Raising the priority of non-communicable diseases in development work at global and national levels Page 1

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1 Raising the priority of non-communicable diseases in development work at global and national levels Page 1 Presentation for discussion (Not an official document)

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3 The lives of far too many people in developing countries are being blighted and cut short by four types of noncommunicable diseases (NCDs) heart diseases and stroke, cancers, diabetes and chronic lung diseases. People in developing countries tend to develop these diseases at younger ages, suffer more often with preventable complications and die sooner than those in high-income countries. These four types of NCDs make the largest contribution to mortality in the majority of developing countries, with an enormously negative impact on socio-economic development. These diseases are largely preventable by promoting healthy lifestyles and implementing effective interventions that tackle shared risk factors, namely: tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol. Better health outcomes can also be achieved by improving access to health care for people with established NCDs. The cost of inaction is unacceptable. This presentation, which is intended for discussion, shares facts about NCDs in developing countries and makes three points. One is the urgent need for public policies to prevent and control NCDs and their devastating consequences to the greatest extent possible in all developing countries. The second is the need to adopt a whole-of-government approach and ensure the commitment and active involvement of non-health sectors. The third is the importance of recognizing that the burden of NCDs will continue to increase in developing countries, disproportionally affecting the poor, and, therefore, policy makers and international development partners have a key role to play in ensuring that NCD prevention and control becomes an integral part of the development agenda. Dr Ala Alwan Assistant Director-General World Health Organization Page 3

4 Four types of non-communicable diseases are largely preventable by means of effective interventions that tackle shared modifiable risk factors Causative risk factors Tobacco use Unhealthy diets Physical inactivity Harmful use of alcohol Non-communicable diseases Heart disease and stroke Diabetes Cancer Chronic lung disease Page 4

5 Key messages In all developing countries, and by any metric, heart diseases, strokes, cancers, diabetes and chronic respiratory diseases now account for a large enough share of premature deaths and poverty to merit a concerted and coordinated policy response. They are already dominating health care needs in most developing countries, as a result of globalization, rapid unplanned urbanization and population ageing. Tackling non-communicable diseases constitutes one of the major challenges for development in the twenty-first century. There is clear evidence that low-cost solutions exist to reduce the level of exposure of individuals and populations in developing countries to the common modifiable risk factors (mainly tobacco use, unhealthy diet and physical inactivity, and the harmful use of alcohol), to strengthen health care for people with non-communicable diseases, and map the emerging epidemic of non-communicable diseases, and that these are excellent economic investments. Public policy makers in developing countries are increasingly challenged to formulate effective strategies to address non-communicable diseases. But requests for technical support (through aid and expertise) from developing countries remain largely unanswered by the international development community, partly because these problems are not included in the framework of the MDGs. To galvanize action to halt and begin to reverse the prevalence of premature deaths from non-communicable diseases, the UN General Assembly will be convening a High-level Meeting in September 2011, with the participation of Heads and State and Government, on the prevention and control of non-communicable diseases. Converting aspirations into achievements will require unprecedented commitment to include the prevention and control of non-communicable diseases as an integral part in global development initiatives and in related investment decisions. Page 5

6 fact 1 60% of the world's annual deaths are due to non-communicable diseases. Approximately 25% of these deaths are premature (below the age of 60) and could be prevented. 70 million 10% 60 million 50 million 40 million 30 million 20 million 10 million 35 million (60% of all deaths) 5.8 M 26.0 M (above the age of 60) 9.0 M (below the age of 60) 18.0 M 25% of 35 million Source: 0 Total number of deaths in the world (2004) Group III - Injuries Low-income countries Group II Other deaths from non-communicable diseases Group II Premature deaths from non-communicable diseases (below the age of 60), which are preventable Group I Communicable diseases, maternal, perinatal and nutritional conditions Page 6

