1. Dr Mikko Vienonen, M.D., Ph.D. Chair a,i. 1st meeting of the NCD EG / NDPHS Helsinki, Finland 28 September 2010 Document NCD 1/ NDPHS EG Group on Non-Communicable Diseases related to Lifestyles, and Good Social and Work Environments (“NCD”)

2. Decisions by NDPHS CSR-7 Moscow (30 June 2010) A new Expert Group on EG Group on Non-Communicable Diseases related to Lifestyles, and Good Social and Work Environments (“NCD EG”) was established for time-period 2010 - 2013. The previous SIHLWA Sub-group on Occupation Health and Safety (SIHLWA-OSH) was transformed into a Task Group on Occupational Safety and Health (“OSH TG”) affiliated with NCD EG. A new Task Group on Indigenous Mental Health, Addictions and Parenting (“IMHAP TG”) was established affiliated with NCD EG

3. SIHLWASecretariatSUB-GROUPSADO ALCOSHIMHAP Old SIHLWA 2005 -2010 CSR

4. CSR New Option 2010  ”NCD-EG” Expert Group on Non-Communicable Diseases related to Lifestyles, and Good Social and Work Environments (“NCD”). OSH TG IMHAP TG EG-NCD OSH and IMHAP will report to CSR through NCD EG and also receive other types of logistic support for organizing e.g. meetings

5. CSR Overall structure of NDPHS EGs &TGs 2010  EGHIV/AIDSFIN(POL) EGPHC-SYSTSWE (RUS) EGNCDFIN(LTU) EGALC-POLNOR(RUS) TG IMHAP CAN (NCM) TG OSH ILO (LTU) TG ALC FLAG- SHIP SWE (XXX?) TG ANTIB. RESIST. SWE (XXX?) PROPOSAL

6. ? ? ?? ? As from NDPHS Secretariat 22/9/10

7. NDPHS EG Group on Non-Communicable Diseases related to Lifestyles, and Good Social and Work Environments (“NCD”). Establishing EG on “NDP” would emphasize healthy lifestyle promotion, the NCD prevention, and management of chronic NCDs taking into account social determinants and health in all policies,

8. NCD-EG Objectives 1.The main role of the Expert Group is to act as a focal point for national inputs from the Partner Countries and Organisations for the Thematic area 4: Lifestyle-related NCDs and good social and work environments in coordination with the responsible Expert Groups. 2.In this capacity, the overall objective of the NCD Expert Group is to support the responsible Expert Groups through facilitation of the work towards the achievement of Goals 7-11 stated in the NDPHS Strategy Thematic area. 3.Further, the Expert Group will contribute to the implementation of the Operational Targets specified within Goal 1 and other relevant thematic Goals.

9. Goal 1: The role and working methods of the NDPHS are strengthened Operational target 1.1: By 2013, international/regional, national, sub-national and local health authorities or other actors have recognized the NDPHS as a renowned source of knowledge and expertise in the region and contacted it for cooperation and/or advice in their own planned activities (at least two actors from each level). Indicator 1.1A: Number of actors per each of the abovementioned levels who have contacted the NDPHS for cooperation and/or advice. Operational target 1.2: Social well-being aspects are systematically and concretely included in the work of the NDPHS including, but not limited to its Expert Groups. Indicator 1.2A: The percentage of NDPHS activities (projects, policy papers) including social well-being aspects out of the total number of respective NDPHS activities in a given period of time.

