1. Review of NCDs: Current Situation &Future Prospect
Orratai Waleewong
Health Promotion Policy Research Center (HPR)
International Health Policy Program (IHPP), Thailand

2. Global Epidemic of NCDs NCDs and Socio-economic development
Outline
Global Epidemic of NCDs
NCDs and Socio-economic development
Poverty and productivity
MDGs
Global movement on NCDs
Best Buy Intervention: Policy and intervention to prevent and control NCDs

3. Global Risks Landscape 2013 (World Economic Forum)
The Dangers of Hubris on Human Health
Impact if the risk were to occur
Likelihood to occur in the next

4. Global Epidemic of NCDs
NCDs caused  36 million deaths (60 %) of global deaths (2008)
 80% of these occur in developing countries
Annual number of deaths in the world
25 million
Low-income countries
6.8 M
13.6M
3.7M
2.3M
Injuries
Other deaths from NCDs
20 million
Lower middle-income
2.3M
10.2M
3.3 M
3.0M
Premature deaths from NCDs (below age of 60), which are preventable
15 million
10 million
Communicable diseases, maternal, perinatal and nutritional conditions
High-income countries
5.9M
0.9M
0.5M
0.6M
Upper middle-income
3.0M
1.1M
3.3M
Source: The Global Burden of Disease 2004

5. 10 leading diseases & injuries and 10 leading risk factors based on percentage of global deaths and DALYs, 2010.
NCDs account for 65.5% of all deaths, 54% of DALYs
Source: Institute for Health Metrics and Evaluation, ‘The Global Burden of Disease: Generating Evidence, Guiding Policy: 2012.

6. NCDs mortality by countries (2008 estimates)
% NCD deaths
(all ages)
% NCD deaths under age 60
Males
Female
Australia 90
13.4
9.2
Bangladesh 52
37.5
38.7
Bhutan 53
32.5
32.6
China 83
22.8
17.4
India
38.0
32.1
Indonesia 64
33.9
26.3
Japan 80
11.6
7.0
Myanmar 40
32.4
Thailand 71
32.3
25.0
Vietnam 75
26.4
19.4
World Health Organization - NCD Country Profiles , 2011.

7. Poverty contributes to NCDs and NCDs contribute to poverty

8. NCDs undercut the attainment of the MDGs
Poverty: Household income is spent on health care for NCDs, medicines, tobacco and alcohol use
Hunger: Underweight children and overweight adults are often found in the same households
Maternal health: Malnutrition increases the risk of gestational diabetes and poor maternal health, high prevalence of cervical cancer (300,000 a year)
Child health: Malnutrition in pregnancy is associated with a vulnerability to obesity, cardiovascular disease and diabetes later in life
Education: NCD-related costs displace household resources for education
HIV/AIDS: Increases the risk of cancers, and ARVs increase the risk of cardiovascular diseases
Tuberculosis: Tobacco and alcohol use, and diabetes are associated with TB deaths
Essential drugs: Cost-effective medicines to treat NCDs are available in low-cost generic forms, but remain inaccessible and unaffordable to most who need them
NCDs hamper the achievement of MDGs. 8

9. Cost of inaction Vs Cost of action
The cumulative economic lost output in developing countries associated with NCDs
US$ 7 trillion
over
US$ 500 billion per year
US$ 25 in LICs, 50 in LMICs & 139 in UMICs
The average cost for LMICs to scale up action by implementing the “best buy interventions”
US$ 170 billion
for
US$ 11.4 billion per year
US$1 per capita in LICs, 1.5 in LMICs & 3 in UMICs

10. 4 NCDs X 4 common risk factors
Tobacco use
Harmful use of alcohol
Unhealthy diet
Physical inactivity
4 Risk factors
Chronic respiratory disease
4 NCDs
Cardiovascular disease
Diabetes
Cancers

11. What is driving the NCD epidemic?
Social Determinants
of Health 11

12. Global action against NCDs
Political Declaration on NCDs
UNGA High-level Meeting on the prevention and control of NCDs A/RES/66/2
Doha Declaration on NCD & Injuries
ECOSOC
2009
WHO Global Status Report on NCDs
Global Strategy for the Prevention and Control of NCDs
WHA53.17
WHA61.14
Action Plan on the Global Strategy for the Prevention and Control of NCDs
Moscow Declaration
WHA64.11
WHA60.23
Implementation Global Strategy
WHA66.10
2003
WHA56.1
Global Strategy on Diet,
Physical Activity and Health
WHA57.17
Global Strategy to Reduce the Harmful Use of Alcohol
WHA63.13
WHA63.14
Marketing of food &
non-alcoholic beverages to children
2004
A Comprehensive global monitoring framework
Global Action Plan
Options & timeline for strengthening and facilitating multisectoral action
2000
2007
2008
2010
2011
2013 12

13. UN High-level Meeting on NCDs
(19-20 September 2011, New York)
It was only the 2nd time in history that the UN General Assembly discussed a health issue
113 Member States
34 Presidents & Prime-Ministers
3 Vice-Presidents & Deputy Prime-Ministers
51 Ministers of Foreign Affairs and Health
11 Heads of UN Agencies 100s of NGOs
Political Declaration on NCDs (A66/RES/2)

