Global Strategy and Global Action Plan 2013-2020 for the prevention and control of NCDs Dr Shanthi Mendis MBBS MD FRCP FACC Director a.i. Department for the Management of NCDs 1

Global Mile stones : Prevention and Control of NCDs 2000 Global Strategy for the Prevention and Control of Noncommunicable Diseases 2003 Global Strategy on Diet, Physical Activity and Health 2004 Action Plan 2008-2013 on the Global Strategy for the Prevention and Control of NCDs 2008 Global Strategy to Reduce the Harmful Use of Alcohol 2009 WHO Global Status Report on NCDs 2010 2011 Political Declaration on NCDs 2013 2020 WHO Action Plan for the Prevention and Control of NCDs for 2013-2020

UN High-level Meeting on NCDs NCDs as priority within the development agenda Leading role of WHO as the Global Public Health Agency Specific assignments that WHO has to deliver by 2014

WHO Executive Board resolution EB130.R7 2. REQUESTS the Director-General: 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; 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.

Process 2012 April – October 2012: Regional consultations (WHO Regional Discussion Papers) 26 July 2012 – 7 September 2012: Web-based consultation (WHO Discussion Paper) 16-17 August 2012: First informal consultation with Member States and UN 10 October 2012: Web-based consultation ('Zero Draft' Action Plan) 1 November 2012: Second informal consultation with Member States and UN 2013 January 2013: Executive Board (Draft Action Plan) 8 February – 10 March 2013 : Web-based consultation (Revised Draft Action Plan) 6-7 March 2013: Informal dialogues with NGOs and Private Sector entities 11-13 March 2013: Third informal consultation with Member States and UN May 2013: World Health Assembly (Final Draft Action Plan)

WHO Global NCD Action Plan 2013-2020 –objectives To strengthen international cooperation and advocacy to raise the priority accorded to prevention and control of NCDs in the development agenda and in internationally-agreed development goals Objective 2: To strengthen national capacity, leadership, governance, multisectoral action and partnerships to accelerate country response for prevention and control of NCDs Objective 3: To reduce exposure to modifiable risk factors for NCDs through creation of health-promoting environments Objective 4: To strengthen and reorient health systems to address prevention and control of NCDs through people-centred primary health care and universal coverage Objective 5: To promote and support national capacity for high quality research and development for prevention and control of NCDs   Objective 6: To monitor trends and determinants of NCDs and evaluate progress in their prevention and control The Action Plan comprises a set of actions which, when performed collectively by Member States, UN agencies, international partners and WHO, will reduce the burden of preventable morbidity and disability and avoidable mortality due to NCDs.

Global NCD Action Plan 2013-2020 Vision A world free of the avoidable burden of noncommunicable diseases. Goal To reduce the preventable and avoidable burden of morbidity, mortality and disability due to noncommunicable diseases by means of multisectoral collaboration and cooperation at national, regional and global levels, so that populations reach the highest attainable standards of health, quality of life, and productivity at every age and those diseases are no longer a barrier to well-being or socioeconomic development.

Global NCD Action Plan 2013-2020 Overarching principles and approaches Human rights Equity based approach Universal health coverage Life-course approach Evidence-based strategies Multisectoral action National action and international cooperation and solidarity Empowerment of people and communities Management of conflict of interest

Voluntary global targets Appendix 3 Obj. Set of actions Voluntary global targets WHO tools 1 Raise public and political awareness and understanding about NCDs social marketing, mass-media and responsible media reporting Strengthen international collaboration for training the health workforce Integrate NCDs into the development agenda and poverty alleviation strategies Contributes indirectly to achieve a 25% relative reduction in premature by2025 WHO Global status report on NCDs 2010 WHO Fact Sheets Global Atlas on Cardiovascular disease 2011 IARC GLOBOCAN 2008 Existing regional/national tools  

