3rd Meeting of UN Agencies on NCDs (Geneva, 12 October 2012)

Hig

h-le

vel M

eetin

g 113 Member States 34 Presidents and Prime-Ministers 3 Vice-Presidents and Deputy Prime-Ministers 51 Ministers of Foreign Affairs and Health 11 Heads of UN Agencies 100s of NGOs

Polit

ical

Dec

lara

tion Establish multisectoral

national plans by 2013 Integrate NCDs into health-planning processes and the national development agenda Promote multisectoral action through health-in-all policies and whole-of-government approaches Build national capacity Increase domestic resources

One

-WH

O w

ork

plan

Develop a global monitoring framework and targets Exercise a leading and coordinating role within the UN system Develop a global implementation plan 2013-2020 Expand technical competence and resources Scale up technical assistance

UN High-level Meeting on NCDs (New York, 19-20 September 2012)

WHO Director-General

Technical assistance to developing countries to support national efforts, including targets and indicators

Develop a global monitoring framework and global voluntary targets for NCDs

Develop an updated global action plan for the development and control of NCDs (2013-2020)

WHO-wide work plan 2012-2013 on NCDs

Exercise WHO's leadership and coordination role in relation to UN agencies

Articulate options for multisectoral action for the prevention and control of NCDs through effective

partnership

Work streams established by WHO

Articulating options for strengthening multisectoral action for the prevention and control of NCDs through effective partnerships

64. Request the Secretary-General, in close collaboration with the Director-General of the World Health Organization, and in consultation with Member States, United Nations funds and programmes and other relevant international organizations, to submit by the end of 2012 to the General Assembly, at its sixty-seventh session, for consideration by Member States, options for strengthening and facilitating multisectoral action for the prevention and control of non-communicable diseases through effective partnership.

Political Declaration on NCDs

2012 • 19 March – 19 April 2012: Member States, UN Agencies, NGOs and private sector entities

provided inputs during a web-based consultation (Two WHO Discussion Papers)

2012 • 21-26 May 2012: Member State discussed WHA A65/7 (options for strengthening MS action

for preventing and controlling NCDs through partnership)

2012 • 29 June 2012: UN agencies provided inputs

2012 • July 2012: WHO internal drafting process involving RDs and ADGs

2012 • August 2012: UN agencies reviewed final WHO draft

2013 • 27 August 2012: WHO's report submitted to the Office of the UNSG

2013 • September 2012: Secretary-General finalizing the report for submission to UNGA

2013 • November/December 2012: SG's report will be discussed at the UNGA

Timeline

Note by the SG transmitting the report of the WHO DG Will be available towards the end of October 2012

Option 1 – Aligned independent efforts Organic model: Activities to evolve without coordination or shared strategy WHO to host a forum (or series of fora) to invite interested parties to express commitment and to

seek partnerships

Option 2 – Social movement: Multistakeholder model: governments, NGOs, private sector, people living with NCDs WHO to forge a social movement to direct national and global efforts towards national

multisectoral policies and plans for the prevention and control of NCDs Option 3 – Coordinated network Networked model: Cultivate a hub-and-spoke of coordinated collaborative arrangements WHO to establish a small Secretariat (based on UN Road Safety Collaboration) Option 4 – Merger (a loose coordinated network around a social movement for NCDs) A merger of options 1, 2 and 3 Option 5 – Centralized, formal partnerships Vertical model: Large, centralized organization with a limited-time response and instigating

parallel structures in countries WHO to establish a single centralized partnership

Note by the SG transmitting the report of the WHO DG Global partnership options

Development of a WHO global action plan for the prevention and control of NCDs covering the period 2013-2020

2000

2003

2004

2008

Global Strategy for the Prevention and Control of Noncommunicable Diseases

Global Strategy on Diet, Physical Activity and Health

Action Plan 2008-2013 on the Global Strategy for the Prevention and Control of NCDs

2010

2009

2011

Global Strategy to Reduce the Harmful Use of Alcohol

WHO Global Status Report on NCDs

Political Declaration on NCDs

2013 2020

The World Health Assembly has requested WHO to develop a 'WHO Action Plan for the Prevention and Control of NCDs for 2013-2020'

WHO Action Plan for the Prevention and Control of NCDs for 2013-2020

World Health Assembly resolution WHA64.11

REQUESTS THE DIRECTOR-GENERAL TO: (4) to report to the Sixty-fifth World Health Assembly,

through the Executive Board, on the outcomes of the first Global Ministerial Conference on Healthy Lifestyles and NCD Control and the high-level meeting, and to develop, together with relevant United Nations agencies and entities, an implementation and follow-up plan for the outcomes, including its financial implications, for submission to the Sixty-sixth World Health Assembly, through the Executive Board.

