First meeting of UN Agencies on the implementation of the Political Declaration on Noncommunicable Diseases (New York, 8 December 2011) Dr Ala Alwan Assistant Director General World Health Organization
Why are we here today? The Political Declaration on NCDs is a landmark achievement to start supporting developing countries in addressing NCDs and mitigate their health and socioeconomic impacts Currently, there is: lack of adequate recognition, within the UN, of NCDs as a development issue few UN agencies have started to include NCDs in their programmes no coordinated approach to identify opportunities to support Member States in addressing NCDs roles and responsibilities across the UN System to scale up work on NCDs are not clearly defined
Why an UN wide vision and roadmap for NCDs? To realize the commitments included in the Political Declaration on NCDs There is a strong demand from developing countries to scale up UN System's work on NCDs Capture the momentum and move from advocacy to action
Expected outcomes of today's meeting A common understanding of NCDs across the UN System Feedback Overview A common vision to support developing countries in addressing NCDs A collective overview of ongoing and planned efforts across the UN System to strengthen national capacities to address NCDs in developing countries Opportunities identified to develop joint programmes at global and national levels Views on an UN Ad hoc Coordination Mechanism on NCDs, if appropriate
Provisional Agenda Thursday, 8 December 2011 09:00 09:30 NCDs in developing countries 09:30 10:30 Political Declaration on NCDs 10:30 Coffee available 10:30 11:30 Ongoing efforts by UN funds, programmes and agencies 11:30 12:30 Opportunities for joint work 12:30 Working lunch available 12:30 13:30 Opportunities (continued) 13:30 14:00 Conclusions and recommendations 14:00 14:30 Conclusions 14:30 Meeting adjourns
Global burden of NCDs is a major challenge to all countries but developing countries are disproportionately affected
Global burden of NCDs 4 diseases and 4 modifiable risk factors Modifiable causative risk factors for NCDs Tobacco use Unhealthy diets Physical inactivity Harmful use of alcohol Noncommunicable diseases Heart disease and stroke Diabetes Cancer Chronic lung disease
Mortality due to NCDs The rapidly increasing burden in developing countries NCDs after the age of 60 injuries communicable diseases, maternal, perinatal and nutritional conditions 9% 28% 10% 31% 47% Global deaths (2008) NCDs before the age of 60 16% 42% 17% Deaths in low and middleincome countries only (2008)
Global burden of NCDs Women are dying too young from NCDs in developing countries Sierra Leone Afghanistan Equatorial Guinea Nauru Papua New Guinea Gambia Angola Kiribati Ethiopia Andorra Norway Spain Japan Germany Austria Switzerland San Marino Sweden Italy 0% 10% 20% 30% 40% 50% 60% 70% Percentage of women who die from NCDs before the age of 60 (2008) Source: WHO NCD Country Profiles (2010)
Global burden of NCDs Overweight is rapidly increasing in developing countries % of population 70% 60% 50% 40% 30% 20% 10% 0% 1980 2008 High income countries Upper Middle income countries Lower middle income countries Low income countries Overweight (2008) Source: WHO NCD Country Profiles (2010)
Global burden of NCDs High blood pressure is rapidly increasing in developing countries % of population 40% 30% 20% 10% High income countries Upper Middle income countries Lower middle income countries Low income countries 0 1980 2008 Raised blood pressure (2008) Source: WHO NCD Country Profiles (2010)
50% Percentage of insufficient physical activity (2008 estimates) 40% 30% 20% 10% 0% AFR AMR EMR EUR SEAR WPR Men Women Both Sexes
70% Prevalence of overweight in adults (2008 estimates) 60% 50% 40% 30% 20% 10% 0% AFR AMR EMR EUR SEAR WPR Men Women Both Sexes
50% Prevalence of raised blood pressure (2008 estimates) 40% 30% 20% 10% 0% AFR AMR EMR EUR SEAR WPR Lowincome Lowermiddleincome Upper- Middle- income- Highincome Men Women Both Sexes
15% Prevalence of diabetes (2008 estimates) 10% 5% 0% AFR AMR EMR EUR SEAR WPR Men Women Both Sexes
Global burden of NCDs Why is this occurring? NCDs Underlying drivers Behavioural risk factors Metabolic/ physiological risk factors Social Determinants of Health Raised blood pressure Overweight/obesity Raised blood glucose Raised lipids Tobacco use Unhealthy diet Physical inactivity Harmful use of alcohol Globalization Urbanization Population ageing
