Components of a National Action Plan Ala Alwan Assistant Director-General World Health Organization 1

Lessons Learned From International Experience - NCDs are preventable through interventions against the common risk factors and their determinants - Strategies to reduce exposure to established risk factors should be combined with strategies to prevent the emergence of risk factors in the first place Early life: Nutrition in early life Adolescence: Smoking Physical inactivity Unhealthy diet Here are some of the principles adopted by the GS based on the lessons learned. First: The evidence we have indicates that countries can reverse the advance of these diseases and Rfs if appropriate action is taken. Much is now known about measures to reduce risks like smoking, obesity, physical inactivity and alcohol. We know that interventions work and they are cost-effective. We do need to generate more evidence but enough is known to prevent a considerable proportion of the global burden of the four major NCDs. Second: Strategies to reduce exposure to established RFs and to lower the risk for individuals who present with clinical signs do not achieve the full potential for prevention. A comprehensive long-term strategy must therefore necessarily include prevention of the emergence of RFs in the first place. Action on the origin and determinants of Risks in early life is essential. Third, In any population, most people have a moderate level of risk factors and only a minority have a high level. Taken together those with a moderate risk obviously contribute more to the total burden than those with high risk. Consequently, a comprehensive prevention strategy needs to blend synergistically an approach which aims to reduce risk in the population as a whole with one directed at high risk individual Fourth: Review of studies indicate that for substantial reduction of RF levels and in disease outcomes, the delivery of interventions should be of appropriate intensity and sustained over an extended period of time. Most examples of interventions that have failed to make a difference were those inadequately planned and impleented, delivered with small intensity and coverage and implemented intermittently or over short periods. Fifth: Experience indicates that Trade, food, agric, urban development, finance, and taxation policies

Lessons Learned From International Experience - Strategies should combine population and high risk approaches - To have an impact, interventions should be of appropriate intensity and sustained over extended periods of time - Success requires community participation, supportive policy decisions, legislation, intersectoral action and health care reforms - More health gains are achieved by influencing public policies in other sectors like trade, education, agriculture, food production, urban development and taxation than by changes in health policy alone. …… Here are some of the principles adopted by the GS based on the lessons learned. Third lesson: In any population, most people have a moderate level of risk factors and only a minority have a high level. Taken together those with a moderate risk obviously contribute more to the total burden than those with high risk. Consequently, a comprehensive prevention strategy needs to blend synergistically an approach which aims to reduce risk in the population as a whole with one directed at high risk individual Fourth: Review of studies indicate that for substantial reduction of RF levels and in disease outcomes, the delivery of interventions should be of appropriate intensity and sustained over an extended period of time. Most examples of interventions that have failed to make a difference were those inadequately planned and implemented, delivered with small intensity and coverage and implemented intermittently or over short periods. Fifth: Experience indicates that Trade, food, agric, urban development, finance, and taxation policies

Key Components of the Global Strategy 1. Surveillance: to quantify and track NCDs and their risk factors and determinants to provide the foundation for advocacy, national policy and global action -integrating monitoring of NCD trends into the national surveillance system 2. Promotion of health across the life course and prevention of risk factors -Nationwide risk factors reduction through intersectoral action -Community-based primary prevention programmes 3. Improving access to, and quality of, health care,focusing on cost-effective and equitable interventions for people with chronic diseases (PHC reforms) -Integrating health care for NCDs into PHC -Strengthening health systems for more effective chronic care

Objective 2: Establishing and strengthening national programmes with emphasis on PHC Developing a national multisectoral framework for NCD prevention Mechanisms of ISA for Health Legislation and fiscal policies Integrating NCD prevention into the national health development plan Comprehensive policy and plan Infrastructure NCD Surveillance and monitoring system Evidence-based and cost-effective interventions in primary and secondary prevention (packages) Reorienting/strengthening health systems to address chronic care Ensure that Health System Strengthening covers basic elements: appropriate policies based on PHC and integrated care, trained human resources, access to medicines and standards of care as well as a well functioning referral systems Address obstacles to continuity of care like patients records Objectives 2 is to… There are three broad lines of action Under each there are specific action points that need to be implemented by MS