1. Nick Banatvala & Pascal Bovet
The global agenda for NCD prevention and control & focus of the Seminar
Nick Banatvala & Pascal Bovet
9th WHO-IUMSP International Seminar on the Public Health Aspects of Noncommunicable Diseases
Lausanne, 4-8 May 2015

2. Key messages to date
NCDs are already leading health problems in almost all countries and their magnitude is still increasing
Shared risk factors
Premature deaths
The poor are disproportionately affected
Negative impact on socioeconomic development
As countries continue to develop, market forces will further promote unhealthy patterns.
Action is urgently needed

3. Focus on 4 NCDs and 4 common risk factors for NCDs
Tobacco use
Unhealthy diets
Physical inactivity
Harmful use of alcohol
Heart disease and stroke 
Diabetes
Cancer
Chronic lung disease
four groups of NCDs that constitute around 80%of NCD deaths and that share the same risk factors and therefore also the same strategies

4. Global Burden of Diseases: global mortality, 2004-2030
Intentional injuries
Other unintentional 25
Road traffic accidents
Other NCD 20
Cancers
Deaths (millions) 15
CVD 10
Mat//peri/nutritional 5
Other infectious
HIV, TB, malaria
2004
2015
2030
2004
2015
2030
2004
2015
2030
High-income
countries
Middle-income
countries
Low-income
countries

5. World Health Organization
27 September 2017
World Health Assembly in 2000: A clear vision on how to address NCDs
Surveillance
Mapping the epidemic of NCDs
Prevention
Reducing the level of exposure to risk factors
Management
Strengthen health care for people with NCDs
We know what we need to do at country level

7. WHO Global NCD Action Plan including a set of very-effective and affordable interventions ("best buys")

8. WHO Global Monitoring Framework on NCDs: 9 global NCD targets to be attained by 2025
A 25% relative reduction in risk of premature mortality from cardiovascular disease, cancer, diabetes or chronic respiratory diseases
At least a 10% relative reduction in the harmful use of alcohol
A 10% relative reduction in prevalence of insufficient physical activity
A 25% relative reduction in prevalence of raised blood pressure or contain the prevalence of raised blood pressure
A 30% relative reduction in prevalence of current tobacco use
A 30% relative reduction in mean population intake of salt/sodium
At least 50% of eligible people receive drug therapy and counselling to prevent heart attacks and strokes
Targets to be attained by 2025
Baseline: 2010
Accountability framework: Progress reports to the World Health Assembly in 2016, 2021 and 2026
An 80% availability of the affordable basic technologies and essential medicines, incl. generics, required to treat NCDs
Halt the rise in diabetes and obesity

9. WHO Global Monitoring Framework on NCDs: 25 outcome indicators
Mortality and Morbidity
Risk factors
National Systems Response
Unconditional probability of dying between the ages of 30 and 70 years from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases
Cancer incidence by type of cancer
Harmful use of alcohol (3)
Low fruit and vegetable intake
Physical inactivity (2)
Salt intake
Saturated fat intake
Tobacco use (2)
Raised blood glucose/diabetes
Raised blood pressure
Overweight and obesity (2)
Raised total cholesterol
Cervical cancer screening
Drug therapy and counselling
Essential NCD medicines and technologies
Hepatitis B vaccine
Human Papilloma Virus vaccine
Marketing to children
Access to palliative care
Policies to limit saturated fats and virtually eliminate trans fats
Total number of related indicators in brackets

10. United Nations General Assembly
2011 UN Political Declaration on NCDs
2014 UN Outcome Document on NCDs
Roadmap of 19 concrete national commitments, including one time-bound commitment:
By 2013, consider developing national multisectoral policies and plans
International commitments (completed):
By 2012, WHO to develop a global monitoring framework for NCDs, including global targets
By 2013, WHO to submit a progress report to the UN General Assembly
By 2014, UN General Assembly to convene a second High-level Meeting on NCDs
Reiterated the same roadmap of 19 national commitments, including four time-bound commitments:
By 2015, consider setting national targets
By 2015, consider developing national multisectoral policies and plans
By 2016, implement "best buys" to (i) reduce risk factors for NCDs and (ii) enable health systems to respond
International commitments:
By 2017, WHO to submit a progress report to the UN General Assembly
By 2018, UN General Assembly to convene a third High-level Meeting on NCD

11. Moving forward from global commitments to country action: a set of strategic interventions
By 2015, establish a high-level national multisectoral commission, agency or committee
By 2015, develop multisectoral action plan & set national targets for 2025
By 2016, implement “best buys” for prevention
Tobacco (MPOWER)
Diet (healthy nutrition in early life; salt and fat reduction)
Physical inactivity
Harmful use of alcohol
Governance
Risk factors
By 2016 , strengthen and orient health systems to address the prevention and control of NCD
integrate and finance interventions for early detection and management of NCD into essential primary care package
Implement the WHO framework on NCD surveillance
Integrate into the national health information systems
Strengthen human resources and institutional capacity
Health care
Surveillance

12. Examples of regional framework & process indicators

13. The way forward Surveillance Implement framework on surveillance
Vision: Global Strategy & UN Political Declaration Roadmap: Updated framework & process indicators
WHO Tools: Covering all areas
Governance
National targets and indicators Operational multisectoral action plans
Surveillance
Implement framework on surveillance
Prevention
Implement “best buys”
Health care
Implement “best buys”; strengthen PHC
So important work is still ahead of us to address the gaps in each of the four areas of the regional framework for action

14. Topics addressed during Seminar
Global situation of NCD
Major strategies to prevent and control NCDs & risk factors
Priority interventions (best buys)
Surveillance, global and national targets
Selected processes underlying implementation (governance, multisectoral action, leadership, etc)
Review of a number of tools and resources available to implement WHO Plan of Action
Build knowledge and skills to implement strategy and plan of action for NCD prevention and control at national level