WORLD HEALTH ORGANIZATION

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1 SDG target 3.4: By 2030, reduce by one third premature mortality from NCDs through prevention and treatment and promote mental health and well-being Where do we stand today? What progress has been made between 2000 and 2017? What are the plans until 2018? Douglas Bettcher Director Prevention of NCDs WORLD HEALTH ORGANIZATION

2 2000: WHO Global Strategy on NCDs Tobacco use Causative risk factors Unhealthy diets Physical inactivity Harmful use of alcohol Noncommunicable diseases Heart disease and stroke Diabetes Cancer Chronic lung disease

3 Source: WHO Global Health Estimates 2015: 15 million people died from NCDs between the ages of 30 and 69 25,000, ,000, ,000, ,000, ,000, to to and beyond Communicable, maternal, perinatal and nutritional conditions NCDs Injuries

4 Premature deaths (30-70) in millions 2015: # of premature deaths (30-69) from NCDs among men, ex rich countries Low-income Lower middle-income Upper middle-income High-income Years

5 Premature deaths (30-70) in millions 2015: # of premature deaths (30-69) from NCDs among women, ex rich countries Low-income Lower middle-income Upper middle-income High-income Years

6 Premature deaths (30-70) in millions 2015: # of premature deaths (30-69) from NCDs among men, except EUR AFR AMR EMR EUR SEA WPR Years

7 Premature deaths (30-70) in millions 2015: # of premature deaths (30-69) from NCDs among women, except EUR AFR AMR EMR EUR SEA WPR Years

8 Probability of dying (0-1) 2015: Probability of men dying from any major NCD between ages Developed countries Developing countries Years

9 Probability of dying (0-1) 2015: Probability of women dying from any major NCD between ages Developed countries Developing countries Years

10 Source: WHO Global Health Estimates 2015: Huge disparities between countries Probability of dying from any of cardiovascular disease, cancer, diabetes, chronic respiratory disease between the ages of 30 and 70 WHO estimates for 2015 (both sexes) 40% AFR Algeria Cabo Verde, Gabon 15% 16% 35% AMR Canada Chile, Costa Rica 10% 11% 30% EMR EUR Qatar Iran (IR) Iceland Italy, Israel, Sweden, Switzerland 14% 15% 8% 9% 25% SEAR Maldives Thailand 12% 16% 20% WPR Republic of Korea Australia, Japan 8% 9% AFR Cote d'ivoire Sierra Leone 28% 30% 15% AMR EMR Trinidad and Tobago Guyana Sudan Afghanistan, Yemen 26% 28% 26% 31% 10% EUR Belarus, Kazakhstan, Russian Federation, Ukraine Turkmenistan 29% 35% 5% SEAR WPR DPRK Indonesia Fiji Papua New Guinea 26% 27% 31% 36% 0%

11 Source: WHO Global Health Estimates The most important question Globally, the probability of dying prematurely from these four main NCDs declined by 17% between 2000 and This rate of decline is insufficient to meet the SDG target 3.4 on NCDs (i.e. by 2030, reduce by one third premature mortality from NCDs)

12 Commitments made by world leaders to curb premature deaths from NCDs 2007 CARICOM Port-of-Spain Declaration on NCDs 2009 ECOSOC Doha Declaration on NCDs rd HLM 2011 Moscow Declaration 2011 Political Declaration 2014 Outcome Document 2015 AAAA 2015 SDGs

13 2030 Agenda for Sustainable Development Commits governments to develop national responses: Target 3.4: By 2030, reduce by one third premature mortality from NCDs through prevention and treatment and promote mental health and wellbeing Target 3.5: Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for al

14 2030 Agenda for Sustainable Development Target 3.a: Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate Target 3.b: Support the research and development of vaccines and medicines for the communicable and NCDs that primarily affect developing countries, provide access to affordable essential medicines and vaccines, in accordance with the Doha Declaration on the TRIPS Agreement and Public Health, which affirms the right of developing countries to use to the full the provisions in the Agreement on Trade- Related Aspects of Intellectual Property Rights regarding flexibilities to protect public health, and, in particular, provide access to medicines for all

