MAKING THE WORLD SAFE FORM - THE THREATS OF EMERGING INFECTIOUS DISEASES - (PMAC) 2019
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MAKING THE WORLD SAFE FORM THE THREATS OF EMERGING INFECTIOUS DISEASES
| BACKGROUND
The Prince Mahidol Award Conference (PMAC) is an annual international conference focusing on policy-related health issues.
The Prince Mahidol Award Conference 2019 is co-hosted by the Prince Mahidol Award Foundation, the Thai Ministry of Public
Health, Mahidol University, the World Health Organization, The World Bank, U.S Agency for International Development, Japan
International Cooperation Agency, The Rockefeller Foundation, with support from other key related partners. The Conference
will be held in Bangkok, Thailand, from 29 January – 3 February 2019. The theme for PMAC 2019 is “Making the World Safe
from the Threats of Emerging Infectious Diseases”.
We live in an era when the emergence of novel infectious disease agents is posing an increasing threat to global health and
security. The threat from novel infectious diseases is accelerating at a pace and with an intensity unprecedented in human
history, driven by increasing human populations, climate change and surging global travel. The possibility that a single lethal
microbe could suddenly emerge and sweep through every household, through every community without regard to national
borders or social and economic standing is a shared fear across the globe. Just the fear can cost billions, as illustrated by
recent Ebola and Zika virus panics in little-affected countries. But the reality of the threat is all too clear, proven by the
decades of response to the HIV-AIDS pandemic. Yet the world is not prepared to either mitigate the impact of an emergent
disease threat or prevent its emergence.
Zoonotic and AMR related diseases account for more than 95% of all emerging infectious diseases reported during the
second half of the 20th century. In this century the emergence of SARS, pandemic influenza, MERS, and the spread of Ebola
and Zika reflect the world’s increasing vulnerability to novel zoonotic threats. The simultaneous emergence of pathogens
resistant to antibiotic therapies raises the prospect of a “post antibiotic” world. While the drivers underlying the emergence
of zoonotic and antibiotic resistant diseases are complex, human behaviours and their impact on animal populations and the
environment are understood to be central to the emergence of both disease threats. The role of increasing animal-human
contact in the emergence of zoonotic diseases has been well documented and been increasingly the focus of One Health
initiatives across the globe. The contribution made by the inappropriate use of antibiotics in animal husbandry to AMR is less
well documented but in recent years has been increasingly understood to be a core driver behind the emergence and global
spread of antibiotic resistant organisms, along with inappropriate “prescriber-user” practices associated with antibiotic use
in clinical care. Changing environmental and climatic conditions have also been closely linked to the emergence of novel
infectious diseases. That infectious disease emergence is closely associated with practices and behaviours at the animal-
human-environment interface speak to the importance of an expanded multi-sectoral alliance across the animal, human and
environmental sectors to address the threats posed by both zoonosis and AMR. The Global Health Security Agenda and
related One Health movement provide important frameworks for mobilizing international action.
1
K. E. Jones et al., Global trends in emerging infectious diseases. Nature 451, 990‐993 (2008).THE RISING THREAT OF ZOONOTIC DISEASES
Since the Influenza Pandemic of 1918 when between 50-100 million died (5-10% of the human population) we have been
fully aware of how vulnerable our place on this planet is.
Even in the absence of significant global mortality, epidemics and pandemics can cost tens of billions of dollars, reversing
development gains and pushing communities and households into poverty. The SARS outbreak in 2003 cost the economies
of East Asia between $30-50 billion and estimates of the global economic cost of an influenza pandemic range from $374
billion, for a mild pandemic, to $7.3 trillion, for a severe pandemic - with a 12.6% loss of gross domestic product.