10. Goal 1: The role and working methods of the NDPHS are strengthened (continued …) Operational target 1.3: By 2013, external expertise is involved in the NDPHS policy development. This will be achieved through, inter alia, identifying relevant actors and subsequently approaching them with an invitation to take part in the Partnership policy development as well as project development and implementation. Activities will be undertaken to promote the establishment of cooperation frameworks, such as partnerships involving national, local and sub-regional actors and expert networks (e.g. universities, hospitals and prisons). In this way the NDPHS will be able to promote practical cooperation contributing to its own goals through activities run beyond its institutional framework. Indicator 1.3A: Number of organizations and/or authorities, not currently participating in the NDPHS, involved in NDPHS policy development. Operational target 1.4: By 2013, external expertise (especially of relevant national, sub-national and local actors in the area of public health and social well being, when available) is involved in the NDPHS project development and implementation. Indicator 1.4A: Number of external organizations and/or authorities involved in NDPHS project development and implementation.

11. Goal 1: The role and working methods of the NDPHS are strengthened (continued …) Operational target 1.5: By 2013, the regional dimension of the NDPHS is further developed among other things by facilitating projects involving partners from more than only two countries. Indicator 1.5A: Number of projects facilitated by the NDPHS which involve regional cooperation (partners from more than two countries are involved). Operational target 1.6: By 2013, new sources of funding, such as EU programmes and private funds, are mobilized. Indicator 1.6A: Number of projects funded completely or partly by new sources of financing. Indicator 1.6B: Percentage of funding raised from new sources of financing out of the total raised project funding. Operational target 1.7: Relevant international projects are included in the NDPHS Database for improved coordination and facilitation. Indicator 1.7A: Number of new projects added to the NDPHS Database.

12. Thematic area 4: Lifestyle-related non-communicable diseases and good social and work environments  Unequal socio-economic conditions and lack of empowerment among disadvantaged population groups play major roles in the development of non-communicable diseases (NCD).  These circumstances contribute to increasing health inequities. However, policies and actions directed towards “vectors” of NCD will mitigate such health inequities.  Hence, the NDPHS will have contributed to the development of comprehensive policies and actions in the entire region to prevent and minimize harm from tobacco smoking, alcohol and drug-use to individuals, families and society (especially young people) through the achievement of the following: NB OUR DILEMMA? : Title speaks about NCDs in general, but third point focuses it on tobacco and alcohol only which belong under ASA EG and ADPY TG.

13. Goal 7: The impact in the ND countries on society and individuals of hazardous and harmful use of alcohol and illicit drugs is reduced  ADPY TG Operational target 7.1: By 2012, the Partnership will have developed a regional flagship project on alcohol and drug prevention among youth in cooperation with relevant actors and consistent with the provisions of the EU Strategy for the Baltic Sea Region’s Action Plan. Goal 8: Pricing, access to and advertising of alcoholic beverages is changed to direction, which supports the reduction of hazardous and harmful use of alcohol  ASA EG Operational target 8.1: By 2011, the Partnership will have organized a side event back-to-back with the Baltic Sea Parliamentary Conference (BSPC) to promote parliamentarians’ attention to and awareness of the impact of alcohol on society and to propose actions to be taken by national parliaments to reduce this impact and to support evidence based and cost effective preventive methods. Operational target 8.2: BSPC parliamentarians, as a result of the side event, will have included a plea to national parliaments in the ND area to adopt legislation aimed to limit the impact of alcohol on society in the BSPC Resolution 2011.

14. Goal 9: Tobacco use and exposure to tobacco smoke is prevented and reduced in the ND area.  ASA EG Operational target 9.1: By 2012, experiences, legislation and best practices in tobacco control are exchanged through a series of seminars organized by the WHO EURO with the participation of other interested NDPHS Partners. Among the issues to be addressed are (i) the strengthening of the national tobacco control surveillance systems in view of making them internationally comparable; and (ii) the strengthening of the use of data for the policy making. Actions to be taken will be consistent with and contribute to the implementation of the Framework Convention on Tobacco Control (FCTC) and will be run in close cooperation with the FCTC Secretariat.