Voluntary global targets Appendix 3 Obj. Set of actions Voluntary global targets WHO tools 2 Increase and prioritize budgetary allocations for NCDs Assess national capacity for prevention and control of NCDs Develop and implement a national multisectoral policy and plan Develop and implement a national multisectoral strategy to engage relevant sectors outside health Contributes indirectly to achieve a 25% relative reduction in premature mortality by 2025 UN Secretary-General’s report A/67/373 NCD country capacity survey tool NCCP Core Capacity Assessment tool Existing regional/national tools

Voluntary global targets Appendix 3 Obj. Set of actions Voluntary global targets 3 Tobacco use (these interventions reduce>50% of tobacco burden, 25-30m DALYs averted) Reduce affordability of tobacco products by increasing tobacco excise taxes Create by law completely smoke-free environments in all indoor workplaces, public places and public transport Warn people of the dangers of tobacco and tobacco smoke through effective health warnings and mass media campaigns Ban all forms of tobacco advertising, promotion and sponsorship   Harmful alcohol use (these interventions reduce 10-20% alcohol burden, 5-10m DALYs averted) Excise tax increases on alcoholic beverages Comprehensive restrictions and bans on alcohol advertising and promotion Restrictions on the availability of retailed alcohol  Unhealthy diet and physical inactivity (intervention to reduce salt averts 5 m DALYs) Salt reduction through mass media campaigns/reduced salt content in processed foods Replacement of trans-fats with polyunsaturated fats Public awareness programme about diet and physical activity  A 30% relative reduction in prevalence of current tobacco use in persons aged 15+ years      At least a 10% relative reduction in the harmful use of alcohol, as appropriate, within the national context.    A 10% relative reduction in prevalence of insufficient physical activity A 30% relative reduction in mean population intake of salt/sodium intake A 25% relative reduction in the prevalence of raised blood pressure or contain the prevalence of raised blood pressure according to national circumstances Halt the rise in diabetes and obesity

Voluntary global targets Appendix 3 Obj. Set of actions Voluntary global targets 4 Integrate highly cost effective noncommunicable disease interventions into the basic primary health care package to advance the universal health coverage agenda Explore viable health financing mechanisms and innovative financing approaches, like tobacco and alcohol taxation, to generate resources to expand health coverage Improve availability of affordable basic technologies and essential medicines, including generics, required to treat major noncommunicable diseases in both public and private facilities Scale-up coverage starting with very cost effective high impact interventions listed below    Cardiovascular disease and diabetes (these interventions reduce 37% of CVD burden, 64m DALYs averted) Multi-drug therapy (including glycaemic control for diabetes mellitus) to individuals who have had a heart attack or stroke, and to persons with high risk (≥ 30%) of a fatal and nonfatal cardiovascular event in the next 10 years Acetylsalicylic acid for acute myocardial infarction   Cancer (the intervention to address cervical cancer reduces 6% of the cancer burden, 5m DALYs averted) 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 An 80% availability of the affordable basic technologies and essential medicines, including generics, required to treat major noncommunicable diseases in both public and private facilities. At least 50% of eligible people receive drug therapy and counseling (including glycaemic control) to prevent heart attacks and strokes A 25% relative reduction in overall mortality from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases

Voluntary global targets Appendix 3 Obj. Set of actions Voluntary global targets 5 Develop and implement a prioritized national research agenda for NCDs Strengthen research capacity through cooperation with research institutes Contributes indirectly to achieve a 25% relative reduction in premature mortality by 2025 6 Develop national targets and indicators based on global monitoring framework Establish/strengthen a comprehensive NCD surveillance system, including reliable registration of deaths by cause, cancer registration, periodic data collection on risk factors, and monitoring national response, Integrate NCD surveillance/monitoring into national health information systems

World Health Organization 19 May 2018 UN Task Force on NCDs

Cross-sectoral government engagement to reduce risk factors and potential health effects of multisectoral action Sector Tobacco Physical inactivity Harmful use of alcohol Unhealthy diet Agriculture    Communication Education Energy Environment Finance Food Health Housing Industry Justice/Security Legislature Transport Social/Welfare Sports Trade Urban planning

UN Secretary-General's report: Five functional gaps in the global response to NCDs 5 Advocacy and awareness raising Financing and resource mobilization Capacity building Product access Product development and innovation

Thank you 18