Global Forum on Chronic Diseases Prevention and Control
Together in global action: Africa, Europe, South-East Asia, the Americas, the Eastern Mediterranean, the Western Pacific
About the Global Forum
Noncommunicable diseases (NCDs) are the leading causes of death and disability worldwide. Disease rates from these conditions are accelerating globally, advancing across regions and social classes. The World Health Report 2000 estimates that these disorders together contributed to almost 60% of global mortality (31.7 million deaths) and 43% of the global burden of disease in 1999. Four of the most prominent NCDs – cardiovascular disease, cancer, chronic obstructive pulmonary disease and diabetes – are linked by common preventable risk factors including tobacco use, unhealthy diet and low physical activity.
RESPONSE OF COUNTRIES
Therefore, action to reduce these major NCDs should focus on preventing and controlling the risk factors in an integrated manner. Intervention at all levels of society, from communities to governments, private organizations and nongovernmental groups, is essential for prevention since the risk factors are entrenched in the framework of society and influenced by many areas of national policy. In addition, legitimate health care needs of large segments of the population afflicted by NCDs need to be addressed through innovative and cost-effective interventions focused on individuals and communities.
As part of the implementation of the strategy, an assessment of national capacity for NCD prevention and control was carried out and a survey was conducted by WHO during 2001. One of the objectives of the survey was to assess the current situation in relation to existing capacity for NCD prevention and control in Member States and to identify constraints and needs.
According to this survey, less than half the 160 responding countries reported having NCD policies. One-third to one-half of responding states reported having CVD, tobacco, diabetes, and cancer plans. A considerable proportion of countries did not have any legislation for tobacco or food & nutrition. Most countries do not have information on the major NCD risk factors included in their Annual Health Reporting System and a large proportion of countries indicated that they had no surveillance systems for the major NCDs.
In many countries, NCD prevention does not seem to be highly rated among other priorities in Ministries of Health. Less than two thirds of countries seem to have an NCD unit in their Ministries of Health, while only 39% reported having a specific NCD budget line.
RESPONSE OF WHO
Although more than two thirds of nations reported having NCD prevention and control programmes integrated into their PHC systems, information from qualitative interviews with senior health policy-makers in developing countries suggested that the term "integrated" was not interpreted in a uniform manner. It was most commonly used to denote if care of individuals with NCDs was provided by the primary care system. It is also clear from this survey and from other assessment exercises that there are serious shortages in human manpower with basic skills and expertise in NCD prevention and control.
For example, only two thirds of health professionals were reported to receive training in the management of hypertension. Similar patterns were also observed in relation to basic training in the management of other major NCDs like diabetes and bronchial asthma. Another major constraint encountered is the lack of essential standards of health care for people with NCDs. A considerable proportion of countries reported those essential medicines like insulin, oral hypoglycaemic agents, anti-hypertensive drugs and anti-neoplastic medications are not available or affordable in primary care settings.
Based on the current situation and in order to address the constraints impeding effective action at the global level, several key areas for action emerge as priorities for WHO technical support to Member States with regard to NCD prevention and control.
These include: advocacy and marketing for NCD prevention; provision of expertise in practical policy development; supporting countries in initiating standardized data collection and strengthening surveillance systems; identifying minimally acceptable standards for the diagnosis and treatment of people with the major NCDs; developing an effective strategy for improving access to essential NCD drugs in low- and middle-income countries; looking for innovative ways of strengthening human resource capacity and providing training courses in technical and managerial aspects of policy formulation, programme development, implementation, and evaluation in the field of NCD prevention and control.
In addition, WHO and its partners should develop a focused and targeted research agenda which is supportive of the Organization's priorities, leading to development of practical and innovative methods for surveillance and surveys of major risk factors for NCDs and cause-specific mortality particularly in low- and middle-income countries.
The global threat posed by NCDs and the need to provide an urgent and effective public health response was recognized by the World Health Assembly in 1998. A request was made to the Director-General of WHO to prepare a global strategy for NCD prevention and control (resolution WHA51.18). This strategy has now been developed (WHA 53/14) and was endorsed by the WHO Executive Board in January 2000 (resolution EB105.R12) and adopted by 53rd WHA in May 2000 (resolution WHA53.17).
The strategy highlights the role of WHO in stimulating regional and international networking and strengthening community-based activities for the integrated prevention of the major NCDs, particularly in developing countries. The global strategy considers networking as one of the four major areas of work for WHO in the global struggle against NCDs. It specifically recommends the establishment of a global network of national and regional programmes for prevention and control of NCDs in order to disseminate information, exchange experiences, and support regional and national initiatives.