GLOBAL ACTION PLAN 2013-2020 - FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES
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GLOBAL ACTION PLAN
FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES
2013-2020
TABLE OF
WHO LIBRARY CATALOGUING-IN-PUBLICATION DATA
Global action plan for the prevention and control of noncommunicable diseases 2013-2020.
CONTENTS
1. Chronic diseases. 2. Cardiovascular diseases. 3. Neoplasms. 4. Respiratory tract diseases. 5. Diabetes mellitus. 6. Health planning.
7. International cooperation. I. World Health Organization.
ISBN 978 92 4 150623 6 (NLM classification: WT 500)
© World Health Organization 2013 >> Foreword 1
All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be >> Overview 3
purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264;
fax: +41 22 791 4857; e-mail: bookorders@who.int). >> Voluntary Global Targets 5
Requests for permission to reproduce or translate WHO publications—whether for sale or for non-commercial distribution—
should be addressed to WHO Press through the WHO web site (www.who.int/about/licensing/copyright_form/en/index.html). >> Action Plan 7
The designations employed and the presentation of the material in this publication do not imply the expression of any opinion
>> Objective 1 15
whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its
authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines
>> Objective 2 21
for which there may not yet be full agreement.
The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended >> Objective 3 29
by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excep-
ted, the names of proprietary products are distinguished by initial capital letters. >> Objective 4 39
All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publica-
tion. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsi-
>> Objective 5 47
bility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable
for damages arising from its use.
>> Objective 6 51
Photo Credits:
p2: WHO/SEARO/Vismita Gupta-Smith Annex
p6: WHO/AMRO
p14: UNICEF
>> Appendix 1 57
p20: WHO/Jan Brouwer
p28: DFID
>> Appendix 2 61
p38: WHO/SEARO/Vismita Gupta-Smith
p46: World Bank
>> Appendix 3 65
p50: UNICEF
p56: WHO/SEARO/Vismita Gupta-Smith
>> Appendix 4 73
p60: WHO/EURO
p64: WHO/Antonio Suarez Weise
>> Appendix 5 77
p72: WHO/Anna Kari
p76: WHO/Simon Lim
p82 WHO/AMRO Other relevant documents
p90 WHO/Christopher Black
>> Document 1 83
Design and layout: MEO design & communication, Rossinière, Switzerland.
Printed by the WHO Document Production Services, Geneva, Switzerland. >> Document 2 91
iii
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
FOREWORD
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 poli-
cies 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 opportuni-
ties 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 sophisticat-
ed technical assistance, ranging from helping governments to set national targets to implement even rela-
tively 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.
We are looking forward to working with countries to save lives, improve the health and wellbeing of present
and future generations and ensure that the human, social and financial burden of NCDs does not undermine
the development gains of past years.
Dr Oleg Chestnov
Assistant Director-General
Noncommunicable Diseases and Mental Health
World Health Organization
1
Foreword |
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 noncom-
municable 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
2 3
| Foreword Overview |
VOLUNTARY
OBJECTIVES
GLOBAL TARGETS
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.
A25% relative reduction in risk of premature mortality
from cardiovascular diseases, cancer, diabetes, or chronic
respiratory diseases.
2
At least10% relative reduction in the harmful use of alcohol,
as appropriate, within the national context.
To strengthen national capacity, leadership, governance, multisectoral action
and partnerships to accelerate country response for the prevention and
control of noncommunicable diseases. A10% relative reduction in prevalence of insufficient
3
physical activity.
To reduce modifiable risk factors for noncommunicable diseases and
underlying social determinants through creation of health-promoting
A30% relative reduction in mean population intake
of salt/sodium.
environments.
4
A30% relative reduction in prevalence of current tobacco use
To strengthen and orient health systems to address the prevention and in persons aged 15+ years.
control of noncommunicable diseases and the underlying social determinants
through people-centred primary health care and universal health coverage.
A25% relative reduction in the prevalence of raised blood
5
pressure or contain the prevalence of raised blood pressure,
according to national circumstances.
To promote and support national capacity for high-quality research and
development for the prevention and control of noncommunicable diseases.
Halt the rise in diabetes and obesity.
6
To monitor the trends and determinants of noncommunicable diseases and
evaluate progress in their prevention and control.
At least50% of eligible people receive drug therapy and
counselling (including glycaemic control) to prevent heart attacks
and strokes.
An 80% availability of the affordable basic technologies and
essential medicines, including generics, required to treat major
noncommunicable diseases in both public and private facilities.
4 5
| Overview Voluntary Global Targets |
ACTION PLAN
BACKGROUND dren can die from treatable noncommunicable
diseases (such as rheumatic heart disease, type
1.
The global burden and threat of noncommu- 1 diabetes, asthma and leukaemia) if health
nicable diseases constitutes a major public promotion, disease prevention and comprehen-
health challenge that undermines social and sive care are not provided. According to WHO’s
economic development throughout the world, projections, the total annual number of deaths
and inter alia has the effect of increasing ine- from noncommunicable diseases will increase
qualities between countries and within popu- to 55 million by 2030 if “business as usual”
lations. Strong leadership and urgent action are continues. Scientific knowledge demonstrates
required at the global, regional and national that the noncommunicable disease burden can
levels to mitigate inequality. be greatly reduced if cost-effective preventive
and curative actions, along with interventions
2.
