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Global Alliance against Chronic Respiratory Diseases
www.who.int/gard
Chronic respiratory diseases:One of the priorities of a global strategy for
prevention and control of noncommunicable
diseases
Dr Ala Alwan, Assistant Director-General
World Health OrganizationGARD General Meeting, 30-31 May 2008, Istanbul
Global Alliance against Chronic Respiratory Diseases
www.who.int/gard
• Noncommunicable diseases including CRDs
• The action plan for the global strategy on
noncommunicable diseases 2008-2013
• What does the plan mean to CRD prevention and GARD
members?
Overview
Global Alliance against Chronic Respiratory Diseases
www.who.int/gard
Assistant
Director-General
Chronic Diseases
and Health
Promotion
Mental Health and
Substance Abuse
Nutrition for
Health and
Development
Tobacco Free
Initiative
Violence and
Injury Prevention
and Disability
Standing
Committee on
Nutrition
WHO Centre for
Health
Development
WHO's cluster for Noncommunicable Diseases and Mental Health (NMH)
D
Global Alliance against Chronic Respiratory Diseases
www.who.int/gard
+17%-3%38835.758.2Total
+20%+11059.712.4Western Pacific
+21%-16%898.014.7South-East Asia
+4%+7%888.59.8Europe
+25%-10%252.24.3Eastern Mediterranean
+17%-8%534.86.2Americas
+27%+6%282.510.8Africa
Trend: Death from
NCD
Trend: Death from
infectious disease
NCD
deaths
(millions)
NCD deaths
(millions)
Total
deaths
(millions)
Geographical regions
(WHO classification)
2006-2015 (cumulative)2005
Noncommunicable diseases (2005-2015)
WHO projects that over the next 10 years, the largest increase in deaths from cardiovascular disease, cancer, respiratory disease and diabetes will occur in Africa, the Middle East and Asia
(WHO Preventing Chronic Diseases: A vital investment, 2005)
Global Alliance against Chronic Respiratory Diseases
www.who.int/gard
Currently hundreds of millions of people have chronic respiratory diseases
� including 300 million people with asthma (increasing)
� 210 million people with COPD (increasing)
� and millions of others with other chronic respiratory diseases, such as sleep apnoea, pulmonary hypertension, occupational
disorders and allergic rhinitis, which are often underdiagnosed
Over 4 million people died of chronic respiratory diseases in 2005
(WHO Preventing Chronic Diseases: A vital investment 2005)
Chronic Respiratory Diseases
Global Alliance against Chronic Respiratory Diseases
www.who.int/gard
Deaths by cause in the world (2004-2030)
(WHO World Health Statistics, 2008)
Global Alliance against Chronic Respiratory Diseases
www.who.int/gard
Tobacco
Tobacco use is a risk factor for six of the eight leading causes of death in the world
(WHO World Health Statistics, 2008)
Global Alliance against Chronic Respiratory Diseases
www.who.int/gard
Why action is needed to address NCDs
• Why action is needed now to address noncommunicable diseases:
– 60% of global deaths are due to noncommunicable diseases (and still increasing)
– 40% of cancer is preventable
– 80% of cardiovascular disease, stroke and diabetes is preventable
– A large part of chronic respiratory diseases is preventable
– Cost-effective secondary prevention interventions exist and have worked in many countries
• Major noncommunicable diseases:
– Cardiovascular disease
– Cancer
– Chronic Respiratory disease
– Diabetes
• Shared preventable risk factors:
– Tobacco use
– Unhealthy diet
– Physical inactivity
– Harmful use of alcohol
Chronic
Respiratory
DiseasesCardiovascular
Disease
DiabetesCancer
Physical
inactivity
Obesity
Unhealthy
diets
SmokingHarmful use of
alcohol
Malnutrition
Other NCDs
Global Alliance against Chronic Respiratory Diseases
www.who.int/gard
Primary preventionpopulation-wide
Secondaryprevention
Primary prevention atindividuallevel
Very cost
effective
Cost effective
Cost effective if
targeted at high
risk people
Cost-effective strategies exist
Global Alliance against Chronic Respiratory Diseases
www.who.int/gard
Increased health support by donors is mostly directed towards HIV/AIDS,
not noncommunicable diseases
US$2.9 billion ±0.1%
Official Development Aid (ODA) to the health sector in 2002
Allocated to noncommunicable diseases and mental health
International donors
Global Alliance against Chronic Respiratory Diseases
www.who.int/gard
The global response to address NCDs
Global strategy on diet,
physical activity and
health
Global strategy on
noncommunicable diseases
Action Plan for the Global strategy
on noncommunicable diseases
A six-year Global Action Plan to address cardiovascular disease, cancer, respiratory disease and diabetes was endorsed by the WHO World Health Assembly on 24 May 2008.
Implementation of the
global strategy on NCDs
2008 2000 2003 2004 2007 2013 implementation in
countries
WHO Framework
Convention on Tobacco
Control
Global strategy on
harmful use of alcohol
Global Alliance against Chronic Respiratory Diseases
www.who.int/gard
Process:
• January 2008 – Discussions at WHO's Executive
Board
• February 2008 – Informal consultations with Member States, International Partners and the
business community
• April 2008 – Final draft Action Plan was published on the internet (www.who.int/gb)
• 24 May 2008 – Six-year Action Plan endorsed by
the 61st World Health Assembly
Action Plan for the Global strategy
on noncommunicable diseases
Global NCD Action Plan
Global Alliance against Chronic Respiratory Diseases
www.who.int/gard
"... any discussion of health development must
include the chronic noncommunicable
diseases. Heart disease and cancer now rank
as leading killers in all parts of the world,
regardless of a country’s income status.
