Non-communicable Diseases Action Plan Research Articles

International Cancer Control Leadership Forum Program

Abstract 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 International Cancer Control Leadership Forum is a 2-3 day regional workshop with thematic seminar modules on cancer control planning and implementation, as well 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 3-6 months 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-up phone calls to address technical assistance needs as countries begin to implement their action plan. Thus far, Forums have been held in Africa, Southeast Asia, the Pacific, the Caribbean, 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.

Implementation of Policies and Strategies for Control of Noncommunicable Diseases in Malawi: Challenges and Opportunities.

Malawi is a Sub-Saharan African country experiencing the epidemiological transition from predominantly infectious to noncommunicable diseases (NCDs) with dramatically increasing prevalence of lifestyle-related diseases such as obesity, hypertension, and diabetes. Malawi's 2011-2016 Health Sector Strategic Plan included NCDs, and an NCD Control Program was established with subsequent development of a National Action Plan for prevention and management of NCDs launched in 2013. The current study was designed to identify gaps in implementation of NCD control program policies and action plan strategies by describing current efforts toward prevention and management of NCDs in Malawi with emphasis on challenges and opportunities. Semistructured questionnaires were used to collect quantitative and qualitative data from Malawi Ministry of Health personnel (senior officers, service providers, health education officers, and nutritionists) in 10 health districts and 3 central hospitals. Frequencies were generated for quantitative data. Qualitative data were used to generate themes and most common responses. Results showed that current services focus on facility-based NCD screening and clinical services rather than active screening, prevention, and community awareness and outreach, although respondents emphasized the importance of prevention, lifestyle education, and community outreach. Respondents indicated inadequate resources for NCD services including financial capital, human resources, equipment and supplies, and transportation. While Malawi has begun to address NCDs, policy and practice implications include (a) better integration of services within the existing infrastructure with emphasis on capacity building; (b) greater implementation of planned NCD activities; (c) a stronger, more comprehensive data management system; and (d) innovative funding solutions.

Disability, noncommunicable disease and health information.

Noncommunicable diseases (NCDs) are a major cause of preventable disability worldwide.1 While actions to monitor NCDs have gained significant momentum in the global health agenda, similar developments to monitor and manage the growing burden of NCD-related disability have been relatively slow. The global NCD action plan was developed to support country efforts in addressing the devastating social, economic and public health impacts of NCDs.2 The NCD action plan includes nine voluntary targets and a monitoring framework. However, the monitoring framework has been criticized for its focus on mortality while neglecting adequate measures of morbidity and disability.3 This has resulted from focusing on existing data within health information systems, rather than on identifying appropriate data for measuring disease burden. Indeed, the issue of the chronicity of NCDs seems absent in most monitoring and evaluation frameworks, with an implicit assumption that the only outcome of interest for countries is premature mortality.

Translating global commitments on NCDs into national action: the role of civil society

The inclusion of non-communicable diseases (NCDs) in the UN Agenda 2030 for Sustainable Development, 1 UN General Assembly resolutionTransforming our world: the 2030 Agenda for Sustainable Development, Sept. A/69/L.85. United Nations, 2015 Google Scholar adopted in September, 2015, firmly establishes NCDs as an urgent global health and development priority. With the global prioritisation of NCDs and associated commitments, such as the WHO Global NCD Action Plan 2013–20, 2 WHOGlobal NCD Action Plan 2013–2020. World Health Organization, Geneva2013 Google Scholar in place, the responsibility for action has shifted to the national and regional level. However, progress at the national level has been insufficient and highly uneven, 3 UN Secretary General Progress Report on NCDs, December, 2A/68/650. World Health Organization, Geneva2013http://ncdalliance.org/sites/default/files/rfiles/SG%20progress%20report_January%202014.pdf Google Scholar to use the words of the UN Secretary-General Ban Ki-moon. According to the recent WHO NCD Progress Monitor, 4 WHONoncommunicable Diseases Progress Monitor 2015. World Health Organization, Geneva2015 Google Scholar only 33% of countries have a national NCD action plan or strategy, and only 31% have national NCD targets and indicators. The situation is even bleaker when it comes to resources for NCDs. 5 Dain K Sustainable financing: the Achilles heel of the non-communicable diseases response. Lancet Diabetes Endocrinol. 2015; (published online Oct 22.)http://dx.doi.org/10.1016/S2213-8587(15)00393-9 Google Scholar With only 10 years to achieve the global 25 by 25 NCD mortality reduction goal, what is missing to ensure significant progress over the coming years? The ageing of AfricaDemographically speaking, Africa is the world's youngest continent—as recently as 2011, an estimated 70% of the population was younger than 30 years. But Africa is now ageing faster than the global average, with the number of Africans aged 55 years or older predicted to increase from 64·5 million to 103 million by 2030, and to 212 million by 2050. And with an increasing aged population comes an increased burden of diabetes and other non-communicable diseases (NCDs). Full-Text PDF