7 90% of world's people dying prematurely from non-communicable diseases are living in developing countries fact 2 Total number of deaths (2004) 25 million 2.3M 6.8 M 20 million Source: 15 million 10 million 2.3M 10.2M 3.7M 13.6M Annually, 8.1 million premature deaths from non-communicable diseases occur in developing countries 0.5M 5.9M 0.9M 0.5M High-income countries 0.6M 3.0M 1.1M 0.8M Upper middleincome 3.3M 3.0M Lower middleincome Low-income countries Group III - Injuries Group II Other deaths from non-communicable diseases Group II Premature deaths from non-communicable diseases (below the age of 60), which are preventable Group I Communicable diseases, maternal, perinatal and nutritional conditions Page 7

8 fact 3 60 million In developing countries, more than 8 million premature deaths from non-communicable diseases per year are not covered by global development initiatives 50 million 40 million 5.3 M 20.0 M 14.2 M 30 million 20 million 10 million 0 million 8.1 M 17.4 M Not covered by global development initiatives: More than 8 million premature deaths from non-communicable diseases Source: Total number of deaths in low- and middle-income countries (2004) Group III - Injuries Low-income countries Group II Other deaths from non-communicable diseases Group II Premature deaths from non-communicable diseases (below the age of 60), which are preventable Group I Communicable diseases, maternal, perinatal and nutritional conditions Page 8

9 In all developing countries, premature deaths from non-communicable diseases account for a large enough share of the disease burden to merit a serious policy response fact 4 The top-10 leading causes of death Low-income countries Middle-income countries High-income countries Source: Lower respiratory infections (11.2%) Coronary heart disease (9.4%) Diarrhoeal diseases (6.9%) HIV/AIDS (5.7%) Stroke and other cerebrovascular diseases (5.6%) Chronic obstructive pulmonary disease (3.6%) Tuberculosis (3.5%) Neonatal infections (3.4%) Malaria (3.3%) Premature and low birth weight (3.2%) Stroke and other cerebrovascular disease (14.2%) Coronary heart disease (13.9%) Chronic obstructionary pulmonary disease (7.4%) Lower respiratory infection (3.8%) Trachea, bronchus, lung cancers (2.9%) Road traffic accidents (2.8%) Hypertensive heart disease (2.5%) Stomach cancer (2.2%) Tuberculosis (2.2%) Diabetes mellitus (2.1%) Coronary heart disease (16.3%) Stroke and other cerebrovascular diseases (9.3%) Trachea, bronchus, lung cancers (5.9%) Chronic obstructive pulmonary disease (3.5%) Alzheimer and other dementias (3.4%) Colon and rectum cancers (3.3%) Diabetes mellitus (2.8%) Breast cancer (2.0%) Stomach cancer (1.8%) Page 9

10 fact 5 Without action, Africa will witness the largest increase in deaths from non-communicable diseases in 2015 (compared to 2004) 2.5 million 30% 2.0 million % 1.5 million 1.0 million 20% 15% 10% Source: 5% 0 0% Africa Americas East. Med Europe South- East Asia Western Pacific Africa Americas East. Med Europe South- East Asia Western Pacific Page 10

11 More people die from heart diseases and strokes in the poorest developing countries than in the richest industrialized countries fact m 3.8 m 8.2 m 9.0 m 6.1 m Source: m 3.4 m 2.4 m 3.0 m 5.1 m 6.5 m 7.3 m Low income countries Lower middle-income countries Upper middle-income countries High income countries 0 2 million 4 million 6 million 8 million 10 million Estimated deaths from cardiovascular diseases (2004) Page 11

12 fact 7 Only 5% of the world's population was covered by comprehensive smoke-free laws in Page 12

13 The majority of populations with the highest prevalence of diabetes live in developing countries fact 8 Country Prevalence (2010) Country 1 Nauru 31% 1 Nauru 33% 2 United Arab Emirates 19% 2 United Arab Emirates 21% 3 Saudi Arabia 17% 3 Mauritius 20% 4 Mauritius 16% 4 Saudi Arabia 19% Prevalence (2030) ( ) 5 Bahrain 15% 5 Bahrain 17% 6 Kuwait 15% 6 Kuwait 17% 7 Oman 13% 7 Tonga 16% 8 Tonga 13% 8 Oman 15% 9 Malaysia 12% 9 Malaysia 14% Prevalence of diabetes Source: International International Diabetes Diabetes Federation's Federation's Diabetes Atlas Diabetes Atlas Page 13

