1. Advances in Policy Observatory Chronic non-communicable diseases in Chile Advances in Policy Observatory Chronic non-communicable diseases in Chile Dr. María Cristina Escobar Non-communicable Diseases Department Prevention & Control of Diseases Division Undersecretary of Public Health Montreal, May 12, 2008

2. CONTENTS  Context  Purpose & Goals  Recommendations  Participants

3. CONTEXT International  Canada & Chile co-founders of the CARMEN network  PAHO´s Regional Strategy and Action Plan for Integrated Prevention & Control of NCDs including Diet, Physical Activity & Health  PAHO/PHAC Policy Observatory for NCDs

4. CONTEXT National  National Health Objectives for the decade 2000-2010: Mid-term evaluation  On-going Health Reform  New structure & roles within MOH  GES: Explicit guarantees regime in health  Burden of disease of NCDs in Chile

5. Opportunities  Political will to strengthen preventive actions: Preventive health examination & preventive interventions within GES conditions.  The proposal would be finished one year before the formulation of the National Health Objectives for the next decade 2010-2020.

6. Purpose & Goals  Effective integration of NCD prevention & control policies:  Health promotion and prevention of NCDs;  Treatment & care in the primary health level;  Strengthening population/public health policies for health promotion, health protection and action on social determinants. “Achieving greater integration in prevention and control of chronic non-communicable diseases in Chile”

7. Canada/Chile Policy Observatory Project Chronic, Non-communicable Diseases  Three stages  Stage 1: Canadian/PAHO delegation visit to Chile (December 2007)  Stage 2: Chilean delegation visits Canada (August 2008)  Stage 3: NCD policy dialogue External experts will review observations and recommendations from the first two stages to assist chileans in formulation of a comprehensive approach to NCD policy that will achieve a better balance between health promotion, prevention, treatment & care of NCDs. (to be determined)

8. RECOMMENDATIONS Stage 1  Integrated health plan based on the principles of PAHO Regional Strategy for NCDs, revision of National Health Objectives  Need strenghen public health competencies regarding NCD prevention at national and regional levels in support of population level approaches  Strengthen public health leadership at a regional level  Strengthen collaborative work between regional level & health services  Need for a set of indicators representing NCD prevention for Regional Public Health Plans.  Integrated individual and population based approaches & strategies for care and treatment of diabetes and cancer.

9. RECOMMENDATIONS (cont.) Stage 1  Improvement of information technology to support gathering, assembling and processing NCD and risk factor data to facilite easier access to health information and services for various users: general population, patients and health professionals.  Address NCD information system development through a phased approach.  Prioritize primary health care centres.  Standarize and streamline data collection process to meet requirements for GES, health statistics, program reports.  Develop a unified set of indicators that apply across the health sector that serve to link primary care with secondary and tertiary services (eg. avoidable hospitalizations)  Simplify, automate and disseminate more practical clinical guidelines for health professionals that allow more accurate diagnosis, better treatment and effective self-mangament.  Develop and disseminate patient education and self- management tools.

10. RECOMMENDATIONS (cont.) Stage 1  Optimize health promotion & health protection regarding risk factors  Examine tobacco, diet and physical activity in light of regulatory frameworks of what has been proven to be effective thus far and present multisector best practices.  Broaden the scope of GES to incorporate prevention and early detection measures/interventions.  Reorient human resources toward team work and prevention of risk factors  Strengthen the interdisciplinary team approach through health human resources training.

11. RECOMMENDATIONS (cont.) Stage 1  Strengthen the role of NGOs and civil society.  Increase effectiveness of collaboration between the various levels of MOH and existing NGOs (Juvenile Diabetes Association, Cancer Society) to improve their efforts in public education, patient education and patient self-management.  Activate physicians and medical societies to advocate for health promotion and health protection.

12. PARTICIPANTS  WHO Collaborating Centre on Chronic Disease Policy, Public Health Agency of Canada (PHAC):  Dr. Sylvie Stachencko  Ms. Lise Mathieu  Ms. Barbara Lewoski  Health Canada, International Affairs Directorate  Ms. Kate Dickson  Pan American Health Organization (PAHO)  Dr. Branka Legetic  Ministry of Health of Chile  Office of International Affairs: Dr. Osvaldo Salgado  Prevention & Control of Diseases Division: Dr. Pedro Crocco  Chronic Non-communicable Diseases Department: Dra. María Cristina Escobar and team  Public Health Policies Division: Dra. Helia Molina  Nutrition & Food Department: Dr. Tito Pizarro; Judith Salinas, Health Promotion Department  Primary Health Care Division, Dr. Hugo Sánchez  Planning Division, Dra. Ximena Aguilera  Epidemiology Department: Dr. Andrea Guerreo & Clelia Vallebuena