An estimated 36 million deaths, or 63% of the for prevention and control of noncommunicable
57 million deaths that occurred globally in 2008, diseases already available, are implemented in
were due to noncommunicable diseases, com- an effective and balanced manner.
prising mainly cardiovascular diseases (48%
of noncommunicable diseases), cancers (21%),
chronic respiratory diseases (12%) and diabetes AIM
(3.5%). 1,2 These major noncommunicable diseas-
es share four behavioural risk factors: tobacco 3.
As requested by the World Health Assembly in
use, unhealthy diet, physical inactivity and harm- resolution WHA64.11, the Secretariat has devel-
ful use of alcohol. In 2008, 80% of all deaths oped a draft global action plan for the preven-
(29 million) from noncommunicable diseases tion and control of noncommunicable diseases
occurred in low- and middle-income countries, for the period 2013–2020, building on what has
and a higher proportion (48%) of the deaths in already been achieved through the implementa-
the latter countries are premature (under the age tion of the 2008–2013 action plan. Its aim is to
of 70) compared to high income countries (26%). operationalize the commitments of the Political
Although morbidity and mortality from noncom- Declaration of the High-level Meeting of the Gen-
municable diseases mainly occur in adulthood, eral Assembly on the Prevention and Control of
exposure to risk factors begins in early life. Chil- Noncommunicable Diseases.3
1
http://www.who.int/healthinfo/global_burden_disease/ 3
United Nations General Assembly resolution 66/2
cod_2008_sources_methods.pdf. (http://www.who.int/nmh/events/un_ncd_summit2011/
political_declaration_en.pdf).
2
Global Status Report on noncommunicable diseases 2010,
Geneva, World Health Organization, 2010.
6 7
| Voluntary Global Targets Action Plan |
PROCESS i. other noncommunicable diseases (renal, en- iv. health systems and universal health coverage; to reduce the harmful use of alcohol (resolu-
docrine, neurological, haematological, gastro- tion WHA63.13), Sustainable health financing
4.
The global and regional consultation process enterological, hepatic, musculoskeletal, skin v. research, development and innovation; and structures and universal coverage (resolution
to develop the action plan engaged WHO and oral diseases and genetic disorders); WHA64.9) and the Global strategy and plan of
Member States, relevant United Nations system vi. surveillance and monitoring. action on public health, innovation and intel-
agencies, funds and programmes, international ii. mental disorders; lectual property (resolution WHA61.21). Also
financial institutions, development banks and relevant are the Outcome of the World Confer-
other key international organizations, health iii. disabilities, including blindness and deaf- MONITORING ence on Social Determinants of Health (reso-
professionals, academia, civil society and the ness; and
OF THE ACTION PLAN lution WHA65.8) and the Moscow Declaration
private sector through regional meetings or- of the First Global Ministerial Conference on
ganized by the six WHO regional offices, four iv. violence and injuries (Appendix 1). Healthy Lifestyles and Noncommunicable Dis-
web consultations which received 325 written 8.
The global monitoring framework, including 25 ease Control (resolution WHA64.11). The action
submissions, three informal consultations with Noncommunicable diseases and their risk fac- indicators and a set of nine voluntary global plan also provides a framework to support and
Member States and two informal dialogues with tors also have strategic links to health systems targets (see Appendix 2), will track the imple- strengthen implementation of existing regional
relevant nongovernmental organizations and and universal health coverage, environmental, mentation of the action plan through moni- resolutions, frameworks, strategies and plans
selected private sector entities. occupational and social determinants of health, toring and reporting on the attainment of the on prevention and control of noncommunica-
communicable diseases, maternal, child and voluntary global targets in 2015 and 2020. The ble diseases including AFR/RC62/WP/7, CSP28.
adolescent health, reproductive health and action plan is not limited in scope to the global R13, EMR/C59/R2, EUR/RC61/R3, SEA/RC65/
SCOPE ageing. Despite the close links, one action plan monitoring framework. The indicators of the R5, WPR/RC62.R2. It has close conceptual and
to address all of them in equal detail would be global monitoring framework and the voluntary strategic links to the comprehensive mental
5.
The action plan provides a road map and a unwieldy. Further, some of these conditions are global targets provide overall direction and the health action plan 2013–2020 1 and the action
menu of policy options for all Member States the subject of other WHO strategies and action action plan provides a road map for reaching plan for the prevention of avoidable blindness
and other stakeholders, to take coordinated plans or Health Assembly resolutions. Appen- the targets. and visual impairment 2014–2019, 2 which will
and coherent action, at all levels, local to glob- dix 1 outlines potential synergies and linkages be considered by the Sixty-sixth World Health
al, to attain the nine voluntary global targets, between major noncommunicable diseases Assembly. The action plan will also be guided
including that of a 25% relative reduction in and lists some of the interrelated conditions, to RELATIONSHIP TO THE by WHO’s twelfth general programme of work
premature mortality from cardiovascular dis- emphasize opportunities for collaboration so
CALLS MADE UPON WHO (2014–2019). 3
eases, cancer, diabetes or chronic respiratory as to maximize efficiencies for mutual benefit.
diseases by 2025. Linking the action plan in this manner also & ITS EXISTING STRATEGIES, 10.
The action plan is consistent with WHO’s re-
reflects WHO’s responsiveness to the organiza- REFORM & PLANS form agenda, which requires the Organization
6.
