… BE IT FURTHER RESOLVED, that the Policy on NCDs shall include benchmarks for ending the Regional State of Health Emergency;

… BE IT FURTHER RESOLVED, that the Policy shall provide clear justification for its goals, including clear, accurate and referenced data on NCDs and their impact ;

… BE IT FURTHER RESOLVED, that the Regional approach to NCDs shall integrate effectively with other regional, national and local NCD policies and plans;

Adaptation & Implementation

Policies(Laws, regs, school, govt agency, church, traditional leader policies)

USAPI Health Professional Associations

Youth Risks(obesity, tobacco, alcohol)

Environments

Clinical Services

Adults Risks Adults Illness (hypertension, diabetes, cholesterol, lung & vascular disease) Primary

Care

Advocacy

Health Education& Promotion

Ministers, Secretaries, Directors of Health

Hospital Services

OutcomesStroke, dialysis, heart attacks, cancer, amputations, hospitalizations, death

Regional Bodies & Mechanisms for Control of NCDs

APIL, MCIS, Trad Leaders, Religious Leaders

N

CD S

urve

illan

ce &

Mon

itorin

g Fr

amew

ork

& P

lans

NCD Burden- Impact of Interventions

Policy80%

(Environments & Social Determi-

nants)

Health Ed&Promo

6%

Med Care14%

Sources: Franks P, et. al. JAMA, 27(6):737-741. 1993. McGinnis J, et. al. Health Affairs. 21(2) 2002

Timeline, USAPI Regional NCD Response, 2010-14

THE COMMITMENT:Fifteen Essential Policies for Reversing the Epidemic of Non-Communicable Diseases

in PIHOA jurisdictions

Risk Factor: Tobacco Commitment 1: Increase taxes on tobacco products (to extent needed to offset costs)*Commitment 2: Pass and enforce model comprehensive smoke-free air acts *Commitment 3: Restrict all forms of tobacco product advertising*Commitment 4: Establish and sustain tobacco cessation programs Risk Factor: Alcohol Commitment 5: Restrict all forms of alcohol advertising*Commitment 6: Restrict access to alcohol*Commitment 7: Increase taxes on alcohol (to extent needed to offset costs)* Risk Factor: Poor Nutrition Commitment 8: Implement policies that reduce salt consumption*Commitment 9: Implement policies that reduce sugar consumptionCommitment 10: Implement policies that reduce fat consumption*Commitment 11: Implement policies that promote breastfeedingCommitment 12: Implement policies that promote local foods Risk Factor: Lack of Physical Activity Commitment 13: Develop the built environment to promote physical activityCommitment 14: Promote physical activity in the work place [reconsider]Commitment 15: Promote physical activity in the schools

*WHO

“Be

st B

uys”

NCD

Pol

icy

Tool

kit

Regional Road Map

for Ending the Epidemic of Non-Communicable

Diseases

In the United States Affiliated Pacific Islands

Version 9

Updated May 22, 2013

1

Adaptation & Implementation

Policies(Laws, regs, school, govt agency, church, traditional leader policies)

Health Leadership Council Roadmap

USAPI Professional Associations

Youth Risks(obesity, tobacco, alcohol)

NCD Policy Commitment Package(includes WHO “Best Buys”)

Environments

Clinical Services

NCD Policy Tool Kit (model laws, regs, policies)

Adults Risks Adults Illness (hypertension, diabetes, cholesterol, lung & vascular disease) Primary

Care

Advocacy

Health Education& Promotion

Clinical Guidelines, Chronic care delivery systems(WHO PEN, JNC, ADA, etc.)

Ministers, Secretaries, Directors of Health

Hospital Services

OutcomesStroke, dialysis, heart attacks, cancer, amputations, hospitalizations, death

Mechanisms for Control of NCDs

Legislators, Exec Branch, Schools,Relig & Trad Leaders

N

CD S

urve

illan

ce &

Mon

itorin

g Fr

amew

ork

& P

lans

4 major decreases: 1999, 2003, 2005, 2007

Synar Amendment started

Cigarette tax increasedDMHSA cessation started

Natasha Act passed

By: Dr. Annette David, SPW & DMHSA PEACE

Guam- Youth Tobacco Use

USAPINCD Core SurveillanceIndicators

Tobacco Alcohol

↑BMI Diseases(adult)

Deaths(30-69 years)

