Present NCDI situation in Mongolia Kh.Altaisaikhan /Professor of Medicine, Vice president of HSUM/

Mongolian step survey on non-communicable disease risk factors 2006

Mongolian step survey on non-communicable disease risk factors 2006 The Mongolian NCD – STEPs survey is a nationwide cross–sectional survey, carried out throughout Mongolia in 2005. The goal of the survey was to determine the prevalence of major NCD risk factors and to establish the baseline information for the surveillance of NCDs prevention and control. The survey was conducted through three subsequent steps with the concept of the WHO Stepwise approach for NCD surveillance and data obtained from 3411 participants aged 15-64 years.

Mongolian step survey on non-communicable disease risk factors 2006 Questionnaire method Step 2 Physiological measurements Step 3 Laboratory analysis

Survey results: Behavioral risk factors 1. Tobacco use The prevalence of daily smokers was 24.2 % of the surveyed population aged 15 - 64 years. There was a marked gender difference noted in the prevalence of daily smokers. The proportion of daily smokers in males (43.1%) were higher by 10 times as compared to that of females (4.1%). An average age of initiation to smoking was 20 years.

Survey results: Behavioral risk factors 2. Alcohol consumption 30.2% of the surveyed population aged 15-64 years consumed alcoholic beverages on a regular basis in the past 30 days; and in terms of gender, 44% of the surveyed male respondents and 15% of the surveyed female respondents consumed alcoholic beverages on a regular basis. In the past 30 days, 2.2% of the surveyed population who consumed alcohol on a regular basis were drinking alcohol on 4 and more days a week thus presenting to be at high risk; and in regard to gender, 2.5% of male regular drinkers and 1.2% of female regular drinkers were at high risk. There was a gender difference in alcohol consumption. The proportion of alcohol consumption on a regular basis and binge drinking were 3 times higher in males as compared to females.

Survey results: Behavioral risk factors 3. Fruit and vegetable intake

Survey results: Behavioral risk factors 4. Physical inactivity

Survey results: Health indicators 1. Overweight and obesity

Survey results: Health indicators 2. Diabetes mellitus Prevalence of diabetes was 9.3% and this proportion was much higher as compared to 3.1% of the data from the survey conducted in 1999. A proportion of impaired fasting glucose was found in 10.3% and there was no remarkable difference compared to the prevalence of 9.2% in 1999.

Survey results: Health indicators 3. Hypertension and blood pressure The prevalence of hypertension 28.1 (+0.1)%. With increased age the prevalence of hypertension was higher in both sexes.

Survey results: Conclusion Smoking 27.6% Alcochol in moderate use 5% Current use of alcochol 0.7 % Unhealthy diet 72.5% Physical inactivity 23.1% Hypertension 28.1% Diabetes 8.2% Obesity 9.8%

Survey results: Conclusion 9 in every 10 people (90.6% of the surveyed population) had at least one risk factor for developing NCDs. One in every five people (20.7% of the surveyed population) had three or more risk factors or were at HIGH risk and in particular, One in every two males aged 45 years and above were at high risk in developing NCDs.

National programme on prevention and control of non-communicable disease

National programme on prevention and control of non-communicable disease 1. Goal Reduce deaths caused by major NCDs through improving control and surveillance of NCDs and their risk factors and through effective health promotion action The program will be implemented in two stages splitting into stage one as to be implemented during 2006-2009 and two as for 2010-2013

National programme on prevention and control of non-communicable disease Objectives Objective 1. To create sustainable mechanism for coordination on prevention and control of major NCDs such as cardiovascular diseases, cancer and diabetes mellitus Objective 2. To reduce risk factors of major NCDs by promoting healthy lifestyles and supportive environment Objective 3. To make reorientation of health services (towards community-based, appropriate, accessible and effective) for major NCD-s

Non-communicable disease related our experience

Non-communicable disease related our experience National survey on diabetes prevalence /2002/ Diabet Med. 2002 June;19 (6):502-8 Mongolian NCD STEPS risk factors survey /2005/ Development of national program on NCD prevention and control /2005/ WHO Local fellowship on NCD prevention and control for primary health workers NCD Regional Center establishment /2005/ (Khovd, Uvurkhangai, Dornod) Essential emergency surgical care WHO Local fellowship WHO Local fellowship training on primary health care Distance learning training program for primary health providers

The Diabetes Center in Ulaanbaatar, 2005

The Diabetes Center in Erdenet, 2005 New diabetes center was established with 3 rooms at out-patient clinic in Erdenet cities Central Hospital with necessary equipments

