NCD Burden The Regional Responses

Dr. Ibtihal FadhilRegional Adviser Non communicable diseases,

World Health Organization, Regional Office for EMR10-11 May 2009

Doha, Qatar

ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting “Addressing non communicable diseases and injuries: major challenges to sustainable development in the 21st century

lesson learned• The ADG and prominent panelists presented the

detailed insight to the growing NCD burden globally and in EMR

• Non communicable diseases constituted around 55% of the mortality in EMR in 2005. It is estimated that it will increase to more than 60% by 2020 if the current trends continue

• The Risk Factors are identifiable in EMR and therefore can be prevented. Increasing trend of smoking overweight and obesity among different age groups.

Effective interventions exist for primary prevention: Examples..- Raising tobacco taxes and prices- Salt reduction- Improving availability and affordability of healthy food- Improving transportation policies and environmental designs - Raising alcohol taxes and prices

Cost-effective interventions exist for secondary and tertiary prevention:- Cardiovascular disease can be prevented by targeting high risk people- 75% of recurrent heart attacks and strokes can be prevented by 4 medicines- Treating diabetes - Early detection of cancer

Cost-effective interventions are available to prevent up to 80% of cardiovascular disease and diabetes and 40% of cancer,

Global strategy for NCD prevention & controlNCD Action plan for the global strategyFramework convention on tobacco controlStrategy on diet physical activity and health Regional Framework on DPASThe Regional strategy on cancer control

WHO Responses

Successful interventions

• Heart file in Pakistan, • The Isfahan healthy heart project in the

Islamic Republic of Iran, • Nizwa Healthy City in Oman and • Dar Al Fatwa in Lebanon • Araina in Tunisia

community-based interventionIsfahan - Iran

A 6-year program Launched in 1999 an integrated, community-based intervention aimed at fostering

healthy diet,

• The program is quasi experimental: a reference population exists

Isfahan healthy Heart community Program“North Karelia of the Middle East”

The Isfahan Healthy Heart Program (IHHP)

• IHHP interventions in two cities of Isfahan and Najaf Abad have involved more than 150 government and non-government organizations.

• Interventions: community-based approach reduced tobacco smoking, increased physical activity and stress reduction among 2 m people in central Iran. to tackle NCDs risk factors using a.

IHHP strategies to control CVD• increasing fibre and decreasing salt content in bread • convincing snack producers to market for children new snacks with less trans fats and sugars • serving healthy foods and increasing exercise

times in schools and workplaces • setting standards for restaurants • stopping television advertising of sausage and soft drinks • incorporating messages into TV programs• simplifying food labelling.

• Results: increased intake of liquid oil, decreased smoking, increased physical activity, increased awareness of health personnel.

•

A bicycle path in Isfahan

Promotion of vegetarianpizza served with salad

IHHP initiatives

community-based InterventionsNizwa - Oman

Nizwa healthy lifestyle project in Oman

• Community–based approach to tackle risk factors

• Interventions were undertaken in 2004. • Evaluation in 2009• The project promotes healthy lifestyle through

three subcommittees; (1) Tobacco control & accident prevention;(2) Promotion of physical activity and (3) Promotion of healthy nutrition.

Targeted outcome

Physical Activity:• Increase of percentage of physical activity among

men from 52% to 67%.• Increase of percentage of physical activity among

women from 27% to 42%.• Reduce the current prevalence of overweight among

men from 31.9% to 25% and among women from 25.3% to 19%.

• Reduce the current prevalence of obesity among men from 8.6% to 5.6% and among women from 17% to 11%.

Targeted outcome

Dietary styles: • Reduce the percentage of usage the animal’s fat from

83.9% to 68.9% and increase the percentage of usage the vegetarian oils from 74.9% to 89.9%.

• Reduce the prevalence of hypercholesterolemia from 34.6% to 28.6% among men and among women from 36% to 30%.

• Increase the knowledge (know-how) about healthy dietary habits from 32% to 67%.

Targeted OutcomeTobacco use, RTA, and domestic accidents• Reduce the percentage of the regular smokers

and irregular smokers from 9.2% to 4.5% .• Establishment of counseling service to assist

quitting smoking.• Reduce the deaths and diseases related to

tobacco.• Increase public awareness about prevention of

road traffic, home (domestic) accidents, work injuries, and poisonings.

• Reduce the percentage of road traffic accidents, injuries and poisonings subsequently reduce the death related to them

Interventions

• NHLP Friendly Schools • Alharaka Baraka (Move for Health)• Lifestyle Clinic • Health professionals education and

involvement• Obesity screening and management at

PHC• Tobacco intervention, Health education

in schools and tobacco cessation clinic

The Regional Framework is a response to the growing burden of NCDs in the EM Region.

Addresses two of the main risk factors for non-communicable diseases, namely diet and physical activity

Develop multicultural approach for the prevention and control of NCD's

Specificity in EM Region ( physical activities, diet and food consumption patterns

WHO Global Strategy on Diet, Physical Activity and Health &Regional Framework

Policy to promote physical activities

0

20

40

60

80

100

No/light Moderate Vegorous

LeisureWork

• Under The Patronage of his highness the Crown Prince of Kuwait.

• Multiple sectors involved as members ( Health professionals, exercise specialists, Nutritionists, Media, Politicians etc.

Outcome

Be an active Citizen

Inter-sectoral collaborationSupport Physical Activities In Bahrain

School based interventionsHealth Promoting Schools in EMR

• The health-promoting schools initiative is being implemented in all countries

• Healthy choices made easy and enjoyable to all school children, school staff and parents

Health promoting schools

• In United Arab Emirates & Bahrain is a collaborative effort between the Ministry of Health and Ministry of Education (through the Joint Committee), with other relevant partners including the Gulf Cooperation Council (GCC) School Health Committee and WHO.

• The 8 components of the health promotion are implemented in all schools .

Key challenges

Leaders Supportive environment Funding Community awareness Clear Problem, Indeed we have the

ability to make clear Actions

A Way Forward