Strategically, policies to address a potential pandemic threat are constrained by an unresolved debate over the use of
adaptive measures - that aim through the use of technological measures to reduce the impact of diseases after they have
emerged vs mitigation measures - that focus on the underlying causes of disease emergence. The adaptive tools we
traditionally rely on to protect us from the world of infectious diseases – vaccine and therapeutics – too often are shown
ineffective against a novel threat; and, the timely development and deployment of new and effective biomedical
countermeasures is undercut by the speed at which the threat spreads
Similarly, our ability to mitigate the emergence of new threats is undermined by a lack of knowledge about the viral ecology
and the drivers, including human behaviors, which propel the emergence of a new threat. It is at these moments we realize
just how few our adaptive and mitigation options are – and how vulnerable the global community is. After each episode the
world admonishes itself for being ill prepared to deal with a global threat – but after decades of largely reacting adaptively to
each event, with only a tangential focus on mitigation, we are only marginally better able to deal with the next one.
A "POST ANTIBIOTIC WORLD"
The development and commercialization of antimicrobials stands as a defining achievement of 20th century medical
practice. Antimicrobials heralded an era of expanded life expectancy, paved the way for advanced medical and surgical
treatments, improved animal health and welfare, and made possible curative therapy for once fatal infections. Decades of
superfluous and inattentive use of antimicrobials across the human and animal health sectors now threaten these
advancements. The pace of reported treatment failures and antimicrobial resistance (AMR) in common pathogens is
increasing, with multi-drug resistant pathogens creating the prospect of a ‘post antibiotic’ world. In the absence of
interventions, AMR-associated human mortality is projected to soar from a current rate of 700 000 to over 10 million
annually by 2050—as readily treatable infections become life threatening, and routine procedures are rendered unsafe. Asia
is expected to account for half of this projected global mortality. The impact of AMR on morbidity and mortality is matched
by a substantial economic burden, with resistance linked to aggregate losses anticipated to exceed USD 100 trillion by 2050.
Antimicrobial resistance is exacerbated by the unregulated use of antimicrobials across both the human health and animal
health sectors. A particular concern is the shared use of same classes of antibiotics in humans and in animals, potentially
exacerbating the selection pressures on pathogen populations in animals and humans that encourage the development of
resistance and exchange of resistance genes. By example, in the United States the livestock production industry accounts
for 80% of the total use of antibiotics used for treatment of human infections.
2
O’Neill, J. Review on Antimicrobial Resistance. Tackling a Global Health Crisis: Initial Steps. 2015Antimicrobial resistance is one of the three flagship topics for the tripartite (FAO, OIE and WHO) collaboration. At the Sixty-
eight World Health Assembly in May 2015, the World Health Assembly endorsed the Global Action Plan (GAP) on AMR and
requested to strengthen the tripartite collaboration between FAO, OIE and WHO for combating antimicrobial resistance in the
spirit of the “One Health” approach. The Global Action Plan, which ensured a One Health approach and consistency with
Codex Alimentarius and OIE inter-governmental standards and guidelines, aims to ensure continuity of successful treatment
and prevention of infectious diseases with effective and safe medicines that are quality-assured, used in a responsible way,
and accessible to all who need them. Guided by this global action plan, the Member States, the Secretariat, and their
international and national partners aim to: (1) improve awareness and understanding of antimicrobial resistance; (2)
strengthen knowledge through surveillance and research; (3) reduce the incidence of infection; (4) optimize the use of
antimicrobial agents; and (5) develop the economic case for sustainable investment that takes account of the needs of all
countries, and increase investment in new medicines, diagnostic tools, vaccines and other interventions.
A high level meeting on anti-microbial resistance was held in September 2016 at the United Nations General Assembly,
generating a statement of global commitment to address AMR through a multi-disciplinary approach.
PMAC 2019 WILL BE ACTION FOCUSED.
Protecting the world from the threat of zoonotic diseases and ensuring effective stewardship of antibiotics requires a
common and well-coordinated multi-sectoral effort. While there has been significant progress in building multi-sectoral One
Health action against zoonotic diseases, AMR efforts remain highly siloed with an unequal focus on the respective
contributions made by the inappropriate use of antibiotics in clinical care and animal production, as well as limited
opportunities for bringing human, animal and environmental health sectors together to forge a common strategy. There is
an urgent need to bring a comprehensive One Health risk mitigation approach to address zoonotic and AMR related diseases
that addresses the direct consequences of animal-human interactions and contributory pressures related to environmental
and climate changes.
