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WHO Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013-2020

Foreword

Noncommunicable diseases (NCDs)—mainly cardiovascular diseases, cancers, chronic respiratory diseases and diabetes—are the world’s biggest killers. More than 36 million people die annually from NCDs (63% of global deaths), including more than 14 million people who die too young between the ages of 30 and 70. Low- and middle-income countries already bear 86% of the burden of these premature deaths, resulting in cumulative economic losses of US$7 trillion over the next 15 years and millions of people trapped in poverty.

Most of these premature deaths from NCDs are largely preventable by enabling health systems to respond more effectively and equitably to the health-care needs of people with NCDs, and influencing public policies in sectors outside health that tackle shared risk factors—namely tobacco use, unhealthy diet, physical inactivity, and the harmful use of alcohol.

NCDs are now well-studied and understood, and this gives all Member States an immediate advantage to take action. The Moscow Declaration on NCDs, endorsed by Ministers of Health in May 2011, and the UN Political Declaration on NCDs, endorsed by Heads of State and Government in September 2011, recognized the vast body of knowledge and experience regarding the preventability of NCDs and immense opportunities for global action to control them. Therefore, Heads of State and Government committed themselves in the UN Political Declaration on NCDs to establish and strengthen, by 2013, multisectoral national policies and plans for the prevention and control of NCDs, and consider the development of national targets and indicators based on national situations.

To realize these commitments, the World Health Assembly endorsed the WHO Global Action Plan for the Prevention and Control of NCDs 2013-2020 in May 2013. The Global Action Plan provides Member States, international partners and WHO with a road map and menu of policy options which, when implemented collectively between 2013 and 2020, will contribute to progress on 9 global NCD targets to be attained in 2025, including a 25% relative reduction in premature mortality from NCDs by 2025. Appendix 3 of the Global Action Plan is a gold mine of current scientific knowledge and available evidence based on a review of international experience.

WHO’s global monitoring framework on NCDs will start tracking implementation of the Global Action Plan through monitoring and reporting on the attainment of the 9 global targets for NCDs, by 2015, against a baseline in 2010. Accordingly, governments are urged to (i) set national NCD targets for 2025 based on national circumstances; (ii) develop multisectoral national NCD plans to reduce exposure to risk factors and enable health systems to respond in order to reach these national targets in 2025; and (iii) measure results, taking into account the Global Action Plan.

WHO and other UN Organizations will support national efforts with upstream policy advice and sophisticated technical assistance, ranging from helping governments to set national targets to implement even relatively simple steps which can make a huge difference, such as raising tobacco taxes, reducing the amount of salt in foods and improving access to inexpensive drugs to prevent heart attacks and strokes. As the United Nations gears up to support national efforts to address NCDs, it is also time to spread a broader awareness that NCDs constitute one of the major challenges for development in the 21st century— and of the new opportunities of making global progress in the post-2015 development agenda.

Overview

VISION: A world free of the avoidable burden of noncommunicable diseases.

GOAL: To reduce the preventable and avoidable burden of morbidity, mortality and disability due to noncommunicable diseases by means of multisectoral collaboration and cooperation at national, regional and global levels, so that populations reach the highest attainable standards of health and productivity at every age and those diseases are no longer a barrier to well-being or socioeconomic development.

OVERARCHING PRINCIPLES:

> Life-course approach

> Empowerment of people and communities

> Evidence-based strategies

> Universal health coverage

> Management of real, perceived or potential conflicts of interest

> Human rights approach

> Equity-based approach

> National action and international cooperation and solidarity

> Multisectoral action

OBJECTIVES

1. To raise the priority accorded to the prevention and control of noncommunicable diseases in global, regional and national agendas and internationally agreed development goals, through strengthened international cooperation and advocacy.

2. To strengthen national capacity, leadership, governance, multisectoral action and partnerships to accelerate country response for the prevention and control of noncommunicable diseases.

3. To reduce modifiable risk factors for noncommunicable diseases and underlying social determinants through creation of health-promoting environments.

4. To strengthen and orient health systems to address the prevention and control of noncommunicable diseases and the underlying social determinants through people-centred primary health care and universal health coverage.

5. To promote and support national capacity for high-quality research and development for the prevention and control of noncommunicable diseases.

6. To monitor the trends and determinants of noncommunicable diseases and evaluate progress in their prevention and control.

