National Research Center for Preventive Medicine of the Russian Federation WHO Collaborating Center on Development and Implementation of Non-communicable Disease Prevention Policy and Programs Collaborating Centre, reference number RUS - 111 9/13/2013 Some good practices in an interagency approach to the prevention of NCDs in Russia Professor Sergey Boytsov, Director of National Research Centre for Preventive Medicine Ministry of Health Technical Meeting on Action Across Sectors and Health in All Policies WHO headquarters, Geneva, Switzerland 19-20 January 2016
Large diversity between the levels of cardiovascular mortality in different regions of Russia Difference between Moscow and Tver region is 2,4 1200,0 1000,0 Standardized CV mortality in regions of RF (per 100 000 population) 1135,0 800,0 739,9 838,1 733,5 600,0 543,3 400,0 290,3 200,0 0,0 Standardized mortality (Europe), males Standardized mortality (Europe), females Standardized mortality (Europe) СПС (европа) муж. СПС (европа) жен. СПС (европа)
60 % 50 40 High prevalence of main risk factors of non-infectious diseases in RF (ESSE RF, 2013; 12 regions) Females, Женщины, N=11386 Males, Мужчины, N=6919 N=6919 All, N=18305 Всего, N=18305 30 20 10 0 Smoking Курение Low НФА Physical Excessive ИПС Salt Lack НПОФ of Повышенное Arterial Activity intake Veggies and Hypertension АД Fruits intake Повышенный High Cholesterol ХС Ожирение Obesity Повышенная High Glucose глюкоза National Research Center for Preventive Medicine
Development of universal regional system of non-communicable disease prevention in RF Strategy of the high-risk Population strategy (multisectoral task force) Regular check-ups, health centers 3 rd element Strategy of the secondary prevention Education and motivation about healthy life-style (mass media, education, culture, public organizations, volunteers) 1 st element Ensuring conditions for healthy life style 2 nd element Regional Health Care Authority Centers of medical prevention Regular follow-ups 4 th element Hospitals, rehabs, health care resorts 5 th element
Capacity building for & dissemination of NCD preventive programs in Russia Government federal programme Development of the Health Care System" Regional programs Development of the Health Care System" in all regions, which in 46 regions are created on inter-sectoral base (since 2013) "Action plan on the prevention of cardio-vascular diseases in the Russian Federation in 2015" (developed in all regions of the RF) Wide- ranging screening for CVD, malignant tumors, COPD and diabetes Development of the system for evaluation of implementation of the federal and regional prevention programmes (Epidemiological monitoring in 14 regions and STEPs in 4 regions of the RF) Training of decision makers in evidence-based approaches to development, implementation and evaluation of NCD prevention programmes Development of the National strategy on NCD prevention and control in Russia in collaboration with WHO
Some good practices in an interagency approach to the prevention of NCDs in Russia Objectives 1. Develop a methodology for assessment of existing experiences in implementation of the HiAP principles at the country, regional and municipal levels with emphasis on interagency, cross-sectoral cooperation. 2. Assess the ongoing interagency, cross-sectoral programs for the prevention of NCDs in the selected regions. 3. Prepare a technical report based on the data obtained on the existing experience in the development of interagency, cross-sectoral programs for the prevention of NCDs and accounting for the impact of conducted activities on population health at the regional and municipal levels. 3 regions were selected to participate in the survey: 1. The Republic of Chuvashia 2. The Vologda region 3. Yekaterinburg city
Republican program «Prevention of Use of Tobacco and Tobacco Products in the Republic of Chuvashia in 2009-2011» Justification of the program: in the Republic of Chuvashia, the prevalence of smoking in the population was 37.5%; the average age of initiation of tobacco smoking was 11 years; 15% of boys and 10.7% of the girls were active consumers of cigarettes. In the period from 2005 to 2009, the incidence of chronic obstructive lung diseases in the country increased by 35%. Actions: Regulatory and legal framework Information and communication campaigns Prevention in primary care settings Training for public health specialists on medical assistance with smoking cessation Project coordinator: The Ministry of Health and Social Development of the Republic of Chuvashia. Participants: the Ministries of the Republic of Chuvashia: Health and Social Development, Education and Youth Policy, Physical Culture, Sports and Tourism, Culture, Ethnic Affairs, Information Policy and Archives, Urban Development and Development of Social Infrastructure, Economic Development and Trade, Industry and Energy, Agriculture, the Office of the Federal Service for Supervision of Consumer Rights Protection and Human Wellbeing in the Republic of Chuvashia, local self-governing bodies, and NGOs. Regulatory basis of the program: Federal laws: Federal Law N 52-FL of 30 March 1999 "On the Sanitary- Epidemiological Wellbeing of the Population"; Federal Law N 87-FL of 10 July 2001 "On Restriction of Tobacco Smoking"; Federal Law N 38-FL of 13 March 2006 "On Advertising"; Federal Law N 51-FL of April 24, 2008 "On Ratification of the WHO Framework Convention on Tobacco Control in the Russian Federation". Regional laws: Decree of the President of the Republic of Chuvashia N65 of June 18, 2004 "On the Concept of Health Protection of the Population of the Republic of Chuvashia in 2004-2010 "; Decree of the President of the Republic of Chuvashia N 129 of 29 November 2004 "On Prevention of Tobacco Smoking.
