Heartfile, 2012

NCDs: a global view

International Conference On Healthy Lifestyles And Non-communicable Diseases (Ncds) In The Arab World And The Middle East, Riyadh, Kingdom Of Saudi Arabia, 9-12 September 2012

Dr. Sania NishtarFounder and President

Heartfile Pakistan

Heartfile, 2012

Stocktaking

• Where do we stand?• What needs to happen next? • Does the EMR have capacity?• What at the immediate next steps, at the

regional level?

Heartfile, 2012

NCDs: Where do we Stand

• On a positive note– International consensus—Political declaration – Normative clarity

• Evidence based best buys • Strategies, tools and instruments• Voluntary global targets• Civil society mobilization and public private convergence

• Less auspicious – Paucity of development resources – NCDs are not (yet) fully part of domestic priorities– Capacity to cascade policy into action is limited

1

Heartfile, 2012

NCDs and HIV and AIDS

Heartfile, 2012

NCDs: Where do we Stand

• On a positive note– International consensus—Political declaration – Normative clarity

• Evidence based best buys • Strategies, tools and instruments• Voluntary global targets• Civil society mobilization and public private convergence

• Less auspicious – Paucity of development resources – NCDs are not (yet) fully part of domestic priorities– Capacity to cascade policy into action is limited

1

US $ 22 Billion spent on health by International AID agencies in in LMIC

Source IDF

Global mortalityFrom NCD

Overseas health aid

Heartfile, 2012

What needs to happen next

Regionally • Step up capacity to be responsive to country

needs Domestically 1. Societal change 2. Next generation public health, action outside

health 3. Reorienting health from episodic to chronic

care

2

Heartfile, 2012

Framework for action: NCDs 1

Nishtar S. Prevention of non-communicable diseases in Pakistan. Health Res Policy Syst. 2004

Heartfile, 2012

Framework of action: NCDs 2Lifestyle risks • Smoking • Un healthy diet • Lack of physical activity • Stress

Biological risks • Obesity • Dyslipidaemia• Diabetes • High blood pressure

Disease conditions • Cardiovascular disease • Diabetes• Lung conditions• Some cancers

Heartfile, 2012

Societal change

Policy action at all levels

Health Systems for both acute and chronic

care

Framework of action: NCDs 3

Heartfile, 2012

Societal choice• The imperative for societal change in EMRO

– Six out of 10 countries with the highest prevalence of diabetes

– Smoking amongst men ranges from 12-60% – Grossly overweight population

• 50% women in the region overweight • Escalating level of obesity in children

– Trends in per-capita sale of manufactured food and fizzy drinks

Policy action

Behavior change

Market shaping

Heartfile, 2012

• Multi-sectoral action• Inter-sectoral action • Opportunity for embedding NCDs in

– Medium term development frameworks – Sustainable development goals?– Universal coverage, the 21st century Health for all – Social protection agendas– Innovations dives (technological and design)– The poverty reduction strategies

Policy action by all levels of government

Pakistan: Composition of Shocks categories of shocks

Heartfile, 2012

Health systems; from acute to chronic care

• Health information systems • Financing • Service delivery• Medicines and related products• Governance • Workforce• Technology

3

Learning

Innovations

Heartfile, 2012

Slide courtesy: Miriam Rabkin

Leveraging innovationsLearning lessons

Heartfile, 2012© Alison Koler 2010

Heartfile, 2012

HIV—Lessons to be learnt for NCDs

Rabkin, and Nishtar. J Acquir Immune Defic Syndr 2011

Heartfile, 2012

Examples

Ethiopia Cambodia

Slide courtesy: Miriam Rabkin

Heartfile, 2012

Does the EMR have capacity to deliver

• Tier 1—capacity and resources exist• Capacity constraints in Tier I and II

– Fiscal space – International development priorities – Health systems distortion

Heartfile, 2012

What will be the Riyadh promise for NCDs ?