Reducing avoidable disease burden and premature deaths

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1 Reducing avoidable disease burden and premature deaths James Gillian Director Public Health & Social Services Department of Public Health and Social Services Guam 11 th Pacific Health Ministers Meeting April, 2015 Yanuca, Fiji

2 Leading causes of death in Oceania 1990 and 2010 Double burden of disease NCD crisis!

3 Progress and achievements -1 Good progress on child mortality TB control on track to achieve MDG Malaria morbidity and mortality reduced Pacific Lymphatic Filariasis Elimination Programme (PacELF) achieved the bench mark of less than 1% prevalence in most PICs

4 Progress and achievements 2 NCDs raised as a national priority Highlighted In regional and global agenda Tobacco tax increase in 11 PICs 12 PICs have raised taxes on sugar sweetened beverages (SSBs) PEN demonstration in 15 PICs STEPs surveys in 17 countries (with 3 completing two rounds)

5 Issues Determinants and risk factors are beyond the health ministries Tobacco, food, water/sanitation, trade, rapid unplanned urbanization Fragmented health service delivery and public health programmes Too many vertical programmes, sustainability Inequitable service delivery Service provision not meeting the population needs in an equitable manner Not enough timely information Multiple surveys, but information is not complete, reliable and timely. Overall inconsistent gains in LE.

6 Communicable Diseases -priorities Strengthening surveillance and response IHR, PPHSN, outbreak response, capacity building Outreach activities with low cost interventional tools EPI, Preventive Chemotherapy for NTDs, TB-DOTS Improvement of the determinants of CDs WASH, vector control, food safety and environmental hygiene

7 NCD prevention and control -Roadmap Strengthen tobacco control Taxation, legislation and implementation Reduce consumption of food and drinks related to obesity, diabetes and heart disease Food standards, control of imports, taxation Improve efficiency and impact of the health sector PEN adaptation and integration in primary health care Strengthening monitoring and evaluation Adult and adolescent risk factor surveys once in 5 years NCD dashboard with annual updates

8 COMPONENT Draft -NCD Dashboard ACTIONS Status and Leadership /Governance strength G1 Country NCD Roadmap / National NCD Plan which is fully resourced G3 National Multi-Sectoral Taskforce Preventative Policies Tobacco T1 Tobacco legislation and regulations T2 Tobacco taxation Alcohol A1 Alcohol legislation and regulations A2 Alcohol taxation Food F1 Fiscal policies for healthy/unhealthy foods Physical activity F2 Restrictions on unhealthy food marketing to children F3 Healthy food policies in school and pre-school settings PA1 Physical education is integral within school curriculum Health System Response Programmes H1 Cessation treatment for tobacco dependence H2 H3 NCD medicines in WHO PEN (or equivalent) included in Essential Drug List (EDL) CVD risk assessment is utilised in health system Monitoring M1 Population Risk Factor prevalence (surveys) - Adults M2 Population Risk Factor prevalence (surveys) - Youth M5 Monitoring childhood BMI/growth

9 Future directions Multisectoral action and Health in All Policies National mechanisms for implementing win-win solutions Expand health promotion and protection beyond health education Policies, legislation and fiscal interventions Integrated people centered health service delivery Defined package of services based on principles of UHC Reliable and timely data on key indicators Small set of indicators with periodic data collection and timely reporting. Continued improvement CRVS Cross-cutting: capacity building, risk communication/ health promotion

10 Multisectoralaction and Health in All Policies Poverty reduction, planned urbanization and reducing inequities can lead to improved health outcomes. Consider national mechanisms to achieve health in all policies Actions in the NCD roadmap can guide multisectoral action Increasing taxes on tobacco helps to reduce demand for tobacco and increase revenue. Prioritize and protect access to essential medicines

11 Expand health promotion and protection beyond health education Build healthy public policy through legislation, fiscal measures, taxation and organizational changes. Prepare to respond to disease outbreaks and to manage the ongoing risk of epidemic-prone diseases through robust all-hazards preparedness plans and diseasespecific strategies, including at the health-facility level Strengthen opportunities for community participation and contributions to health, and improve access to information.

12 Integrated people centered health service delivery Define a service delivery package for the primary health care level to meet population needs, and ensure adequate facilities and well-trained staff Consider equitable access especially for remote and rural populations Sustain referral facilities as part of integrated care to treat critical patients. Funding is crucial and ultimately should become part of national budgets Involve communities in managing health facilities.

13 Reliable and timely data on key indicators Population based data on mortality, diseases and risk factors Globally agreed targets and indicators are available for many diseases and risk factors They can be prioritized and adapted as per the Pacific context Continued focus on improving mortality and cause of death data and strengthening HIS: needs leadership, collaboration, technical support, regular reporting A color coded dashboard can be considered to assess progress on an annual basis. Under MANA a dashboard is being developed for NCD prevention and control Similar approach can be developed for other areas

14 Group work Proposed questions for the working group How can we sustain and build on achievements in disease control in PICs? How can we ensure multisectoral approach and buy-in? What areas of weakness need most focus? What are the specific tasks/recommendations for discussion with Ministers for the next two years?

15 Group work Expected outcomes Specific, relevant ways forward based on future directions in the paper-short term and long term and for countries Common for all PICs For different situation (disease burden, population size etc) Specific tasks for Ministers to commit to

16 Thank you!