NCDs: history of the initiative, its content, strategies and future developments

Dr Nicholas Banatvala

Course 17: NTDs and NCDs: Link to Eye Health IAPB 9th General Assembly, 17-20 September 2012, Hyderabad

In May 2000, WHO Member States began mobilizing a global response to address NCDs, with a particular focus on developing countries…by 2011 this issue was addressed at the UNGA

High-level Meeting on NCDs (New York, 19-20 September 2011)

Action Plan on the Global Strategy for the Prevention and Control of NCDs

Global Strategy for the Prevention and Control of Noncommunicable

Diseases

WHO Framework Convention on Tobacco Control

Global Strategy on Diet, Physical Activity and Health

Global Strategy on Infant and Young Child Feeding

Global Strategy to Reduce the Harmful Use of Alcohol

2000

2002

2003

2004

2008

2010

2011

2005

WHA resolution on cancer prevention and control

Set of recommendations on the marketing of foods and non-alcoholic beverages to children

The 2000 global strategy for the prevention and control of NCDs

• 4 diseases and 4 risk factors

• Goal of reducing morbidity, disability and premature mortality from NCDs

• 3 objectives• Mapping the epidemic• Reducing individual and population

exposure to risk factors• Strengthening health care

• Components: surveillance, prevention/health promotion and healthcare management

• Clear roles for the three partners

Low-income countriesGroup III - InjuriesGroup II – Other deaths from NCDsGroup II – Premature deaths from NCDs (below 60 years), which are preventableGroup I – Communicable diseases, maternal, perinatal and nutritional conditions

Total deaths in the world (2008)

10%

5.1 M5.1 M

0

10 million

20 million

30 million

40 million

50 million

60 million

26.9 M(above the age of 60)

26.9 M(above the age of 60)

9.1 M(below the age of 60)

9.1 M(below the age of 60)

15.7 M15.7 M

So

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8

NCDs are the single biggest cause of death

Tota

l dea

ths

(200

8)

10 million

15 million

20 million

25 million

High-income countries Upper middle-income Lower middle-income Low-income countries

2.9M

1M

0.8M

0.5M 2.3 M2.3 M

1.4M

5.6M5.6M

13.6M13.6M

5.3M

8.3M8.3M

4.4M4.4M

1.4M1.2M

6.6M6.6M

1M0.6M

90% of global premature deaths from NCDs occur in low- and middle-income countries

Low-income countriesGroup III - InjuriesGroup II – Other deaths from NCDsGroup II – Premature deaths from NCDs (below 60 years), which are preventableGroup I – Communicable diseases, maternal, perinatal and nutritional conditions

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Four types of NCDs account for most deaths in all regions

WHO Region for the Western Pacific

DiabetesRespiratory diseasesCancersCardiovascular diseases

Other NCDs

0%

20%

40%

60%

80%

100%

WHO Region for Africa

WHO Region for the Americas

WHO Region for the Eastern Mediterranean

WHO Region for Europe

WHO Region for South-East Asia

Tobacco use Unhealthy diets Physical inactivity

Harmful use of alcohol

Heart disease and stroke

Diabetes

Cancer

Chronic lung disease

Clear focus on 4 NCDs and 4 common risk factors for NCDs

SurveillanceMapping the epidemic of

NCDs

ManagementStrengthen

health care for people with

NCDs

PreventionReducing the

level of exposure to risk factors

World Health Assembly in 2000: There is a clear vision on how to address NCDs

2007: Raising the profile of diabetes through theUnited Nations

• Resolution 61/225 issued on World Diabetes Day

• Adopted by the UNGA in 2007

• encouraged Member States to develop national policies for the prevention, treatment and care of diabetes in line with the sustainable development of their health-care systems, taking into account the internationally agreed development goals, including the MDGs

2007: First Summit of CARICOM Heads of Government on NCDs

• 15 September, Port of Spain• WHO invited to address Heads of Government• First time commitment at this sort of level for NCDs• Magnitude, socioeconomic impact highlighted• The need to implement national responses• Summit Declaration with a commitment for regional and

national response

By the end of 2008…

• Global strategy

• Developing tools for reducing exposure to risk factors

• Action Plan for implementing the global strategy

1. Integrating NCD prevention into the development agenda, and into policies across all government departments

2. Establishing/strengthening national policies and programmes

3. Reducing/preventing risk factors 4. Prioritizing research on prevention and health care5. Strengthening partnerships6. Monitoring NCD trends and assessing progress made

at country level

Sets of actions for member states, WHO Secretariat and international partners.

2009: UN Economic and Social Council• ECOSOC/UNDESA/UNDP e-discussion on global health (29

January – 11 February 2009)

• ECOSOC Preparatory Ministerial Meeting on NCDs and Injuries (Doha, Qatar, 10-11 May 2009)– Agreement that NCDs should be on the ECOSOC agenda– Resulted in the Doha Declaration on NCDs and Injuries

The 2009 Doha Declaration: including NCDs in global discussions on development

We the participants, call

1. For integration of evidence‐based indicators on NCDs and injuries into the core MDG monitoring and evaluation system during the 2010 review of the MDGs.