Noncommunicable Disease Prevention and Control in Mongolia: A Policy Analysis.

BackgroundNoncommunicable diseases (NCDs) are the major global cause of morbidity and mortality. In Mongolia, a number of health policies have been developed targeting the prevention and control of noncommunicable diseases. This paper aimed to evaluate the extent to which NCD-related policies introduced in Mongolia align with the World Health Organization (WHO) 2008–2013 Action Plan for the Global Strategy for the Prevention and Control of NCDs.MethodsWe conducted a review of policy documents introduced by the Government of Mongolia from 2000 to 2013. A literature review, internet-based search, and expert consultation identified the policy documents. Information was extracted from the documents using a matrix, mapping each document against the six objectives of the WHO 2008–2013 Action Plan for the Global Strategy for the Prevention and Control of NCDs and five dimensions: data source, aim and objectives of document, coverage of conditions, coverage of risk factors and implementation plan. 45 NCD-related policies were identified.ResultsPrevention and control of the common NCDs and their major risk factors as described by WHO were widely addressed, and policies aligned well with the objectives of the WHO 2008–2013 Action Plan for the Global Strategy for the Prevention and Control of NCDs. Many documents included explicit implementation or monitoring frameworks. It appears that each objective of the WHO 2008–2013 NCD Action Plan was well addressed. Specific areas less well and/or not addressed were chronic respiratory disease, physical activity guidelines and dietary standards.ConclusionsThe Mongolian Government response to the emerging burden of NCDs is a population-based public health approach that includes a national multisectoral framework and integration of NCD prevention and control policies into national health policies. Our findings suggest gaps in addressing chronic respiratory disease, physical activity guidelines, specific food policy actions restricting sales advertising of food products, and a lack of funding specifically supporting NCD research. The neglect of these areas may hamper addressing the NCD burden, and needs immediate action. Future research should explore the effectiveness of national NCD policies and the extent to which the policies are implemented in practice.

PHS157 - Noncommunicable Disease Prevention and Control in Mongolia: a Policy Analysis

Noncommunicable diseases (NCDs) are the major global causes of morbidity and mortality. In Mongolia, a number of health policy documents have been developed targeting the prevention and control of noncommunicable diseases. This paper aimed to evaluate the extent to which NCD-related policies introduced in Mongolia align with the World Health Organisation 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of NCDs (Action Plan). We conducted a qualitative review of policy documents introduced by the Government of Mongolia from 2000 to 2013. A literature review, internet–based search, and expert consultation identified the policy documents. Information was extracted from the documents using a matrix, mapping each document against the six objectives of the Action Plan and five dimensions: data source, aim and objectives of document, coverage of conditions, coverage of risk factors and implementation plan. 40 NCD-related policies were identified. Prevention and control of the common NCDs and their major risk factors as described by WHO were widely addressed as were the objectives of the Action Plan. It appears that each objective of the WHO 2008-2013 NCD Action Plan was well addressed. Many documents included explicit implementation or monitoring frameworks. Areas less well or/and not addressed were chronic respiratory disease, physical activity guidelines and dietary standards. The Mongolian Government response to the emerging burden of NCDs is a population-based public health approach which includes a national multisectoral framework and integration of NCD prevention and control policies into national health policies. Our findings suggested gaps in addressing chronic respiratory disease, physical activity guidelines, specific food policy actions restricting sales advertising of food products, and a lack of funding specifically supporting NCD research. Future research should explore the effectiveness of national NCD policies and the extent to which the policies are implemented in practice.

