ECOSOC Western Asia Ministerial Meeting Addressing noncommunicable diseases

ECOSOC Western Asia Ministerial Meeting Addressing noncommunicable diseases

ECOSOC Western Asia Ministerial Meeting Addressing noncommunicable diseases and injuries: major challenges to sustainable development in the 21st century Addressing common, modifiable risk factors for noncommunicable diseases Dr Fiona Adshead Director, Chronic Diseases and Health Promotion World Health Organization 10-11 May 2009 Doha, Qatar Noncommunicable Diseases and their shared risk factors Four diseases: Cardiovascular diseases Diabetes Cancers Chronic respiratory diseases

Four risk factors: Tobacco use Unhealthy diet Physical inactivity Harmful use of alcohol These diseases predominantly affect poor people in developing countries, but they are preventable through action on four risk factors. 2| ECOSOC Western Asia Ministerial Meeting, Doha, Qatar | 10-11 May 2009 Addressing noncommunicable diseases and injuries: major challenges to sustainable development in the 21st century Know your risk: Countries with STEPS surveys STEPS survey completed Survey or data analysis under way

3| ECOSOC Western Asia Ministerial Meeting, Doha, Qatar | 10-11 May 2009 Addressing noncommunicable diseases and injuries: major challenges to sustainable development in the 21st century STEPwise approach to surveillance (STEPS) A simple, standardized method for collecting, analysing and disseminating risk factor data in countries. Three different "steps" of risk factor assessment: Questionnaire, Physical measurements, Biochemical measurements. Multiple modules on different topics. 4| ECOSOC Western Asia Ministerial Meeting, Doha, Qatar | 10-11 May 2009 Addressing noncommunicable diseases and injuries: major challenges to sustainable development in the 21st century From data to policy Using the STEPS data for programs:

5| To target your audience, To target your intervention, To target your location, To monitor progress. ECOSOC Western Asia Ministerial Meeting, Doha, Qatar | 10-11 May 2009 Addressing noncommunicable diseases and injuries: major challenges to sustainable development in the 21st century Modelling work has shown the need to: anticipate and prepare for change, aim for impact at a societal level. Combined approaches to tackle multiple risk factors can be effective:

6| involve all stakeholders, create enabling environments, improve health literacy, use "daily life" interventions where people live and work: improving urban or rural "walkability" or "cyclability", school or worksite based health promotion programmes. ECOSOC Western Asia Ministerial Meeting, Doha, Qatar | 10-11 May 2009 Addressing noncommunicable diseases and injuries: major challenges to sustainable development in the 21st century UK Foresight Tackling Obesities: Future Choices 2007 Tackling obesity: how we respond to challenges Nizwa Healthy Lifestyle Project Oman Goal: to improve the health of people in Nizwa through community based projects for primary prevention of NCDs (2004-2009). Interventions tackle following risk factors: - physical inactivity, - unhealthy diet, - unhealthy environment, - smoking,

- traffic accidents. 7| ECOSOC Western Asia Ministerial Meeting, Doha, Qatar | 10-11 May 2009 Addressing noncommunicable diseases and injuries: major challenges to sustainable development in the 21st century School based interventions: "Know Your Body" Crete, Greece Intervention: Know Your Body: 6-year programme (grades 1 to 6), Characteristics: Comprehensive, multi-component, school-based, focus on diet and PA, Constructs from social learning theory, Curricula offered by trained teachers, Strong parental focus, Outcomes: significant improvements in knowledge and food choices, substantive reductions in intake of dietary fat, particularly saturated fat, and four- to five-fold increases in selfreported leisure-time activity.

Source: WHO, What Works, 2009 8| ECOSOC Western Asia Ministerial Meeting, Doha, Qatar | 10-11 May 2009 Addressing noncommunicable diseases and injuries: major challenges to sustainable development in the 21st century Improving health at work: shared benefits Workplace health promotion can achieve a 25-30% reduction in medical and absenteeism costs. 27% reduction in sick leave absenteeism, 26% reduction in healthcare costs, return on investment: $1 invested results in $3 savings. Source: Chapman LS, 2003 9| ECOSOC Western Asia Ministerial Meeting, Doha, Qatar | 10-11 May 2009 Addressing noncommunicable diseases and injuries: major challenges to sustainable development in the 21st century Community intervention Pasos Adelante

