first informal consultation with member states and un ......control, the rio declaration on social...

First Informal Consultation with Member States and UN Agencies on the Development of an Updated Global Action Plan for the Prevention and Control of NCDs (2013 to 2020) (Geneva, 16-17 August 2012)

Co-Chair Dr Oleg Chestnov Assistant Director-General for NCDs and Mental Health World Health Organization

To review the political relevance of the 2008 to 2013 Action Plan, identify the main strengths and weaknesses, and strategic lessons learned.

To identify new challenges, opportunities and recommended actions for Member States, UN agencies, international partners and the WHO Secretariat

To discuss the role of Member States, UN agencies, international partners and the WHO Secretariat in the preparatory process leading to World Health Assembly in May 2013 where the final draft 2013 to 2020 Action Plan will be considered by Member States.

Scope and purpose of the first informal consultation

Consensus on the strengths and weaknesses of the 2008 -2013 Action Plan

Common understanding on how the external environment has changed and its implications for the 2013-2020 Action Plan

Consensus on the goal and objectives of the 2013-2020 Action Plan

Recommendations on the structure of the 2013-2020 Action Plan, including links with regional and country initiatives

Ideas generated on ways to effectively articulate the role of Member States, UN agencies, international partners and the WHO Secretariat

Expected outcomes of the first informal consultation

World Health Assembly resolution WHA64.11

REQUESTS THE DIRECTOR-GENERAL TO:

(4) to report to the Sixty-fifth World Health Assembly, through the Executive Board, on the outcomes of the first Global Ministerial Conference on Healthy Lifestyles and NCD Control and the high-level meeting, and to develop, together with relevant United Nations agencies and entities, an implementation and follow-up plan for the outcomes, including its financial implications, for submission to the Sixty-sixth World Health Assembly, through the Executive Board.

(24 May 2011)

2. REQUESTS the Director-General:

(4) to develop, in a consultative manner, a WHO action plan for the prevention and control of NCDs for 2013–2020, building on lessons learnt from the 2008–2013 action plan and taking into account the outcomes of the High-level Meeting of the United Nations General Assembly on the Prevention and Control of NCDs, the Moscow Declaration on Healthy Lifestyles and NCD Control, the Rio Declaration on Social Determinants of Health, building on and being consistent with existing WHO strategies and tools on tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity;

(20 January 2012)

WHO Executive Board resolution EB130.R7

2. REQUESTS the Director-General:

(5) to build on work from the 2008–2013 action plan, which, inter alia, called for WHO to provide support to countries in enhancing access to essential medicines, to facilitate engagement by governments and, as appropriate, civil society and the private sector with appropriate safeguards against conflict of interest, in accordance with relevant paragraphs of the Political Declaration on NCDs, for improved access to medicines;

(6) to submit to the Sixty-sixth World Health Assembly, through the Executive Board, a WHO action plan for the prevention and control of NCDs for 2013–2020 for consideration and possible adoption. (20 January 2012)

WHO Executive Board resolution EB130.R7

THE SIXTY-FIFTH WORLD HEALTH ASSEMBLY,

DECIDED to adopt a global target of a 25% reduction in premature mortality from NCDs by 2025

(26 May 2012)

World Health Assembly decision WHA65(8)

South-East Asia

24-26 April 2012

Yangon, Myanmar

Americas

7-8 May 2012

Brasilia, Brazil

Eastern Mediterranean

30 June – 2 July 2012

Cairo, Egypt

Western Pacific

11-14 June 2012

Kuala Lumpur, Malaysia

Europe

28-29 June 2012

Almaty, Kazakhstan

Africa

(Pending)

Process: Steps to date Regional consultations based on a WHO Discussion Paper

2012

• 26 July 2012 – 7 September 2012: Web-based consultation for Member States, UN Agencies, NGOs and private sector entities (WHO Discussion Paper)

2012

• 16-17 August 2012: First informal consultation with Member States and UN Agencies (WHO Discussion Paper)

2012

• 1 November 2012: Second informal consultation with Member States and UN Agencies ('Annotated Zero Draft' Action Plan)

2013 • January 2013: Executive Board (Annotated Draft Action Plan)

2013

• February 2013: Third informal consultation with Member States and UN Agencies (Draft Action Plan)

