Overview

1. Subregional Meetingof Representatives and Directors from Central America, Cuba, the Dominican Republic, Haiti, Mexico, and the US-Mexican Border Field Office Session 5: Noncommunicable Diseases (Belize, 12–16 February 2007)

2. Overview • Global situation • National Capacity Survey forCentral America • Review of effective interventions • Regional Strategy and Plan of Action • CAMDI Initiative • PAHO Actions • Next Steps

3. Global Situation Chronic diseases are the major cause of death in almost all countries! 60% of all deaths are due to chronic diseases. Over 35,000,000 people will die from chronic diseases in 2007.

4. Global Situation 2 The poorest countries are the worst affected! 80% of chronic disease deaths will occur in low- and middle-income countries. The problem has a serious impact.

6. Global Situation 3 • The risk factors are widespread. • The threat is growing. • 1,000,000 people are overweight or obese.

7. Source: WHO, Preventing Chronic Diseases, A Vital Investment.

8. Global Situation 4 • The global response is inadequate. • 388,000,000 million people will die in the next 10 years of a chronic disease.

10. Global Situation • The major causes of chronic diseases are known. • At least 80% of heart disease, stroke and type 2 diabetes, and 40% of cancer can be prevented. • A full range of cost-effective interventions exist for all regions of the world. Many are inexpensive. • We must strike a new balance of prevention and control.

11. National Capacity Survey / Central America NOTE: X= NOT PRESENT

12. National Capacity Survey.Central America • Deficient areas • Financial resources. • Quality of care / Monitoring System • National health-reporting system, surveys and surveillance. • National community-based demonstration program.

13. What works? • A small shift in average population levels of several risk factors can lead to a large reduction in chronic diseases. • Population-wide approaches form the central strategy for preventing and controlling chronic disease epidemics, but should be combined with interventions for individuals. • Many interventions are not only effective, but suitable for resource-constrained settings.

14. Review of Effective Interventions • Laws and Regulations • Tax and Price Interventions • Improving the built environment for physical activity • Advocacy, communication and information • Community based interventions • School-based interventions • Workplace interventions • Screening - CVD, diabetes, HBP, some cancers • Clinical prevention: focus on overall risk • Disease Management • Rehabilitation • Palliative care

15. Health Promotion Strategies • Improve management of existing disease • Healthy public policy • Reorienting health services • Creating supportive environments • Strengthening community action • Developing personal skills • Building partnerships and alliances

16. Role of the Health Sector • Advocacy at all times, by all health workers • Advances in disease prevention (primary, secondary and tertiary care) • Collaboration with partners in health promotion • Catalyst for human safety and development, working with “all of society”

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

18. Goal Indicator • A 2% annual reduction in chronic disease death rates from the major chronic diseases, over and above current trends • Globally, to prevent 36 million deaths in the next 10 years

19. Public Policy 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. Strengthen NCD public policy development

20. Development & strengthening of chronic disease and risk-factor surveillance systems Surveillance To encourage and support the development and strengthening of countries’ capacity for better surveillance of chronic diseases, their consequences, their risk factors, and the impact of public health interventions.

21. Health Promotion & Prevention To foster, support, and promote social and economic conditions that address the determinants of chronic diseases and empower people to increase control over their health and to adopt healthy behaviors. Tobacco, Alcohol, Diet & Physical Activity Home, School, Community, Workplace

22. Provide technical assistance to countries in the development, strengthening, implementation, and evaluation of their chronic- disease programs Integrated NCD Management To facilitate and support the strengthening of the capacity and competencies of the health system for the integrated management of chronic diseases and their risk factors.

23. StepWise Implementation Step 3: Desirable Step 2: Expanded Step 1: Core

24. Consultation for Central America and Mexico

25. Consultation for Central America and Mexico

26. Action at Different Levels in Support of Strategy in Central America • National Ministry of Health • Local and Municipal • PAHO/WHO Country Offices • Subregional, e.g. PAHO/INCAP, SICA, RESCA, • Regional, e.g. PAHO-Washington, OAS, Summits • Global, e.g. WHO-Geneva

27. What is available to us now? • Strategic partnerships: Interinstitutional: CDC, NHLBI, Canada, partnering universities, CIP, BID, World Bank, Networks: CARMEN, bicycle paths, fruits & vegetables, AMNET, RAFA • Political progress Tobacco: Ratification of the Framework Convention for Tobacco Control (FCTC)CARMEN Policy Observatory