15. Goal 10: The NDPHS Strategy on Health at Work is implemented in the ND area  OSH TG Operational target 10.1: By 2013, the Partner countries have implemented the agreed actions in the NDPHS Strategy on Health at Work. Goal 10: The NDPHS Strategy on Health at Work is implemented in the ND area  IMHAP TG Operational target 10.1: By 2013, the Partner countries have implemented the agreed actions in the NDPHS Strategy on Health at Work. Goal 11: Public health and social well-being among indigenous peoples in the ND area is improved Operational target 11.1: By 2010, the Partnership will have developed a work plan which will clearly specify steps to be taken towards: (i) improving mental health, (ii) preventing addictions, and (iii) promoting child development and family/community health among indigenous peoples. The work plan will be implemented by 2013.

16. ??? What is left for NCD EG???

17. NCD-EG SUMMARY Scope of Responsibilities The TOR of NCD EG, approved by CSR-17 on 30 June lists the following tasks on NCD EG agenda: to develop strong partnerships with a wide variety of stakeholders; to stablish and maintain relations within the Partner Countries and Organisations as well as with international and national organisations, and other institutions; to facilitate lifestyle and social wellbeing and work environment related WHO and ILO Declarations and Conventions such as, e.g., on Tobacco, Alcohol, Obesity/Nutrition, Mental Health, Accidents & Violence, NCD, etc. (continued)

18. NCD-EG SUMMARY Scope of Responsibilities (continued) to improve the general awareness of and increase positive attitudes towards health promotion, NCD prevention and management; to promote healthy lifestyles promotion and NCD prevention oriented service systems and health sector reforms with attention to populations at risk; to contribute to the development of national policies that respond to the needs and requirements of the Partner Countries; to map Member Countries’ needs for technical and financial support to scale-up national programmes; to formulate and develop ideas for project proposals (including flagship project), facilitate the project application, and follow-up on their implementation:

19. NCD-EG SUMMARY Outputs and Results to advise the Partnership through the NDPHS Secretariat on related Partnership activities and proposals for various forms of support; to facilitate the exchange of information on programmes and projects; to provide expert contributions to policy evaluation; to promote partnership-building and activities relevant to achieving the goals of the Partnership; to promote regional synergies and synergies with other international organisations; to monitor and peer evaluate ongoing activities. MOTTO: HAVING ACTIVITIES IS NOT ENOUGH - ONLY RESULTS WILL COUNT!

20. NCD-EG General Representation and Participation 1.AS TO OTHER EGs: the NCD-EG will include one representative from each interested Partner Country and Organisation (+ 1- 2 alternates ). 2.IN ADDITION: the Area 4 Expert/Task Group Chairs and Co- chairs will be invited to NCD-EG meetings as full members. 3. IN ADDITION: special effort will be made in order that from each Partner Country at least one prominent, well-known expert with considerable prestige and over-arching respect based on proven career on national and international fora on healthy lifestyle and social well-being (“wise men” and “wise women”) would be invited to the NCD EG. Their advise and voice would be needed for the societal advocacy of the messages, In order to contract such persons, it will be evident that NCD EG meetings will frequently need to use video-conferencing facilities.

21. But honestly speaking, at present NDPHS Strategy does not provide NCD EG to monitor progress. Am I right??? Should they be formulated???

22. Dalai Lama has crystallized an individual group’s value, which many may consider as zero: “ If you think that you are too small to make an impact, then try to sleep in a room together with a mosquito”

23. Maintaining the focus on prevention Investment in public health and prevention is trending downwards in some countries in our region after years of concerted upstream efforts. NCD-EG wishes to emphasize its concern that the valuable progress achieved over the last decades is still fragile and can easily be undone if efforts are not maintained.

24. Agis Tsouros/WHO-EURO (26/3/2010): Non-communicable Diseases (NCD) & Lifestyles We have an NCD epidemic ongoing in Europe – and the world We started with blaming the victim: “ you are responsible yourself”! INDIVIDUAL RESPONSIBILITY (just focusing on this does not lead you anywhere!) Public Relations (PR) -agencies benefit  campaigns, money goes, nothing changes Developed into understanding that there is also COLLECTIVE RESPONSIBILITY = SOCIETY & SOCIETAL RESPONSIBILITY.