2013 • May 2013: World Health Assembly (Final Draft Action Plan)

Process: Next steps

Co-Chair Dr Anu Garg Joint Secretary Ministry of Health and Family Welfare India

First presentation Dr Douglas Bettcher Director, Department of Tobacco Free Initiative Director AI, Department of Chronic Diseases and Health Promotion World Health Organization

Key points to bear in mind as we develop the 2013-2020 Action Plan

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

WHO Director-General's vision for WHO

NCDs and their risk factors Mental health conditions Violence and injury prevention Disability Nutrition

IMP

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TC

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EG

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IES

P

RIO

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WHO reform: Draft 12th Global Programme of Work

Modifiable common risk factors for NCDs

Tobacco use Unhealthy

diets

Physical

inactivity

Harmful use

of alcohol

No

nc

om

mu

nic

ab

le

dis

ea

se

s

Heart

disease and

stroke

Diabetes

Cancer

Chronic

lung disease

NCDs = 4 diseases + 4 risk factors

14.2 million people die every year from an NCD between the ages 30 and 70: Most of these premature deaths could have been prevented

0

5,000,000

10,000,000

15,000,000

20,000,000

25,000,000

0-29 30-69 70-80+

Communicable, maternal,perinatal and nutritionalconditions

Noncommunicable diseases

Injuries

73%

12% 15%

19%

69%

12% 10%

86%

4%

High-income countries

2.0 million (14%)

Upper middle-income countries

2.3 million (16%)

Lower middle-income countries

8.3 million (59%)

Low-income countries

1.5 million (11%)

86% of people who die from NCDs between the ages of 30 and 70 live in a developing country

Huge disparities exist across countries in relation to the probability of death from an NCD between the ages of 30-70

0% 10% 20% 30% 40% 50% 60% 70%

Japan

San Marino

Switzerland

Iceland

Australia

Italy

Cyprus

Andorra

Israel

Sweden

World

Swaziland

Kyrgyzstan

Cote d'Ivoire

Malawi

Afghanistan

Kazakhstan

Tuvalu

Turkmenistan

Nauru

Marshall Islands

A rapidly rising epidemic in developed and developing countries …

… with serious socio-economic impacts, particularly in developing countries.

Workable solutions exist to prevent most premature deaths from NCDs and mitigate the negative impact on development.

The way forward: these solutions need to be mainstreamed into programmes promoting economic growth and poverty reduction.

The problem is so enormous that the UN Secretary-General is now involved

A package of low-cost "best buys" interventions exist, but implementation in developing countries is still weak

Interventions NCDs and risk factor Best buys

Population-based interventions addressing NCD risk factors

Tobacco use Tax increases smoke-free indoor workplaces and public places health information and warnings about tobacco bans on advertising and promotion

Harmful use of alcohol Tax increases on alcoholic beverages; Comprehensive restrictions and bans on alcohol marketing; Restrictions on the availability of retailed alcohol

Unhealthy diet and physical inactivity

Salt reduction through mass media campaigns and reduced salt content in processed foods;

Replacement of trans-fats with polyunsaturated fats Public awareness programme about diet and physical activity

Individual-based interventions addressing NCDs in primary care

Cardiovascular disease and diabetes

Drug therapy and counseling to prevent heart attacks and strokes, including those with established cardiovascular diseases (including glycaemic control for diabetes mellitus)

Providing aspirin to people having an acute heart attack

Cancer Prevention of liver cancer through hepatitis B immunization Prevention of cervical cancer through screening and

treatment of pre-cancerous lesions

Hig

h-l

evel

Meeti

ng

113 Member States

34 Presidents and Prime-Ministers

3 Vice-Presidents and Deputy Prime-Ministers

51 Ministers of Foreign Affairs and Health

11 Heads of UN Agencies

100s of NGOs P

oli

tical D

ecla

rati

on

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

Wh

at

WH

O is d

oin

g

Develop a global monitoring framework and targets

Develop a global implementation plan 2013-2020

Provide technical support to developing countries

Identify options for partnerships

Coordinate work with other UN Agencies

Measure results

UN High-level Meeting on NCDs (New York, 19-20 September 2011)

World Health Assembly in May 2012: Decided to adopt a global target of a 25% reduction in premature mortality from

noncommunicable diseases by 2025

Provide technical assistance to low- and middle-income countries to support national efforts to address NCDs