2. On ECOSOC to consider the issue of NCD prevention and injury prevention in its 2010 coordination segment.

3. For the development and dissemination of tools that enable decision makers to assess the impact of policies on the determinants of, risk factors for, and consequences of NCDs and injuries and provide models of effective, evidence‐based policy making.

4. For strengthening the standardized data collection on NCDs, risk factors and injuries, and establish baselines, with special emphasis on strengthening data on the socioeconomic impact, health, and equity.

The 2009 Doha Declaration: including NCDs in global discussions on development

We the participants, call

5. For raising the priority accorded to NCDs and injury prevention on the agendas of relevant high level forums and meetings of national, regional, and international leaders.

6. For a review of international experience in the prevention and control of NCDs and injuries in low‐ and middle‐income countries, including community‐based programmes,and identify and disseminate successful approaches for intersectoral action.

7. For the establishment of a Regional Ministerial Multisectoral Task Force to provide strategic and technical input and conduct external reviews of the progress made by the region with regards to NCDs and injuries and its partners, and the impact of initiatives on the prevention and control of NCDs and injuries

2009: UN Economic and Social Council Ministerial

• ECOSOC Ministerial Breakfast on NCDs (Geneva, 8 July)

• ECOSOC High-level Segment (Geneva, 6-9 July)– hears many calls for a Special Session of the General Assembly

on NCDs

Clear set of key messages on NCDs coming out ECOSOC

NCDs reflected in the final ECOSOC Ministerial Declaration

2009: UN General Assembly

• Prime-Minister of Trinidad and Tobago calls for a Special Session of the General Assembly on NCDs

• The Global Economic Situation

• Reform of the International Economic System

• CARICOM. Middle Income Countries and Haiti

• Security

• Climate Change

• NCDs

• Food Security

• UN reform

2009: UN General Assembly

Prime-Minister of Trinidad and Tobago on NCDs

"We are firmly of the view that non-communicable diseases demand heightened attention by the international community at this time. It is forecasted that by 2020, NCDs will account for about 73% of global deaths and 60% of the global burden of diseases. We join the call for indicators on non-communicable diseases and injuries to be integrated into the core Millennium Development Goals (MDGs) monitoring and evaluation system.

We have taken on board this matter at the level of CARICOM. Indeed, we held a special Regional Summit in Port of Spain on Chronic Non-Communicable Diseases in 2007. I now propose to this august Assembly, that a Special Session of the United Nations General Assembly on Non-Communicable Diseases be convened at the earliest opportunity."

78 Member States sponsored the draft resolution

Cameroon on behalf of Member States who are members of the Group of African States

December 09 – May 10: Drafting of a UN resolution on NCDs plus a HLMThe drafting process was led by the Caribbean Community (CARICOM)

May 2010 - UN General Assembly adopts resolution 64/265 on the High-level Meeting on NCDs

1. Decides to convene a HLM of the GA in September 2011, with participation of Heads of State and Government

2. Also decides to hold consultations on the scope, modalities, format and organization of the HLM

3. Encourages Member States to include NCDs in their discussions at the high level plenary meeting of the Sept 2010 GA MDG review

4. Requests the SG to submit a report to the GA on NCDs, esp. in developing countries.

20 September 2010: Side-event on NCDs during the MDG Summit in New York

• The political and policy relevance of addressing NCDs in developing countries as a development issue

• The challenges and opportunities for integrating the prevention and control of NCDs in the development agenda at global and national levels

• The collaboration required to assist Member States in preparing for the High-level Meeting of the UN General Assembly on NCDs (September 2011)

Key note presentations by global advocates and international experts

Statements from the floor and an open debate

13 December 2010 – UN General Assembly adopts resolution 65/238 on the modalities of the HLM 1. Decides the date: 19-20

September 2012

2. Outlines the working arrangements and preparatory process

3. And sets out the involvement of partners

"The summit in September in New York is our chance to broker an international commitment that puts NCDs high on the development agenda, where they belong"

Mr Ban Ki-Moon, UN Secretary-General, World Economic Forum, 27 January 2011

"The summit in September in New York is our chance to broker an international commitment that puts NCDs high on the development agenda, where they belong"

Mr Ban Ki-Moon, UN Secretary-General, World Economic Forum, 27 January 2011

2010 and 2011: Preparatory process

1. 1-2 November 2010: Informal dialogue with NGOs and the private sector

2. Oct 2010 – Apr 2011: Regional meetings to discuss the challenges of NCDs and provide an input to the HLM.– Each hosted by Member State with WHO as a co-sponsor. – Declarations/statements agreed at each event.

