… BE IT FURTHER RESOLVED, that the Policy on NCDs shall include benchmarks for ending the Regional State of Health Emergency;
… BE IT FURTHER RESOLVED, that the Policy shall provide clear justification for its goals, including clear, accurate and referenced data on NCDs and their impact ;
… BE IT FURTHER RESOLVED, that the Regional approach to NCDs shall integrate effectively with other regional, national and local NCD policies and plans;
Adaptation & Implementation
Policies(Laws, regs, school, govt agency, church, traditional leader policies)
USAPI Health Professional Associations
Youth Risks(obesity, tobacco, alcohol)
Environments
Clinical Services
Adults Risks Adults Illness (hypertension, diabetes, cholesterol, lung & vascular disease) Primary
Care
Advocacy
Health Education& Promotion
Ministers, Secretaries, Directors of Health
Hospital Services
OutcomesStroke, dialysis, heart attacks, cancer, amputations, hospitalizations, death
Regional Bodies & Mechanisms for Control of NCDs
APIL, MCIS, Trad Leaders, Religious Leaders
N
CD S
urve
illan
ce &
Mon
itorin
g Fr
amew
ork
& P
lans
NCD Burden- Impact of Interventions
Policy80%
(Environments & Social Determi-
nants)
Health Ed&Promo
6%
Med Care14%
Sources: Franks P, et. al. JAMA, 27(6):737-741. 1993. McGinnis J, et. al. Health Affairs. 21(2) 2002
Timeline, USAPI Regional NCD Response, 2010-14
THE COMMITMENT:Fifteen Essential Policies for Reversing the Epidemic of Non-Communicable Diseases
in PIHOA jurisdictions
Risk Factor: Tobacco Commitment 1: Increase taxes on tobacco products (to extent needed to offset costs)*Commitment 2: Pass and enforce model comprehensive smoke-free air acts *Commitment 3: Restrict all forms of tobacco product advertising*Commitment 4: Establish and sustain tobacco cessation programs Risk Factor: Alcohol Commitment 5: Restrict all forms of alcohol advertising*Commitment 6: Restrict access to alcohol*Commitment 7: Increase taxes on alcohol (to extent needed to offset costs)* Risk Factor: Poor Nutrition Commitment 8: Implement policies that reduce salt consumption*Commitment 9: Implement policies that reduce sugar consumptionCommitment 10: Implement policies that reduce fat consumption*Commitment 11: Implement policies that promote breastfeedingCommitment 12: Implement policies that promote local foods Risk Factor: Lack of Physical Activity Commitment 13: Develop the built environment to promote physical activityCommitment 14: Promote physical activity in the work place [reconsider]Commitment 15: Promote physical activity in the schools
*WHO
“Be
st B
uys”
NCD
Pol
icy
Tool
kit
Regional Road Map
for Ending the Epidemic of Non-Communicable
Diseases
In the United States Affiliated Pacific Islands
Version 9
Updated May 22, 2013
1
Adaptation & Implementation
Policies(Laws, regs, school, govt agency, church, traditional leader policies)
Health Leadership Council Roadmap
USAPI Professional Associations
Youth Risks(obesity, tobacco, alcohol)
NCD Policy Commitment Package(includes WHO “Best Buys”)
Environments
Clinical Services
NCD Policy Tool Kit (model laws, regs, policies)
Adults Risks Adults Illness (hypertension, diabetes, cholesterol, lung & vascular disease) Primary
Care
Advocacy
Health Education& Promotion
Clinical Guidelines, Chronic care delivery systems(WHO PEN, JNC, ADA, etc.)