Diabetes and asthma are on the rise
everywhere. "
Chronic Respiratory Diseases
Dr Margaret Chan, Director General, World Health Organization
Opening address to the 61st World Health Assembly (19-24 May 2008)
Global Alliance against Chronic Respiratory Diseases
www.who.int/gard
NCD Action Plan Objectives 2008-2013
1. Raise the priority accorded to noncommunicable disease in development work at global and national levels, and to integrate prevention of such diseases into policies across all government departments
2. Establish and strengthen national policies and plans for the prevention and control of noncommunicable diseases
3. Promote interventions to reduce the main shared modifiable risk factors for noncommunicable diseases: tobacco use, unhealthy diets, physical inactivity and harmful use of alcohol
4. Promote research for the prevention and control of noncommunicable diseases
5. Promote partnerships for the prevention and control of noncommunicable diseases
6. Monitor noncommunicable diseases and their determinants and evaluate progressat the national, regional and global levels
Global Alliance against Chronic Respiratory Diseases
www.who.int/gard
Global Strategy for the Prevention and Control of NCDsImplementation Plan: Objectives 2008-2013
Objective 1: To raise the priority accorded to NCDs in development work at global and national levels, and to integrate prevention of such diseases into
policies across all government departments:
Key messages:
• NCDs including CRDs are closely linked to socio-economic development
• Public policies in sectors other than health have a major bearing on NCD-
CRD risk factors: All Government Approach to Prevention
• Inequities to exposure of risks and to access to care result in major
inequalities in occurrence and outcomes of CRDs: Addressing the social
determinants of health
Global Alliance against Chronic Respiratory Diseases
www.who.int/gard
Global Strategy for the Prevention and Control of NCDsImplementation Plan: Objectives 2008-2013
Objective 1: To raise the priority accorded to NCDs in development work at global and national levels, and to integrate prevention of such diseases into policies across all government departments:
Key Actions:
• Raise priority given to CRDs on the agendas of relevant high level forums and meetings of policy makers
• Build and disseminate evidence-base and surveillance data to inform policy makers and to assess the burden imposed by CRDs with emphasis on poor populations
• Develop tools to assess impact of public policies on determinants and risk factors and provide models for evidence-based policies
• Incorporate NCD-CRD prevention and control into poverty reduction plans
Global Alliance against Chronic Respiratory Diseases
www.who.int/gard
Global Strategy for the Prevention and Control of NCDsImplementation Plan: Objectives 2008-2013
Objective 2: To establish/strengthen national policies and plans for NCD prevention
Key Areas of Actions:
• Strengthen national multisectoral framework for the integrated prevention of
NCDs: Policy, plan, multisectoral work, legislation to reduce risk factors
• Integrate the prevention of NCDs into national health development:
surveillance, prevention and health care
• Reorient and strengthen health systems to respond more effectively to health
care needs of chronic diseases; integrate CRD control into primary health care
Global Alliance against Chronic Respiratory Diseases
www.who.int/gard
Global Strategy for the Prevention and Control of NCDsWhat do we need to do?
Objective 3: To promote interventions to reduce the main modifiable risk factors e.g
tobacco use
Key Areas of Actions for Tobacco Use (FCTC – MPOWER)
• Monitor tobacco use tobacco prevention policies
• Protect people from tobacco smoke in public places and workplaces
• Offer help to people who want to stop
• Warn people about dangers of tobacco
• Enforce bans on advertising, promotion, and sponsorship
• Raise tobacco taxes and prices
Global Alliance against Chronic Respiratory Diseases
www.who.int/gard
Global Strategy for the Prevention and Control of NCDsImplementation Plan: Objectives 2008-2013
Objective 4: To promote research for the prevention and control of NCDs-CRDs
Key Areas of Actions:
• Develop a prioritized research agenda, with special focus on gaps in prevention
and control in low and middle income countries (assessing burden, monitorinf
impact of social determinants and disparities, assessing national capacity,
evaluate cost-effectiveness and impact of interventions including early
detection, evaluate health care models, study approaches to improving access
to essential medicines and technologies..etc..
• Strengthen national capacity in research and encourage establishment of
national centres and networks
• Strengthen joint work, coordination and the role of WHO Collaborating Centres
Global Alliance against Chronic Respiratory Diseases
www.who.int/gard
Global Strategy for the Prevention and Control of NCDsImplementation Plan: Objectives 2008-2013
Objective 5: To promote partnerships for the prevention and control of NCD/CRDs
Key Areas of Actions:
• Encourage the involvement of international and regional initiatives/institutions in
implementing the Global Strategy plan
• Strengthen role of WHO collaborating centres by linking their plans to the GS
plan
• Facilitate global and regional networking
• Invite all stakeholders to strengthen joint work and coordination
Global Alliance against Chronic Respiratory Diseases
www.who.int/gard
Global Strategy for the Prevention and Control of NCDsImplementation Plan: Objectives 2008-2013
Objective 6: To monitor NCDs/CRDs and evaluate progress at national and global
levels
Key Areas of Actions:
• Develop an information system to collect, analyze and disseminate data on
trends in respect of mortality, disease burden, risk factors, policies, and actions
taken by countries
• Set realistic and evidence-based targets and indicators to track global and
national progress
• Strengthen technical support to countries in improving their collection of data
and statistics, on risk factors, determinants and mortality