The main focus of this action plan is on four tion’s reform agenda as it relates to working in a to engage an increasing number of public
types of noncommunicable disease—cardio- more cohesive and integrated manner. 9.
Since the adoption of the global strategy for health actors, including foundations, civil
vascular diseases, cancer, chronic respiratory the prevention and control of noncommunica- society organizations, partnerships and the pri-
diseases and diabetes—which make the largest 7.
Using current scientific knowledge, available ev- ble diseases in 2000, several Health Assembly vate sector, in work related to the prevention and
contribution to morbidity and mortality due idence and a review of experience on preven- resolutions have been adopted or endorsed control of noncommunicable diseases. The roles
to noncommunicable diseases, and on four tion and control of noncommunicable diseases, in support of the key components of the and responsibilities of the three levels of the
shared behavioural risk factors—tobacco use, the action plan proposes a menu of policy op- global strategy. This action plan builds on the Secretariat—country offices, regional offices
unhealthy diet, physical inactivity and harmful tions for Member States, international partners implementation of those resolutions, mutu- and headquarters—in the implementation of
use of alcohol. It recognizes that the condi- and the Secretariat, under six interconnected ally reinforcing them. They include the WHO the action plan will be reflected in the organ-
tions in which people live and work and their and mutually reinforcing objectives involving: Framework Convention on Tobacco Control ization-wide workplans to be set out in WHO
lifestyles influence their health and quality of (WHO FCTC) (resolution WHA56.1), the Global programme budgets.
life. There are many other conditions of public i. international cooperation and advocacy; strategy on diet, physical activity and health
health importance that are closely associated (resolution WHA57.17), the Global strategy
with the four major noncommunicable diseases. ii. country-led multisectoral response;
They include:
iii. risk factors and determinants; 1
http://apps.who.int/gb/ebwha/pdf_files/EB132/B132_8- 3
http://apps.who.int/gb/ebwha/pdf_files/EB132/B132_26-
en.pdf. en.pdf.
2
http://apps.who.int/gb/ebwha/pdf_files/EB132/B132_9-
en.pdf.
8 9
| Action Plan Action Plan |
11.
Over the 2013–2020 time period other plans is estimated to be US$ 47 trillion. This loss would enable all countries to make significant municable diseases. The global coordination
with close linkages to noncommunicable diseas- represents 75% of global GDP in 2010 (US$ 63 progress in attaining the nine voluntary global mechanism is to be developed based on the
es(such as the action plan on disability called trillion). 2 This action plan should thus be seen targets by 2025 (Appendix 2). The exact manner following parameters:
for in resolution EB132.R5) may be developed as an investment prospect, because it provides in which sustainable national scale-up can be
and will need to be synchronized with this action direction and opportunities for all countries to: undertaken varies by country, being affected >> The mechanism shall be convened, hosted
plan. Further, flexibility is required for updating by each country’s level of socioeconomic de- and led by WHO and report to the WHO
Appendix 3 of this action plan periodically in i. safeguard the health and productivity of velopment, degree of enabling political and governing bodies.
light of new scientific evidence and reorienting populations and economies; legal climate, characteristics of the noncom-
parts of the action plan, as appropriate, in re- municable disease burden, competing national >> The primary role and responsibility for
sponse to the post-2015 development agenda. ii. create win-win situations that influence public health priorities, budgetary allocations preventing and controlling noncommuni-
the choice of purchasing decisions relat- for prevention and control of noncommunica- cable diseases lie with governments, while
ed inter alia to food, media, information ble diseases, degree of universality of health efforts and engagement of all sectors of
COST OF ACTION and communication technology, sports coverage and health system strengthening, society, international collaboration and
VERSUS INACTION and health insurance; and type of health system (e.g. centralized or de- cooperation are essential for success.
centralized) and national capacity.
iii. identify the potential for new, replicable >> The global mechanism will facilitate en-
12.
For all countries, the cost of inaction far and scalable innovations that can be gagement among Member States, 1 United
outweighs the cost of taking action on non- applied globally to reduce burgeoning GLOBAL COORDINATION Nations funds, programmes and agencies,
communicable diseases as recommended in health care costs in all countries.
MECHANISM and other international partners, 2 and non-
this action plan. There are interventions for State actors, 3 while safeguarding WHO
prevention and control of noncommunicable and public health from any form of real,
diseases that are affordable for all countries ADAPTATION 14.
The Political Declaration reaffirms the leader- perceived or potential conflicts of interest.
and give a good return on investment, gen-
OF FRAMEWORK ship and coordination role of the World Health
erating one year of healthy life for a cost Organization in promoting and monitoring >> The engagement with non-State Actors 3
that falls below the gross domestic product TO REGIONAL & global action against noncommunicable dis- will follow the relevant rules currently
(GDP) per 1 person and are affordable for all NATIONAL CONTEXTS eases in relation to the work of other relevant being negotiated as part of WHO reform
countries (see Appendix 3). The total cost of United Nations system agencies, development and to be considered, through the Exec-
implementing a combination of very cost- 13.