Ministers, Secretaries, Directors of Health
Hospital Services
OutcomesStroke, dialysis, heart attacks, cancer, amputations, hospitalizations, death
Mechanisms for Control of NCDs
Legislators, Exec Branch, Schools,Relig & Trad Leaders
N
CD S
urve
illan
ce &
Mon
itorin
g Fr
amew
ork
& P
lans
4 major decreases: 1999, 2003, 2005, 2007
Synar Amendment started
Cigarette tax increasedDMHSA cessation started
Natasha Act passed
By: Dr. Annette David, SPW & DMHSA PEACE
Guam- Youth Tobacco Use
USAPINCD Core SurveillanceIndicators
Tobacco Alcohol
↑BMI Diseases(adult)
Deaths(30-69 years)
Cigs- youth
Cigs- adult
Chew- Youth
Chew- adult
Youth
Adult
Youth
Adult
HTN
DM
↑Cholesterol
All Cause
Cardiovascular
Cancer
Diabetes
Chronic Lung
Am Samoa ↓ N ↓ ↑ N N N N N
CNMI ↓ N ↓ N ↓ N ↑ ↑ ↑ N ↓
FSM
Chuuk
Kosrae
Pohnpei
Yap N N N N N ↓ N ↓ N
Guam ↓ ↓ ↑ N ↓ N N N N N N ↑ N ↑ ↑ ↑
Palau ↑ N ↓ N ↓ N N N ↑ ↑ ↑ N N
RMI ↑ ↓ ↑ ↓ N
↓= Improved (rate decreased) N= No change↑= Worse (rate increased) Blank= Not enough data
Out of 144 measurements: 14=improved, 15=worse, 33=no change, 82=not enough data
USAPINCD Core SurveillanceIndicators
Tobacco Alcohol
↑BMI Diseases(adult)
Deaths(30-69 years)
Cigs- youth
Cigs- adult
Chew- Youth
Chew- adult
Youth
Adult
Youth
Adult
HTN
DM
↑Cholesterol
All Cause
Cardiovascular
Cancer
Diabetes
Chronic Lung
Am Samoa ↓ N ↓ ↑ N N N N N
CNMI ↓ N ↓ N ↓ N ↑ ↑ ↑ N ↓
FSM
Chuuk
Kosrae
Pohnpei
Yap N N N N N ↓ N ↓ N
Guam ↓ ↓ ↑ N ↓ N N N N N N ↑ N ↑ ↑ ↑
Palau ↑ N ↓ N ↓ N N N ↑ ↑ ↑ N N
RMI ↑ ↓ ↑ ↓ N
Take Home Messages• Some progress, especially tobacco and alcohol• Need to do much better overall• Many gaps in surveillance picture, because:
At jurisdiction level-> No clear delegation of responsibility at jurisdiction level> Lack of NCD surveillance plans at jurisdiction level
At regional level-> Surveillance activities initiated by variety of TA agencies> Very long turn-around time for analysis of some surveys> Vital stats problems
Addressing the Gaps- Jurisdiction Level
> Clear identification of surveillance teams in your jurisdiction> Nominate members to attend May Palau EpiTech Workshop (or hold similar activity in your jurisdiction)
- Jurisdiction-level NCD Surveillance Plan- Technical work to harmonize CDC with WHO stuff- Credited Epi course delivery
> Encourage/require enrollment of team members in EpiTech certificate program (for credit!)
NCD SURVEILLANCE STYLES- Your Choices:
WHO- NCD STEPS- Comparisons across Pacific- Fits well with MANA- Face-to-face survey-Does not fit as easily with CDC programs/HP2020
-Costs to come from country budgets
-Analysis support not completely established
-Not very flexible
CDC- BRFSS- Comparisons with US- Fits well with CDC/HP2020- Stable external funding - Good analysis support- Flexible- Telephone survey- Does not fit as well with
MANA- Not as good for Pacific
comparisons
BOTH- Comparisons with both US
and Pacific- More burden on Depts of
Health- Survey fatigue- Difficult to monitor trends
NCD SURVEILLANCE STYLES (Creating another choice)
Harmonizing WHO with CDC Styles
- Adapt BRFSS (and YRBS) to meet WHO needs as well as US program needs - physical measures - fit with new WHO NCD Surveillance Framework
- Secretariats to work more closely to harmonize technical assistance
Addressing the Gaps- PIHOA Board
• Communique to CDC NCDPHP to request:> Assist to provide Epi TA/place epidemiologist in region> BRFSS & YRBS funding support> Adapt BRFSS and YRBS> Help support delivery of EpiTech and Pacific FETP
• Asking WHO to assist with harmonization of BRFSS & YRBS, and harmonizing TA
> ? Formal communique
Regional Surveillance TA Entities
PPHSN (Pacific Public Health Surveillance Network)- Outbreak prone diseases
PHIN(Public Health Information Network)- HIS planning
Brisbane Accord Group- Vital stats
SAMHSA- Behav
Health
HIV-STI TB,Etc,etc.
CounterpartsFrameworksTraining programSurveillance plansOff-island trips
CounterpartsFrameworksTraining programSurveillance plansOff-island trips
CounterpartsFrameworksTraining programSurveillance plansOff-island trips