1. 1 Translation of Research Findings for Prevention and Control of NCDs Shanthi Mendis Chronic Disease Prevention and Management World Health Organization

2. 2 Translation of Research Findings (Evidence) into national NCD policies and programs in low- and- middle- income countries l Does evidence exist to inform NCD policies? l How can evidence be translated into policies?

3. Global mortality Major NCDs = Heart disease, Stroke, Cancer, Diabetes, asthma Cardiovascular diseases 30% Cancer 13% Other NCDs, injuries Other NCDs, injuries & mental health 18% Communicable maternal maternal infant 30% infant 30% Asthma/COPD7% Diabetes 2% 2%

4. 4 What research findings do we have ? Research has found the causes of major NCDs. Research findings on effective interventions that protect the population from NCDs address people with NCDs or at high risk These interventions have been effectively implemented in developed countries to reverse NCD trends.

5. 5 What are the evidence informed NCD Policies ? Promote physical Activity Promote fruits/vegetables intake Reduce salt and fat intake Control tobacco Early detection and management National NCD Policies

6. 6 Potential Impact of evidence based NCD policies l Reduce recurrent heart attacks and strokes 75% l Reduce mortality from heart disease 50% l Reduce mortality from cancer, asthma, COPD l Reduce health care costs l Reduce social and macroeconomic costs

7. Wider determinants of NCD Housing Employment Education & health literacy Environment For healthy living Protection of Health Primary health care Social determinants policies and programs

8. Projected Mortality Trends 2000-2030 Projected global deaths (2004-2030) Global Burden of Disease 2004 data Cancers Stroke Road traffic accidents HIV/AIDS TB Malaria Acute respiratory infections Ischaemic HD Perinatal

9. 9 Gap in Knowledge Translation l What are the challenges for evidence informed policy making? l What factors affect the policy environment ? l How can policy making be made more open to the influence of evidence ?

10. 10 Challenges l Intersectoral nature of NCD policies l Associated with the pressures of globalization l Constraints to knowledge translation control tobacco e.g. increase in tobacco tax reduce salt/fat intake e.g. agreement with food industry promote healthy eating e.g. regulate fast food chains increase fruits/vegetable intake e.g. agriculture subsidies

11. Per capita expenditure on health (International dollars ) Less than 50 $ 50 – 99 100-499 500-999 1000-1999 >2000 33 25 72 24 19 18 ExpenditureNumber of countries LMIC < 5% of GDP on health aim at 10-15%

12. 12 Evidence informed policy making Policy process Open process Players known Constraints identified Formal mechanisms for consultation Clear stages in decision making

13. 13 Political, Social, Economic and other Factors that influence policy making Agenda of donors Resource constraints Competing interests and priorities Governments that encourage policy debate Partnerships Networks Governance Legislation, mandatory regulations

14. The Need for Partnerships and Governance Food labelling Partnership with industry to reduce salt in processed food l Governance e.g. mandatory regulations or supervisory bodies

15. Partnerships are key l Causes/solutions often outside health systems l Need to look across society for the solutions l Work intersectorally across ministries l Alliances and coalitions, public/private

16. 16 Evidence informed NCD policies e.g. Loose networks Lobbying NGO or civil society groups Media Professional associations Community organizations Researchers Technocrats and civil Servants Evidencemakers Need for Knowledge brokers Policymakers

17. l Support evidence informed policy making Improve Health Literacy - Improve Health Literacy - Helping People to: New ways to engage people so that they can influence policy – Empowerment of the community Radio Radio Internet Internet Mobiles Mobiles Interactive TV Interactive TV

18. 18 How can networks Influence policy process ? Policy Process Media and Civil Society networks Agenda settingAdvocacy Policy formulationCollaborate in discussion ImplementationEnhance policy communication EvaluationCollect evidence on problems

19. 19 Need to Strengthen Country Capacity For Broader Intersectoral Approaches to Research and Knowledge Translation that goes beyond the health sector Source: Potter and Brough (2004). Structures, systems roles Staff and infrastructure Skills Tools Enableeffective use of… Enableeffective Enableeffective Require… Require… Require…

20. 20 World Health Organization Tools for translation of evidence into policies l Action Plan for Prevention and Control of NCD l Framework Convention on Tobacco Control l Global Strategy for Diet, Physical activity and Health Primary Care Package of Essential NCD interventions

21. 21 Conclusions Requirements for prevention and control of NCDs l Broader intersectoral approaches to research l Translation of research findings into policies l Recognition of the widespread failure to implement evidence-based Health Interventions

22. 22 ConclusionsConclusions For prevention and control of NCDs we need l To find better ways for evidence informed policy making l Partnerships to support intersectoral policies l Networks to link researchers and technocrats l Strong role of the State and better governance l Knowledge translation that goes beyond the health sector

23. Health in all Policies