Cigs- youth

Cigs- adult

Chew- Youth

Chew- adult

Youth

Adult

Youth

Adult

HTN

DM

↑Cholesterol

All Cause

Cardiovascular

Cancer

Diabetes

Chronic Lung

Am Samoa ↓ N ↓ ↑ N N N N N

CNMI ↓ N ↓ N ↓ N ↑ ↑ ↑ N ↓

FSM

Chuuk

Kosrae

Pohnpei

Yap N N N N N ↓ N ↓ N

Guam ↓ ↓ ↑ N ↓ N N N N N N ↑ N ↑ ↑ ↑

Palau ↑ N ↓ N ↓ N N N ↑ ↑ ↑ N N

RMI ↑ ↓ ↑ ↓ N

↓= Improved (rate decreased) N= No change↑= Worse (rate increased) Blank= Not enough data

Out of 144 measurements: 14=improved, 15=worse, 33=no change, 82=not enough data

USAPINCD Core SurveillanceIndicators

Tobacco Alcohol

↑BMI Diseases(adult)

Deaths(30-69 years)

Cigs- youth

Cigs- adult

Chew- Youth

Chew- adult

Youth

Adult

Youth

Adult

HTN

DM

↑Cholesterol

All Cause

Cardiovascular

Cancer

Diabetes

Chronic Lung

Am Samoa ↓ N ↓ ↑ N N N N N

CNMI ↓ N ↓ N ↓ N ↑ ↑ ↑ N ↓

FSM

Chuuk

Kosrae

Pohnpei

Yap N N N N N ↓ N ↓ N

Guam ↓ ↓ ↑ N ↓ N N N N N N ↑ N ↑ ↑ ↑

Palau ↑ N ↓ N ↓ N N N ↑ ↑ ↑ N N

RMI ↑ ↓ ↑ ↓ N

Take Home Messages• Some progress, especially tobacco and alcohol• Need to do much better overall• Many gaps in surveillance picture, because:

At jurisdiction level-> No clear delegation of responsibility at jurisdiction level> Lack of NCD surveillance plans at jurisdiction level

At regional level-> Surveillance activities initiated by variety of TA agencies> Very long turn-around time for analysis of some surveys> Vital stats problems

Addressing the Gaps- Jurisdiction Level

> Clear identification of surveillance teams in your jurisdiction> Nominate members to attend May Palau EpiTech Workshop (or hold similar activity in your jurisdiction)

- Jurisdiction-level NCD Surveillance Plan- Technical work to harmonize CDC with WHO stuff- Credited Epi course delivery

> Encourage/require enrollment of team members in EpiTech certificate program (for credit!)

NCD SURVEILLANCE STYLES- Your Choices:

WHO- NCD STEPS- Comparisons across Pacific- Fits well with MANA- Face-to-face survey-Does not fit as easily with CDC programs/HP2020

-Costs to come from country budgets

-Analysis support not completely established

-Not very flexible

CDC- BRFSS- Comparisons with US- Fits well with CDC/HP2020- Stable external funding - Good analysis support- Flexible- Telephone survey- Does not fit as well with

MANA- Not as good for Pacific

comparisons

BOTH- Comparisons with both US

and Pacific- More burden on Depts of

Health- Survey fatigue- Difficult to monitor trends

NCD SURVEILLANCE STYLES (Creating another choice)

Harmonizing WHO with CDC Styles

- Adapt BRFSS (and YRBS) to meet WHO needs as well as US program needs - physical measures - fit with new WHO NCD Surveillance Framework

- Secretariats to work more closely to harmonize technical assistance

Addressing the Gaps- PIHOA Board

• Communique to CDC NCDPHP to request:> Assist to provide Epi TA/place epidemiologist in region> BRFSS & YRBS funding support> Adapt BRFSS and YRBS> Help support delivery of EpiTech and Pacific FETP

• Asking WHO to assist with harmonization of BRFSS & YRBS, and harmonizing TA

> ? Formal communique

Regional Surveillance TA Entities

PPHSN (Pacific Public Health Surveillance Network)- Outbreak prone diseases

PHIN(Public Health Information Network)- HIS planning

Brisbane Accord Group- Vital stats

SAMHSA- Behav

Health

HIV-STI TB,Etc,etc.

CounterpartsFrameworksTraining programSurveillance plansOff-island trips

CounterpartsFrameworksTraining programSurveillance plansOff-island trips

CounterpartsFrameworksTraining programSurveillance plansOff-island trips