Global burden of NCDs NCDs undercut the attainment of the MDGs Poverty: Household income is spent on health care for NCDs, medicines, tobacco and alcohol use Hunger: Underweight children and overweight adults are often found in the same households Maternal health: Malnutrition increases the risk of gestational diabetes and poor maternal health Child health: Malnutrition in pregnancy is associated with a vulnerability to obesity, cardiovascular disease and diabetes later in life Education: NCD related costs displace household resources for education HIV/AIDS: Increases the risk of cancers, and ARVs increase the risk of cardiovascular diseases Tuberculosis: Tobacco and alcohol use, and diabetes are associated with TB deaths Essential drugs: Cost effective medicines to treat NCDs are available in low cost generic forms, but remain inaccessible and unaffordable to most who need them
Global burden of NCDs NCDs is a development issue New perspectives Globalization Urbanization Population ageing Poverty Populations in low and middle income countries Increased exposure to common modifiable risk factors Loss of household income NCDs Limited access to effective and equitable health care services Poverty at household level More than 8 million people die before the age of 60 in developing countries from noncommunicable diseases
NCDs: The poor are affected the most Percent with and without cancer experiencing catastrophic spending and impoverishment percentage 60 50 40 30 20 10 0 Catastrophic expenditures Cancer No cancer Impoverishment
How can countries address NCDs? There is a global vision to reduce the NCD burden: The Global Strategy for the Prevention and Control of NCDs Surveillance Mapping the epidemic of NCDs Prevention Reducing the level of exposure to risk factors Management Strengthen health care for people with NCDs
The Vision, road map and global tools 2000 Global Strategy for the Prevention and Control of Noncommunicable Diseases 2003 2004 2008 2009 2010 Global Strategy on Diet, Physical Activity and Health Action Plan on the Global Strategy for the Prevention and Control of NCDs Global Strategy to Reduce the Harmful Use of Alcohol WHO Global Status Report on NCDs 2011 Political Declaration on NCDs 2012+ Realizing the commitments made in the Political Declaration
Outcomes of the 2011 UN General Assembly High level Meeting on NCDs
The UN High level Meeting on NCDs in numbers (New York, 19 20 September 2011) 113 Member States 34 Presidents and Prime Ministers 54 Vice Presidents, Deputy Prime Ministers, Ministers of Foreign Affairs and Health 100s of civil society 11 Heads of UN Agencies 1000+ news articles
Some key conclusions in the Political Declaration on NCDs Consensus and clear positions of NCDs as priority within the development agenda Strong call for a whole of government approach to implement the Global Strategy and its Action Plan, and WHO's recommendations on surveillance, prevention and health care Specific assignments that WHO has to deliver over the coming months and years
Implement the Action Plan for the Global Strategy for the Prevention and Control of NCDs Calls on Member States to establish, by 2013, national multisectoral policies and plans for NCDs, taking into account the Action Plan Calls on Member States to integrate NCDs policies and programmes into health planning processes and the national development agenda of each Member State President of Brazil
Advance multisectoral action Calls on Member States to promote health in all policy and whole of government approaches Calls on WHO to collaborate with the Secretary General in articulating policy options for multisectoral action through effective partnership Prime Minister of Mali
Enable health systems to respond Calls on Member States to accelerate the implementation of the WHO FCTC and existing WHA-endorsed strategies and recommendations Calls on Member States to strengthen health systems that support primary care and prioritise early detection and treatment Calls on Member States to improve access to affordable essential medicines for NCDs, including generics Calls on Member States to increase budgetary allocations for NCDs Prime Minister of Barbados
Set targets and measure results Calls upon WHO to develop a comprehensive global monitoring framework and recommendations for a set of voluntary global targets Call on Member States to develop national targets and indicators based on guidance provided by WHO President of Namibia
Reduce the exposure to risk factors Calls upon the private sector to contribute to NCD prevention and control Prime Minister of Foreign of Affairs Tonga of Indonesia
The way forward for Member States Building on the Declaration, now important for Member States to: Adhere to the commitments Put plans in place by 2013 and targets Increase investments both domestic and donor Monitor progress BUT Member States will require support President of Ukraine WHO President Director General of Hungary
