Non-communicable Diseases Action Plan Research Articles

The Case for Integrating Health Systems to Manage Noncommunicable and Infectious Diseases in Low- and Middle-Income Countries: Lessons Learned From Zambia.

Noncommunicable diseases (NCDs) are the leading cause of death in the world, and 80% of all NCD deaths occur in low- and middle-income countries (LMICs). The COVID-19 pandemic has demonstrated that patients with NCDs are at increased risk of becoming severely ill from the virus. Disproportionate investment in vertical health programs can result in health systems vulnerable to collapse when resources are strained, such as during pandemics. Although NCDs are largely preventable, globally there is underinvestment in efforts to address them. Integrating health systems to collectively address NCDs and infectious diseases through a wide range of services in a comprehensive manner reduces the economic burden of healthcare and strengthens the healthcare system. Health system resiliency is essential for health security. In this article, we provide an economically sound approach to incorporating NCDs into routine healthcare services in LMICs through improved alignment of institutions that support prevention and control of both NCDs and infectious diseases. Examples from Zambia's multisector interventions to develop and support a national NCD action plan can inform and encourage LMIC countries to invest in systems integration to reduce the social and economic burden of NCDs and infectious diseases.

Countrywide cardiovascular disease prevention and control in 49 countries with different socio-economic status.

Cardiovascular disease (CVD) is the major noncommunicable disease (NCD) accounting for 17.9 million deaths. If current trends continue, the annual number of deaths from CVD will rise to 22.2 million by 2030. The United Nations General Assembly adopted a sustainable development goal (SDG) by 2030 to reduce NCDmortality by one-third. The purpose of this study was to analyze the CVD mortality trends in different countries implementing World Health Organization (WHO) NCD Action Plan and emphasize effective ways to achieve SDG. WHO statistics, based on the Member-States unified mortality and causes-of-death reports were used for analyzing trends and different interventions. Reduction of CVD mortality from 2000 to 2016 in 49 countries was achieved for stroke at43% and ischemic heart disease at 30%. Smoking prevalence and raised blood pressure (RBP) decreased in 84% and 55% of the countries. Eighty-nine percent of high-income countries (HIC) demonstrated a decline in tobacco smoking against 67% in middle-income countries (MIC). Sixty-nine percent of HIC demonstrated a decline in RBP against 15% in MIC. CVD management, tobacco, and unhealthy diet reduction measures are significantly better in HIC. The air pollution level was higher in MIC. Building partnerships between countries could enhance their efforts for CVD prevention and successful achievement of SDG.

A tool to identify NCD interventions to achieve the SDG target

A tool to identify NCD interventions to achieve the SDG target

Assuring Bangladesh’s future: non-communicable disease risk factors among the adolescents and the existing policy responses

BackgroundThe aim of this study is to assess the current status of non-communicable disease (NCD) risk factors amongst adolescents in Bangladesh. We also critically reviewed the existing policy responses to NCD risk among adolescents in Bangladesh.MethodsThis study used a mixed method approach. To quantify the NCD risk burden, we used data from the Global School-based Student Health Survey conducted in Bangladesh. To understand policy response, we reviewed NCD-related policy documents introduced by the Government of Bangladesh between 1971 and 2018 using the WHO recommended NCD Action Plan 2013–2020as study framework. Information from the policy documents was extracted using a matrix, mapping each document against the six objectives of the WHO 2013–2020 Action Plan.ResultsAlmost all adolescents in Bangladesh had at least one NCD risk factor, and there was a high prevalence of concurrent multiple NCD risk factors; 14% had one NCD risk factor while 22% had two, 29% had three, 34% had four or more NCD risk factors. Out of 38 policy documents, eight (21.1%) were related to research and/or surveys, eight (21.1%) were on established policies, and eleven (29%) were on legislation acts. Three policy documents (7.9%) were related to NCD guidelines and eight (21.1%) were strategic planning which were introduced by the government and non-government agencies/institutes in Bangladesh.ConclusionsThe findings emphasize the needs for strengthening NCD risk factors surveillance and introducing appropriate intervention strategies targeted to adolescents. Despite the Government of Bangladesh introducing several NCD-related policies and programs, the government also needs more focus on clear planning, implementation and monitoring and evaluation approaches to preventing NCD risk factors among the adolescents in Bangladesh.