(24 May 2011)

2. REQUESTS the Director-General:

(4) to develop, in a consultative manner, a WHO action plan for the prevention and control of NCDs for 2013–2020, building on lessons learnt from the 2008–2013 action plan and taking into account the outcomes of the High-level Meeting of the United Nations General Assembly on the Prevention and Control of NCDs, the Moscow Declaration on Healthy Lifestyles and NCD Control, the Rio Declaration on Social Determinants of Health, building on and being consistent with existing WHO strategies and tools on tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity;

(20 January 2012)

WHO Executive Board resolution EB130.R7

2. REQUESTS the Director-General:

(5) to build on work from the 2008–2013 action plan, which, inter alia, called for WHO to provide support to countries in enhancing access to essential medicines, to facilitate engagement by governments and, as appropriate, civil society and the private sector with appropriate safeguards against conflict of interest, in accordance with relevant paragraphs of the Political Declaration on NCDs, for improved access to medicines;

(6) to submit to the Sixty-sixth World Health Assembly, through the Executive Board, a WHO action plan for the prevention and control of NCDs for 2013–2020 for consideration and possible adoption. (20 January 2012)

WHO Executive Board resolution EB130.R7

2012 • 26 July 2012 – 7 September 2012: Web-based consultation for Member States,

UN Agencies, NGOs and private sector entities (WHO Discussion Paper)

2012 • 16-17 August 2012: First informal consultation with Member States and

UN Agencies (WHO Discussion Paper)

2012 • 1 November 2012: Second informal consultation with Member States and

UN Agencies ('Annotated Zero Draft' Action Plan)

2013 • January 2013: Executive Board (First Draft Action Plan)

2013 • February 2013: Third informal consultation with Member States and UN

Agencies (Second Draft Action Plan)

2013 • May 2013: World Health Assembly (Final Draft Action Plan)

Process: Next steps

"Zero Draft" Global NCD Action Plan 2013-2020 Available at www.who.int/ncd

Development of a WHO global mental health action plan covering the period 2013-2020

REQUESTS the Director-General to:

• To strengthen advocacy, and develop a comprehensive mental health action plan with measurable outcomes, based on an assessment of vulnerabilities and risks, in consultation with and for consideration by Member States, covering services, policies, legislation, plans, strategies and programmes to provide treatment, facilitate recovery and prevent mental disorders, promote mental health and empower persons with mental disorders to live a full and productive life in the community

• To submit the comprehensive mental health action plan, through the Executive Board at its 132nd session, for consideration by the Sixty-sixth World Health Assembly

World Health Assembly resolution WHA65.4 (May 2012)

2012 • May 2012: Report by the WHO Secretariat on the global burden of mental health discussed

at the World Health Assembly

2012 • May 2012: WHA adopted resolution WHA65.4 on the development of a global mental health

action plan 2013-2020

2012

• 27 August 2012 – 19 October 2012: WHO Secretariat posted a 'zero draft' 2013-2020 Global Mental Health Action Plan for a web-based consultation until 19 October 2012

2012 • April – October 2012: Regional consultations (AFRO, AMRO, EMRO, EURO, SEARO)

2012 • 10 October 2012: Provide clarifications at mhGAP Forum, disseminate information on the

web-based consultation and encourage participation

2012 • 2 November 2012: Informal consultation with Member States and UN agencies

2013 • January 2013: Executive Board

2013 • May 2013: World Health Assembly

Process

Zero Draft Global Mental Health Action Plan (available at www.who.int/mental_health)

Development of a global monitoring framework, including indicators, and a set of voluntary global targets for the prevention and control of NCDs

61. Call upon WHO, … to develop before the end of 2012, a comprehensive global monitoring framework, including a set of indicators, … to monitor trends and to assess progress made in the implementation of national strategies and plans on NCDs.

62. Call upon WHO, … to prepare recommendations for a set of voluntary global targets for the prevention and control of NCDs, before the end of 2012.

63. Consider the development of national targets and indicators based on national situations, building on guidance provided by WHO, …

UN Political Declaration on NCDs (resolution A/RES/66/2)

WELCOMED the work under way and recognizes the significant progress made

DECIDED to adopt a global target of a 25% reduction in premature mortality from NCDs by 2025

EXPRESSED strong support for additional work aimed at reaching consensus on targets relating to the four main risk factors, namely tobacco use, harmful use of alcohol, unhealthy diet, and physical inactivity

DECIDED to note wide support expressed by Member States and other stakeholders around global voluntary targets considered so far including those relating to raised blood pressure, tobacco, salt/sodium and physical inactivity

FURTHER noted that consultations to date, including discussions during the Sixty-fifth World Health Assembly, indicated support from among Member States development of targets relating to obesity, fat intake, alcohol, cholesterol and health system responses such as availability of essential medicines for noncommunicable diseases

NOTED that other targets or indicators may emerge in the remainder of the process established by resolution EB130.R7

World Health Assembly decision WHA65(8) (May 2012)

REQUESTS the Director-General to:

(1) undertake further technical work on targets and indicators and prepare a revised discussion paper on the comprehensive global monitoring framework which reflects all discussions and submissions to date and which takes into account measurability, feasibility, achievability and the existing WHO strategies in this area.

