NCD Burden The Regional Responses ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting “Addressing non communicable diseases and injuries: major challenges to sustainable development in the 21st century NCD Burden The Regional Responses Dr. Ibtihal Fadhil Regional Adviser Non communicable diseases, World Health Organization, Regional Office for EMR 10-11 May 2009 Doha, Qatar

lesson learned The ADG and prominent panelists presented the detailed insight to the growing NCD burden globally and in EMR Non communicable diseases constituted around 55% of the mortality in EMR in 2005. It is estimated that it will increase to more than 60% by 2020 if the current trends continue The Risk Factors are identifiable in EMR and therefore can be prevented. Increasing trend of smoking overweight and obesity among different age groups.

Cost-effective interventions are available to prevent up to 80% of cardiovascular disease and diabetes and 40% of cancer, Effective interventions exist for primary prevention: Examples.. Raising tobacco taxes and prices Salt reduction Improving availability and affordability of healthy food Improving transportation policies and environmental designs Raising alcohol taxes and prices Cost-effective interventions exist for secondary and tertiary prevention: Cardiovascular disease can be prevented by targeting high risk people 75% of recurrent heart attacks and strokes can be prevented by 4 medicines Treating diabetes Early detection of cancer

WHO Responses Global strategy for NCD prevention & control NCD Action plan for the global strategy Framework convention on tobacco control Strategy on diet physical activity and health Regional Framework on DPAS The Regional strategy on cancer control

Successful interventions Heart file in Pakistan, The Isfahan healthy heart project in the Islamic Republic of Iran, Nizwa Healthy City in Oman and Dar Al Fatwa in Lebanon Araina in Tunisia

community-based intervention Isfahan - Iran

Isfahan healthy Heart community Program “North Karelia of the Middle East” A 6-year program Launched in 1999 an integrated, community-based intervention aimed at fostering healthy diet, The program is quasi experimental: a reference population exists

The Isfahan Healthy Heart Program (IHHP) IHHP interventions in two cities of Isfahan and Najaf Abad have involved more than 150 government and non-government organizations. Interventions: community-based approach reduced tobacco smoking, increased physical activity and stress reduction among 2 m people in central Iran. to tackle NCDs risk factors using a. 8

IHHP strategies to control CVD increasing fibre and decreasing salt content in bread convincing snack producers to market for children new snacks with less trans fats and sugars serving healthy foods and increasing exercise times in schools and workplaces setting standards for restaurants stopping television advertising of sausage and soft drinks incorporating messages into TV programs simplifying food labelling. Results: increased intake of liquid oil, decreased smoking, increased physical activity, increased awareness of health personnel.

A bicycle path in Isfahan IHHP initiatives A bicycle path in Isfahan Promotion of vegetarian pizza served with salad

community-based Interventions Nizwa - Oman

Nizwa healthy lifestyle project in Oman Community–based approach to tackle risk factors Interventions were undertaken in 2004. Evaluation in 2009 The project promotes healthy lifestyle through three subcommittees; (1) Tobacco control & accident prevention; (2) Promotion of physical activity and (3) Promotion of healthy nutrition.

Targeted outcome Physical Activity: Increase of percentage of physical activity among men from 52% to 67%. Increase of percentage of physical activity among women from 27% to 42%. Reduce the current prevalence of overweight among men from 31.9% to 25% and among women from 25.3% to 19%. Reduce the current prevalence of obesity among men from 8.6% to 5.6% and among women from 17% to 11%.

Targeted outcome Dietary styles: Reduce the percentage of usage the animal’s fat from 83.9% to 68.9% and increase the percentage of usage the vegetarian oils from 74.9% to 89.9%. Reduce the prevalence of hypercholesterolemia from 34.6% to 28.6% among men and among women from 36% to 30%. Increase the knowledge (know-how) about healthy dietary habits from 32% to 67%.

Targeted Outcome Tobacco use, RTA, and domestic accidents Reduce the percentage of the regular smokers and irregular smokers from 9.2% to 4.5% . Establishment of counseling service to assist quitting smoking. Reduce the deaths and diseases related to tobacco. Increase public awareness about prevention of road traffic, home (domestic) accidents, work injuries, and poisonings. Reduce the percentage of road traffic accidents, injuries and poisonings subsequently reduce the death related to them

Interventions NHLP Friendly Schools Alharaka Baraka (Move for Health) Lifestyle Clinic Health professionals education and involvement Obesity screening and management at PHC Tobacco intervention, Health education in schools and tobacco cessation clinic

WHO Global Strategy on Diet, Physical Activity and Health & Regional Framework The Regional Framework is a response to the growing burden of NCDs in the EM Region. Addresses two of the main risk factors for non-communicable diseases, namely diet and physical activity Develop multicultural approach for the prevention and control of NCD's Specificity in EM Region ( physical activities, diet and food consumption patterns                             

Policy to promote physical activities

Kuwait National Physical Activity Committee Under The Patronage of his highness the Crown Prince of Kuwait. Multiple sectors involved as members ( Health professionals, exercise specialists, Nutritionists, Media, Politicians etc. 19

Outcome Be an active Citizen 20

Inter-sectoral collaboration Support Physical Activities In Bahrain

School based interventions Health Promoting Schools in EMR The health-promoting schools initiative is being implemented in all countries Healthy choices made easy and enjoyable to all school children, school staff and parents

Health promoting schools In United Arab Emirates & Bahrain is a collaborative effort between the Ministry of Health and Ministry of Education (through the Joint Committee), with other relevant partners including the Gulf Cooperation Council (GCC) School Health Committee and WHO. The 8 components of the health promotion are implemented in all schools .

A Way Forward Key challenges Leaders Supportive environment Funding Community awareness Clear Problem, Indeed we have the ability to make clear Actions