The framework provided in this action plan banks and other regional and international utive Board, by the Sixty-seventh World
effective population-wide and individual needs to be adapted at the regional and organizations. In consultation with Member Health Assembly.
interventions, in terms of current health national levels, taking into account region- States, the Secretariat plans to develop a global
spending, amounts to 4% in low-income specific situations and in accordance with nation- mechanism to coordinate the activities of the
countries, 2% in lower middle-income coun- al legislation and priorities and specific national United Nations system and promote engage-
tries and less than 1% in upper middle- circumstances. There is no single formulation ment, international cooperation, collaboration
income and high-income countries. The cost of of an action plan that fits all countries, as they and accountability among all stakeholders.
implementing the action plan by the Secretar- are at different points in their progress in the
iat is estimated at US$ 940.26 million for the prevention and control of noncommunicable 15.
The purpose of the proposed global mecha-
eight-year period 2013–2020. The above es- diseases and at different levels of socioeco- nism is to improve coordination of activities
timates for implementation of the action plan nomic development. However, all countries which address functional gaps that are barri-
should be viewed against the cost of inaction. can benefit from the comprehensive response ers to the prevention and control of noncom-
Continuing “business as usual” will result in to the prevention and control of noncommu-
loss of productivity and an escalation of health nicable diseases presented in this action plan.
care costs in all countries. The cumulative There are cost-effective interventions and 1
And, where applicable, regional economic integration 3
Non-State actors include academia and relevant
output loss due to the four major noncommuni- policy options across the six objectives organizations. nongovernmental organizations, as well as selected
private sector entities, as appropriate, excluding
cable diseases together with mental disorders (Appendix 3), which, if implemented to scale,
2
Without prejudice to ongoing discussions on WHO the tobacco industry, and including those that are
engagement with non-State actors, international partners demonstrably committed to promoting public health
are defined for this purpose as public health agencies and are willing to participate in public reporting and
with an international mandate, international development accountability frameworks.
agencies, intergovernmental organizations including other
1
Scaling up action against noncommunicable disease: how 2
The global economic burden of noncommunicable diseases. >
United Nations organizations and global health initiatives,
much will it cost? Geneva, World Health Organization, 2011 World Economic Forum and Harvard School of Public Health, 2011.
international financial institutions including the World
http://whqlibdoc.who.int/publications/2011/9789241502313_eng.pdf.
Bank, foundations, and nongovernmental organizations.
10 11
| Action Plan Action Plan |
VISION groups and the entire population, is essential health, including preconception, antenatal and
MANAGEMENT OF REAL, PERCEIVED
to create inclusive, equitable, economically postnatal care, maternal nutrition and reducing
OR POTENTIAL CONFLICTS OF INTEREST
16.
A world free of the avoidable burden of non- productive and healthy societies. environmental exposures to risk factors, and
communicable diseases. continuing through proper infant feeding prac- Multiple actors, both State and non-State ac-
tices, including promotion of breastfeeding and tors including civil society, academia, industry,
NATIONAL ACTION, INTERNATIONAL
health promotion for children, adolescents and non-governmental and professional organiza-
COOPERATION & SOLIDARITY
GOAL youth followed by promotion of a healthy work- tions, need to be engaged for noncommunicable
The primary role and responsibility of govern- ing life, healthy ageing and care for people with diseases to be tackled effectively. Public health
17.
To reduce the preventable and avoidable bur- ments in responding to the challenge of non- noncommunicable diseases in later life. policies, strategies and multisectoral action for
den of morbidity, mortality and disability due communicable diseases should be recognized, the prevention and control of noncommuni-
to noncommunicable diseases by means of mul- together with the important role of internation- cable diseases must be protected from undue
EMPOWERMENT OF PEOPLE & COMMUNITIES
tisectoral collaboration and cooperation at na- al cooperation in assisting Member States, as a influence by any form of vested interest. Real,
tional, regional and global levels, so that popu- complement to national efforts. People and communities should be empowered perceived or potential conflicts of interest must
lations reach the highest attainable standards of and involved in activities for the prevention and be acknowledged and managed.
health, quality of life, and productivity at every control of noncommunicable diseases, including
MULTISECTORAL ACTION
age and those diseases are no longer a barrier to advocacy, policy, planning, legislation, service
well-being or socioeconomic development. It should be recognized that effective non- provision, monitoring, research and evaluation.
communicable disease prevention and con-
trol require leadership, coordinated multi-
EVIDENCE-BASED STRATEGIES
OVERARCHING PRINCIPLES stakeholder engagement for health both at
& APPROACHES government level and at the level of a wide Strategies and practices for the prevention and
range of actors, with such engagement and control of noncommunicable diseases need to
action including, as appropriate, health-in-all be based on latest scientific evidence and/or
18.
The action plan relies on the following policies and whole-of-government approaches best practice, cost-effectiveness, affordability
overarching principles and approaches: across sectors such as health, agriculture, com- and public health principles, taking cultural
munication, education, employment, energy, considerations into account.
environment, finance, food, foreign affairs,
HUMAN RIGHTS APPROACH
housing, justice and security, legislature, social
UNIVERSAL HEALTH COVERAGE
It should be recognized that the enjoyment welfare, social and economic development,
of the highest attainable standard of health is sports, tax and revenue, trade and industry, All people should have access, without dis-
one of the fundamental rights of every human transport, urban planning and youth affairs crimination, to nationally determined sets of
being, without distinction of race, colour, sex, and partnership with relevant civil society and the needed promotive, preventive, curative
language, religion, political or other opinion, private sector entities. and rehabilitative basic health services and
national or social origin, property, birth or oth- essential, safe, affordable, effective and quality
er status, as enshrined in the Universal Declara- medicines. At the same time it must be ensured
LIFE-COURSE APPROACH
tion of Human Rights. 1 that the use of these services does not expose
Opportunities to prevent and control noncom- the users to financial hardship, with a special
municable diseases occur at multiple stages of emphasis on the poor and populations living in
EQUITY-BASED APPROACH
life; interventions in early life often offer the vulnerable situations.