14 The top-10 risks of dying in developing countries are from risk factors for NCDs 7 million Attributable deaths in developing countries by risk factor 6 million 5 million 4 million 3 million 2 million 1 million 0 Page 14 Child sexual abuse Lead exposure Global climate change Unmet contraceptive need Illicit drug use Iron deficiency Unsafe health care injections Zinc deficiency Vitamin A deficiency Occupational risks Urban outdoor air pollution Sub-optimal breastfeeding Low fruit and vegetable intake Unsafe water, sanitation, hygiene Indoor smoke from solid fuels Alcohol use Overweight and obesity High cholesterol Underweight Unsafe sex Physical inactivity High blood glucose fact 9 Tobacco use High blood pressure

15 The poorest households in the poorest countries smoke the most fact 10 (percentage) Smoking prevalence (2004) Lowest household income quintiles Highest household income quintiles Low-income countries Lower-middleincome countries Upper-middleincome countries High-income countries Page 15

16 fact 11 Non-communicable diseases are among the leading causes of death among women in developing countries, as well as high-income countries 10 leading causes of deaths in females (2004) Source: WHO's report on "Women and Health: today's evidence, tomorrow's agenda" Page 16

17 More women aged years die from non-communicable diseases in Africa than in high-income countries (per 1,000 adults) fact Mortality rates among women aged years (deaths per 1,000) Highincome countries Western Pacific Americas Eastern Mediterranean South East Asia Europe Low- and middle-income countries only Africa Page 17

18 fact 13 Non-communicable diseases are the third largest global risk in terms of likelihood and the fourth largest global risk in terms of economic severity Oil spikes Retrenching from globalization Asset price collapse World Economic Forum: Global Risk 2010 Report Food price volatility Financial crisis Infectious diseases Non-communicable diseases "A problem neither the developed world nor the developing world can afford" "Declining development assistance has already led to a significant reduction of public spending on health in many countries. When funds are limited, governments tend to focus on basic health services, in line with the MDGs, at the expense of the prevention and treatment of non-communicable diseases." (WEF Global Risk 2010 Report) Page 18

19 Poverty at household level At household level, non-communicable diseases are affecting the poorest people in developing countries disproportionally Populations in low- and middle-income countries fact 14 Globalization Urbanization Population ageing Increased exposure to common modifiable risk factors: Unhealthy diets Physical inactivity Tobacco use Harmful use of alcohol Loss of household income from unhealthy behaviours Non-communicable diseases: Cardiovascular diseases Cancers Diabetes Chronic respiratory diseases Loss of household income from poor physical status Limited access to effective and equitable health-care services which respond to the needs of people with non-communicable diseases Loss of household income from high cost of health care 8 million people die prematurely each year in developing countries from non-communicable diseases Poverty contributes to non-communicable diseases and non-communicable diseases contribute to poverty Page 19

20 fact 15 In May 2008, WHO Member States started to mobilize a global response to address non-communicable diseases, with a particular focus on developing countries Global Strategy for the Prevention and Control of Non-communicable Diseases Global Strategy on Infant and Young Child Feeding WHO Framework Convention on Tobacco Control Global Strategy on Diet, Physical Activity and Health 2008 Action Plan on the Global Strategy for the Prevention and Control of Non-communicable Diseases Page 20

21 The Action Plan for the Global Strategy for the Prevention and Control of Non-communicable Diseases was endorsed by the World Health Assembly in May 2008 fact 16 Six objectives: 1. Raising the priority accorded to non-communicable diseases in development work at global and national levels, and integrating prevention and control of noncommunicable diseases into policies across all government departments 2. Establishing and strengthening national policies and programmes 3. Reducing and 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 Under each of the six objectives, there are sets of actions for Member States, the WHO Secretariat and international partners Page 21