15 Addis Ababa Action Agenda The Addis Ababa Action Agenda defines the means of implementation for the 2030 Agenda for Sustainable Development The Addis Ababa Action Agenda recognizes that price and tax measures on tobacco represent a revenue stream for financing for development in many countries Governments already collect nearly US$270 billion in tobacco excise revenues each year Tobacco taxation offers a win-win policy option for governments

16 Third High-level Meeting of the UN General Assembly on NCDs in 2018 By 2030, reduce by one third premature mortality from NCDs 2030 milestone: NCD-related targets in the SDGs 2025 milestone: 9 voluntary global NCD targets 2018 milestone: Four time-bound commitments Components of national NCD responses Governance Risk factors Health systems Surveillance 2011 UN Political Declaration on NCDs 2014 UN Outcome Document on NCDs WHO Global NCD Action Plan WHO Regional NCD Action Plans Agenda for Sustainable Development

17 Four time-bound commitments in the 2014 UN Outcome Document on NCDs Set national NCD targets for 2025 or 2030 and monitor results Develop a national multisectoral action plan Implement the "best buy" interventions to reduce NCD risk factors Implement the "best buy" interventions to strengthen health systems to address NCDs

18 Global accountability framework for NCDs 2015 WHA68 (2016) 2020 WHA73 (2021) 2025 WHA78 (2026) 25 outcome indicators 2015 WHA68 (2016) 2017 WHA69 (2018) 2020 WHA73 (2021) 9 process indicators UNGA (2017) progress indicators 2016 UNGA 2017 UNGA 2 indicators

19 Where can we find these indicators? Table 1 in Appendix 1 of document A66/8 (endorsed by resolution WHA66.10) 25 outcome indicators Table in paragraph 2 in Annex 4 of document A67/14 (agreed by WHA67) Technical note published by the WHO Director-General on 1 May Report of the IAEG-SDGs to the 47 session of the UN Statistical Commission process indicators 10 progress indicators 2 indicators

20 Outcome indicators (reported to the World Health Assembly in May 2016) Progress towards the 9 global NCD targets for Trend Unconditional probability of dying between ages of 30 and 70 from one of the mayor NCDs 20% 19% Total alcohol per capita (aged 15+ years old) consumption within a calendar year (in litres of pure alcohol) Prevalence of current tobacco smoking use among adults aged 18+ Age-standardized prevalence of raised blood pressure among persons aged 18+ years and mean systolic blood pressure Age-standardized prevalence of raised blood glucose/diabetes among persons aged 18+ years 23.1% 21.8% 23% 22% 8% 9% Age-standardized prevalence of overweight and obesity in persons aged 18+ years) 11% (obesity) 37% (overweight) 13% (obesity) 39% (overweight)

21 Process indicators (reported to the World Health Assembly in May 2016) Number of countries Trend with at least one operational multisectoral national NCD action plan that have operational NCD unit with an operational policy to reduce the harmful use of alcohol with an operational policy to reduce physical inactivity with an operational policy to reduce the burden of tobacco use with an operational policy to reduce unhealthy diet. that have evidence-based national guidelines for the management of major NCDs through a primary care approach that have an operational national policy on NCD-related research with NCD surveillance and monitoring systems in place 30/166 (18%) 88/166 (53%) 80/166 (48%) 91/166 (55%) 109/166 (66%) 99/166 (60%) 125/166 (75%) NO DATA 60/166 (36%) 61/166 (37%) 110/166 (66%) 111/166 (67%) 119/166 (72%) 135/166 (81%) 123/166 (74%) 61/166 (37%) N/A 60/166 (36%) N/A 48/166 (29%) N/A

22 Number of "fully achieved" Indicators WHO NCD Progress Monitor for UN General Assembly: 2015 progress report card Number of Member States

23 What can WHO report to the UN General Assembly in November 2017? No Is the world on track for 2030 to meet SDG target 3.4 (NCDs)? Is the world on track for 2018 to meet the four time-bound commitments? Are health outcomes for NCDs improving since 2011? Are counties strengthening their capacities for NCDs since 2011? Are countries implementing the WHO Global NCD Action Plan? No Yes, but Remarkable progress, even in some of the poorest countries, but bolder measures are needed. Successes to date are still outstripped by illness, disability, human suffering, and premature deaths from NCDs Yes The NCD community needs an electric shock to its semicomatose soul. But who has the courage to deliver it? Yes