It should be recognized that the unequal dis- best chance for primary prevention. Policies,
tribution of noncommunicable diseases is ul- plans and services for the prevention and
timately due to the inequitable distribution of control of noncommunicable diseases need to
social determinants of health, and that action take account of health and social needs at all
on these determinants, both for vulnerable stages of the life course, starting with maternal
1
The Universal Declaration of Human Rights http://www.
un.org/en/documents/udhr/index.shtml.
12 13
| Action Plan Action Plan |
TO RAISE THE PRIORITY ACCORDED
TO THE PREVENTION AND
CONTROL OF NONCOMMUNICABLE OBJECTIVE
DISEASES IN GLOBAL, REGIONAL
1
AND NATIONAL AGENDAS AND
INTERNATIONALLY AGREED
DEVELOPMENT GOALS, THROUGH
STRENGTHENED INTERNATIONAL
COOPERATION AND ADVOCACY
19.
The Political Declaration of the High-level Meeting of the General Assembly on the Prevention and
Control of Non-communicable Diseases, the outcome document of the United Nations Conference on
Sustainable Development 1 (Rio+20) and the first report of the UN System Task Team on the Post-2015
UN Development Agenda 2 have acknowledged that addressing noncommunicable diseases is a priority
for social development and investment in people. Better health outcomes from noncommunicable
diseases is a precondition for, an outcome of and an indicator of all three dimensions of sustainable
development: economic development, environmental sustainability, and social inclusion.
20.
Advocacy and international cooperation are vital for resource mobilization, capacity strengthening
and advancing the political commitment and momentum generated by the High-level Meeting of the
General A ssembly on the Prevention and Control of Noncommunicable Diseases. Actions listed under
this objective are aimed at creating enabling environments at the global, regional and country levels
for the prevention and control of noncommunicable diseases. The desired outcomes of this objective
are strengthened international cooperation, stronger advocacy, enhanced resources, improved capac-
ity and creation of enabling environments to attain the nine voluntary global targets (see Appendix 2).
1
United Nations General Assembly resolution 66/288. 2
www.un.org/millenniumgoals/pdf/Post_2015_
UNTTreport.pdf.
14 15
| Action Plan Objective 1 |POLICY OPTIONS PROPOSED ACTIONS FOR
>> PARTNERSHIPS >> PROVISION OF POLICY ADVICE & DIALOGUE
FOR MEMBER STATES 1
INTERNATIONAL PARTNERS
Forge multisectoral partnerships as appropriate, to This will include :
& THE PRIVATE SECTOR
21.
It is proposed that, in accordance with their promote cooperation at all levels among govern-
legislation, and as appropriate in view of their mental agencies, intergovernmental organizations, • Addressing the interrelationships between
specific circumstances, Member States may nongovernmental organizations, civil society and the prevention and control of noncommunicable 23.
Without prejudice to ongoing discussions on
select and undertake actions from among the the private sector to strengthen efforts for preven- diseases and initiatives on poverty alleviation WHO engagement with non-State actors, inter-
policy options set out below tion and control of noncommunicable diseases. and sustainable development in order to pro- national partners are defined for this purpose
mote policy coherence. as public health agencies with an international
mandate, international development agencies,
>> ADVOCACY ACTIONS FOR • Strengthening governance, including man- intergovernmental organizations including other
Generate actionable evidence and disseminate THE SECRETARIAT agement of real, perceived or potential con- United Nations organizations and global health
information about the effectiveness of inter- flicts of interest, in engaging non-State actors initiatives, international financial institutions
ventions or policies to intervene positively on 22.
The following actions are envisaged for the in collaborative partnerships for implementa- including the World Bank, foundations, and
linkages between noncommunicable diseases Secretariat : tion of the action plan, in accordance with the nongovernmental organizations and selected
and sustainable development, including oth- new principles and policies being developed as private sector entities that commit to the ob-
er related issues such as poverty alleviation, > LEADING & CONVENING part of WHO reform. jectives of the action plan and including those
economic development, the Millennium De- Facilitate coordination, collaboration and coop- that are demonstrably committed to promoting
velopment Goals, sustainable cities, non-toxic eration among the main stakeholders including • Increasing revenues for prevention and public health and are willing to participate in
environment, food security, climate change, Member States, United Nations funds, programmes control of noncommunicable diseases through public reporting and accountability frameworks.