PMAC 2019 will provide an important setting for fostering policy and strategic action by engaging multi-sectoral experts in
zoonosis and AMR, as well as climate change and related environmental fields from across the public and private sectors,
international organizations, foundations, academics and non-governmental organizations, as well as critical players in Global
Health Security Agenda (GHSA). Importantly, a PMAC sponsored “Making the World Safe from the Threats of Emerging
Infectious Diseases” would build on PMAC 13’s highly successful conference on One Health and lead to real change.
PMAC 2019 WILL BUILD ON PAST PMAC THEMES.
Since 2007, the Prince Mahidol Award Conference has been organized as an annual international conference focusing on
policy-related public health issues of global significance – including, Universal Health Coverage, Health Equity, Meeting the
Needs of Vulnerable Populations, and addressing the threats posed by infectious diseases. Each of these meeting has
brought together leading public health leaders and stakeholders from around the world to propose concrete solutions and
recommendations. PMAC 2019 will explicitly look to build on the successes of past PMACs and to identify opportunities to
further contribute to the systems and capacities required to address the comprehensive health needs of the world’s
populations.
3
Global Action Plan on Antimicrobial Resistance, http://www.who.int/drugresistance/global_action_plan/en/
4
http://www.un.org/pga/71/2016/09/21/press‐release‐hl‐meeting‐on‐antimicrobial‐resistance/| OBJECTIVES 1. To accelerate progress in the adoption of multi-sectoral approaches for addressing zoonotic diseases and antimicrobial resistance 2. To advocate for evidence-based priority setting and policy decisions for zoonotic diseases and antimicrobial resistance 3. To share knowledge and experience in addressing the challenges posed by zoonotic diseases and antimicrobial resistance 4. To promote a greater understanding of the range and nature of the “drivers” underlying the emergence of new disease threats and options for their mitigation 5. To highlight emerging demographic, climatic and travel trends to better understand how disease emergence will evolve over the course of this century 6. To underscore the collateral socio-economic and development benefits associated with a One Health Agenda
Sub-Theme 1 Learning from the Past: Towards Effective and Sustainable Policies, Practices and Capacities for “Prevention, Detection and Response” to Emerging Zoonosis and Antimicrobial Resistance
SUB-THEME 1
This sub-theme is focused on presenting evidence for how efforts across the globe over the past two decades to address
zoonotic and AMR related threats are contributing to more effective policies, practices and capacities for “prevention,
detection and response” to EIDs. Given the inherent multi-sectoral aspects of disease emergence this is an opportunity to
learn from recent experience with efforts such as the Global Health Security Agenda (GHSA), International Health
Regulations, the One Health movement, and other platforms illustrating challenges and solutions for building effective
partnerships for addressing zoonosis and AMR.
Issues to be discussed under this sub-theme are:
1. Evidence for optimal policies, regulations and systems for addressing EIDs
What we have learned from country, regional and global level experiences in addressing EIDs
Case studies illustrating successes and failures; how well do we manage and mitigate present threats (e.g.
MERS CoV, Nipah virus, Zika virus, Zoonotic Influenza, Ebola virus, AMR, and others)
Organizational options for building sustainable national-level partnerships across multi-ministerial groups,
including Health, Agriculture, Environment, Finance and Education
What are the policy requirements
What are the human resource requirements
What are the organization requirements
What are resource requirements
How are these experiences translated to the sub-national level
What are the equivalent requirements for provincial/county level operations
2. Evidence for optimal global and regional level structures for addressing EIDs
What are the lessons learned on building global and regional level partnerships, including the GHSA, One Health and
Planetary Health, to address EIDs
How effective have global and regional partnerships been in building multi-sectoral alliances to enable
country level actions
What are the policy requirements
What are the human resource requirements
What are the organization requirements
What are resource requirements
What is the evidence for proactive, flexible structures that enhance capacities and preparedness across the
prevention-detection-response continuum?
What have we learned from the pandemic vaccine development banks; consortia for conservation of
antimicrobials?
What can we learn from parallel efforts, such as those addressing global climate change and carbon
emissions?
