1. contact : galeag @ who.int
&
ncd intersectoral action
contact : who.int

2. ncd
sdh
dev

3. threesteps
sir george alleyne

4. specificity of purpose identification of specific resources
threesteps
mutuality of interest
specificity of purpose
identification of specific resources

5. sustainable development
a range of interests
globalisation
health systems
sustainable development
specific populations
fiscal instruments
synergies with a.t.m.
urban planning
children, mothers
food trade
public policy & health systems
climate change
gender equity
intervention points e.g. prsp
education
ageing

6. adelaide statement

7. adelaide statement tools and instruments
inter-ministerial and inter-departmental committees
cross-sector action teams
integrated budgets and accounting
cross-cutting information and evaluation systems
joined-up workforce development
community consultations and Citizens’ Juries
partnership platforms
Health Lens Analysis
impact assessments
legislative frameworks

9. identifying mutual interest [example 1]
ncd and tb

10. current trend (0.5%) extrapolated
global plan | tb not eliminated by 2050
10000
current trend (0.5%) extrapolated
1000
100
global plan prediction incidence falls 5-6% per year
incidence/million/yr 10
desired trend
elimination target: 1 / million / year by 2050 1
1990
2000
2010
2020
2030
2040
2050

11. population attributable fraction selected risk factors
relative risk for active tb disease
weighted prevalence
(22 HBCs)
population attributable fraction
hiv infection
8.3
1.1% 7%
malnutrition
3.0
17.2%
25%
diabetes
3.0
3.4% 6%
alcohol use (>40g / d)
2.9
7.9%
13%
active smoking
2.6
18.2%
23%
indoor air pollution
1.5
71.1%
26%
source: lönnroth k, raviglione m. global epidemiology of tuberculosis: prospects for control. semin respir crit care med 2008; 29: 

12. additional tb intervention entry points
improving access and early case finding:
target risk populations: poor people, urban slums, vulnerable groups
target "clinical risk groups": hiv, smokers, malnourished, diabetics, alcoholics
risk factors: within health system
managing comorbidities within ntps: hiv, smoking, nutrition, diabetes, alcohol, etc
integrated management and preventive actions within phc (part of hss agenda)
determinants: beyond the health system
joint across priority public health conditions
action within ntps: poverty reduction and improved living conditions among tb patients
advocate for social change: ntps, the stop tb partnership, activists, civil society

13. specificity of purpose [example 2]
ncd & transport

14. Transport: a common upstream cause of many risks to health
Physical inactivity → 1.9 million deaths
Traffic injuries → 1.2 million deaths
Ambient air pollution → 800,000 estimated deaths in cities
Climate Change → over 150,000 deaths
Noise – annoyance, learning issues for children
Networks of support, urban quality of life
Slide by: Carlos Dora, WHO

15. Slide by: Carlos Dora, WHO
Health sector response: disconnected, little understanding of co-benefits from policy decisions
Noise
TRAFFIC INJURIES
PHYSICAL
INACTIVITY
AIR POLLUTION
CLIMATE CHANGE
Slide by: Carlos Dora, WHO

16. What are the issues identified by the other sector?
Stakeholders analysis
NGOs – car dependency, no support for walking and cycling or public transport
Environmentalists worried about externalities
Transport sector concerned with traffic congestion
International agencies slow negotiations on transport and environment (OECD, UNECE)
EEHC agreed to support focus on THE (Austria, Denmark, Netherlands, Switzerland...)
Slide by: Carlos Dora, WHO

17. Why should governments act?
To make optimal decisions in view of competing points of view
Car and Road lobby: “Benefits outweigh the Costs, the health burden is a price societies pay for mobility and convenience they enjoy.”
Health & Environment: “Healthy transport can improve public health, safeguard the environment, enhance access and the economic vitality of cities”
Those using/benefiting from transport do not pay for all its costs
With no intervention the level of road use will be higher than socially optimal, as the costs for society exceed the costs for the road user.
Slide by: Carlos Dora, WHO

18. To give a voice to groups excluded from decision making
Children are vulnerable to injuries, air pollution and noise, their cognitive and physical development require exploration of the neighbourhood and outdoor activity.
Children and other vulnerable groups are exposed to risks from traffic but enjoy few benefits from it.
These groups often do not have a voice to influence decisions. Governments need to be that voice.
Slide by: Carlos Dora, WHO

19. To promote health equity
Exposure to health risks depends on mode of transport used
Need to ensure safety of people using all modes
Pedestrians and cyclists do not cause pollution, contribute to reducing traffic congestion, will use health services less and be more assiduous to work, but are exposed to health risks caused by motor vehicle users (injuries, pollution)
Car uses much more space per person transported
Road space is limited
And yet, policies are made for the car user
Transport policies should focus on reducing the risks that affect the poor as a way to reduce inequalities in health and as a means of poverty reduction
Slide by: Carlos Dora, WHO

20. Slide by: Carlos Dora, WHO
Tools
Scenarios
Case studies
Health impact assessment
Evidence clearinghouse
Guidance for economic assessment
Performance standards
Slide by: Carlos Dora, WHO

21. intersectoral mechanisms/instruments for implementing hiap
formal consultations on e.g. legislation
horizontal public health committees (legal base)
ad hoc committees on specific initiatives
public health reporting (with co-operation of other sectors, legal base)
formal communication between sectors (e.g. bilateral meetings of permanent secretaries)
informal contacts at desk level
impact assessment (integrated/health)
Slide by: Timo Ståhl, THL

22. ncd
thank you
sdh
dev