1. PAN AMERICAN/WORLD HEALTH ORGANIZATION NCDs in Latin America & the Caribbean Regional Workshop on Economic Dimensions of NCDs C. James Hospedales PAHO/WHO

2. PAN AMERICAN/WORLD HEALTH ORGANIZATION: OVERVIEW We have a serious problem in the NCDs We have a serious problem in the NCDs Human & economic burden not sustainable; development threat Human & economic burden not sustainable; development threat Multifactorial, multisectoral links and causes Multifactorial, multisectoral links and causes Largely Preventable; all of society solution is needed Largely Preventable; all of society solution is needed UN HIGH LEVEL MEETING (SUMMIT) ON NCDs September 19-20, New York

4. Diabetes Chronic respiratory disease Cancer Cardiovascular deseases TOTAL NCD DEATHS 2007 3,9 M Other NCDs FACING THE FACTS IN THE AMERICAS: desease burden 149 million smokers 30% of 25-64 are hypertensive 25% persons >15 years old obese 36% deaths are below age 70 years Approx 250,000,000 million people live with an NCD in the Americas region

6. Epidemiological transition: different rhythms Brasil Guatemala

7. Prevalencia Actual de Consumo de Tabaco Source: PAHO, Informe sobre Control del Tabaco para la Región de las Americas, 2011 Adults Youth(13-15) Smoking prevalence in the Americas

8. FACING THE FACTS: Source: Ono T, Guthold R, Straong K, WHO Global Comparable Estimates, 2005 ALCOHOL IMPACT IN THE AMERICAS

9. FACING THE FACTS IN THE AMERICAS: Estimated Obesity (BMI >30) prevalence, 2010. Source: Ono T, Guthold R, Straong K, WHO Global Comparable Estimates, 2005

11. Risk factors: -current daily smokers -less than 5 servings of fruits & vegetables per day -low level of physical activity -overweight or obese -raised BP (SBP ≥ 140 and/or DBP ≥ 90 mmHg or currently on medication for raised BP) Raised Risk: 3-5 Risk factors

12. Coexistence of children with malnutrition and mothers with overweight in same home Fuente: Garret, J, Ruel, Marie T. The coexistence of child undernutricion and maternal overweight

14. FAT & POOR America’s Fattest States Mississippi — 32.5% Alabama — 31.2% West Virginia — 31.1% Tennessee — 30.2% South Carolina — 29.7% Oklahoma — 29.5% Kentucky — 29% Louisiana — 28.9% Michigan — 28.8% Arkansas / Ohio (tie) — 28.6% America’s Poorest States (median household income) Mississippi — $34,473 West Virginia — $35,059 Arkansas — $36,599 Oklahoma — $38,770 Alabama — $38,783 Louisiana — $39,337 Kentucky — $39,372 Tennessee — $40,315 Montana — $40,627 New Mexico — $40,629 Obesity increases health costs an average of 42% compared with normal weight

15. SOME OF THE OPPORTUNITIES NCDs ARE HIGHLY PREVENTABLE

16. Many Cost Effective Interventions Tobacco taxes and smoke free spaces (Uruguay) Trans Fat Free Americas Reduction of sodium in bread, Argentina; restaurants New York Ciclovias (car free Sundays) Scale up PHC for diabetes/hypertension (Brazil) Reduce amputations through foot care (T&T) School meals reformulation as part of obesity law (Colombia) Quality of care improved using “promotoras” (Mexico) Mostly outside the health sector; need broader political commitment

18. The CARICOM Heads Summit on NCDs, 2007. “We, the Heads of State of the Caribbean Community….” 15-point “Port of Spain Declaration”; multi-sectoral Tobacco – Ratify and implement the WHO FCTC: taxes, packaging, earmark some revenue for health promotion & disease prevention, ban smoking in public places Alcohol- use alcohol taxes to finance NCD prevention and control Healthy Diet - Trade policies on food imports, agriculture policies, Healthy school meals, Food labeling, reduce or eliminate trans fats Physical activity-physical education in schools; physical activity in work places; improve public facilities for physical activity Health services - screening and management of NCDs to achieve 80% coverage by 2012; primary and secondary prevention, comprehensive health education Monitoring - Surveillance of risk factors; monitoring of the actions agreed upon in Declaration (CARICOM Secretariat, CAREC, UWI & PAHO/WHO) Mobilizing Society - National Commissions on NCDs; including public, private sector and civil society, media and communications industry Caribbean Wellness Day – Second Saturdays in September WWW.CARICOM.ORG

19. NCDs and the global agenda : an intersectoral nature > HEALTH NCDs and Risk Factors GENDE R ENVIRONMENT AND SUSTAINABLE DEVELOPMENT URBAN PLANNING AND TRANSPOR T POVERTY REDUCTIO N EQUITY& SOCIAL PROTECIO N ECONOMIC DEVELOPME NT URBAN PLANNING & TRANSPO RT HEALT HY WORK PLACE S AGRIFOO D

20. Highlights of UN High Level Meeting on NCDs Member States: 113 From Americas: 25 Heads of State/Government: 35 From Americas: 9 Over 300 civil society groups Participan ts economic & development challenge; prevention as cornerstone calls for multi-sector approach strengthen national NCD policies and programs strengthen health systems, based on primary health care, and increase access to essential medicines; TRIPS flexibilities improve international coordination and collaboration Political Declaratio n over 120 interventions unanimous call for action against tobacco, more surveillance, improve care and treatment more investments on the ‘’best buys’’ Plenary & roundtabl e discussio ns over 35 side events: 4 sponsored by WHO, 3 sponsored by PAHO illustrated integration of NCDs in: nutrition/agriculture, HIV, women’s health, urban health, communications, gender, oral health, physical activity, Pan Am Forum for Action on NCDs 2 nd phase launched Side events

21. By 2012 WHO: global monitoring framework, including indicators, and recommendations for voluntary global targets UNSG: present options for multi sectoral partnership By 2013 Member States: develop /strengthen national multi-sector NCD policies and plans By 2014 UN: comprehensive review and assessment of progress SPECIFIC COMMITMENTS FROM THE UN HLM on NCDs

22. NEXT STEPS FOR PAHO 1. Revise Regional Strategy and Plan of Action for NCD prevention and control include regional targets and indicators 2. Technical cooperation with Member States to fulfill commitments of the Political Declaration 3. Continue advocacy in global fora: Social Determinants, G8/G20, Summit of the Americas, etc. 4. Promote multi-sector partnerships, through the Pan American Forum for Action on NCDs 5. Broader engagement in NCDs with other regional UN agencies

23. THANK YOU MERCI BEAUCOUP OBRIGADO MUCHAS GRACIAS

24. PAHO CALENDAR OF EVENTS TO PREPARE FOR THE UN Summit