Develop a comprehensive global monitoring framework, including indicators, and a set of voluntary global targets

Develop a 2013-2020 Global NCD Action Plan

Develop options for multisectoral action for the prevention and control of NCDs through effective partnerships

Exercise WHO's leadership and coordination role in relation to the work of UN Agencies and development banks

Implement WHO-wide work plan 2012-2013 on NCDs and develop Programme Budget 2014-2015

High-level Meeting of the UN General Assembly on NCDs Now important for WHO too:

US$ 170B is the overall cost for all developing countries to scale up action by implementing a set of "best buy" interventions between 2011 and 2025, identified as priority actions by WHO

US$ 7T is the cumulative lost output in developing countries associated with NCDs between 2011-2025

Reports are available at www.who.int/ncd

Huge disparities exist between the cost of action vs. inaction in low- and middle-income countries over the next 15 years

Political Declaration on NCDs We [Heads of State and Government] therefore commit to:

45.c According to national priorities, and taking into account domestic circumstances, increase and prioritize budgetary allocations for addressing NCD risk factors and for surveillance, prevention, early detection and treatment of NCDs and the related care and support, including palliative care;

45.d Explore the provision of adequate, predictable and sustained resources, through domestic, bilateral, regional and multilateral channels, including traditional and voluntary innovative financing mechanisms;

Domestic financing to support national NCD efforts remains low

Thailand's Health Promotion Foundation – Receives revenue from national 2% surcharge on revenue of

producers of alcohol and tobacco products

Egypt's tobacco tax increase – At least a third of additional revenues from 2010 tax increase

to fund National Health Insurance

Mongolia and Thailand's alcohol tax – Revenues used for domestic health financing

Domestic financing to support national NCD efforts remains low Opportunities to increase taxation on tobacco and alcohol

"The potential to increase taxation on tobacco and alcohol exists in many developing countries. Even if only a portion of the proceeds were allocated to health, access to services would be greatly enhanced."


Assessing national capacity for the prevention and control of NCDs (WHO 2010 Global Survey)

Policies:

92% of countries have developed at least one policy, plan, or strategy to address NCDs and/or their risk factors.

79% have at least one operational policy and only

71% have at least one operational policy with dedicated funding.

Major sources of funding:

84% of countries: government revenues

56% of countries: international donors (56%),

39% of countries: health insurance (39%)

20% of countries: earmarked taxes (20%)


The Solidarity Tobacco Contribution (STC)

Available at www.who.int/ncd


The Solidarity Tobacco Contribution

A new innovative financing mechanism that builds on national taxes

A WHO-developed concept:

– Follows recommendation of the 2009 High-Level Task-Force on Innovative Financing for Health Systems: feasibility study

– Builds upon existing tobacco tax excise systems in Member States

– Complementary to need to increase national tobacco excise taxes (and not a substitute for large increases in national tobacco taxes) for public health purposes


20

09

The rationale for the Solidarity Tobacco Contribution: Recommendation: “Expand the mandatory solidarity levy on airline tickets and explore the technical viability of other solidarity levies on tobacco and currency transactions”


WHO developed suggestions to implement the recommendation:

Earmarking tobacco taxes for international aid: If all G20+ countries were to devote a small tobacco levy for each pack of cigarettes sold, WHO estimates that an additional

US$5.5 billion could be generated each year.

$0.05 for high-income G-20+ countries: US$3.1B

$0.03 for middle-income G-20+ countries: US$1.2B

$0.01 for low-income G-20+ countries: US$1.2B

Domestic financing to support national NCD efforts remains low

Opportunities to increase taxation on tobacco and alcohol

Innovation With Impact Financing 21st Century Development A report by Bill Gates to G20 leaders Cannes Summit, November 2011

G-20 Cannes Summit


82. We agree that, over time, new sources of funding need to be found to address development needs. We discussed a set of options for innovative financing highlighted by Mr Bill Gates, such as Advance Market Commitments, Diaspora Bonds, taxation regime for bunker fuels, tobacco taxes, and a range of different financial taxes. Some of us have implemented or are prepared to explore some of these options. We acknowledge the initiatives in some of our countries to tax the financial sector for various purposes, including a financial transaction tax, inter alia to support development.


