors, protection Morbidity Mortality Population-based survey Use of Services (PNAD*) Population-based cancer registry Hospital information system Authorization for hospital stays Basic cause Specific population: Schoolchildren (PNAD*) Hospital cancer registry Ambulatory Information System (APAC**) Multiple causes Other: Phone, users * PNAD: Pesquisa Nacional por Amostras de Domicílios ** APAC: Autorização de Procedimentos de Alta Complexidade

9. Data Used for Policy- and Program- Planning Purposes

10. Regional Strategy and Plan of Actionapproved in September 2006 Goal: To prevent and reduce the burden of chronic diseases and related risk factors in the Americas Integrated Approach • Common risk factors • Life course perspective • Comprehensive approach • Multisectoral • Multilevel that includes promotion, prevention and control

11. Regional Strategy (cont’d) • Within public-health response to chronic diseases, Surveillance is stated as a necessary element for further development and expansion of a comprehensive approach that would allow countries to address chronic noncommunicable diseases from a public-health perspective.

12. Regional Strategy: Lines of Action • Health Promotion To reduce the burden of chronic disease through support, and promotion of social and economic conditions that address the determinants of chronic diseases and empower people to increase control over their health, especially the adoption of sustained healthy behaviors. • Surveillance To encourage and support the development and/or strengthening of countries’ capacities to better monitor chronic diseases, their impacts, their risk factors, and the impact of interventions as part of the integrated strategy on chronic disease prevention. • Integrated Management of Chronic Diseases and Risk Factors To facilitate and support the strengthening of the capacity and competencies of the health system for prevention and control in the integrated management of chronic diseases and their risk factors. • Public Policy and Advocacy To ensure and promote the development and implementation of effective, integrated, sustainable, and evidence-based public policies on chronic disease, their risk factors and determinants.

13. Regional Strategy (cont’d) • The Strategy and action plan is guided first and foremost by the expressed interests and needs of counties. • It is based on WHO Global surveillance strategic directions. • It is in coherence and continuity with previous work within PAHO, WHO, national and international community • Data selection, indicators, instruments for analysis are based on existing WHO and PAHO health information and health statistics initiatives (PAHO Basic data, Healthy metrics, Global Info base).

14. To encourage and support the development and the strengthening of countries’ capacity to better monitor chronic diseases, their consequences, their risk factors, and the impact of public-health interventions as part of the integrated strategy on NCD prevention and control. Line of Action: Surveillance Outcome Goal

15. Line of Action: SurveillanceSub-goals Focus on strengthening the following capacities in the countries: • Strengthening or building CNCD surveillance system as part of country health inf. System. • Ongoing systematic collection of reliable, comparable, and quality data. • Timely and advanced analysis. • Dissemination and use of analysis results for national policy and program planning and evaluation. • Technical competency of the surveillance workforce. • Monitoring and continuous Evaluation of system itself. • Novel thinking and innovation.

16. The Regional Strategy and Action Plan promote the following: • Gradual/STEPwise approach through 3 levels: • Minimum /basic /core requirements for surveillance of CNCDs and RF • Expanded /optimum requirements for surveillance of CNCDs and RF • Desirable requirements for surveillance of CNCDs and RF • This approach enables insight of the entire framework, so that counties can move from one level to another as their capacities grow over time.

17. Core level: Theexisting resources will be in use and will include the collection, analysis of core/existing information strengthening quality, reliability and timeliness. Content of this level will be developed in collaboration with key countries and those that are part of the unfinished agenda. Expanded level is focused on obtaining and analyzing the information that will be collected with realistic projection of increase or reallocation of resources. Content of this level will include regular and periodic data collection of health determinants and biological RF using PAHO/WHO instrument(s) and methodology. Desirable level includes obtaining and analyzing the desired information that remains beyond the reach of most countries and their available resources. Content of this level will include data on health determinates, policy and program evaluation, information and analysis for fine-tuning of intervention programs. This approach facilitates collection of selected data, production of reliable indicators, levels of analysis to establish groups or areas of priority for NCD control, development of national infobases, & participation in global & regional infobases.

18. Implementation Activities to follow: • Consensus-building of gradual /STEPwise approach • Production of guidelines for each level • Building infrastructure and resources • Provision of adequate tools and training • Development of academic centers to support capacity building • Building national, subregional and regional infobases

19. On what are we building the implementation plan for surveillance? • Situation analysis (country capacity, availability of data, integration of the national or local system, etc.). • PAHO Interprogrammatic Working Group in formation Tasks: Proposal of core and expended set of indicators( Caribbean proposal for core a starting point) PAHO Basic Data initiative, guidelines for each level of system. • RF surveillance modalities: Pan American version of STEPS (Aruba and Grenada trained) CAREC Workshop, BRFS tested in Trinidad. • Infobase: WHO infobase decentralization. • Quality, under-reporting, timelines: Part of PAHO program for quality improvement of vital statistics.