(2) consult with Member States, including through Regional Committees, and where appropriate, regional technical/expert working groups which report to Regional Committees through the Secretariat, on this revised discussion paper;.

(3) continue to consult with all relevant stakeholders in a transparent manner on this revised discussion paper.

World Health Assembly decision WHA65(8) (May 2012)

REQUESTS the Director-General to:

(4) prepare a report summarizing the results of the discussions in each of the Regional Committees and the inputs from the above-mentioned dialogues with stakeholders.

(5) convene a formal Member States meeting, to be held prior to the end of October 2012, to conclude the work on the comprehensive global monitoring framework, including indicators, and a set of global voluntary targets for the prevention and control of NCDs.

(6) submit a substantive report on the recommendations relating to paragraphs 61 and 62 of the Political Declaration through the Executive Board at its 132nd session to the Sixty-sixth World Health Assembly.

World Health Assembly decision WHA65(8) (May 2012)

Global monitoring framework: • Is an architecture for monitoring and evaluating actions to prevent and control and

reduce NCDs and their risk factors • Consistent with the WHO framework for health systems priorities to monitor

exposures, outcomes, and health systems response • Priorities of the Global Strategy for the Prevention and Control of NCDs and its Action

Plan, as well the Political Declaration.

Indicator

• An "indicator" is a measure to track and assess progress over time

Voluntary global target • "voluntary" indicates that there is no legal obligation • "global target" represents a specific aim to be achieved, is time bound, and defines a

realistic but ambitious level of achievement

Definitions

Outcomes • Cancer incidence,

by type • Premature

mortality from cardiovascular disease, cancer, diabetes, or chronic respiratory disease

Exposures •Alcohol • Fat intake • Low fruit and vegetable intake •Overweight and obesity • Physical inactivity •Raised blood glucose •Raised Blood pressure •Raised total cholesterol • Salt/sodium intake • Tobacco

Health system response •Cervical cancer screening •Drug therapy to prevent heart attacks

and strokes • Essential NCD medicines and

technologies • Palliative care • Policies to eliminate PHVOs from food

supply • Policies to reduce marketing of foods to

children •Vaccination against infectious cancers

Revised WHO Discussion Paper: Comprehensive Global Monitoring Framework for NCDs, including 19 indicators

Monitoring of core indicators should be done by key dimensions of equity including gender, age and socioeconomic status.

Monitoring of progress should also include key social determinants such as income level, education and relevant country/regional specific stratifiers.

Where data are to be collected by survey, there are implications (for sample size and costs to ensure a sample large enough to capture accurate data)

Mortality data (WHO Department of Health Statistics and Informatics to give estimates)

Equity

Raised blood pressure

25%

Salt/ sodium intake

30%

Tobacco smoking 30%

Physical inactivity 10%

Obesity 0%

Fat intake 15%

Alcohol 10%

Raised cholesterol

20%

Generic medicines and technologies

80%

Drug therapy and

counselling 50%

Premature mortality from NCDs 25% reduction

Target adopted by the World Health Assembly

Targets with wide support Targets with support for further development

Revised WHO Discussion Paper 11 voluntary global targets

High epidemiological and public health relevance Coherence with major strategies Evidence driven

– Availability of evidence-based effective and feasible public health interventions

Evidence of achievability at the country level Existence of unambiguous data collection instruments and

potential to set a baseline and monitor changes over time.

Criteria recommended for selection of voluntary global targets

National targets should be consistent with the global target. Targets may be adapted nationally, based on the country's

situation. Adaptations would reflect what might be achievable in a

specific country based on their performance, current exposure and what actions can be achieved.

National adapted targets may be more or less ambitious than the global target.