22 fact 17 The international development community has been slow in responding to the call to raise the priority accorded to non-communicable diseases in development work HIV/AIDS & STDs Health Policy & Admin. Management Infectious Disease Control Reproductive Health Basic Health Care Malaria Control Family Planning Tuberculosis Control Basic Nutrition Medical Services Basic Health Infrastructure Medical Research Medical Education/Training Health Education Water Supply/Sanitation - Large Systems Water resources policy/admin. mgmt Basic Drinking Water Supply & Sanitation Waste Management/Disposal River Development Water Resources Protection Water Education/Training Health ODA Commitments (2007) in US$ billions $1.65 $1.33 $1.16 $1.14 $0.80 $0.53 $0.45 $0.33 $0.24 $0.23 $0.22 $0.21 $0.06 Total Health ODA: $22.1 billion Health ODA for non-communicable diseases:? There is no OECD/DAC Creditor Reporting System code yet to track health commitments for the prevention and control of non-communicable diseases $3.90 $0.93 $0.92 $0.42 $0.10 $0.06 $0.01 Source: Kaiser Family Foundation ( $7.40 (Based on analysis of data obtained via online query of the OECD Development Assistance Committee (DAC) Database and Creditor Reporting System (CRS) on 31 May 2009) Page 22

23 The Paris Declaration invites donors to base their support on demand from developing countries fact 18 Pending Page 23

24 fact 19 The Regional Summit of Heads of Government of the Caribbean Community (CARICOM) adopted a Declaration on Non-communicable Diseases on 15 September 2007 Page 24

25 The Western Asia Ministerial Meeting on Non-communicable Diseases called on leaders to place non-communicable diseases at the forefront of development efforts fact 20 ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting Addressing non-communicable diseases and injuries: major challenges to sustainable development in the 21st century (Hosted in Doha by the Government of Qatar, May 2009) Page 25

26 fact 21 Participants at the Western Asia Ministerial Meeting on Non-communicable Diseases adopted the Doha Declaration on Non-communicable Diseases We call: For integration of evidence-based indicators on NCDs and injuries into the core MDG monitoring and evaluation system during the 2010 review of the MDGs. For raising the priority accorded to NCDs and injury prevention on the agendas of relevant high level forums and meetings of national, regional, and international leaders. For a review of international experience in the prevention and control of NCDs and injuries in low- and middle-income countries, including community-based programmes, and identify and disseminate successful approaches for intersectoral action. Page 26

27 Many national and international leaders have started to call on global development initiatives to take into account the prevention and control of non-communicable diseases fact 22 Regional Ministerial Meeting on Health Literacy (Beijing, April 2009) Regional Ministerial Meeting on Non-communicable Diseases and Injuries, Poverty and Development (Qatar, May 2009) ECOSOC High-level Segment on Global Health (Geneva, 6-9 July 2009) ECOSOC Ministerial Roundtable Meeting on Noncommunicable Diseases and Injuries (Geneva, 8 July 2009) Doha Declaration on Non-communicable Diseases ECOSOC Ministerial Declaration United Nations General Assembly Resolution A/RES/64/265 on the prevention and control of non-communicable diseases (adopted on 13 May 2010) Page 27

28 fact 23 The 2009 Commonwealth Heads of Government Meeting issued a statement on action to combat non-communicable diseases Page 28

29 The First Ladies of Gambia, Ghana, Niger, South Africa, Swaziland, Uganda and Zambia call for greater focus and investment in addressing women's cancers fact 24 Page 29

