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Global action plan for the prevention and control of noncommunicable diseases 2013-2020.
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
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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
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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 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


                                                                                                  Foreword |


                 A world free of the avoidable burden of noncommunicable diseases.

                 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.

                    >> 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 |
                                                                                    GLOBAL TARGETS

    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.

                                                                                      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

                                                                                      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.

                                                                                      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

                                                                                      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.

    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 |

                                 BACKGROUND                                                             dren can die from treatable noncommunicable
                                                                                                        diseases (such as rheumatic heart disease, type
                                      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
                                      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

                                                                                                            United Nations General Assembly resolution 66/2
                                          cod_2008_sources_methods.pdf.                                     (
                                          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
         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
         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
         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
                                                                                                                                     en.pdf.                                                          en.pdf.

8                                                                                                                                                                                                                                                             9

                  | Action Plan                                                                                                                                                                                                   Action Plan |
           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-
           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,
                                                                                                                                                                         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
               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
                                                                                                                                                                         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
           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
           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
           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,
                                                                         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
                                                                         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

               The Universal Declaration of Human Rights http://www.

12                                                                                                                                                                                                                                         13

                       | Action Plan                                                                                                                                                                            Action Plan |
                     TO THE PREVENTION AND
                     CONTROL OF NONCOMMUNICABLE                                                                    OBJECTIVE
                     DISEASES IN GLOBAL, REGIONAL

                     AND NATIONAL AGENDAS AND
                     INTERNATIONALLY AGREED
                     DEVELOPMENT GOALS, THROUGH
                     COOPERATION AND ADVOCACY

                                 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.

                                 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).

                                     United Nations General Assembly resolution 66/288.   2

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
           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
                                                                            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.

               And, where applicable, regional economic integration         2
               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.

         Document A/8124 available at http://daccess-dds-ny.

18                                                                                                                             19

                 | Objective 1                                                                                 Objective 1 |
                     CAPACITY, LEADERSHIP,
                     GOVERNANCE, MULTISECTORAL                                                                         OBJECTIVE
                     ACTION AND PARTNERSHIPS
                     TO ACCELERATE COUNTRY
                     RESPONSE FOR THE
                     PREVENTION AND CONTROL OF

                           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.

                           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.

                           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 |
           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
           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-
               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
                                                                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
                                                                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
                                                                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 |
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