disaster preparedness, peace and security and and agencies (see Appendix 4), civil society and domestic resource mobilization, and improve Proposed actions include:
gender equality, based on national situations. the private sector, as appropriate, guided by the budgetary allocations particularly for strength-
Note by the Secretary-General transmitting the ening of primary health care systems and • Encouraging the continued inclusion of
report of the WHO Director-General on options provision of universal health coverage. Also noncommunicable diseases in development
>> BROADER HEALTH & DEVELOPMENT AGENDA
for strengthening and facilitating multisectoral consideration of economic tools, where justi- cooperation agendas and initiatives, interna-
Promote universal health coverage as a means action for the prevention and control of non fied by evidence, which may include taxes and tionally-agreed development goals, economic
of prevention and control of noncommunicable communicable diseases through effective part- subsidies, that create incentives for behaviours development policies, sustainable development
diseases, and its inclusion as a key element nership, 2 including the strengthening of regional associated with improved health outcomes, as frameworks and poverty-reduction strategies.
in the internationally agreed development coordinating mechanisms and establishment of a appropriate within the national context.
goals; integrate the prevention and control United Nations task force on noncommunicable • Strengthening advocacy to sustain the inter-
of noncommunicable diseases into national diseases for implementation of the action plan. est of Heads of State and Government in imple-
>> DISSEMINATION OF BEST PRACTICES
health-planning processes and broader devel- mentation of the commitments of the Political
opment agendas, according to country context Promote and facilitate international and inter Declaration, for instance by strengthening ca-
>> TECHNICAL COOPERATION
and priorities, and where relevant mobilize the country collaboration for exchange of best pacity at global, regional and national levels,
United Nations Country Teams to strengthen Offer technical assistance and strengthen practices in the areas of health-in-all policies, involving all relevant sectors, civil society and
the links among noncommunicable diseases, global, regional and national capacity to raise whole-of-government and whole-of-society communities, as appropriate within the nation-
universal health coverage and sustainable de- public awareness about the links between approaches, legislation, regulation, health al context, with the full and active participation
velopment, integrating them into the United noncommunicable diseases and sustainable system strengthening and training of health of people living with these diseases.
Nations Development Assistance Framework’s development, to integrate the prevention personnel, so as to disseminate learning from
design processes and implementation. and control of noncommunicable diseases the experiences of Member States in meeting • Strengthening international cooperation with-
into national health-planning processes and the challenges. in the framework of North-South, South-South
development agendas, the United Nations De- and triangular cooperation, in the prevention
velopment Assistance Framework and poverty and control of noncommunicable diseases to:
alleviation strategies.
1
And, where applicable, regional economic integration 2
http://www.who.int/nmh/events/2012/20121128.pdf
organizations (accessed 22 April 2013).
16 17
| Objective 1 Objective 1 |>> Promote at the national, regional and inter- • Support the informal collaborative arrange-
national levels an enabling environment to ment among United Nations agencies, con-
facilitate healthy lifestyles and choices. vened by WHO for prevention and control of
noncommunicable diseases.
>> Support national efforts for prevention
and control of noncommunicable diseas- • Fulfil official development assistance com-
es, inter alia, through exchange of infor- mitment. 1
mation on best practices and dissemina-
tion of research findings in the areas of
health promotion, legislation, regulation,
monitoring and evaluation and health
systems strengthening, building of insti-
tutional capacity, training of health per-
sonnel, and development of appropriate
health care infrastructure.
>> Promote the development and dissemina-
tion of appropriate, affordable and sustain-
able transfer of technology on mutually
agreed terms for the production of afford
able, safe, effective and quality medicines
and vaccines, diagnostics and medical
technologies, the creation of information
and electronic communication technolo-
gies (eHealth) and the use of mobile and
wireless devices (mHealth).
>> Strengthen existing alliances and initia-
tives and forge new collaborative part-
nerships as appropriate, to strengthen
capacity for adaptation, implementation,
monitoring and evaluation of the action
plan for prevention and control of non-
communicable diseases at global, regional
and national levels.
• Support the coordinating role of WHO in areas
where stakeholders—including nongovernmental
organizations, professional associations, ac-
ademia, research institutions and the private
secto—can contribute and take concerted
action against noncommunicable diseases.
1
Document A/8124 available at http://daccess-dds-ny.
un.org/doc/RESOLUTION/GEN/NR0/348/91/IMG/
NR034891.pdf.
18 19
| Objective 1 Objective 1 |TO STRENGTHEN NATIONAL
CAPACITY, LEADERSHIP,
GOVERNANCE, MULTISECTORAL OBJECTIVE
ACTION AND PARTNERSHIPS
TO ACCELERATE COUNTRY
RESPONSE FOR THE
PREVENTION AND CONTROL OF
2
NONCOMMUNICABLE DISEASES
24.
As the ultimate guardians of a population’s health, governments have the lead responsibility for ensuring
that appropriate institutional, legal, financial and service arrangements are provided for the prevention
and control of noncommunicable diseases.
25.
Noncommunicable diseases undermine the achievement of the Millennium Development Goals and
are contributory to poverty and hunger. Strategies to address noncommunicable diseases need to
deal with health inequities which arise from the societal conditions in which people are born, grow,
live and work and to mitigate barriers to childhood development, education, economic status, em-
ployment, housing and environment. Upstream policy and multisectoral action to address these social
determinants of health will be critical for achieving sustained progress in prevention and control of
noncommunicable diseases.
26.
Universal health coverage, people-centred primary health care and social protection mechanisms are
important tools to protect people from financial hardship related to noncommunicable diseases and
to provide access to health services for all, in particular for the poorest segments of the population.
Universal health coverage needs to be established and/or strengthened at the country level, to sup-
port the sustainable prevention and control of noncommunicable diseases.