Preparedness for Mitigating Noncommunicable Diseases in Gaindakot Municipality, Nepal: Perspectives of Key informants

Introduction: Non-communicable Diseases (NCDs) are the major public health problem that leads to high morbidity and mortality in the world including Nepal. Government of Nepal has launched the Multi-sectoral NCD Action Plan in 2014 and established NCD and Injuries Poverty Commission in 2016 for the management and control of NCDs nevertheless the implementation status and its outcomes are not identified till date at the local level.
 Objectives: To explore the preparedness of the local government for the prevention and control of NCDs at Gaindakot, Nawalpur, Nepal.
 Methodology: A qualitative study was conducted in the Gaindakot municipality; Nawalpur to document the key informant's perspectives on health system's preparedness to prevent the potential impacts of NCDs. Face to face Indepth interview was performed using open-ended questions. Interview guidelines were prepared on the basis of building blocks of health system. Information was processed basis on thematic analysis.
 Result: The study revealed that health section has NCD preparedness structure but need to strengthening for the better delivery of health services. The study highlights that screening services and the medicine for major NCDs like hypertension and diabetes were available at local level. Limited budget was allocated and health workforce was not trained for NCDs prevention and control. There was no reporting mechanism for NCD related data from local level.
 Conclusion: Basic medicine and screening services were provided from the local level to the selected NCDs such as hypertension and diabetes. There was no provision of reporting NCD related information and health workforce were not trained to respond NCDs. Local level health system strengthening is an urgent need to address the increasing burden of NCDs.

Trends in premature mortality in the Islamic Republic of Iran: probability of dying between ages 30 and 70 years.

The burden of noncommunicable diseases (NCDs) is a major challenge facing the whole world. Around 15 million premature deaths due to NCDs occur in people aged 30-70 years annually. Mortality data based on death registration systems and population data were used to estimate proposed mortality statistics in the Islamic Republic of Iran. Various criteria and methods were used to assess the quality of mortality data. The probability of dying among those aged 30-70 years for all causes and for NCDs was calculated using the life table method. The mortality rate in the population aged 30-69 years was 343.12 (per 100 000 persons) in 2006 and decreased to 240.62 in 2016 in both sexes. The probability of dying due to NCDs was 21.36% in 2006 and declined to 14.95% in 2016 for both sexes. The number of premature deaths due to NCDs have decreased over the last decade. We predict that this reduction will continue and the country will meet the targets of the WHO NCD action plan by 2025 and also the targets of the Sustainable Development Goals for reducing premature deaths by 2030. However, the morbidity and burden of NCDs are still public health concerns in the country. Due to advancements in health care technologies and also the aging population, these concerns will impose greater costs on the health system. Hence, prevention programmes for NCDs should be an urgent priority for Iranian health policy.

Reducing the Harmful Use of Alcohol: Have International Targets Been Met?

Alcohol use has been identified in major United Nations (UN) initiatives, such as the Sustainable Development Goals and the Non-Communicable Disease Action Plan, as a major contributor to the global burden of disease. As a result, levels of alcohol use serve as an official indicator of progress towards these UN-set goals. Given current trends, UN targets for reduced alcohol consumption are unlikely to be met. Moreover, in many countries, especially in low- and middle-income countries, the alcohol-attributable burden of disease continues to increase. Pressure will need to be exerted on national and international decision-makers to arrive at more powerful and normatively persuasive instruments, such as a treaty.

Benchmarking food environment policies for the prevention of diet-related non-communicable diseases in Kenya: National expert panel's assessment and priority recommendations.