Organizational update: the world health organization global status report on noncommunicable diseases 2014; one more landmark step in the combat against stroke and vascular disease.

Most countries are likely to fail to meet global targets on tackling noncommunicable diseases (NCDs), according to the second Global Status Report on Noncommunicable Diseases 2014 released by the World Health Organization on January 19, 2015. ‘Attaining the nine global NCD targets; a shared responsibility’ is the theme of this global report. The report aims to inform Ministries of Health and all stakeholders of the progress made on targets set in 2013, 2 years after world leaders agreed to tackle this global health problem at a United Nations high-level meeting. In May 2013, the World Health Assembly adopted a global NCD action plan monitoring framework with 25 indicators and 9 voluntary global targets set for 2025. According to the latest statistics in the report, NCDs continue to be the leading cause of deaths worldwide and were responsible for 38 million of the world’s 56 million deaths in 2012. An estimated 17.5 million NCD deaths were caused by cardiovascular disease, including 6.7 million from strokes. Some 16 million of NCD deaths occurred in people …

A Behavioural Approach to Health Promotion: Informing the Global NCD Agenda with Behavioural Insights

At a time in which behavioural science has gained increasing attention for the design of population-wide health interventions, this chapter discusses its potential contributions to the prevention and control of Non-Communicable-Diseases (NCDs). Given the largely preventable nature of NCDs, any lifestyle intervention faces the challenge to induce behavioural change. By highlighting the role of social and physical environments in shaping our behaviour, applied behavioural science provides policymakers with a new understanding of human decision-making and, as a result, may support an innovative approach to the promotion of behaviour change leading to healthier lives. While only a combination of policy instruments, such as legislation, regulation, and even financial and fiscal incentives, may induce behaviour change to the scale required to reduce the burden of chronic disease at the population level, a behavioural informed approach may valuably complement the current regulatory mix. In particular, an analysis of the WHO NCD Action Plan and its accompanying strategies suggests an increased awareness of the roles played by environmental and social factors on behaviour change. Although the language employed falls short of operationalizing the major behavioural insights into the NCD agenda, it clearly highlights that their integration into the current regulatory mix appears fundamental today for the design of any lifestyle policy intervention. As behavioural change is progressively becoming the focus of health promotion efforts, the lesson learned is that there is more to behaviour change than merely empowering the targeted individuals, communities and populations with the necessary information.

Global Response to the Burden of Cancer: The WHO Approach

As the burden of many cancer types of major public health relevance worldwide are in part determined by behavioral risks, much of the success of cancer control depends on the up take of prevention strategies at the population level. Over the last decade, the World Health Organization (WHO) has developed global prevention strategies of major relevance for cancer prevention and the prevention of other non-communicable diseases (NCDs), such as the 2003 WHO Framework Convention on Tobacco Control and others. The implementation of these core strategies gained momentum in 2011, when heads of states at the United Nation's (UN) High Level Meeting (HLM) on NCDs declared that NCDs are a global health threat that menaces social and economic development globally and requires urgent action. They asked for a paradigm change of the global health agenda by including NCD prevention and control into the group of priorities set by the Millennium Development Goals. WHO's translation of this call for action by the UN into practice has been consolidated into one clearly defined the WHO Global NCD Action Plan 2013-2020, including the pre-existing prevention strategies. Although cancer risk reduction will profit from the WHO Global NCD Action Plan, comprehensive cancer prevention and control will require other supplementary strategies not included in the plan because they are not shared with other NCDs. Causality of the over 200 cancer types is complex. A myriad of non-behavioral factors such as environmental and infectious risks, require specific attention when planning comprehensive cancer prevention. In reducing the cancer burden globally much will depend on how prevention strategies are implemented and how progress in cancer treatment can be translated into the reality of health systems in less affluent countries.