$0.01

$0.06

$0.10

$0.42

$0.92

$0.93

$3.90

$0.06

$0.21

$0.22

$0.23

$0.24

$0.33

$0.45

$0.53

$0.80

$1.14

$1.16

$1.33

$1.65

$7.40

Water Education/Training

Water Resources Protection

River Development

Waste Management/Disposal

Basic Drinking Water Supply & Sanitation

Water resources policy/admin. mgmt

Water Supply/Sanitation - Large Systems

Health Education

Medical Education/Training*

Medical Research

Basic Health Infrastructure

Medical Services

Basic Nutrition

Tuberculosis Control

Family Planning

Malaria Control

Basic Health Care

Reproductive Health

Infectious Disease Control

Health Policy & Admin. Management*

HIV/AIDS & STDs*

Health ODA Commitments (2007) in US$ billions

Total health ODA: $22.1 billion

Health ODA for NCDs:

?

Bilateral and multilateral financing to support national NCD efforts remains low

NCDs are integrated in bilateral ODA policies:

Australia (AusAID)

Denmark

EC/DG Dev (EuropeAid)

France

Germany

Luxembourg

Norway

Switzerland

UK (DFID)

Exploring:

Japan (JICA)

Others

Recent developments: Bilateral donors have started to integrate NCDs into ODA policies

“ 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 twenty-first century. ” (paragraph 141)

Rio+20: "NCDs constitute one of the major challenges for sustainable development"

“ 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)

UN Task Team on the post-2015 UN development agenda: NCDs is a priority for social development and investments in people

2000

2003

2004

2008

Global Strategy for the Prevention and

Control of Noncommunicable Diseases

Global Strategy on Diet,

Physical Activity and Health

Action Plan 2008-2013 on the Global Strategy for the

Prevention and Control of NCDs

2010

2009

2011

Global Strategy to Reduce

the Harmful Use of Alcohol

WHO Global Status

Report on NCDs

Political Declaration on NCDs

2013

2020

The World Health Assembly has requested WHO to develop a 'WHO Action Plan for the Prevention and Control of NCDs for 2013-2020'

WHO Action Plan for the Prevention and Control of NCDs for 2013-2020

Jan-May 2012 EB/WHA

27 August 2012

WHO Action Plan for the prevention and control of NCDs

for 2013-2020

Jan-May 2013 EB/WHA

WHO's input into SG's report on options for strengthening and

facilitating multisectoral action for the prevention and control of NCDs through effective partnership

Sep 2013

2014 GA

Comprehensive review and assessment of the progress

achieved in the prevention and control of NCDs

Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of NCDs

(resolution A/RES/66/2)

WHO's input into SG's report on the progress achieved in realizing the commitments

made in the Political Declaration

Final progress report on implementing the 2008-2013

action plan

Jan-May 2014 WHA

Development of a global monitoring framework and

targets for NCDs

Options and a time line for multisectoral action through

partnerships

Global monitoring framework, indicators and and targets for

NCDs

WHO Global Status Report on NCDs (2013)

2014

SG's report on options for strengthening and facilitating multisectoral action for the

prevention and control of NCDs through effective partnership

Nov/ Dec 2012

Formal consultation with Member States to conclude the work on a global

monitoring framework and targets

5-7 Nov 2012

SG's report on the progress achieved in realizing the

commitments made in the Political Declaration

Dec 2013

1st informal consultation on action plan

2nd informal consultation on action plan

Timelines

3rd informal consultation

on action plan

16-17 Aug

1 Nov

Feb/Mar 2013

Second presentation Dr Shanthi Mendis Coordinator, Chronic Diseases Prevention and Management Department of Chronic Diseases and Health Promotion World Health Organization

Feedback from recent regional consultations on the development of the 2013-2020 Action Plan

1. Integrating NCD prevention into the development agenda, and into policies across all government departments

2. Establishing/strengthening national policies and programmes

3. Reducing/preventing risk factors

4. Prioritizing research on prevention and health care

5. Strengthening partnerships

6. Monitoring NCD trends and assessing progress made at country level

2008-2013 Action Plan for the Global Strategy for the Prevention and Control of NCDs