30 fact 25 The United Nations General Assembly adopted resolution A/RES/64/265 on non-communicable diseases unanimously -- it was sponsored by 78 Member States List of sponsors: Antigua and Barbuda, Australia, Azerbaijan, Bahamas, Bangladesh, Barbados, Belgium, Belize, Bolivia (Plurinational State of), Brazil, Bulgaria, Cameroon*, Canada, Chile, China, Colombia, Croatia, Cuba, Cyprus, Dominica, Dominican Republic, El Salvador, Finland, France, Georgia, Germany, Greece, Grenada, Guatemala, Guyana, Haiti, Hungary, India, Ireland, Israel, Italy, Jamaica, Japan, Kazakhstan, Luxembourg, Malaysia, Maldives, Malta, Marshall Islands, Mexico, Monaco, Montenegro, Nauru, New Zealand, Nicaragua, Pakistan, Palau, Panama, Papua New Guinea, Paraguay, Peru, Portugal, Qatar, Russian Federation, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Samoa, Serbia, Singapore, Slovenia, Solomon Islands, Spain, Suriname, Switzerland, Thailand, Timor-Leste, Tonga, Trinidad and Tobago, Turkey, United Kingdom of Great Britain and Northern Ireland, United States of America and Uruguay *on behalf of the Member States which are members of the Group of African States Page 30

31 Resolution A/RES/64/265 decides to convene a High-level Meeting of the UN General Assembly in September 2011 on the prevention and control of non-communicable diseases fact 26 Decides to convene a High-level Meeting of the General Assembly in September 2011, with the participation of Heads of State and Government, on the prevention and control of noncommunicable diseases; Also decides to hold consultations on the scope, modalities, format and organization of the highlevel meeting of the General Assembly on the prevention and control of non-communicable diseases, with a view to concluding consultations, preferably before the end of 2010; Encourages Member States to include in their discussions at the High-level Plenary Meeting of the sixty-fifth session of the General Assembly on the review of the Millennium Development Goals, to be held in September 2010, the rising incidence and the socio-economic impact of the high prevalence of non-communicable diseases worldwide; Requests the Secretary-General to submit a report to the General Assembly at its sixty-fifth session in collaboration with Member States, the World Health Organization and the relevant funds, programmes and specialized agencies of the United Nations system, on the global status of non-communicable diseases, with a particular focus on the developmental challenges faced by developing countries. Page 31

32 fact 27 At the occasion of the 2009 ECOSOC High-level Segment, WHO launched a new global network to combat non-communicable diseases (NCDnet) on 8 July 2009 Mission of NCDnet: Help implement the Action Plan by catalyzing a multi-sectoral, multi-level response, with a particular focus on developing countries Goals of NCDnet: Increase focus on prevention and control of non-communicable diseases through collective advocacy Increase resource availability (both financial and human capital) Catalyze effective multi-stakeholder action with a focus on countrylevel implementation Page 32

33 NCDnet is composed of the WHO Secretariat staff, an International Advisory Council, NCDnet Global and Regional Forum meetings and functional Working Groups fact 28 WHO International Advisory Council Innovative Financing Mechanisms Global Forum Meetings Regional Forum Meetings Working groups Advocacy and Communications Innovative Financing Mechanisms Monitoring and evaluation Partnership capacity building Page 33

34 fact 29 The NCDnet First Global Forum took place on 24 February Page 34

35 WHO will prepare Global Status Reports on Non-communicable Diseases in 2010 and 2013 fact Page 35

36 Contacts Dr Ala Alwan Assistant Director-General World Health Organization Geneva, Switzerland Tel: Acknowledgements This presentation for discussion was compiled with the input, support and assistance from staff across WHO's cluster for Noncommunicable Diseases and Mental Health. This presentation does not represent an official position of the World Health Organization. It is a tool to explore the views of interested parties on the subject matter. References to international partners are suggestions only and do not constitute or imply any endorsement whatsoever of this presentation. The World Health Organization does not warrant that the information contained in this presentation is complete and correct and shall not be liable for any damages incurred as a result of its use. The designations employed and the presentation of the material in this presentation does not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this presentation. However, the presentation is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the presentation lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Unless specified otherwise, the data contained in this presentation is based on the 2004 update on the Global burden of disease. Additional information is available at World Health Organization, All rights reserved. The following copyright notice applies: Page 36