IntroductionUnhealthy food environments drive the increase of diet-related non-communicable diseases (NCDs).ObjectiveWe aimed to examine healthy food environment policies in Kenya and identify priorities for future action.MethodsUsing the Healthy Food Environment Policy Index (Food-EPI) we collected evidence on the extent of government action to create healthy food environments across 13 policy and infrastructure support domains and 43 related good practice indicators between 2017 and 2018. A panel of 15 national experts rated the extent of government action on each indicator compared to the policy development cycle and international best practice respectively. Based on gaps found, actions to improve food environments in Kenya were identified and prioritized.ResultsIn the policy development cycle, 16/43 (37%) of good practice policy indicators were judged to be in ‘implementation’ phase, including: food composition targets, packaged foods’ ingredient lists/nutrient declarations; systems regulating health claims; restrictions on marketing breast milk substitutes; and school nutrition policies. Infrastructure support actions in ‘implementation’ phase included: food-based dietary guidelines; strong political support to reduce NCDs; comprehensive NCD action plan; transparency in developing food policies; and surveys monitoring nutritional status. Half (22/43) of the indicators were judged to be ‘in development’. Compared to international best practice, the Kenyan Government was judged to be performing relatively well (‘medium’ implementation) in one policy (restrictions on marketing breast milk substitutes) and three infrastructure support areas (political leadership; comprehensive implementation plan; and ensuring all food policies are sensitive to nutrition). Implementation for 36 (83.7%) indicators were rated as ‘low’ or ‘very little’. Taking into account importance and feasibility, seven actions within the areas of leadership, food composition, labelling, promotion, prices and health-in-all-policies were prioritized.ConclusionThis baseline assessment is important in creating awareness to address gaps in food environment policy. Regular monitoring using Food-EPI may contribute to addressing the burden of diet-related NCDs in Kenya.

Balneotherapy and hydrotherapy in chronic respiratory disease.

Chronic respiratory diseases (CRD) belong to major noncommunicable diseases (NCD) targeted by World Health Organization (WHO) NCD Action Plan and United Nations (UN) Sustainable Development Goal (STG) 3.4 to achieve 30% decline of mortality by the year 2030. Strong evidence is now available in the literature for therapeutic aquatic exercise interventions in improving health status of chronic obstructive pulmonary diseases (COPD) patients. However, gym-based exercises can be difficult for patients with COPD who are mainly elderly and often have co-morbidities—such as severe arthritis and obesity—which may impair their ability to exercise at an adequate intensity. Besides improving respiratory function and health status in COPD, exercise in water helps overcoming patient’s fears and promote socialization, contrasting the risk of depression, which is a major condition often associated with long term COPD condition. Susceptibility to respiratory infections plays a role in exacerbations of COPD. Sulphur-rich water inhalations improve muco-ciliary clearance, reduce inflammatory cytokines production and inflammatory mucosal infiltration, reduce elastase secretion by neutrophils, preserving elastic properties of pulmonary interstitium and thus facilitating expectoration. Repeated cold water stimulations in COPD also reduce frequency of infections. Finally, sauna bathing reduces the risk of pneumonia. On the other side, hydrotherapy/balneotherapy also help obesity control, which is one of the most difficult NCD risk factors to modify and consequently is an important component of the WHO preventive strategy to achieve STG 3.4. Along with high prevalence and mortality, CRD cause increasing pharmaceutical and hospital costs. In this perspective, Health Resort Medicine should not be ignored as a resource in the WHO NCD strategy and Universal Health Coverage, providing a multi-stakeholder platform (including the network of health resorts and their facilities) able to give a real help to the achievement of UN goal STG 3.4 by the year 2030.