20 21
| Objective 1 Objective 2 |27.
Effective noncommunicable disease prevention civil society, academia, the media, policy-makers, der equity and the health needs of people living urban planning) and of the impact of financial,
and control require multisectoral approaches at voluntary associations and, where appropriate, in vulnerable situations, including indigenous social and economic policies on noncommunica-
the government level including, as appropriate, traditional medicine practitioners, the private peoples, migrant populations and people with ble diseases, in order to inform country action.
a whole-of-government, whole-of-society and sector and industry. The active participation of mental and psychosocial disabilities.
health-in-all policies approach across such civil society in efforts to address noncommuni-
>> DEVELOP NATIONAL PLAN
sectors as health, agriculture, communication, cable diseases, particularly the participation of
>> MOBILIZE SUSTAINED RESOURCES & ALLOCATE BUDGET
customs/revenue, education, employment/ grass-roots organizations representing people
AS APPROPRIATE TO NATIONAL CONTEXT,
labour, energy, environment, finance, food, for- living with noncommunicable diseases and their As appropriate to national context, develop and
& IN COORDINATION WITH THE RELEVANT
eign affairs, housing, industry, justice/security, carers, can empower society and improve ac- implement a national multisectoral noncommu-
ORGANIZATIONS AND MINISTRIES,
legislature, social welfare, social and economic countability of public health policies, legislation nicable disease policy and plan; and taking into
INCLUDING THE MINISTRY OF FINANCE
development, sports, trade, transport, urban and services, making them acceptable, respon- account national priorities and domestic cir-
planning and youth affairs (Appendix 5). Ap- sive to needs and supportive in assisting individ- • Strengthen the provision of adequate, pre- cumstances, in coordination with the relevant
proaches to be considered to implement multi- uals to reach the highest attainable standard of dictable and sustained resources for pre- organizations and ministries, including the Min-
sectoral action could include, inter alia, health and well-being. Member States can also vention and control of noncommunicable istry of Finance, increase and prioritize budg-
promote change to improve social and physi- diseases and for universal health coverage, etary allocations for addressing surveillance,
i. self-assessment of Ministry of Health, cal environments and enable progress against through an increase in domestic budgetary prevention, early detection and treatment of
noncommunicable diseases including through allocations, voluntary innovative financing noncommunicable diseases and related care
ii. assessment of other sectors required for constructive engagement with relevant private mechanisms and other means, including and support, including palliative care.
multisectoral action, sector actors. multilateral financing, bilateral sources
and private sector and/or nongovernmen-
>> STRENGTHEN MULTISECTORAL ACTION
iii. analyses of areas which require multi– 29.
The desired outcomes of this objective are strength- tal sources, and
sectoral action, ened stewardship and leadership, increased re- As appropriate to the national context, set up a
sources, improved capacity and creation of enabling • Improve efficiency of resource utilization national multisectoral mechanism—high-level
iv. development of engagement plans, environments for forging a collaborative multisec- including through synergy of action, inte- commission, agency or task force—for engage-
toral response at national level, in order to attain the grated approaches and shared planning ment, policy coherence and mutual accounta-
v. use of a framework to foster common un- nine voluntary global targets (see Appendix 2). across sectors. bility of different spheres of policy-making that
derstanding between sectors, have a bearing on noncommunicable diseases,
in order to implement health-in-all-policies and
>> STRENGTHEN NATIONAL NONCOMMUNICABLE
vi. strengthening of governance structures, POLICY OPTIONS FOR DISEASES PROGRAMMES
whole-of-government and whole-of-society ap-
political will and accountability mecha-
MEMBER STATES 1 proaches, to convene multistakeholder working
nisms, Strengthen programmes for the prevention groups, to secure budgetary allocations for im-
and control of noncommunicable diseases with plementing and evaluating multisectoral action
vii. enhancement of community participation, 30.
It is proposed that, in accordance with their suitable expertise, resources and responsibility and to monitor and act on the social and envi-
legislation, and as appropriate in view of their for needs assessment, strategic planning, pol- ronmental determinants of noncommunicable
viii. adoption of other good practices to foster specific circumstances, Member States may icy development, legislative action, multisec- diseases (see Appendix 5).
intersectoral action and select and undertake actions from among the toral coordination, implementation, monitoring
policy options set out below. and evaluation.
>> IMPROVE ACCOUNTABILITY
ix. monitoring and evaluation.
Improve accountability for implementation by
>> ENHANCE GOVERNANCE >> CONDUCT NEEDS ASSESSMENT
28.
An effective national response for prevention assuring adequate surveillance, monitoring and
& EVALUATION
and control of noncommunicable diseases re- Integrate the prevention and control of non- evaluation capacity, and by setting up a moni-
quires multistakeholder engagement, to include communicable diseases into health-planning Conduct periodic assessments of epidemiolog- toring framework with national targets and in-
individuals, families and communities, intergov- processes and development plans, with special ical and resource needs, including workforce, dicators consistent with the global monitoring
ernmental organizations, religious institutions, attention to social determinants of health, gen- institutional and research capacity; of the health framework and options for applying it at the
impact of policies in sectors beyond health (e.g. country level.