28. What is available to us now? • Surveillance instruments Basic Data Initiative, Pan American STEPS • Scientific evidence Promotion & prevention: Healthy Lifestyles Project, Healthy People Integrated management & surveillance: Central American Diabetes Initiative (CAMDI), Veracruz Initiative for Diabetes Awareness (VIDA) • Capacity-building CARMEN School

29. What is available to us now? • Healthy food • 5-a-Day Initiative • Healthy Lifestyles Project • Physical Activity • Urban planning: Green spaces, safe streets • Alternative forms of transport: Bicycle paths • Agita (Move!) Movement in São Paulo (RAFA-PANA) • ActiveCities Contest, Healthy Cities Project http://www.ciudadhumana.org/concursociudades/index.htm

30. http://www.dpaslac.org/

31. 1 Design Final evaluation & sharing lessons learned in Latin America. Lessons learned and final evaluation About the Campaign Initial stage of the campaign, starting between July and August 2006. 5 2 Launching & partnerships Between September 2006 and February 2007, campaign media messages will scale up and the scope of activities to promote the campaign will be broadened. Identification ofBest Practices 3 4 Country activities From March–October 2007, the countries will start to act. The Roadshow & Best Practices Contest will be part of the regional activities.

32. Central American Diabetes Initiative

33. CAMDI Workshops I: San Salvador, March 8-9, 2000 II: Tegucigalpa, November 13-14, 2000 III: Guatemala City, August 12-14, 2002 IV: Tegucigalpa, July 8-9, 2003 V: Montelimar, Nicaragua April 29-30, 2004 VI: Miami, FL, May 4-5, 2005 VII: Jacó, Costa Rica, March 13-15, 2006 VIII: Panama City, November 28-29, 2006

34. Main CAMDI Results: Population-Based Survey of Chronic Diseases and Their Risk Factors Preliminary Results

35. Sample Size, Survey Participants Tested by Country: The CAMDI 1 Study

36. Results of the Risk-Factor Survey, 2003–2006

37. Hypertension

38. Diabetes Mellitus

39. CAMDI:Quality of Care for Chronic Diseases Quality of Diabetes Care: Preliminary Analysis Quality of HypertensionCare:In progress

40. Methodology • Medical chart review • Primary, secondary and tertiary care clinics • Centers selected by national teams • Standardized data collection • Records randomly selected

41. Use of Medication by Country

42. Proportion of Records with A1c Results, and Information on Blood Pressure and Height, by country

43. Proportion of Patients with Documented Foot and Eye exam, by country

44. Glycemic* and Blood Pressure** Control, by country * A1C<7 or fasting glucose<130 ** BP<140/90

45. Adjusted* Proportion of Cases with Good Glycemic Control, by Country • * Adjusted by age, gender, type of clinic and insulin use; • ** Glycated hemoglobin (A1c) < 7% or Fasting Blood Glucose < 130 mg/dl

46. Progress Report • Multicenter analysis in progress. • Final report for Guatemala City survey being published. • Peer-reviewed papers on the methodology and prevalence of DM in progress. • QUALIDIAB Final Report circulated (Guatemala, Honduras, Nicaragua, El Salvador, Costa Rica).

47. Progress Report Health Technology Assessment finished. Qualitative analysis: Focus group results available for Costa Rica, El Salvador, Guatemala, Honduras, and Nicaragua. Intervention started in Costa Rica. QUALIHIPER data collection in progress.

48. CAMDI 2: Quality of Care and Health Promotion Intervention about to start in El Salvador, Guatemala, Honduras and Nicaragua. Grant obtained from WDF. CAMDI 3: Surveillance System • Expansion to national survey using STEPS Centroamericano. • Extension to continuous surveillance. • New grant from CDC.

49. Actions • Internal and external partnership to mobilize support. • Inter programmatic group under Assistant Director. • Technical advisory group to give scientific guidance. • Permanent Forum on Chronic Diseases. • Refreshing CARMEN vision and mission. • Accompanying CCS processes with the Country Support Unit (CSU).

50. Actions • Regional level • Surveillance STEPs • Policy and Advocacy • Prevention and Promotion • Integrated Management • Cancer • Supportive Strategies • Communication strategy • Resource mobilization