COST OF ACTION VERSUS INACTION s. 10

For all countries, the cost of inaction far outweighs the cost of taking action on noncommunicable diseases as recommended in this action plan. There are interventions for prevention and control of noncommunicable diseases that are affordable for all countries and give a good return on investment, generating one year of healthy life for a cost that falls below the gross domestic product (GDP) per 1 person and are affordable for all countries (see Appendix 3). The total cost of implementing a combination of very costeffective population-wide and individual interventions, in terms of current health spending, amounts to 4% in low-income countries, 2% in lower middle-income countries and less than 1% in upper middleincome and high-income countries. The cost of implementing the action plan by the Secretariat is estimated at US$ 940.26 million for the eight-year period 2013–2020. The above estimates for implementation of the action plan should be viewed against the cost of inaction. Continuing “business as usual” will result in loss of productivity and an escalation of health care costs in all countries. The cumulative output loss due to the four major noncommunicable diseases together with mental disorders is estimated to be US$ 47 trillion. This loss represents 75% of global GDP in 2010 (US$ 63 trillion). 2 This action plan should thus be seen as an investment prospect, because it provides direction and opportunities for all countries to:

1. safeguard the health and productivity of populations and economies;

2. create win-win situations that influence the choice of purchasing decisions related inter alia to food, media, information and communication technology, sports and health insurance; and

3. iii. identify the potential for new, replicable and scalable innovations that can be applied globally to reduce burgeoning health care costs in all countries.

OVERARCHING PRINCIPLES & APPROACHES s. 12.

The action plan relies on the following overarching principles and approaches:

HUMAN RIGHTS APPROACH

It should be recognized that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being, without distinction of race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status, as enshrined in the Universal Declaration of Human Rights.

EQUITY-BASED APPROACH

It should be recognized that the unequal distribution of noncommunicable diseases is ultimately due to the inequitable distribution of social determinants of health, and that action on these determinants, both for vulnerable groups and the entire population, is essential to create inclusive, equitable, economically productive and healthy societies.

NATIONAL ACTION, INTERNATIONAL COOPERATION & SOLIDARITY

The primary role and responsibility of governments in responding to the challenge of noncommunicable diseases should be recognized, together with the important role of international cooperation in assisting Member States, as a complement to national efforts.

MULTISECTORAL ACTION

It should be recognized that effective noncommunicable disease prevention and control require leadership, coordinated multistakeholder engagement for health both at government level and at the level of a wide range of actors, with such engagement and action including, as appropriate, health-in-all policies and whole-of-government approaches across sectors such as health, agriculture, communication, education, employment, energy, environment, finance, food, foreign affairs, housing, justice and security, legislature, social welfare, social and economic development, sports, tax and revenue, trade and industry, transport, urban planning and youth affairs and partnership with relevant civil society and private sector entities.

LIFE-COURSE APPROACH

Opportunities to prevent and control noncommunicable diseases occur at multiple stages of life; interventions in early life often offer the best chance for primary prevention. Policies, plans and services for the prevention and control of noncommunicable diseases need to take account of health and social needs at all stages of the life course, starting with maternal 1 The Universal Declaration of Human Rights http://www. un.org/en/documents/udhr/index.shtml. Action Plan | health, including preconception, antenatal and postnatal care, maternal nutrition and reducing environmental exposures to risk factors, and continuing through proper infant feeding practices, including promotion of breastfeeding and health promotion for children, adolescents and youth followed by promotion of a healthy working life, healthy ageing and care for people with noncommunicable diseases in later life.

EMPOWERMENT OF PEOPLE & COMMUNITIES

People and communities should be empowered and involved in activities for the prevention and control of noncommunicable diseases, including advocacy, policy, planning, legislation, service provision, monitoring, research and evaluation.

EVIDENCE-BASED STRATEGIES

Strategies and practices for the prevention and control of noncommunicable diseases need to be based on latest scientific evidence and/or best practice, cost-effectiveness, affordability and public health principles, taking cultural considerations into account.

UNIVERSAL HEALTH COVERAGE

All people should have access, without discrimination, to nationally determined sets of the needed promotive, preventive, curative and rehabilitative basic health services and essential, safe, affordable, effective and quality medicines. At the same time it must be ensured that the use of these services does not expose the users to financial hardship, with a special emphasis on the poor and populations living in vulnerable situations.

MANAGEMENT OF REAL, PERCEIVED OR POTENTIAL CONFLICTS OF INTEREST

Multiple actors, both State and non-State actors including civil society, academia, industry, non-governmental and professional organizations, need to be engaged for noncommunicable diseases to be tackled effectively. Public health policies, strategies and multisectoral action for the prevention and control of noncommunicable diseases must be protected from undue influence by any form of vested interest. Real, perceived or potential conflicts of interest must be acknowledged and managed.