Gender differences in self care in type 2 diabetes in rural Kerala

Background: Noncommunicable Diseases (NCDs) were estimated to have contributed to almost 60% of deaths in the world and 43% of the global burden of disease in 1999. NCDs are rapidly becoming a major public health threat in the developing world. The W.H.O fact file on NCDs states that healthy diet, regular physical activity, maintaining a normal body weight (self-care) are ways to prevent or delay the onset of type 2 diabetes or its complications. Thus, self-care in diabetes is the corner stone in achieving good glycemic control, thereby preventing the onset of diabetes complications which increases the morbidity and mortality of the disease. This study was undertaken to understand the effect of self-care on HbA1C (blood sugar control) among males and females with Type -2 diabetes in a rural population in Kerala. The study tries to draw out the differences in self-care among males and females taking into consideration the patriarchal nature of the society and to understand the gender differences in approaches to self-care. Sex- based differences should be considered when developing awareness and treatment programs for people with diabetes, more precisely in NCD preventive measures specifically for the Indian subcontinent.
 Materials and methods: A cross sectional study was conducted in a stratified random sample of diabetes patients belonging to the three religious groups found in the study area, in a diabetes treatment center in Kanjirapally taluk of Kottayam district. Based on pilot study, a sample of 300 is chosen with 138 males and 162 females. For part 1 of the questionnaire, demographic details were entered by the researcher and the medical records were accessed to record the relevant details like height, weight, A1C, B.M.I., F.B.S. and chronic conditions of the patients. The selfcare activity of the patients were assessed with the SDSCAS (Summary of diabetes self-care activity scale). It
 consists a core set of 12 questions to assess the dietary habits, exercise regimen, blood sugar testing, foot care and smoking status for the past 7 days. 
 Results: Since the representative sample is not made of equal number of males and females, comparison of blood sugar control (HbA1C) based on self-care activities for males and females were calculated. The independent sample t-test is highly significant at 0.01 level with respect to general diet, specific diet, dietary adherence and podiatric care. The t-test again shows significance at 0.05 level with respect to physical activities on comparison. 
 Conclusions: The self-care activities varied greatly between males and females. The self-care activities of the females were very poor when compared with the males. The poor self-care activities of the females could be attributed to behaviour conditioned by gender relations prevalent in the society. Women seem to assimilate or internalize the patriarchal subjectivity of the society. But this is a feature of most households not only in the study area but of the country as a whole. This gender difference in self-care can be annihilated by stringent awareness and health education campaigns. NCD prevention strategies should include gender sensitive health promotion measures to achieve the WHO Global Strategy for the Prevention and Control of Noncommunicable Diseases (NCD Action Plan).

Evaluating policy responses to noncommunicable diseases in seven Caribbean countries: challenges to addressing unhealthy diets and physical inactivity.

ABSTRACTObjective.To identify, assess, and compare existing policies on noncommunicable diseases (NCDs) in the Caribbean, gaps in policy responses, and the factors influencing successful policy development and implementation following the Port of Spain Declaration of 2007. Specifically, to examine policies that target the upstream determinants of two NCD risk factors—unhealthy diets and physical inactivity.Methods.A total of 76 semi-structured interviews with 80 relevant stakeholders in government, the private sector, and civil society were complemented by policy document analysis. Interviews were analyzed pragmatically, framed by the CARICOM government commitments, the WHO NCD Action Plan, a Multiple Streams framework approach, and realist evaluation ideas.Results.The most widely-reported policy successes involved health promotion activities (e.g., school meal programs) that leveraged multisectoral collaboration among government ministries, such as Health, Education, and Agriculture. Large policy gaps still exist around creating legislative, physical, and social environments to support healthy eating and physical activity at the population level. Multisectoral NCD commissions successfully reached across sectors, but had limited influence on policy development. Different policy levels emerged with national-level policies considered a lengthy process, while “On-the-ground” programming was considered faster to implement than national policies. External barriers included a reliance on food imports enabled by international trade agreements limited availability, quality, and affordability of healthy foods. International pushback limited legislation to reduce food imports and the absence of an international/regional framework, similar to the Framework Convention on Tobacco Control, further impedes efforts.Conclusions.Regional collaboration and political support across sectors are essential to accelerating the pace of action to support healthy eating and active living environments. Policy “blueprints” could accelerate the process of development. Regional “NCD champions” could spearhead such responses and approaches.