14. UNGA High-level Meeting on the prevention and control of NCDs
Political Declaration on NCDs (A66/RES/2)
Establish multisectoral national plans by 2013
Integrate NCDs into health-planning processes and the national development agenda
Promote multisectoral action through whole-of-government approaches
Set national targets and measure results
Increase domestic resources
Head quarter
WHO Regional Offices
Member states
Develop a global monitoring framework and targets
Develop a global implementation plan
Provide technical support to developing countries
Identify options for multisectoral actions
Coordinate work with other UN Agencies
Measure results and report

15. World Health Organization (WHO)
Vision:
The promotion of equity, universal access,
and self-reliance in health development
Strategies to deliver on this vision:
Health systems and capacity building
NCDs, mental health & disabilities
Health security
Health development for poverty reduction (by
accelerating MDGs)
Improving access to medical products
Improving performance through reform

16. WHO reform: Global Programme of Work (Draft 12th)

17. Rio+20 United Nations Conference on Sustainable Development [June 2012]
“ We understand the goals of sustainable development can only be achieved in the absence of a high prevalence of debilitating communicable and NCDs, and where populations can reach a state of physical, mental and social well-being. ” (paragraph 138)
“ We acknowledge that the global burden and threat of NCDs constitutes one of the major challenges for sustainable development in the 21st century. ” (paragraph 141)

18. UN Task Team on the post-2015 UN development agenda [June 2012]
“ The MDGs did not adequately address … increase in NCDs . ” (paragraph 19) “ Priorities for social development and investments in people would include: … NCDs. Access to sufficient nutritious food and promotion of healthy life styles with universal access to preventive health services will be essential to reduce the high incidence of NCDs diseases in both developed and developing countries” (paragraph 67)

19. Global Action Plan for the Prevention and Control of NCDs 2013–2020
Objectives
To raise the priority accorded to the prevention & control of NCDs in global, regional and national agendas and internationally agreed development goals, through strengthened international cooperation and advocacy
To strengthen national capacity, leadership, governance, multisectoral action and partnerships to accelerate country response for the prevention & control of NCDs
To reduce modifiable risk factors for NCDs and underlying social determinants through creation of health-promoting environments
To strengthen and orient health systems to address the prevention & control of NCDs and the underlying social determinants through people-centred primary health care and universal health coverage
To promote and support national capacity for high-quality research and development for the prevention & control of NCDs
To monitor the trends and determinants of NCDs and evaluate progress in their prevention & control

22. , but implementation in developing countries is still weak
NCDs is preventable !
The package of low-cost "best buys" interventions exist
, but implementation in developing countries is still weak

23. Implementing low-cost workable solutions in developing countries could prevent most premature deaths from NCDs
2/3 + 1/3
Implementing cost-effective interventions that reduce exposure to NCDs risk factors of populations will contribute up to 2/3 of the reduction in premature mortality.
In addition, health systems that respond more effectively and equitably to the health-care needs of people with NCDs can reduce premature mortality by another 1/3 up to 1/2.

24. Population-based interventions addressing NCD risk factors: “Best buy” & “Good buy” interventions
Tobacco use
Protect people from tobacco smoke
Warn about the dangers of tobacco
Enforce bans on tobacco advertising
Raise taxes on tobacco
Offer counseling to smokers
Harmful use of alcohol
Restrict access to retailed alcohol
Enforce bans on alcohol advertising
Raise taxes on alcohol
Enforce drink-driving laws (breath-testing)
Offer brief advice for hazardous drinking
Unhealthy diet
Reduce salt intake
Replace trans-fat with polyunsaturated fat
Promote public awareness about diet
Restrict marketing of food& beverages to children Replace saturated fat with unsaturated fat
Manage food taxes & subsidies
Offer counseling in primary care
Provide health education in worksites
Promote healthy eating in schools
Physical inactivity
Promote physical activity (mass media)
Promote physical activity (communities)
Support active transport strategies
Promote physical activity in worksites
Promote physical activity in schools
Infection
Prevent liver cancer via hepatitis B vaccination

25. >> integrate into primary health care
Individual-based (Health care) interventions addressing NCD risk factors: “Best buys”
Risk factor
Best buy
Good buy
Cardiovascular disease (CVD)
& diabetes
Counseling & multidrug therapy (including glycemic control for DM) for people (≥30 years), with 10-year risk of fatal or nonfatal cardiovascular events ≥ 30%
Aspirin therapy for acute myocardial
infarction
Counseling & multidrug therapy (including glycemic control for DM) for people ( ≥ 30 years), with a 10-year risk of fatal and nonfatal cardiovascular events ≥ 20%
Cancer
Cervical cancer screening (VIA), &
treatment of pre-cancerous lesions to prevent cervical cancer
Breast cancer – treatment of stage I
Breast cancer – early case-finding through biennial mammographic screening (50–70 years) & treatment of all stages
Colorectal cancer-screening at age 50 and treatment
Oral cancer – early detection and treatment
Respiratory
disease
Treatment of persistent asthma with inhaled corticosteroids and beta-2 agonists
Early detection & care, using cost-effective & sustainable health-care interventions
>> integrate into primary health care

26. Orratai Waleewong, B.Pharm, MSc
Health Promotion Policy Research Center (HPR)
International Health Policy Program (IHPP)