NCD surveillance Melanie Cowan, Technical Officer, Surveillance Surveillance and Population-based Prevention Unit Dept. of Chronic Diseases and Health Promotion

NCD Surveillance at WHO NCD Country Capacity Survey (CCS) Comparable Estimates for Key Risk Factors STEPS (adults) GSHS (adolescents)

NCD Country Capacity Survey To gather information about individual country capacity for NCD prevention and control. Assessment focused on current strengths and weaknesses related to: NCD infrastructure, policy response, surveillance and health systems response and partnerships and health promotion. 3rd wave of surveillance in 2010 – previous surveys in 2000 and 2005. A further wave planned for 2013. 96% response rate from Member States in 2010. Periodic monitoring of national progress would assist countries in identifying gaps in prevention and control efforts and assist with future planning.

Comparable estimates for selected NCD Risk Factors GBD 2008 update, includes many NCD risk factors Metabolic risk factors – BMI, Blood pressure, Blood Glucose, Cholesterol Country consultation conducted on all comparable risk factor estimates between September and December 2010 and again during July2011. For inclusion in the NCD Global Status Report released in April 2011 the NCD Country Profiles launched in September 2011. Lancet papers released in April 2011, showing 30 year trends in metabolic risk factors. Also included in Country profiles.

Comparable estimates – overweight/obesity/mean BMI Lancet paper released in April 2011, showing 30 year trends in overweight and obesity. In 2008, 35% adults overweight globally (34% men and 35% women). 10% men and 14% women obese in 2008. Worldwide obesity has more than doubled since 1980. In 2008, 1.5 billion adults, 20 and older, were overweight. Of these over 200 million men and nearly 300 million women were obese.

Age-standardized prevalence of overweight in adults aged 20+ years by WHO Region and World Bank income group, comparable country estimates, 2008

Global Health Observatory (GHO)

Prevalence of overweight (BMI 25+), 2008, ages 20+, age adj

Prevalence of raised blood pressure*, 2008, ages 25+, age std *defined as less systolic BP 140+ and/or diastolic BP 90+ or on medication for raised BP

NCD Country Profiles

STEPwise approach to chronic disease risk factor surveillance (STEPS)

STEPS- adult risk factor surveillance Objectives Empower Member States to gather information on chronic disease risk factors for use in planning health programmes and interventions. Provide standardized questionnaire that allows for comparisons, but is flexible to meet Member States' needs. Build capacity in Member States in all aspects of national survey implementation; in particular, develop skills in sample design, data collection and data analysis.

# in field / data entry or analysis work Current Activity # planning # in field / data entry or analysis work # reporting completed Total # active # trained but inactive # with 1 or more repeats AFRO 10 18 15 43 (3) 7 AMRO 13 8 1 22 EMRO 2 9 (1) EURO 3 (0) SEARO WPRO 11 25 120

Questionnaire Overview Different levels of risk factor assessment: STEP 1 – questionnaire STEP 2 – physical measurements STEP 3 – blood samples Three modules per Step: Core Expanded Optional

Questionnaire Overview, cont. Behavioural Risk Factors Tobacco use Harmful alcohol consumption Unhealthy diet (low fruit and vegetable consumption) Physical inactivity Biological Risk Factors Overweight and obesity Raised blood pressure Raised blood glucose Abnormal blood lipids Optional Modules on Injury and Violence, Oral Health, Sexual Health

*(Personal Digital Assistant) STEPS Methodology Targets a nationally-representative sample of adults aged 25 – 64. STEP 1 (questionnaire) and STEP 2 (physical measures) are conducted in the household by trained interviewers. STEP 3 (biochemical measures) is typically clinic-based. Pocket PCs (PDAs*) are used for data collection: "eSTEPS" Repeat survey should be done every 3 - 5 years. *(Personal Digital Assistant)

Global School-based Student Health Survey (GSHS)

Global School Based Student Health Survey (GSHS) Overview & Objectives System for surveillance of behavioural risk factors and protective factors in school-aged children Help countries develop priorities, establish programmes, and advocate for resources Establish trends in the prevalence of health behaviors and protective factors by country Allow countries and international agencies to make comparisons across countries

GSHS: Methods Self-administered questionnaire and generic answer sheet Targets grades with students aged 13 – 15 years Completed by students during one classroom period Anonymous and confidential 10 Question Modules are available, from which countries can select a minimum of 6: Alcohol, diet, drugs, hygiene, mental health, physical activity, protective factors, sexual behaviours, tobacco, violence & injury

GSHS: Current Implementation Worldwide, 114 countries across all six WHO regions have been trained and 77 have finished GSHS data collection (including 13 countries with repeat surveys).

Questions?