The impact of obesity on cardiovascular disease risk factor

Obesity has emerged as the most potential cardiovascular risk factor and has raised concern among public and their health related issues not only in developed but also in developing countries. The Worldwide obesity occurrence has almost has gone three times since 1975. Research suggests there are about 775 million obese people in the World including adult, children, and adolescents. Nearly 50% of the children who are obese and overweight in Asia in are below 5 years. There is a steep incline of childhood obesity when compared to 1971 which is not only in developed countries but also in developing countries. A considerable amount of weight gain occurs during the transition phase from adolescence to young adulthood. It is also suggested that those adultswho were obese in childhood also remained obese in their adulthood with a higher metabolic risk than those who became obese in their adulthood. In India, the urban Indian female in the age group of 30-45 years have emerged as an 〝at risk population” for cardiovascular diseases. To understand how obesity can influence cardiovascular function, it becomes immense important to understand the changes which can take place in adipose tissue due to obesity. There are two proposed concepts explaining the inflammatory status of macrophage. The predominant cause of insulin resistance is obesity. Epidemiological and research studies have indicated that the pathogenesis of obesity-related metabolic dysfunction involves the development of a systemic, low-grade inflammatory state. It is becoming clear that targeting the pro-inflammatory pathwaymay provide a novel therapeutic approach to prevent insulin resistance, particularly in obesity inducedinsulin resistance. Some cost effective interventions that are feasible by all and can be implemented even in low-resource settings includes - population-wide and individual, which are recommended to be used in combination to reduce the greatest cardiovascular disease burden. The sixth target in the Global NCD action plan is to reduce the prevalence of hypertension by 25%. Reducing the incidence of hypertension by implementing population-wide policies to educe behavioral risk factors. Reducing cigarette smoking, body weight, blood pressure, blood cholesterol, and blood glucose all have a beneficial impact on major biological cardiovascular risk factors. A variety of lifestyle modifications have been shown, in clinical trials, to lower bloodpressure, includes weight loss, physical activity, moderation of alcohol intake, increased fresh fruit and vegetables and reduced saturated fat in the diet, reduction of dietary sodium intake, andincreased potassium intake. Also, trials of reduction of saturated fat and its partial replacement by unsaturated fats have improved dyslipidaemia and lowered risk of cardiovascular events. This initiative driven by the Ministry of Health and Family Welfare, State Governments, Indian Council of Medical Research and the World Health Organization are remarkable. The Government of India has adopted a national action plan for the prevention and control of non-communicable diseases (NCDs) with specific targets to be achieved by 2025, including a 25% reduction inoverall mortality from cardiovascular diseases, a 25% relative reduction in the prevalence of raised blood pressure and a 30% reduction in salt/sodium intake. In a nutshell increased BMI values can predict the nature of obesity and its aftermaths in terms inflammation and other disease associated with obesity. It’s high time; we must realize it and keep an eye on health status in order to live long and healthy life.

Non-communicable disease prevention policy process in five African countries authors

BackgroundThe increasing burden of non-communicable diseases (NCDs) in sub-Saharan Africa is causing further burden to the health care systems that are least equipped to deal with the challenge. Countries are developing policies to address major NCD risk factors including tobacco use, unhealthy diets, harmful alcohol consumption and physical inactivity. This paper describes NCD prevention policy development process in five African countries (Kenya, South Africa, Cameroon, Nigeria, Malawi), including the extent to which WHO “best buy” interventions for NCD prevention have been implemented.MethodsThe study applied a multiple case study design, with each country as a separate case study. Data were collected through document reviews and key informant interviews with national-level decision-makers in various sectors. Data were coded and analyzed thematically, guided by Walt and Gilson policy analysis framework that examines the context, content, processes and actors in policy development.ResultsCountry-level policy process has been relatively slow and uneven. Policy process for tobacco has moved faster, especially in South Africa but was delayed in others. Alcohol policy process has been slow in Nigeria and Malawi. Existing tobacco and alcohol policies address the WHO “best buy” interventions to some extent. Food-security and nutrition policies exist in almost all the countries, but the “best buy” interventions for unhealthy diet have not received adequate attention in all countries except South Africa. Physical activity policies are not well developed in any study countries. All have recently developed NCD strategic plans consistent with WHO global NCD Action Plan but these policies have not been adequately implemented due to inadequate political commitment, inadequate resources and technical capacity as well as industry influence.ConclusionNCD prevention policy process in many African countries has been influenced both by global and local factors. Countries have the will to develop NCD prevention policies but they face implementation gaps and need enhanced country-level commitment to support policy NCD prevention policy development for all risk factors and establish mechanisms to attain better policy outcomes while considering other local contextual factors that may influence policy implementation such as political support, resource allocation and availability of local data for monitoring impacts.

Strengthening non-communicable disease policy with lessons from Bhutan: linking gross national happiness and health policy action.

There is growing global interest in Gross National Happiness (GNH) as a metric to capture population well-being and economic development. Empirical evidence suggests that health is necessary for achievement of happiness. The growing epidemic of non-communicable diseases (NCDs) threatens to undermine the achievement of GNH. We analyze synergies between current policy priorities and the institutional mechanism for GNH and the Global NCD Action Plan 2013-2020 that has informed Bhutan's approach to NCDs. We identify strategic policy opportunities to strengthen outcomes for both policy areas. Lessons from Bhutan also suggest strategic opportunities to address NCDs in other countries where happiness is on the national agenda, or where action on NCDs could be improved through engagement between health and other sectors, especially where ways to promote and measure GNH (population well-being) already exist.