The programme: Pasos Adelante, or "Steps Forward", is a community-participation campaign for chronic NCD prevention, targeting border counties between USA and Mexico. The basis for the intervention: Individuals received culturally appropriate educational classes and participated in a walking club. The outcomes: The programme has an 87% completion rate, with a 120-minute median increase in physical activity, and a four-serving increase in fruit and vegetables per person per week. Source: Staten LK et al, 2005 10 | ECOSOC Western Asia Ministerial Meeting, Doha, Qatar | 10-11 May 2009 Addressing noncommunicable diseases and injuries: major challenges to sustainable development in the 21st century Risk factor reduction: at the heart of NCD prevention and control

Prevent NCDs through four key risk factors: tobacco, unhealthy diet, physical inactivity, harmful use of alcohol, Target action based on risk factors, Target action where people live their lives, Multistakeholder and community-level approaches are best. 11 | ECOSOC Western Asia Ministerial Meeting, Doha, Qatar | 10-11 May 2009 Addressing noncommunicable diseases and injuries: major challenges to sustainable development in the 21st century Background material 12 | ECOSOC Western Asia Ministerial Meeting, Doha, Qatar | 10-11 May 2009 Addressing noncommunicable diseases and injuries: major challenges to sustainable development in the 21st century Physical inactivity Sudan (Khartoum State, 2005, 25-64) Iraq (STEPS 2006, 25-65) Saudi Arabia (STEPS 2005, 15-64) Kuwait (STEPS 2006, 20-64)

Egypt (STEPS 2005, 15-65) United Arab Emirates (WHS 2003, 18-69) Pakistan (WHS 2003, 18-69) % inactive* fem ales % inactive* m ales Tunisia (WHS 2003, 18-69) 0 10 20 30 40 50 60 70 80 90

100 * <600 MET-mins/week (=5x30 minutes of moderate activity Data collected using WHO STEPS surveillance tools 13 | ECOSOC Western Asia Ministerial Meeting, Doha, Qatar | 10-11 May 2009 Addressing noncommunicable diseases and injuries: major challenges to sustainable development in the 21st century % <5 servings of fruits and vegetables Syrian Arab Republic (STEPS 2003, 15-64) Saudi Arabia (STEPS 2005, 15-64) Iraq (STEPS 2006, 2565) Kuwait (STEPS 2006, 20-64) Egypt (STEPS 2005, 1565) United Arab Emirates (W HS 2003, 18-69) 0 10

20 30 40 50 60 70 80 90 100 Data collected using WHO STEPS surveillance tools 14 | ECOSOC Western Asia Ministerial Meeting, Doha, Qatar | 10-11 May 2009 Addressing noncommunicable diseases and injuries: major challenges to sustainable development in the 21st century % with elevated blood pressure

Iraq (STEPS 2006, 25-65) Syrian Arab Republic (STEPS 2003, 15-64)* Egypt (STEPS 2005, 15-65) Saudi Arabia (STEPS 2005, 15-64) Sudan (Khartoum State, 2005, 25-64) Kuwait (STEPS 2006, 20-64) 0 5 10 15 20 25 30 35 40

45 (>=SBP 140 and/or DBP >=90) *note: For Syria: labeled as 'high blood pressure', actual definition unknown 15 | ECOSOC Western Asia Ministerial Meeting, Doha, Qatar | 10-11 May 2009 Addressing noncommunicable diseases and injuries: major challenges to sustainable development in the 21st century Data collected using WHO STEPS surveillance tools % with elevated cholesterol Kuwait (STEPS 2006, 20-64) Iraq (STEPS 2006, 25-65) Syrian Arab Republic (STEPS 2003, 15-64) Saudi Arabia (STEPS 2005, 1564) Sudan (Khartoum State, 2005, 25-64) Egypt (STEPS 2005, 15-65) 0 5

10 15 (Plasma Cholesterol >= 5.2 mmol/L) 16 | ECOSOC Western Asia Ministerial Meeting, Doha, Qatar | 10-11 May 2009 Addressing noncommunicable diseases and injuries: major challenges to sustainable development in the 21st century 20 25 30 35 40 Data collected using WHO STEPS surveillance tools % with elevated fasting blood glucose Sudan (Khartoum State, 2005, 25-64) Saudi Arabia (STEPS 2005, 1564)

Kuwait (STEPS 2006, 20-64) Iraq (STEPS 2006, 25-65) Egypt (STEPS 2005, 15-65) 0 2 4 6 8 10 12 14 16 18

20 (capillary blood glucose >=7.0 mmol/L) Data collected using WHO STEPS surveillance tools 17 | ECOSOC Western Asia Ministerial Meeting, Doha, Qatar | 10-11 May 2009 Addressing noncommunicable diseases and injuries: major challenges to sustainable development in the 21st century

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