The Second Physical Therapy Summit on Global Health: developing an action plan to promote health in daily practice and reduce the burden of non-communicable diseases

Based on indicators that emerged from The First Physical Therapy Summit on Global Health (2007), the Second Summit (2011) identified themes to inform a global physical therapy action plan to integrate health promotion into practice across the World Confederation for Physical Therapy (WCPT) regions. Working questions were: (1) how well is health promotion implemented within physical therapy practice; and (2) how might this be improved across five target audiences (i.e. physical therapist practitioners, educators, researchers, professional body representatives, and government liaisons/consultants). In structured facilitated sessions, Summit representatives (n = 32) discussed: (1) within WCPT regions, what is working and the challenges; and (2) across WCPT regions, what are potential directions using World CaféTM methodology. Commonalities outweighed differences with respect to strategies to advance health-focused physical therapy as a clinical competency across regions and within target audiences. Participants agreed that health-focused practice is a professional priority, and a strategic action plan was needed to develop it as a clinical competency. The action plan and recommendations largely paralleled the principles and objectives of the World Health Organization’s non-communicable diseases action plan. A third Summit planned for 2015 will provide a mechanism for follow-up to evaluate progress in integrating health-focused physical therapy within the profession.

Ensuring the Global Availability of High-quality Dental Restorative Materials

The Minamata Convention, a global legally binding instrument (treaty) on mercury, has been the catalyst for the emerging agenda on global dental materials research. If the current and future challenges of oral health maintenance and healing on a global scale are to be met, a logical and effective research agenda for the discovery and introduction of new, environmentally sustainable, dental materials must be developed through a coordinated effort involving materials scientists, dental clinicians, representatives of industry, members of regional and national regulatory bodies, and advocacy from research organizations. For universal impact, this agenda should be created with awareness of several important ongoing initiatives, such as the WHO non-communicable diseases action plan, the UN sustainable development agenda, and the IADR Global Oral Health In Inequalities Research Agenda (GOHIRA). A significant contributor to this cause is the FDI and its membership, who, through their Vision 2020 initiative, acknowledge their role and responsibility in globally preventing and managing dental disease and providing leadership to the profession in terms of information dissemination and affecting change. Dental researchers also have an obligation to advocate for appropriate funding to match the identified research needs, thus enhancing the possibility that key decision-makers will provide the needed support to achieve the research agenda agreed upon by this diverse group of stakeholders.

Rallying United Nations organizations in the fight against noncommunicable diseases

Rallying United Nations organizations in the fight against noncommunicable diseases

Evidence for non-communicable diseases: analysis of Cochrane reviews and randomised trials by World Bank classification

IntroductionPrevalence of non-communicable diseases (NCDs) is increasing globally, with the greatest projected increases in low-income and middle-income countries. We sought to quantify the proportion of Cochrane evidence relating to NCDs...

The contribution of chronic kidney disease to the global burden of major noncommunicable diseases

Noncommunicable diseases (NCDs) are the most common causes of premature death and morbidity and have a major impact on health-care costs, productivity, and growth. Cardiovascular disease, cancer, diabetes, and chronic respiratory disease have been prioritized in the Global NCD Action Plan endorsed by the World Health Assembly, because they share behavioral risk factors amenable to public-health action and represent a major portion of the global NCD burden. Chronic kidney disease (CKD) is a key determinant of the poor health outcomes of major NCDs. CKD is associated with an eight- to tenfold increase in cardiovascular mortality and is a risk multiplier in patients with diabetes and hypertension. Milder CKD (often due to diabetes and hypertension) affects 5-7% of the world population and is more common in developing countries and disadvantaged and minority populations. Early detection and treatment of CKD using readily available, inexpensive therapies can slow or prevent progression to end-stage renal disease (ESRD). Interventions targeting CKD, particularly to reduce urine protein excretion, are efficacious, cost-effective methods of improving cardiovascular and renal outcomes, especially when applied to high-risk groups. Integration of these approaches within NCD programs could minimize the need for renal replacement therapy. Early detection and treatment of CKD can be implemented at minimal cost and will reduce the burden of ESRD, improve outcomes of diabetes and cardiovascular disease (including hypertension), and substantially reduce morbidity and mortality from NCDs. Prevention of CKD should be considered in planning and implementation of national NCD policy in the developed and developing world.