Alcohol and Noncommunicable Disease Risk

Alcohol use is a major risk factor for noncommunicable diseases (NCDs), annually causing more than 1.8 million deaths, and approximately 52 million disability-adjusted life years lost globally. This review examines the relationship between alcohol use and NCDs in the context of current United Nations (UN) and World Health Organization (WHO) initiatives to reduce the burden of NCDs as well as the resulting policy implications. The importance of alcohol as a major risk factor for NCDs is evidenced by its inclusion as one of only four behavioral risk factors (tobacco use, unhealthy diet, physical inactivity, and harmful use of alcohol) into the World Health Organization’s Global Action Plan for the Prevention and Control of NCDs. Alcohol use also plays a major role in other strategic initiatives of the UN and WHO. While these inclusions help enable policy measures to reduce harmful alcohol use, the Global NCD Action Plan in general disregards many diseases and injuries caused by alcohol, most notably liver cirrhosis and all mental disorders. Furthermore, the Global NCD Action Plan also fails to highlight interactions between risk factors; however, there is strong epidemiological evidence of the differential harms caused by alcohol use between poverty/socioeconomic strata. Thus, future policy plans should explicitly include consideration of health inequalities.

GARD, a new way to battle with chronic respiratory diseases, from disease oriented programmes to global partnership.

Initiated by World Health Organization (WHO) Global Chronic Respiratory Disease (CRD)-oriented programmes, Global Initiative on Asthma (GINA), GOLD-Global Initiative for Chronic Obstructive Pulmonary Disease (COPD), Allergic Rhinitis and its Impact on Asthma (ARIA), and Practical Approach to Lung Health (PAL) have catalyzed creation of the Global Alliance Against CRD (GARD). Forty-five countries sharing GARD's goal to reduce the burden of CRD joint GARD. In 20 countries with reliable death estimates, CRD mortality has been analyzed in 2000, 2005, 2010 and 2015. Dramatic decline in CRD mortality is seen in Kyrgyzstan, Netherlands, Italy and Republic of Korea (69%, 55%, 48%, and 48%). Positive trend in COPD mortality is seen for Lithuania (36% decline) and Spain (21%). In France, Japan, Mexico, Romania and Costa Rica, positive trend for asthma mortality is obvious from 2000 to 2015 from about 40% in France and Romania, 50% and Mexico and Czech Republic, 65% in Japan and 69% in Belgium. In Costa Rica zero asthma mortality was registered in 2015. In Czechia and Belgium decline is seen from 2000 to 2005, which then stabilized in Czech Republic and went further down in Belgium. In Finland initially, low asthma mortality remains practically unchanged with slight decline in 2015. In other countries analyzed, we did not see any positive trend in CRD mortality. In all countries with positive CRD dynamic WHO introduced activities remained active, they have been taken into local guidelines and practice and supported national authorities in implementing these evidence-based guidelines. Before GARD launch WHO initiated activities produced a good basis for further GARD movement and by 2010 we see a visible positive trend in CRD mortality in success countries. By 2015 when WHO noncommunicable disease (NCD) Global Action Plan 2013-2020 rollouts globally dramatic decline in total CRD mortality and particularly in Asthma and COPD mortality became obvious. Global disease oriented programmes, national and international partnerships combined with the Global NCD Action Plan most probable produce a positive synergistic effect on the mortality from CRD.

Translating the WHO 25×25 goals into a UK context: the PROMISE modelling study

ObjectiveModel the impact of targets for obesity, diabetes, raised blood pressure, tobacco use, salt intake, physical inactivity and harmful alcohol use, as outlined in the Global Non-Communicable Disease Action Plan...