• 25-26 October 2010: EMRO (Iran)• 25-26 November 2010:EURO (Norway)• 3-5 February 2011 – WPRO 1 (Fiji) • 24-25 February 2011: PAHO (Mexico) • 1-4 March 2011: SEARO (Indonesia) • 17-18 March: WPRO 2 (S Korea)• 4-6 April 2011: AFRO (Brazzaville)

2010 and 2011: Preparatory process

3. 5–6 April: meeting with UN agencies

4. 27 April 2011. WHO Global Forum: Addressing the challenge of NCDs, Moscow

Brought together a wide group of stakeholders to share views and experiences to date on the challenges and opportunities in

noncommunicable disease prevention, treatment and control.

2010 and 2011: Preparatory process

5. First Global Ministerial Conference on NCDs: 28-29 April 2011, Moscow– Goals:

to highlight the magnitude and socio-economic impact of NCDs

to review international experience on NCD prevention and control;

to provide evidence on the pressing need to strengthen global and national initiatives to prevent NCDs as part of national health plans and sustainable development frameworks

– Participants: Ministers of Health. Also private sector including pharma, insurance, ehealth, sport

– Format: plenary and concurrent sessions– Outcome: Moscow Declaration– Launch: 2010 Global Status Report

• Described a framework for national NCD surveillance– Exposures

• Behavior• Physical & metabolic• Social determinants

– Outcomes– Health system capacity and

response

• Example core indicators

Population-based interventions addressing NCD risk factors

Tobacco use

- Excise tax increases - Smoke-free indoor workplaces and public places- Health information and warnings about tobacco - Bans on advertising and promotion

Harmful use of alcohol - Excise tax increases on alcoholic beverages - Comprehensive restrictions and bans on alcohol

marketing- Restrictions on the availability of retailed alcohol

Unhealthy diet and physical inactivity - Salt reduction through mass media campaigns and reduced salt content in processed foods

- Replacement of trans-fats with polyunsaturated fats- Public awareness programme about diet and physical

activity

Individual-based interventionsaddressing NCDs in primary care

Cancer - Prevention of liver cancer through hepatitis B immunization

- Prevention of cervical cancer through screening (visual inspection with acetic acid [VIA]) and treatment of pre-cancerous lesions

Cardiovascular disease and diabetes - Multi-drug therapy (including glycaemic control for diabetes mellitus) for individuals who have had a heart attack or stroke, and to persons at high risk (> 30%) of a cardiovascular event within 10 years

- Providing aspirin to people having an acute heart attack

Global Status Report: interventions that work

US$ 155B cost for all LMICs to scale up action by implementing the "best buys“ between 2011-2025

US$ 7Tcumulative lost output in developing countries associated with NCDs between 2011-2025

Changing landscape – financial

• The cost of inaction versus action and the costs of scaling up

• Global financial crisis

• Innovative financing

2010 and 2011: Preparatory process

6. Civil society interactive hearing: 16 June 2011

• NGOs, civil society organizations, the private sector and academia.

• Civil Society Taskforce established by the President of the GA to support civil society engagement

Plenary: President of the GA, SG rep, WHO and guest speakers

Consecutive sessions:

o The scale of the challenge presented by NCDs

o National and local solutions for NCD prevention and control.

o What is needed to enhance global cooperation to address NCDs?

• Outcomes of the hearing shared with Member States.

2010 and 2011: Preparatory process

7. Informal consultations on the HLM outcome document - New York - 24 June & 5 July 2011

• Run by 2 co-facilitators: Jamaica and Luxembourg permanent representatives to the UN

19-20 September 2011: UN General Assembly HLM. New York 2nd time in the history of the UN that the GA meets on a health issue

Countries adopted a 13-page action-oriented outcome document to shape global agendas for generations to come.

Articulated roles and responsibilities for Member States and others including WHO

Clear plans for reporting back

HLM: What did it mean for WHO…

• Providing technical assistance to low- and middle-income countries to support national efforts

• Developing a global monitoring framework and recommendations for a set of voluntary global targets

• Articulating policy options for strengthening and facilitating multisectoral action for the prevention and control of NCDs through effective partnership

• Developing an updated/follow-up Action Plan (2013-2020) for the Global Strategy for the Prevention and Control of NCDs

• Leadership and coordination role in promoting and monitoring global action against NCDs with UN funds, programmes and agencies

Latest…• Targets and indicators

– 25% reduction in premature mortality by 2025 agreed– Regional committee discussions– 3 day formal meeting in November– Then to EB and WHA

• multisectoral action and options for partnership– WHO submitted inputs to SG– SG draft for UNGA being finalized– Will be discussed at the end of this year

• updated/follow-up Action Plan (2013-2020) – Discussion paper on web for consultation– 1 day informal meeting in November– Zero draft, consultation, EB and WHA

• Working with UN partners– Helen Clark, Margaret Chan letter– Agreement between WHO and UNAIDS – Other agreements being finalized– Regular dialogue and meetings