The missing elements of the noncommunicable diseases action plan

No money. No targets. No consensus on controversial issues such as guaranteeing access to affordable drugs, stiffened measures against the tobacco and alcohol industries, and regulations to curb international trade in unhealthy products. It seems the United Nations’ (UN) newly minted political

The Burden of Selected Chronic Non-Communicable Diseases and Their Risk Factors in Malawi: Nationwide STEPS Survey

BackgroundChronic non-communicable diseases (NCDs) are becoming significant causes of morbidity and mortality, particularly in sub-Saharan African countries, although local, high-quality data to inform evidence-based policies are lacking.ObjectivesTo determine the magnitude of NCDs and their risk factors in Malawi.MethodsUsing the WHO STEPwise approach to chronic disease risk factor surveillance, a population-based, nationwide cross-sectional survey was conducted between July and September 2009 on participants aged 25–64 years. Socio-demographic and behaviour risk factors were collected in Step 1. Physical anthropometric measurements and blood pressure were documented in Step 2. Blood cholesterol and fasting blood glucose were measured in Step 3.Results and ConclusionA total of 5,206 adults (67% females) were surveyed. Tobacco smoking, alcohol drinking and raised blood pressure (BP) were more frequent in males than females, 25% vs 3%, 30% vs 4% and 37% vs 29%. Overweight, physical inactivity and raised cholesterol were more common in females than males, 28% vs 16%, 13% vs 6% and 11% vs 6%. Tobacco smoking was more common in rural than urban areas 11% vs 7%, and overweight and physical inactivity more common in urban than rural areas 39% vs 22% and 24% vs 9%, all with p<0.05. Overall (both sexes) prevalence of tobacco smoking, alcohol consumption, overweight and physical inactivity was 14%, 17%, 22%, 10% and prevalence of raised BP, fasting blood sugar and cholesterol was 33%, 6% and 9% respectively. These data could be useful in the formulation and advocacy of NCD policy and action plan in Malawi.

International collaborations in cancer control and the Third International Cancer Control Congress

Over the past few decades, there has been growing support for the idea that cancer needs an interdisciplinary approach. Therefore, the international cancer community has developed several strategies as outlined in the WHO non-communicable diseases Action Plan (which includes cancer control) as the World Health Assembly and the UICC World Cancer Declaration, which both include primary prevention, early diagnosis, treatment, and palliative care. This paper highlights experiences/ideas in cancer control for international collaborations between low, middle, and high income countries, including collaborations between the European Union (EU) and African Union (AU) Member States, the Latin-American and Caribbean countries, and the Eastern Mediterranean countries. These proposals are presented within the context of the global vision on cancer control set forth by WHO in partnership with the International Union Against Cancer (UICC), in addition to issues that should be considered for collaborations at the global level: cancer survival (similar to the project CONCORD), cancer control for youth and adaptation of Clinical Practice Guidelines. Since cancer control is given lower priority on the health agenda of low and middle income countries and is less represented in global health efforts in those countries, EU and AU cancer stakeholders are working to put cancer control on the agenda of the EU-AU treaty for collaborations, and are proposing to consider palliative care, population-based cancer registration, and training and education focusing on primary prevention as core tools. A Community of Practice, such as the Third International Cancer Control Congress (ICCC-3), is an ideal place to share new proposals, learn from other experiences, and formulate new ideas. The aim of the ICCC-3 is to foster new international collaborations to promote cancer control actions in low and middle income countries. The development of supranational collaborations has been hindered by the fact that cancer control is not part of the objectives of the Millennium Development Goals (MGGs). As a consequence, less resources of development aids are allocated to control NCDs including cancer.

A review of non-communicable disease in low- and middle-income countries

Non-communicable disease (NCD)-primarily heart and stroke disease, cancer, chronic obstructive pulmonary disease and diabetes-caused an estimated 35 million deaths in 2005, 80% of which occurred in low- and middle-income countries (LAMICs). By 2030, 8 of 10 leading causes of death will be linked to these conditions. The burden of NCDs poses serious implications for social and economic development worldwide but particularly for LAMICs. WHO and member states have developed a clear vision represented by the Global Strategy for the Prevention and Control of Noncommunicable Diseases and an implementation plan to tackle this epidemic, incorporating lessons learned from international experience and the work of WHO in member states. The 2008 NCD Action Plan, which advocates an integrated approach to NCD prevention and control, with emphasis on the role of primary health care, is based on current scientific knowledge, available evidence and a review of international experience. It comprises a set of actions to tackle the growing public-health burden imposed by NCDs. For the plan to be implemented successfully, high-level political commitment and the concerted involvement of governments, communities and health-care providers are required; in addition, public-health policies will need to be reoriented and allocation of resources improved.