25. Knowledge (alone) does not change human behaviour. Knowledge and health education have a miserable impact on health behaviour). On health, we make decisions based on emotions, not on logic. LET’S NOT FOOL OURSELVES AND WASTE OUR TIME ANY LONGER

26. Agis Tsouros/WHO-EURO (26/3/2010): Non-communicable Diseases (NCD) & Lifestyles Times have changed and we know more of “stakeholders”, but we still do not change behaviour. Some things are “easier” to handle: e.g. physical activity promotion (more accessible, more affordable, more popular …), social environment, children in schools … Tobacco control is (was) difficult… Alcohol will be more difficult …

27. Agis Tsouros/WHO-EURO (26/3/2010): Non-communicable Diseases (NCD) & Lifestyles Perhaps the most important document so far: STRATEGY OF Health-for-All 1978 and the OTTAWA CHARTER on HEALTH PROMOTION 1987! ACTUALLY ALL MAIN ELEMENTS ARE THERE, like the idea of “health in all policies” Level of commitment and recognition problem: HFA (HEALTH FOR ALL-1978) did not provide evidence to health sector and health sector remained sceptical. HFA was more “aspirational” than “evidence based”. Evidence was missing then, but now we have it. NCD care and control was not sufficiently emphasized and left health sector outside Health system approach was taken by WHO on board at Tallinn Ministerial Conference on Health Systems 2008

28. Strengthen community action Develop personal skills Create supportive instruments Enable Mediate Advocate Reorient health services OTTAWA Charter for HEALTH PROMOTION 1987

29. What is the Role of the Ottawa Charter Ottawa charter for health promotion  reorienting health services Health sector: moving beyond providing clinical and curative services

30. Inequities in health and social gradient Source: Norwegian Ministry of health Care Services, 2007

31. Brainstorming for NCD-Action plan 2010 and beyond Given framework: NCDs, related to lifestyles & social environment &work environment. Excluded because of ASA EG and ADPY TG: Alcohol related issues & tobacco control & addictions. Basic Documents for our work: WHO-Gaining Health 2006 (and analysis of policy development in Europe 2009; 2008 – 2013 Action plan for global Strategy for the Prevention abd control of Noncommunicable Diseases (WHA A61/8 (18 April 2008) NCDs clearly not linked with lifestyles: Dementia (?), NCDs clearly linked with lifestyles: 1.Obesity (  diabetes, blood-pressure , CVD, arthrosis) 2.Lack of physical activity (  obesity, blood pressure , cardio-vascular and locomotor-system consequences 3.Accidents (e.g. falls of elderly people, bike-accidents of children and young people) and violence 4.Stroke (primary prevention, secondary prevention)? 5.Other suggestions

32. continued… Brainstorming for NCD-Action plan 2010 and beyond Focus on primary prevention, secondary prevention, or NCD- treatment systems? Citizen & patient involvement: ”expert patient”, ”health literacy”, ”salutogenesis” Ways to facilitate intervention / project ideas (management of change”) 1.Salutogenesis (?) 2.Forum for “wise men & women (?) 3.“Life at Stake” TV format (?) 4.Fact-sheets & policy papers(?) 5.“Potential Years of Life Lost”: Roadmap for management of change (“from shadow ro light”, “from knowledge to wisdom”) 6.Involvement in WHO Conferences (e.g. NCD confference 2011 in Russia, 2013 in Helsinki, others ?) 7.Health Promoting Cities Network (WHO-EURO)/ Urban health 8.Health Literacy promotion / “Expert patient “ concept 9.Other ideas?

33. WHO Global NCD Action Plan 2008 tobacco use physical activity unhealthy diets harmful use of alcohol chronic respiratory disease cancers Cardiovascular disease diabetes

35. NCD EG