What examples demonstrate the ability to bridge the apparent dichotomy between capacity building and a
research agenda concerning emerging zoonoses and AMR?3. Evidence of novel, upstream approaches to earlier detection and trends monitoring, including but not
limited to:
Novel surveillance postures and strategies,
digital diseases detection,
crowdsourcing big data,
predictive analytics on disease distribution
4. Evidence for more sustainable approaches for “prevention, detection and response”
What are examples of sustainable financing structures? What have we learned from:
The World Bank Pandemic Emergency Financing Facility?
Evolving schemes for engaging insurance companies to “share” pandemic risk?
Efforts to quantify cost attributable to zoonotic disease and AMR burden, project pandemic influenza
economic impact, and make a credible investment case for prevention and risk mitigation?
What are examples of “preparedness” activities that address long-term sustainability?
What have we learned from the World Bank and WHO’s joint effort to develop strategies for both pandemic
and “all hazards” preparedness and related long-term financing schemes?
Which financing models have proven utility in employing an evidence driven approach to discouraging high risk
practices and incentivizing risk mitigation in approaching pandemic prevention as a global public good?Sub-Theme 2
Harnessing the Power of Public-Private-Community (PPC)
Partnerships for “Preventing, Detecting, and
Responding” to Zoonosis and AMRSUB-THEME 2
This sub-theme is focused on examining the evidence for building effective partnerships that bring together community,
private sector and public sector resources for sustainably addressing the threats posed by zoonosis and AMR. As with the
previous sub-theme, the inherently multi-sectoral nature of zoonosis and AMR requires active engagement across multiple
stakeholders. In addition to the Public sector, Private sector actors who may be directly engaged in activities that
inadvertently contribute to “drivers” for EIDs will need to be actively involved in any efforts to better mitigate the
consequences of their activities. Similarly, communities are key stakeholders, both as consumers and potential contributors
to some of the drivers that underlie disease emergence (e.g. inappropriate use of antibiotics in rearing of livestock and
aquaculture)
Issues to be discussed under this sub-theme are:
1. Evidence for strong PPC partnerships that have contributed to “prevention, detection and response” to
Zoonosis and AMR
What are the lessons from PPC partnerships in addressing EIDs
Country, regional or global examples of how PPC partnerships have been able to harness across each of the
constituencies to address EIDs in ways that greatly enhanced the overall impact
What were the incentives for PPC partnerships
What were the roles and responsibilities of each group
What were the metrics for valuing the PPC partnerships
What were the operational factors for sustainability of PPC parnterships
2. Evidence of successful outreach and community empowerment
What are examples of how risk communications have successfully affected community and/or individual level
practices and behaviors on a scale significant enough to reduce the risk from zoonotic threats and/or AMR
3. Evidence for an active and sustainable engagement of the private sector
What are examples of how private sector partners have been actively and sustainably engaged in efforts to
address zoonotic threats and/or AMR
What can be learned from partnerships with biomedical industry in developing and marketing vaccines and
medical countermeasures? Employing novel diagnostic platforms enabling rapid detection and response to
emerging threats?
What are examples of partnerships with industry in the use of non-medical countermeasures within communities
to help mitigate, prevent, and control infectious disease threats? Employing new technologies and platforms for
health communication and the application of non-pharmaceutical interventions
4. Evidence for how consumer advocacy can contribute to change policies and practices
5. Evidence of economic benefits from PPCSub-Theme 3
Understanding the Selection Pressures Underlying Emergence of
Zoonotic Diseases and Antimicrobial Resistance and the Broad Benefits Realized
From Promoting Healthy Animals and Healthy PeopleSUB-THEME 3
This sub-theme is focused on both:
a.) exploring the contributions made by climate change, population growth, global travel, habitat change, expanding
settlements, resource extraction, increased livestock and crop production and other underlying drivers that contribute
to the emergence of new zoonotic and anti-microbial disease threats, and
b.) examining the broad benefits that are accrued from promoting practices across multiple sectors that aim at reducing
these drivers and the risk of zoonotic diseases and antimicrobial resistance.