A developmental approach to the prevention of hypertension and kidney disease: a report from the Low Birth Weight and Nephron Number Working Group

In 2008, the World Health Assembly endorsed the Global Noncommunicable Disease (NCD) Action Plan based on the realization that NCDs caused more deaths than communicable diseases worldwide. 1 This plan strongly advocates prevention as the most effective strategy to curb NCDs. The “Life Course Approach”, also recently highlighted in the Minsk Declaration, reflects the increasing recognition that early development impacts later-life health and disease. 1,2 Optimization of early development offers the opportunity for true primary prevention of NCDs. Developmental programming in the kidney has been recognized for over 2 decades but its contribution to the global burden of kidney diseases remains underappreciated by policy makers. 3 Given the many factors known to impact fetal kidney development, including maternal health and nutrition, exposure to stress, poverty, pollutants, drugs and infections during gestation, 3 a holistic strategy to prevent such programming effects is consistent with the “Life-Course” approach and aligns with the United Nations Sustainable Development Goals (SDG) to foster health. 2,4 Chronic kidney disease (CKD) is an important contributor to the NCD burden that has been relatively neglected in the Global NCD Action Plan, despite CKD being a major cause of hypertension, and a major risk multiplier of cardiovascular disease 1,5 While the prevalence of CKD in many lower-income countries remains unknown, CKD is more prevalent among disadvantaged populations within industrialized nations, e.g. African Americans and Aboriginal Australians. 6 People receiving dialysis or transplantation are projected to double from 2.6 million in 2010 to 5.4 million in 2030. 7 Between 2.3 and 7.1 million adult people died from lack of access to dialysis and transplantation in lower-income countries in 2010. 7 Given the clinical consequences and often prohibitively high costs of treatment, prevention and early detection are the only sustainable solutions to address this growing global burden. To address the neglected issue of developmental programming of kidney disease and hypertension, a multidisciplinary workgroup, including international expert obstetricians, neonatologists and nephrologists (see Appendix), was convened. We argue that the Global NCD Action Plan does not adequately address the impact of developmental origins of NCDs which is globally but is particularly important in low- and middle-income countries (LMICs) where developmental risk is highest and the burden of NCDs is growing fastest. 8 The working group identified the need to raise awareness of the role of developmental programming in renal disease, and suggests locally adapted preventive strategies that could have long-term benefits on health and heath cost savings worldwide, integrating obstetrical, neonatal and nephrology perspectives.

International cancer control leadership forum program

43 A National Cancer Control Plan (NCCP) comprises an important part of a country’s non-communicable disease (NCD) plan and can help countries meet NCD targets outlined in the WHO Global NCD Action Plan. A comprehensive cancer control plan is based on data such as a country’s cancer burden and cancer risk factors, available resources, and local context of culture and health care. The plan provides a systematic framework for implementation of evidence-based and cost-effective strategies for cancer prevention and control. The InternationalCancerControl LeadershipForum isa2-3day regionalworkshopwith thematic seminar modules on cancer control planning and implementation, aswell as interactive action planning sessions. The goal is to increase the capacity of participating countries to initiate or enhance cancer control planning and implementation through a multisectoral approach. The country teams are composed of high-level leaders who represent government agencies, civil society, oncology professionals, and academia. The program approach engages country teams over a year and a half. Approximately 3-6months prior to the forum, teams conduct a situational analysis of the cancer burden and cancer control planning efforts in their country. During the Forum, teams are introduced to evidence-based approaches and exchange best-practices with colleagues to develop a 12-month action plan to move their cancer control planning and implementation efforts forward. In the year after the Forum, country teams and Forum faculty meet for 3-4 follow-upphone calls to address technical assistanceneeds as countries begin to implement their actionplan.Thus far, Forumshavebeenheld inAfrica,SoutheastAsia, thePacific, theCaribbean,Middle East-North Africa, Latin America, and Central Asia regions. The country teams report that the Forum provides an important opportunity to plan with diverse stakeholders. Participants also report increased awareness and knowledge on developing and implementing a national cancer control plan, and learn best-practices from their colleagues in neighboring countries. In some Forums, countries have shown interest to work collaboratively towards regional initiatives. AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors. Tulika Singh,BrendaKostelecky, and Lisa Stevens, Center forGlobalHealth,National Cancer Institute (NCI),National Institutes of Health, US Department of Health and Human Services Corresponding author: Brenda Kostelecky, Center for Global Health, National Cancer Institute (NCI), National Institutes of Health, US Department of Health and Human Services, 9609 Medical Center Dr, Rockville, MD 20852; 240-276-5585; kosteleckybd@mail.nih.gov DOI: 10.1200/JGO.2016.004853 Tulika Singh Brenda Kostelecky

World Health Organization.

World Health Organization.