World Diabetes Day since 2001

Diabetes Educator Training May 2005 31 Mongolian health professionals were certified as Diabetes Educators

The incidence of diabetes in Mongolia

Global strategy of non-communicable disease prevention and control

Noncommunicable Diseases 4 Diseases, 4 Modifiable Shared Risk Factors Tobacco Use Unhealthy diets Physical Inactivity Harmful Use of Alcohol Cardio-vascular Diabetes Cancer Chronic Respiratory

Total deaths around the world: 58 million

Total deaths around the world: 58 million Deaths from noncommunicable diseases around the world: 35 million

Total deaths around the world: 58 million Deaths from noncommunicable diseases around the world: 35 million Deaths from noncommunicable diseases in developing countries: 28 million

Total deaths around the world: 58 million Deaths from noncommunicable diseases around the world: 35 million Deaths from noncommunicable diseases in developing countries: 28 million Deaths from noncommunicable diseases in developing countries which could have been prevented: an estimated 14 million

Noncommunicable Diseases Mortality among men and women aged 15-59 years (2004)

Noncommunicable Diseases Projected Deaths in 2015 and 2030 Intentional injuries Other unintentional Road traffic accidents Other NCD Cancers CVD Mat//peri/nutritional Other infectious HIV, TB, malaria

WPRO Pattern of Morbidity is Similar to EURO and AMRO Distribution of DALYS, by broad cause group and WHO Region, 1999 % 75 Noncommunicable conditions Communicable diseases, maternal and perinatal conditions and nutritional deficiencies 50 25 Injuries AFR EMR SEAR WPR AMR EUR DALY = Disability-Adjusted Life Year Source: World Health Report, 1999

Noncommunicable Diseases Global Action Plan 2008-2013: Six Objectives 1. Integrating NCD prevention into the development agenda, and into policies across all government departments 2. Establishing and strengthening national policies and programmes 3. Reducing and preventing risk factors 4. Prioritizing research on prevention and health care 5. Strengthening partnerships 6. Monitoring NCD trends and assessing progress made at country level Here are the objectives of the plan. Under each of the six objectives there are three sets of actions to be iplemented during the six year period, one set for member sates, another for WHO and a third for international partners Under each of the 6 objectives, there are sets of actions for member states, WHO Secretariat and international partners

Noncommunicable Diseases Why working in partnership? Consolidate fragmented efforts Promote results-oriented collaborative efforts Engage partners outside the health sector Scale up by pooling limited resources

Noncommunicable Diseases Global NCD Network Mission: Help implement the NCD Action Plan by catalyzing an multi-sectoral, multi-level response, with a particular focus on developing countries Goals: Increase focus on NCD prevention and control through collective advocacy Increase resource availability (both financial and human capital) Catalyze effective multi-stakeholder action with a focus on country-level implementation

Noncommunicable Diseases Global NCD Network: Stakeholders Stakeholders from the disease and risk factor community: Stakeholders outside the health sector: Ministries of Finance, Trade, Education, Social Affairs Development donors (e.g. Austrian Development Agency, Ministry of Foreign Affairs) International Financial Institutions Intergovernmental Organizations Private sector Here are the objectives of the plan. Under each of the six objectives there are three sets of actions to be iplemented during the six year period, one set for member sates, another for WHO and a third for international partners

Noncommunicable Diseases Global NCD Network: Structure Implemented in 2009 WHO Implemented in 2010 International Advisory Council Staff Funding Mechanisms Global/Regional Forum Meetings Working Group Working Group Working Group

Core competencies for caring for patients with chronic conditions Patient-centred care Partnering Quality improvement Information and communication technology Public health perspective

1. Patient-centred care Interviewing and communicating effectively Assisting changes in health-related behaviors Supporting self-management Using a proactive approach

1. Patient-centred care 5 as approach: Assess Advice Agree Assist Interviewing and communicating effectively 5 as approach: Assess Advice Agree Assist Arrange

Supporting self-management 1. Patient-centred care Supporting self-management

2. Partnering Partnering with patients Partnering with other providers Partnering with communities

3. Quality improvement Measuring care delivery and outcomes Learning and adapting to change Translating evidence into practice

4. Information and communication technology Designing and using patient registries Using computer technologies Communicating with partners

5. Public health perspective Providing population-based care Systems thinking Working across the care continuum Working in primary health care-led systems

Partnerships, Collaboration NGOs CCs UN agencies