Strengthen national capacities to address NCDs Calls on WHO and UN System to provide technical assistance and capacity building to developing countries, especially least developed countries Calls on WHO and UN System to work together in a coordinated manner to support national efforts Reaffirms the need for WHO and UN agencies in promoting and monitoring global action against NCDs President of Switzerland President of Hungary
What remains unchanged? We have a global plan to address NCDs Six objectives: 1. Raise the priority accorded to NCDs in development work and promote multisectoral action 2. Strengthen national programmes 3. Reduce risk factors 4. Prioritize research 5. Promote partnerships 6. Monitor NCD trends 2008 2008 World World Health Health Assembly Assembly
What remains unchanged We have a baseline and 'how to' tools supported by the Political Declaration First time time ever: Global baseline Country estimates Countries' Countries' capacities capacities to to respond to to the the NCD NCD crisis Solutions
We now have "best buys" interventions to address NCDs Condition Tobacco use Alcohol use Unhealthy diet &physical inactivity Infections Interventions - Raise taxes on tobacco - Protect people from tobacco smoke - Warn about the dangers of tobacco - Enforce bans on tobacco advertising - Raise taxes on alcohol - Restrict access to retailed alcohol - Enforce bans on alcohol advertising - Reduce salt intake in food - Replace transfat with polyunsaturated fat - Promote public awareness about diet and physical activity - Hepatitis B vaccination
"This is the second health issue ever to be addressed at a special meeting of the United Nations General Assembly. We should all work to meet targets to reduce NCDs. WHO's best buys serve as excellent guidance" Ban Ki moon UN Secretary General 19 September 2011
What is new? The now have articulated the cost of action vs inaction Fifteen years / 2011/2025 US$ 170B is the overall cost for all developing countries to scale up action by implementing a set of "best buy" interventions, identified as priority actions by WHO US$ 7T is the cumulative lost output in developing countries associated with NCDs between 2011 2025
The way forward for WHO Building on the Declaration, now important for WHO to: Set norms and standards Comprehensive global monitoring framework and voluntary global targets for NCDs Policy options for strengthening multisectoral action through partnership Review and exchange of best practices Exercise a coordinating role within the UN System in promoting and monitoring global action against NCDs Develop a global implementation plan for the outcome of the High level Meeting (including the updating of the Action Plan) Scale up technical competence and resources within WHO in order to strengthen technical assistance and capacity building to developing countries, especially least developed countries WHO Director General
Proposals on the way forward for the UN Building on the Declaration, now important for UN funds, programmes and agencies to: Consider Integrating NCDs into UNDAF processes and roll outs Develop joint programmes Include NCDs in discussion on the post 2015 development agenda Contribute to policy options for strengthening multisectoral action for the prevention and control of NCDs through effective partnership Contribute to the development of an updated/follow up 'Action Plan of the Global Strategy for the Prevention and Control of NCDs' (2013 2018), based on the Political Declaration on NCDs Contribute to the development of a comprehensive global monitoring framework and targets for NCDs, building on the work under way at WHO WHO Director General
What is next? Meeting the requests of the UNGA and World Health Assembly 2 Report on the outcomes of the High level Meeting and the Moscow Conference Annex: Comprehensive global framework for monitoring NCDs and voluntary global targets for NCDs (WHA) 1 Progress in implementing the global strategy and the action plan 3 Options for strengthening and facilitating multisectoral action for the prevention and control of NCDs through effective partnership 4 5 Implementation and follow up plan for the outcomes the Highlevel Meeting (developed together with UN agencies and entities) Final progress report on implementing the global strategy and the action plan 6 7 Comprehensive review and assessment of the progress achieved in the prevention and control of NCDs Report on the progress achieved in realizing the commitments made in the Political Declaration Jan May 2012 EB/WHA Q4 2012 GA Jan May 2013 WHA June 2014 GA Sep 2014 GA Political Declaration of the High level Meeting of the General Assembly on the Prevention and Control of NCDs (resolution 66/2) Jan May 2014 WHA