Мillions rub Results of the Republican program «Prevention of Use of Tobacco and Tobacco Products in the Republic of Chuvashia in 2009-2011» Mortality rate reduced in 3 years by 1.5%: including by 12.8 % from CVDs, by 21.3% from respiratory diseases, by 3.0%, from malignant tumors % 40 35 30 25 20 15 10 5 0 Prevalence of smoking among the population reduced by 10.2% 37,5 250 200 150 100 50 27,3 2009 2011 The cost-effective of the program 60,7 159,7 49,4 5 4,8 4,6 4,4 4,2 4 50,3 Incidents of chronic obstructive pulmonary disease in the population reduced by 10.2% (per 1000) 4,9 110,1 209,3 Plan Result 4,43 2009 2011 0 Reduce expenses on tobacco Reducing the cost of treatment The overall economic effect
"Healthy Lifestyles Among the Residents of the Republic of Chuvashia in 2010-2012" per 100 000 Coordinator: The Ministry of Health and Social Development of the Republic of Chuvashia Participants: the Ministries of the Republic of Chuvashia: Health and Social Development, Education and Youth Policy, Physical Culture, Sports and Tourism, f Culture, Ethnic Affairs, Information Policy and Archives, Urban Development and Development of Social Infrastructure, Economic Development and Trade, Industry and Energy, Agriculture, the Office of the Federal Service for Supervision of Consumer Rights Protection and Human Wellbeing in the Republic of Chuvashia, local self-governing bodies, and NGOs. Regulatory basis of the program At the federal level: Resolution of the Government of the Russian Federation N 1157 of December 31, 2009 "On Financial Support of Actions in Promotion of Healthy Lifestyles Among Citizens of the Russian Federation, Including Reduction in the Consumption of Alcohol and Tobacco in 2010" At the regional level: Decrees of the President of the Republic of Chuvashia N137 of December 4, 2002 "On Additional Measures on Strengthening of Control of Alcohol Consumption and Prevention of Alcoholism and Drunkenness", and N17 of April 20, 2009 "On Main Directions of Fiscal Policy of the Republic of Chuvashia in 2010-2012. Actions: Information and communication campaign Prevention in primary care setting Prevention in schools Actions on physical activity Actions on smoking cessation Education of health professionals % The results of the program 40 35 30 25 20 15 10 5 0 25,5 Population regularly engaged in physical activity 37,5 29 27,3 The number of the smokers The incidence of the primary alcoholism decreased by 14.1% 130 120 110 100 90 119,9 105,8 2009 2012 2009 2012
"Development of Physical Activity and Sports in the Republic of Chuvashia in 2010-2020" Coordinator: Ministry of Physical Culture, Sports, and Tourism of the Republic of Chuvashia Participants: The Ministries of the Republic of Chuvashia: Physical Culture, Sport and Tourism, Health and Social Development, Education and Youth Policy, Culture, Ethnic Affairs, Information Policy and Archives, local self-governing bodies. Actions: Construction of new sports complexes and reconstruction of old sports facilities; Construction of football fields with artificial turf; organization and holding of official sports and fitness events; supply sport facilities with equipment; Acquisition of sports, medical diagnostic and rehabilitation equipment; Organization of annual competitions for the best sports school, the best athletes, and coaches; Development of specialized classes with physical activity and sports orientation; Annual Republican contest for the best work on promotion of physical activity and sports; Supporting the network of fitness and sports clubs at educational facilities, work places, or residential areas; Opening fitness clubs and sports facilities in cultural institutions; Opening sports facilities in educational institutions for use by the residents of the surrounding neighborhoods after school hours; Implementation of a system for comprehensive fitness and sports activities among workers; Reconstruction and equipment of sports grounds (exercise areas) in the places of residence; Conduction of fitness and sporting events among children and youth. % 60 50 40 30 20 10 0 27,3 Intermediate results 39 Regularly engaged in physical activity 1920,4 Persons are engaged in sports schools 47,9 45,1 Professional athletes 2010 2015
Decree of the Head of the Chuvash Republic on July 31, 2014 108 «On additional measures to improve the health and quality of life of the population of the Chuvash Republic " State Council Health and Social Development Education and Youth Policy Physical Culture, Sports and Tourism Office of the Federal Service for Supervision of Consumer Rights Protection and Human Wellbeing Information Policy and Archives Urban Development and Development of Social Infrastructure Industry and Energy Authorized Child Rights Ministry of Justice Ministry of Finance Cross-sectoral team Cross-sectoral team Health centers for adults Center for Medical Prevention The cabinets for prevention medicine Health centers for children Cross-sectoral team Culture, Ethnic Affairs Cross-sectoral team Agriculture Economic Development and Trade Authorized Human Rights Ministry of Natural Resources Ministry of property Primary Health Care
Mortality in the Republic of Chuvashia by major causes (per 100 000) 1600 1400-6% 1200 1000 800 600 400-26% CVDs Oncology External causes Total mortality 200 0 2009 2010 2011 2012 2013 2014 2015 (11 months)
Campaign Smoke-free Environment in Vologda region Goal: To draw attention to the smoking-related problems and increase number of people who quit smoking. Coordinator: Health Department of Vologda Region, Regional Center for Prevention Participants: 26 municipalities and 2 urban districts, regional offices of local self-governing organizations, municipal organizations with massive coverage of the population, health departments of local administrations, central district hospitals, health centers for adults. Results: According to the data of epidemiological monitoring of NCD risk factors, there was a clear reduction in prevalence of smoking among the population of the Vologda region from 34.7% to 23.3% during the period from 2004 to 2014 Number of participants: Number of participants is increasing steadily from 876 in 2002 to 1921 in 2008, and to 61732 in 2014. Actions: Was launched in 2002, is conducted bi-annually. Consists of: Quit and Win ; "Vologda without tobacco" (competition for best slogan, drawing, essay, photograph); Tobacco-free educational institutions. The next campaign is planned in 2016.