Focussed effort to combat 4 diseases and 4 risk factors

Growing awareness of the challenge of epidemic proportions: WHO Global Status Report on NCDs

Recognition that NCDs cannot be addressed by one sector only

Increase in number of national NCD plans and programmes

Increase in NCD surveillance and monitoring

'How to' tools to address risk factors: WHO FCTC, DPAS, Alcohol, Marketing

'How to' tools to strengthen health systems: PEN

Increased evidence base: best buys, global price tag and costing tool

Focused research: prioritized NCD research agenda

Collaborative partnerships: NCDnet, Moscow Forum on NCDs, regional and national partnerships

2008-2013 Action Plan: Successes

Weak overall national capacity

Commitments in low- and middle-income countries have rarely translated into multisectoral action at scale

Insufficient domestic budgetary allocations for addressing NCDs in most low- and middle-income countries

Insufficient provision of resources through bilateral and multilateral channels to support low- and middle-income countries

Lack of policy coherence across national NCD policies and plans

Surveillance often not integrated into national health information systems

NCDs are not integrated into health-planning processes in the majority of low- and middle-income countries

Weak primary health care approach

WHO has limited capacity and ability to respond to requests for technical assistance

2008-2013 Action Plan: Shortcomings and challenges

Political : Heads of State and Government have recognized the:

o Primary role and responsibility of governments in responding to NCDs o Need for sustainable financing for the scale up of NCD prevention and control

country level, including through voluntary innovative financing mechanisms Global target to reduce premature mortality from NCDs by 25% in 25 Technical: Package of "Best Buys" NCD interventions Cost of action Global monitoring framework (under development) Voluntary global targets (under development) Rapidly increasing demand for upstream policy advice and sophisticated technical

assistance and capacity-building Stakeholders: Ministries of Health, and ministries outside the health sector with an interest in NCDs NGOs Private sector entities

Changing landscape: What is new?

Provide guidance and propose actions on 'how to':

Accelerate national responses

Promote advocacy, strategic communication and public awareness raising

Integrate NCDs into the development agenda

Integrate NCDs into health-planning processes and health system strengthening

Create synergies between NCD policies and plans and other programmes

Advance the implementation of the NCD "Best Buys" interventions

Reduce exposure of population and individuals to risk factors

Focus on prioritized research and development

Give greater priority to surveillance and monitoring

Take into account the current challenges of our time: The global financial crisis

Advance multisectoral action for the prevention and control of NCDs

Advance multisectoral action through effective partnerships

Strengthen and harmonize the work of UN agencies to address NCDs

Development of the 2013-2020 Action Plan: Recommendations resulting from regional consultations

Further specify:

Role and prioritize the actions for the WHO Secretariat

Structure of the 2013- 2020 Action Plan

Proposed objectives of the 2013-2020 Action Plan

Roles and responsibilities of international partners and the private sector

Development of the 2013-2020 Action Plan: Recommendations resulting from regional consultations

Development of the 2013-2020 Action Plan: Proposed architecture: taking individual country needs as a starting point

VISION A world free of preventable NCDs, premature deaths and avoidable disability GOAL 25% reduction in premature mortality from NCDs by 2025 STRATEGIC DIRECTION

A Set national targets based on national situations and measure results

B Develop and implement comprehensive legislation and regulation that protects populations exposure to NCD risk factors, as well as through advocacy, community mobilization and environmental change

C Enable health systems to respond more effectively and equitably for NCD prevention and control

OBJECTIVES 1 To generate national political commitment and accelerate national action to contribute to a global target of a 25% reduction in premature mortality from NCDs by 2025

2 To ensure that NCDs are included in national health-planning processes and the development agenda of each Member State

3 To establish and implement national multisectoral plans for the prevention and control of NCDs, including national targets and indicators, and actions to strengthen surveillance and monitoring systems

4 To reduce risk factors for NCDs and create health promoting environments

5 To reorient and strengthen national health systems, and make progress to achieve universal coverage

6 To implement the prioritized NCD research agenda for translation of evidence into action

7 To create interconnections with all relevant health and development issues and jointly mitigate risks and repercussions

8. To promote partnerships to forge multisectoral action for the prevention and control of NCDs

“ …we must remember that health is an outcome of all policies…” – Ban Ki Moon

first informal consultation with member states and un ......control, the rio declaration on social...

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