NCD assessments: lessons learned

Transcription

1 NCD assessments: lessons learned Enrique Loyola Coordinator Surveillance of Noncommunicable Diseases WHO Regional Office for Europe, Moscow Sopot, Poland 27 October 2015 NCD assessments: lessons learned 27 October 2016

2 NCD assessments: some lessons from Europe Need for an NCD plan and monitoring & assessment framework, including time-bound targets and specific indicators Assessing of the individual components on the NCD plan Mortality, morbidity, risk factors trends, age/sex distribution, geographical patterns Health system resources, policies & programmes Conducting an comprehensive/integrated assessment, including different health dimensions Data integration, disaggregation and synthesis Regression analyses, modelling, Measuring processes and progress NCD assessments: lessons learned 27 October 2016

3 Health determinants, risk factors and impacts: defining a framework for NCD monitoring and action Risk factors tobacco use, alcohol consumption, physical inactivity, unhealthy diet Risk factors High blood pressure, sugar, lipids & obesity Performance of health system: effects on persons & population

4 Overview of European NCD Action Plan PRIORITY INTERVENTIONS PRIORITY ACTION AREAS Population-level Individual-level SUPPORTING INTERVENTIONS Governance Fiscal and marketing policies Cardio-metabolic risk assessment and management Oral health and musculoskeletal health Surveillance, monitoring and evaluation, research Product reformulation and improvement Salt reduction Early detection and effective treatment Mental health Prevention and health promotion Health systems Active living and mobility Clean air Vaccination and communicable disease control Health in specific settings Source: WHO. Action plan for the prevention and control of noncommunicable diseases (NCDs) in the WHO European Region. 66 th Session of the WHO Regional Committee. Copenhagen, Denmark September, 2016

5 World Health Assembly, May 2013: 9 global NCD targets to be attained by 2025 (against a 2010 baseline) A 25% relative reduction in risk of premature mortality from cardiovascular disease, cancer, diabetes or chronic respiratory diseases At least a 10% relative reduction in the harmful use of alcohol A 10% relative reduction in prevalence of insufficient physical activity A 25% relative reduction in prevalence of raised blood pressure or contain the prevalence of raised blood pressure A 30% relative reduction in prevalence of current tobacco use Halt the rise in diabetes and obesity A 30% relative reduction in mean population intake of salt/sodium An 80% availability of the affordable basic technologies and essential medicines, incl. generics, required to treat NCDs At least 50% of eligible people receive drug therapy and counselling to prevent heart attacks and strokes How do we know we are achieving targets? Monitoring indicators

6 GMF indicators reporting: potential data sources

7 NCD assessments: some lessons from Europe Need for an NCD plan and monitoring & assessment framework, including time-bound targets and specific indicators Assessing of the individual components on the NCD plan Mortality, morbidity, risk factors trends, age/sex distribution, geographical patterns Health system resources, policies & programmes Conducting an comprehensive/integrated assessment, including different health dimensions Data integration, disaggregation and synthesis Regression analyses, modelling, Measuring processes and progress NCD assessments: lessons learned 27 October 2016

8 SDR, ages years, main NCD, per Regional trends in overall premature NCD mortality are promising Age-standardized premature NCD death rates and projections to European Region EU members before May 2004 EU members since May 2004 NIS Source: WHO. European Health for All database, 2015

9 Mortality rates from main broad groups of causes of death in WHO European countries, last available year

10 Regional trends of premature mortality by broad causes

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12 Taking advantage of opportunities: common risk factors to major NCD conditions Risk Factor Cardiovascular diseases Condition Diabetes Cancer Respiratory Conditions Tobacco use Alcohol Low fruit & vegetable Diet high in salt Physical Inactivity Obesity Raised blood pressure Raised blood glucose Abnormal blood lipids Over 50% of premature mortality may be prevented with their control!!

13 NCD assessments: some lessons from Europe Need for an NCD plan and monitoring & assessment framework, including time-bound targets and specific indicators Assessing of the individual components on the NCD plan Mortality, morbidity, risk factors trends, age/sex distribution, geographical patterns Health system resources, policies & programmes Conducting an comprehensive/integrated assessment, including different health dimensions Data integration, disaggregation and synthesis of key indicators Regression analyses, modelling, Measuring processes and progress NCD assessments: lessons learned 27 October 2016