Project «Health Protecting Schools»in the Vologda region Goal : Development of healthy behaviors, protection and strengthening of health of children, improvement of medical and psychological education of parents, creation of health protecting environment in schools Approved by: Director of Educational Organization Implemented: since 2005 Actions: Promoting a culture of health in children Improving parental knowledge of healthy lifestyles Improving health of teachers and administrative staff in schools Monitoring and evaluation of the program according to the international protocol «CINDI- CHILDREN 30 25 20 15 10 5 0 Coordinator: Department of Education Participants: Department of Education, educational organizations, Centers/offices for Medical Prevention The results of the project (2004-2014) 11,3 10,9 Positive tests on smoking among 5-7 grade students 6,02 5 Prevalence of smoking among 8-11 grade students 9,5 7,4 Positive tests on alcohol among 5-7 grade students 28,4 19,7 Prevalence of alcohol consumption among 8-11 grade students 2004 2014
Program "Three Steps to Longevity in Ekaterinburg-city Goal To save lives, to reduce the prevalence of risk factors for NCDs Participants: All sectors of the Administration of the City of Ekaterinburg Coordinator: Ekaterinburg s Ministry of Health % 74,5 73,5 72,5 Public awareness regarding risk factors for NCDs 75 74 73 73 74,5 Interventions on risk factors for cardiovascular diseases: High blood pressure - information and communication campaigns, mass actions Low consumption of fruits and vegetables - action "Five Times a Day." The phased placement of billboards, banners, etc. "Five times a day fruit and vegetables are on your plate" Low physical activity - implementation of the recommendations of the "Stand up from your chair" step of the WHO strategy Health school for city residents - Schools for patients with hypertension, Schools for elderly patients, publications of the newspapers, audio messages Working with medical personnel - distant education of professionals in the prevention of CVDs and NCDs 72 2014 2015
Trends in risk factors in Russian Federation in 1993-2013 Smoking decline in men and increase in women Arterial hypertension increase in males Obesity increase in men and increase in women 60 50 40 % 30 20 10 0 Мужчины males Женщины females 48,6 47,7 35 43 41,4 30 38,6 36,1 25 20 % 15 10 5 0 1993 2003 2013 males Мужчины females Женщины 30,8 26,4 26,9 11,8 National Prospective Sample, 1993 ESSE, 2013 НПВ (1993) ЭССЕ (2013) National Research Center for Preventive Medicine
Trends in mortality rates of the main causes in Russian Federation in 1995-2015 (per 100 000) CVD Cancer Respiratory diseases Forensic all causes 1600,0 1400,0 1497,7 1529,0 1605,3 1520,6 1463,9 1462,4 1420,0 1347,0 1331,2 1304,3 1309 1323,0 1200,0 1000,0 800,0 600,0 790,7 846,1 905,4 864,8 833,9 835,5 806,4 753,0 737,1 698,1 695,0 651,0 400,0 200,0 0,0 1995 2000 2005 2006 2007 2008 2010 2011 2012 2013 2014 9.1.2015 Federal State Statistics Service, 2015
CONCLUSIONS There is legislation base for creation of preventive programs at all levels (federal, regional, municipal) There is an evolvement of the various departmental and non-departmental structures at all the stages of the programs, i.e. cross-sectoral approach was applied to the planning and implementation of these initiatives There were created and further developed conditions for the implementation of health programs in those regions The health indicators were taken into account when the described activities were planned and implemented There was an ongoing monitoring of health indicators and processes of program development at all stages of their implementation We believe that experience of only 3 regions will be useful for Russia and hope it will be useful for other countries