Relationship between global and national targets

Data collection and reporting methodology and costing will be suggested by WHO to assist Member States during 2013

Data on NCD outcomes are collected from vital registration systems capable of reporting cause of death, and population-based cancer registries

Data on exposures are collected from population level surveys which measure behavioral, metabolic and biological NCD risk factors

Data on health system response are collected from policy reviews and service utilization data

For global reporting, WHO produces country comparable estimates which adjust to standardized definitions, age range and structure, year of data collection, representativeness of population, data availability, etc

Implementation

Africa 10-12 October 2012 (technical meeting) Nairobi, Kenya

The Americas 17-21 September 2012 Washington DC, USA

Eastern Mediterranean 1-4 October 2012 Cairo, Egypt

Europe 10-13 September 2012 Valetta, Malta

South-East Asia 4-7 September 2012 Yogyakarta, Indonesia

Western Pacific 24-28 September 2012 Hanoi, Viet Nam

Process: Discussions at Regional Committee Meetings

A/NCD/1

Provisional agenda

• Available (included in

Note Verbale) A/NCD/1 Add.1

Proposed programme of work

• To be published in October

2012 A/NCD/2

Outcome document: Report of the Meeting

• To be circulated during the

formal meeting

A/INF/1

Revised WHO Discussion Paper (version dated 25 July 2012)

• Published on 25 July 2012 at

www.who.int/ncd

A/INF/2

Report summarizing the results of the discussions in each of the regional committees and the inputs from relevant global NGOs and selected private sector entities

• Advance copy to be published

in English on 22 October 2012 • Six languages to be published

on 26 October 2012

A/NCD/DIV/1

List of participants

• 5 November 2012

Proposed documentation for the formal meeting (5-7 November 2012)

Timelines

Jan-May 2012 EB/WHA

WHO Action Plan for the prevention and control of NCDs

for 2013-2020

Jan-May 2013 EB/WHA

Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of NCDs (resolution A/RES/66/2)

1st informal consultation on action plan

2nd informal consultation on action plan

Timelines

3rd informal consultation

on action plan

16-17 Aug

1 Nov

Feb/Mar 2013

2014

Development of the global NCD Action Plan 2013-2020

Jan-May 2012 EB/WHA

WHO Action Plan for the prevention and control of NCDs

for 2013-2020

Jan-May 2013 EB/WHA

Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of NCDs (resolution A/RES/66/2)

Development of a global monitoring framework and

targets for NCDs

Global monitoring framework, indicators and and targets for

NCDs

Formal consultation with Member States to conclude the work on a global

monitoring framework and targets

5-7 Nov 2012

1st informal consultation on action plan

2nd informal consultation on action plan

Timelines

3rd informal consultation

on action plan

Feb/Mar 2013

2014

Revised WHO Discussion Paper

25 July 2012

Development of the global monitoring framework and targets

Jan-May 2012 EB/WHA

27 August 2012

WHO Action Plan for the prevention and control of NCDs

for 2013-2020

Jan-May 2013 EB/WHA

WHO's input into SG's report on options for strengthening and

facilitating multisectoral action for the prevention and control of NCDs through effective partnership

Sep 2013

2014 GA

Comprehensive review and assessment of the progress

achieved in the prevention and control of NCDs

Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of NCDs (resolution A/RES/66/2)

WHO's input into SG's report on the progress achieved in realizing the commitments

made in the Political Declaration

Development of a global monitoring framework and

targets for NCDs

Options and a time line for multisectoral action through

partnerships

Global monitoring framework, indicators and and targets for

NCDs

SG's report on options for strengthening and facilitating

multisectoral action for the prevention and control of NCDs through effective partnership

Nov/ Dec 2012

Formal consultation with Member States to conclude the work on a global

monitoring framework and targets

5-7 Nov 2012

SG's report on the progress achieved in realizing the

commitments made in the Political Declaration

Dec 2013

1st informal consultation on action plan

2nd informal consultation on action plan

Timelines

3rd informal consultation

on action plan

16-17 Aug

1 Nov

Feb/Mar 2013

UN General Assembly

Jan-May 2012 EB/WHA

27 August 2012

WHO Action Plan for the prevention and control of NCDs

for 2013-2020

Jan-May 2013 EB/WHA

WHO's input into SG's report on options for strengthening and

facilitating multisectoral action for the prevention and control of NCDs through effective partnership

Sep 2013

2014 GA

Comprehensive review and assessment of the progress

achieved in the prevention and control of NCDs

Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of NCDs (resolution A/RES/66/2)

WHO's input into SG's report on the progress achieved in realizing the commitments

made in the Political Declaration

Final progress report on implementing the 2008-2013

action plan

Jan-May 2014 WHA

Development of a global monitoring framework and

targets for NCDs

Options and a time line for multisectoral action through

partnerships

Global monitoring framework, indicators and and targets for

NCDs

WHO Global Status Report on NCDs (2013)

2014

SG's report on options for strengthening and facilitating

multisectoral action for the prevention and control of NCDs through effective partnership

Nov/ Dec 2012

Formal consultation with Member States to conclude the work on a global

monitoring framework and targets

5-7 Nov 2012

SG's report on the progress achieved in realizing the

commitments made in the Political Declaration

Dec 2013

1st informal consultation on action plan

2nd informal consultation on action plan

Timelines

3rd informal consultation

on action plan

16-17 Aug

1 Nov

Feb/Mar 2013

Thank you