Feedback by NGOs to the NCD Alliance on the WHO Discussion Paper on a comprehensive global monitoring framework and voluntary global targets for prevention and control of NCDs

Feedback from NGOs to NCD Alliance  Positive and constructive tone to feedback:  “Very much agree with overall approach”  “Fully supportive of main aspects”  Praise for WHO’s work:  “Solid and impressive preparatory work done by WHO”  General support for proposed monitoring framework  Some criticism about targets; concern about what is missing  How will monitoring translate into review and action?  Questions about process, and civil society involvement

An opportunity not to be missed  Recognition of importance of supporting process called for in Political Declaration  Many calls for changes but clear backing for adoption of framework and key targets at WHA 2012  Key targets must include:  Preventable mortality target but as an “overarching goal”  Targets identified as “highest adherence to criteria”  Political Declaration target of “national plans by 2013”

An opportunity not to be rushed  If these are only global targets for NCDs until 2025, then missing too many important issues and linkages  Many NGOs favour a stepped approach:  Initial set of targets in 2012  Followed by agreed process involving civil society experts  Develop surveillance systems  Further targets to be developed to meet agreed criteria  Two sets of targets: core/mandatory and expanded  This means a decision in May to mandate future work

Beyond WHA... Back to UNGA  Political Declaration clear about need for multi-sectoral action, therefore not only health-related targets  Must measure structural interventions and social determinants  Critical that reporting does not stop at WHA  Integration with future development goals planned now  Alignment with existing reporting mechanisms planned now  Preceded by an audit of all global health targets  Duplication of effort and waste of resource must be avoided  FCTC: 174 countries report every two years to the COP  COP and WHO reporting must be harmonised

Questions on interim targets  How and when will interim targets be calculated?  Simple linear progression not suitable  Calculation must take into account evidence of trends  What is relationship between five-year cycle ( ) and “comprehensive review and assessment in 2014”?  How will these targets and reporting cycle feed into post-2015 planning process?  Accountability for progress on interim targets critical to generate political will to effect policy changes required

More questions...  This is going to need a skilled public health workforce – acknowledged by WHO but how will this be resourced?  Crucial that national goals and targets are linked to global targets – but how will this happen?  How is private sector being consulted, and encouraged to share research and market data?  How can monitoring and evaluation of private sector initiatives be included?

Some suggestions for targets and indicators  Widespread support for a target on physical activity; suggestions include:  No further increase in population level physical inactivity, in stabilised countries decrease of 1% / year  20% relative increase in adults who meet WHO recommendations – at least 30 minutes of physical activity five times a week  20% relative increase in children who meet WHO recommendations – 5-17 year olds accumulate 60 minutes for moderate to vigorous intensity physical activity daily

Some suggestions for targets and indicators  Strong calls for targets focused on children and adolescents; recommendations from experts include:  Data on NCD-related deaths should be disaggregated by age  Children and adolescents not excluded from diabetes targets  Monitor levels of tobacco and alcohol use in children beginning at age 10, and obesity beginning at age 6  Develop a target on risk factors and expectant mothers  Measure incidence of asthma in individuals younger than 20  10% relative decrease in school days lost due to oral health problems

Some suggestions for targets and indicators  Calls for musculoskeletal diseases, accidents, mental and oral diseases, disability and rehabilitation to be included  Specific suggestions on dementia and Alzheimer’s disease:  reduce number of persons living with Alzheimer’s disease or related dementia by 10% from current projections  Proposed indicator on pain relief:  Consumption of strong opioid analgesics per death from cancer or HIV as proxy measurement  Calls for establishment of organised stroke care units  Proportion of patients hat have access to organized stroke, heart disease, cancer therapy

Some suggestions for targets and indicators  Systems response targets (not just health systems responses):  For education systems: Regulations and implementation of Physical Education in schools  For transport systems: How many countries do have official transport policies including active transport (walking and cycling)?  Education and training:  At least 50% of health professionals, non-medical professionals and school students to receive training on NCDs and links with social determinants

Thank you, and please keep in touch Alzheimer's Disease International Campaign for Tobacco Free Kids Consumers International Framework Convention Alliance Global Advocacy for Physical Activity Global Alcohol Policy Alliance Global Alliance against Chronic Respiratory Diseases Global Alliance on Chronic Diseases Handicap International HelpAge International International Alliance of Patients' Organizations International Association for the Study of Obesity International Diabetes Federation International Federation of Red Cross and Red Crescent Societies International Union Against Tuberculosis and Lung Disease International Union for Health Promotion and Education Lancet NCD Action Group NCD Child Union for International Cancer Control World Action on Salt and Health World Alliance for Risk Factors Surveillance World Dental Federation World Federation of Public Health Associations World Health Professions Alliance World Heart Federation World Medical Association World Palliative Care Alliance World Stroke Organization