14 Improving health systems: Progress in WHO European Region for Target 9: evidence from recent STEPS surveys % adults (40-64 yrs) with a 10 yr CVD risk of 30% or more, or with existing CVD** Of these... % receiving drug therapy and counselling*** Kyrgyzstan (2013) 17.4% 49.0% Uzbekistan (2014) 20.2% 58.7% Turkmenistan (2014) 20.5% 72. Republic of Moldova (2013)* 23.0% 51.2% * yrs ** A 10-year CVD risk of 30% is defined according to: age; sex; smoking status (current smokers OR those who quit smoking less than 1 year before the assessment); blood pressure (measured); total cholesterol (measured); diabetes status (previously diagnosed OR a fasting plasma glucose concentration >7.0 mmol/l (126 mg/dl)); history of CVD (heart attack, chest pain from heart disease or stroke) using WHO/ISH risk prediction chart. *** Of those aged 40+ with 30% risk of CVD, the percentage receiving drug therapy or counselling defined as: taking medication for raised blood glucose, blood pressure and/or cholesterol; taking aspirin or statins to prevent or treat heart disease; received advice from a doctor or other health worker to quit using tobacco or not start, reduce salt in diet, eat at least five servings of fruit and/or vegetables per day, reduce fat in diet, start or do more physical activity, maintain a healthy body weight or lose weight Source: WHO STEPS surveys

15 Decline in coronary heart disease mortality: contribution of prevention and treatment Turkey (IMPACT) 47% 42% 11% Spain (IMPACT) 48% 51% 1% Italy (IMPACT) 55% 40% 5% Slovakia (IMPACT) 50% 41% 9% Czech Republic (IMPACT) 43% 52% 5% Poland (IMPACT) 37% 54% 8% Iceland (IMPACT) 25% 70% 5% Sweden (IMPACT) 23% 72% 5% Finland (Vartiainen et al) 24% 76% Finland (IMPACT) 23% 72% 5% New Zealand (IMPACT) 46% 50% 4% Treatments New Zealand (Jackson et al) 40% 60% Risk factors Scotland (IMPACT) 40% 51% 9% Unknown Scotland (IMPACT) 43% 39% 18% USA (Goldman et al) 40% 54% 7% USA (Hunink et al) 43% 50% 7% USA (IMPACT) 47% 50% 3% Canada (IMPACT) 43% 48% 9% Ireland (IMPACT) 44% 48% 8% England (IMPACT) 52% 34% 14% England & Wales (IMPACT) 42% 52% 6% The Netherlands (Bots & Grobbee) 46% 44% 10% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Source: WHO. Action plan for the prevention and control of noncommunicable diseases (NCDs) in the WHO European Region. 66 th Session of the WHO Regional Committee. Copenhagen, Denmark September, 2016

16 Relationship between average daily alcohol consumption and relative risk of cancer Source: World Cancer Report 2014

17 Alcohol-attributable mortality rates (per million) Alcohol-attributable mortality rates for cancer and total (recorded & unrecorded) alcohol per capita consumption HUN SVK 100 BLR TJK MKD AZE ISR TKM ARM KGZ UZB BIH ALB GEO ITA NOR ICE KAZ GRE SWE MAT NET SPA DEN IRE SWI FIN FRA SVN SRB POR GER MNE UNK AUT CYP LVA CRO UKR POL BUL BEL CZH ROM EST RUS MDA LTU TUR Total alcohol per capita consumption (litres of pure alcohol) Source: Shield K et al. Public health successes and missed opportunities. Copenhagen: World Health Organization; 2016

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19 NCD assessments: some lessons from Europe Need for an NCD plan and monitoring & assessment framework, including time-bound targets and specific indicators Assessing of the individual components on the NCD plan Mortality, morbidity, risk factors trends, age/sex distribution, geographical patterns Health system resources, policies & programmes Conducting an comprehensive/integrated assessment, including different health dimensions Disaggregation and synthesis of key indicators Regression analyses, modelling, Measuring processes and progress NCD assessments: lessons learned 27 October 2016

20 Objectives and progress on implementation of UN time-bound commitments on NCD (to be reported by WHO in 2018) 1. Time-bound national targets and indicators 2. System for generating reliable cause specific mortality data 3. STEPS survey or a comprehensive health examination survey every 5 years Surveillance, monitoring and evaluation Governance 4. Operational multisectoral national strategy/action plan 5. Focus on four key demand reduction measures of the WHO FCTC 6. Implement three key measures to reduce the harmful use of alcohol 7. Implement four key measures to reduce unhealthy diet 8. Implement at least one public awareness programme on healthy diet / physical activity Prevention and reduction of risk factors Health care 9. Evidence-based national guidelines/ protocols/ standards for the management of major NCDs 10.Provision of drug therapy and counselling for eligible persons

21 Monitoring NCD progress

22 Country Capacity and Response on NCD 2015: UN time-bound indicators Key to colours: Red=no data provided, Light red=no progress, Light green=in progress, Green=achieved Source: WHO NCD Country Capacity Survey 2015

23 NCD assessments: some lessons from Europe Need for an NCD plan and monitoring & assessment framework, including time-bound targets and specific indicators Assessing of the individual components on the NCD plan Mortality, morbidity, risk factors trends, age/sex distribution, geographical patterns Health system resources, policies & programmes Conducting an comprehensive/integrated assessment, including different health dimensions Disaggregation and synthesis of key indicators Regression analyses, modelling, Measuring processes and progress NCD assessments: lessons learned 27 October 2016