24 Why is progress so slow? A lack of adequate commitment and policy expertise to integrate measures to address NCDs into national SDGs responses Unmet demands for technical assistance to be provided through bilateral and multilateral channels to strengthen national capacity Slow progress in engaging the whole-of-government and key sectors beyond health, which is a prerequisite in developing national multisectoral NCD responses, including the implementation of the best buys for NCDs Lack of action to allocate funding to implement NCD control priorities, in developing countries, by domestic mobilization of resources or external aid Weak health systems and inadequate national capacity in public health Insufficient analytical, legal and tax administrative capacity to reduce risk factors and support the implementation of the best buys Actions of opposing forces, including industry interference, that blocks the implementation of certain key measures.

25 Are countries requesting assistance to overcome these bottlenecks?

26 How is WHO helping countries to build national NCD responses? Development and implementation of national NCD responses Components of national NCD responses Governance Risk factors Health systems Surveillance Normative work Technical assistance Technical assistance (beyond the health sector) Advocacy Network Forum WHO Secretariat (through WHO Programme Budget) UN Agencies (coordinated through the WHO-led UN Task Force on NCDs) Non-State actors (coordinated through the WHO GCM/NCD)

27 May 2017: Updated set of good and best buys for NCDs Endorsed by the World Health Assembly in May 2017: 16 best buys 86 good buys Two years process Methodology endorsed by the World Health Assembly in May 2016 Additional information published to understand the underlying analysis related to interventions included in the updated set Additional technical briefings published on the evidence underlying the interventions presented in the updated set -update/en/

28 May 2017: Updated set of 16 best buys for NCDs 1) Increase excise taxes and prices on tobacco products 2) Implement plain/standardized packaging and/or large graphic health warnings on all tobacco packages 3) Enact and enforce comprehensive bans on tobacco advertising, promotion and sponsorship 4) Eliminate exposure to second-hand tobacco smoke in all indoor workplaces, public places, public transport 5) Implement effective mass media campaigns that educate the public about the harms of smoking/tobacco use and second hand smoke 6) Increase excise taxes on alcoholic beverages 7) Enact and enforce bans or comprehensive restrictions on exposure to alcohol advertising (across multiple types of media) 8) Enact and enforce restrictions on the physical availability of retailed alcohol (via reduced hours of sale) 9) Reduce salt intake through the reformulation of food products to contain less salt and the setting of target levels for the amount of salt in foods and meals 10) Reduce salt intake through the establishment of a supportive environment in public institutions such as hospitals, schools, workplaces and nursing homes, to enable lower sodium options to be provided 11) Reduce salt intake through a behaviour change communication and mass media campaign 12) Reduce salt intake through the implementation of front-of-pack labelling 13) Implement public awareness and motivational communications for physical activity, including mass media campaigns for physical activity behavioural change 14) Drug therapy (including glycaemic control for diabetes mellitus and control of hypertension using a total risk approach) and counselling to individuals who have had a heart attack or stroke and to persons with moderate to high risk of a fatal and non-fatal cardiovascular event in the next 10 years 15) Vaccination against human papillomavirus (2 doses) of 9 13 year old girls 16) Prevention of cervical cancer by screening women aged 30 49

29 WHO tools Available at Updated quarterly

30 WHO Global Conference on NCDs (Montevideo, October 2017) Focus: How to develop NCD policies to implement the (updated) best buys for NCDs to reach SDG target 3.4? How to influence public policies in sectors beyond health to reach SDG target 3.4? How to enhance policy coherence between public health, trade and other sectors to reach SDG target 3.4? Outcome: NCD Roadmap for SDG target 3.4 on NCDs

31 Key take away In 2011 and 2014, Heads of State and Government made commitments to reduce premature mortality from NCDs In 2015, Heads of State and Government committed to develop ambitious national responses to the SDGs, including SDG target 3.4 to, by 2030, reduce by one third premature mortality from NCDs Despite these commitments, progress to date has been insufficient and highly uneven. Bolder measures are urgent to focus efforts. Our task at hand: Which bolder measures do we recommend?

32 Thank you