agriculture, communication, education, employ-
1
And, where applicable, regional economic integration ment, energy, environment, finance, industry
organizations. and trade, justice, labour, sports, transport and
22 23
| Objective 2 Objective 2 |and economic determinants and health equity • Facilitate and support capacity assess-
>> STRENGTHEN INSTITUTIONAL CAPACITY >> POLICY GUIDANCE & DIALOGUE
(e.g. through engaging human rights organiza- ment surveys of Member States to identify
& THE WORKFORCE
tions, faith-based organizations, labour organ- Provide guidance for countries in developing needs and tailor the provision of support
Provide training and appropriately deploy izations, organizations focused on children, partnerships for multisectoral action to address from the Secretariat and other agencies.
health, social services and community work- adolescents, youth, adults, elderly, women, pa- functional gaps in the response for prevention
forces, and strengthen institutional capacity tients and people with disabilities, indigenous and control of noncommunicable diseases, guid-
for implementing the national action plan; for peoples, intergovernmental and nongovern- ed by the Note of the Secretary-General trans- PROPOSED ACTIONS FOR
example by including prevention and control mental organizations, civil society, academia, mitting the report of the Director-General, in
INTERNATIONAL PARTNERS
of noncommunicable diseases in the teaching media and the private sector). particular addressing the gaps identified in that
curricula for medical, nursing and allied health report, including advocacy, awareness-raising,
personnel, providing training and orientation accountability including management of real, 32.
Strengthen international cooperation within
to personnel in other sectors and by establish-
ACTIONS FOR perceived or potential conflicts of interest at the framework of North–South, South–South
ing public health institutions to deal with the THE SECRETARIAT the national level, financing and resource mo- and triangular cooperation, and forge collabo-
complexity of issues relating to noncommuni- bilization, capacity strengthening, technical rative partnerships as appropriate, to:
cable diseases (including such factors as multi- 31.
The following actions are envisaged for the support, product access, market shaping and
sectoral action, advertising, human behaviour, Secretariat: product development and innovation. >> Support national authorities in implement-
health economics, food and agricultural sys- ing evidence-based multisectoral action
tems, law, business management, psychology, (see Appendix 5), to address functional
>> LEADING & CONVENING >> KNOWLEDGE GENERATION
trade, commercial influence including advertis- gaps in the response to noncommunicable
ing of unhealthy commodities to children and Mobilize the United Nations system to work as Develop, where appropriate, technical tools, diseases (e.g. in the areas of advocacy,
limitations of industry self-regulation, urban one within the scope of bodies’ respective man- decision support tools and information prod- strengthening of health workforce and
planning, training in prevention and control of dates, based on an agreed division of labour, ucts for implementation of cost-effective in- institutional capacity, capacity building,
noncommunicable diseases, integrated prima- and synergize the efforts of different United terventions, for assessing the potential impact product development, access and innova-
ry care approaches and health promotion). Nations organizations as per established infor- of policy choices on equity and on social deter- tion), in implementing existing internation-
mal collaborative arrangement among United minants of health, for monitoring multisectoral al conventions in the areas of environment
Nations agencies in order to provide additional action for the prevention and control of non- and labour and in strengthening health
>> FORGE PARTNERSHIPS
support to Member States. communicable diseases, for managing conflicts financing for universal health coverage.
Lead collaborative partnerships to address of interest and for communication, including
implementation gaps (e.g. in the areas of through social media, tailored to the capacity >> Promote capacity-building of relevant non
>> TECHNICAL COOPERATION
community engagement, training of health and resource availability of countries. governmental organizations at the national,
personnel, development of appropriate health Provide support to countries in evaluating and regional and global levels, in order to real-
care infrastructure, and sustainable transfer implementing evidence-based options that suit ize their full potential as partners in the pre-
>> CAPACITY STRENGTHENING
of technology on mutually agreed terms for their needs and capacities and in assessing the vention and control of noncommunicable
the production of affordable, quality, safe and health impact of public policies, including on • Develop a “One-WHO workplan for the diseases.
efficacious medicines, including generics, vac- trade, management of conflicts of interest and prevention and control of noncommunica-
cines and diagnostics, as well as for product maximizing of intersectoral synergies for the ble diseases” to ensure synergy and align- >> Facilitate the mobilization of adequate,
access and procurement), as appropriate to prevention and control of noncommunicable ment of activities across the three levels of predictable and sustained financial re-
national contexts. diseases (see Appendix 1) across programmes WHO, based on country needs. sources and the necessary human and
for environmental health, occupational health, technical resources to support the imple-
and for addressing noncommunicable diseases • Strengthen the capacity of the Secretar- mentation of national action plans and the
>> EMPOWER COMMUNITIES & PEOPLE
during disasters and emergencies. Such sup- iat at all levels to assist Member States monitoring and evaluation of progress.
Facilitate social mobilization, engaging and port to be given by establishing/strengthening to implement the action plan, recogniz-
empowering a broad range of actors, includ- national reference centres, WHO collaborating ing the key role played by WHO Country >> Enhance the quality of aid for prevention
ing women as change-agents in families and centres and knowledge-sharing networks. Offices working directly with relevant and control of noncommunicable diseas-
communities, to promote dialogue, catalyse national Ministries, agencies and non- es by strengthening national ownership,
societal change and shape a systematic society- governmental organizations. alignment, harmonization, predictability,
-wide national response to address noncom- mutual accountability and transparency,
municable diseases, their social, environmental and results orientation.
24 25
| Objective 2 Objective 2 |You can also read