There has been a general recognition that the adoption of a core set of best practices that are designed to directly target the
drivers associated with zoonosis and AMR are likely to simultaneously contribute to positive outcomes across a range of
“other” domains and the achievement of the United Nations Sustainable Development Goals, such as food security,
household wealth and economic growth, as well as healthier environments and sustainable communities.
a.) Issues to be discussed under this sub-theme will allow a presentation of the evidence for the drivers of EID
emergence:
1. Evidence for Climate Change in Increasing Infectious Disease threats and models projecting
future impact
How does climate change contribute to spread of infectious disease threats
Topics to be considered could include: impact on vector ecology, animal migration, altered
range and distribution of reservoir host species;
variance in freshwater availability, sanitation, and waterborne disease
2. Evidence for demographic and population change on increasing Infectious Disease threats,
including how settlement patterns (peri-urbanization), population movement (increased air
travel, trade etc), habitat change (impact on animal bio-diversity) contribute to disease
emergence and spread
3. 3. Evidence for how increased economic activity impacts on increased Infectious Disease risk,
including how expanded incursions of extractive industry operations and agricultural
intensification into wildlife domains increase risk for “spillover” and spread of novel diseases
Options for how “risk” can be mitigated at the site of industry operations or in planning/selecting
where industry operations occur
4. Evidence for how increased livestock production and marketing in geographic “hot spots” for
disease emergence may increase risk of pathogen “spillover” and spread
How projected increases in livestock production in Africa and shifting production contexts in Asia over
the 21st century will impact on the risk of disease emergence, including zoonosis and AMR
Models for likely changes in terrestrial and aquatic animal production and marketing patterns
over the coming century
Models for potential increased environmental impact that could elevate risk
Options for minimizing risks associated with increased livestock production and marketing
Considering the impact of a global supply chain of agricultural commodities and production
inputs (e.g. animal feed), and trans-continental risk management strategiesb.) Issues to be discussed under this sub-theme also will allow a presentation of the evidence to broad collateral
benefits accrued from targeting the drivers of EID emergence:
5. Evidence that adoption of practices to reduce zoonotic and AMR risks associated with livestock
production would also contribute to more efficient and more profitable operations
How do improved biosecurity and husbandry practices that strengthen control of pathogenic zoonotic
viruses improve the overall health of livestock and the environment
Reduced animal diseases
Improved animal health can lead to increased livestock productivity and reduced input costs
for production
Enhanced productivity and yield per animal production unit
Reduction in prophylactic antibiotic use
How does proper management of antimicrobials in livestock production and aquaculture improve
economic returns
Improved hygienic conditions, nutrition, and vaccination in animal husbandry associated with
reduced use of antibiotics and corresponding returns on investment
What can be learned from the experience of countries that have phased out and enacted
regulatory controls on use of antimicrobials in animal production
AMR reduces potency of veterinary drugs and negatively affects animal health
Consumer demand for antimicrobial residue free animal source foods
Market based incentives and penalties for reduced antimicrobial use and enhanced adherence
to drug withholding periods, minimizing residues in products entering the food chain
Best practices in strengthening antimicrobial usage regulatory and enforcement structures in
animal production
6. Evidence that reduction in habitat fragmentation has led to the control of zoonosis
How does habitat fragmentation impact on both vector-borne and non vector-borne diseases
Evidence that changes in habitat leads to changes (increase/decrease) the transmission
dynamics of infectious diseases (e.g. chikungunya, malaria)
7. Evidence that that the real and/or projected economic impact from emerging zoonoses and AMR
has informed resource allocation policies and an investment case for prevention
What practices and approaches have shown promise in fostering decision making informed by
economic analyses
What novel structures have proven utility in transcending the challenge of inequitable sectoral cost
and benefit distribution
Evidence for one or more sectors bearing the cost for benefits accruing to different
sectors/stakeholders (e.g. H7N9 control in China: costs borne by producers and markets, but
benefits accrue to health sector; or resource extraction and disease emergence: costs borne by
health sector, but benefits accrue to industry and land planning/mining/forestry entities)| VENUE AND DATES OF THE CONFERENCE
Centara Grand at Central World Hotel, Bangkok
Monday 29 - Tuesday 30 January 2019 Side Meetings
Wednesday 31 January 2019 Field Trip
Thursday 1 - Saturday 3 February 2019 Main Conference
| STRUCTURE OF THE CONFERENCE
This is a closed, invitation only conference host by the Prince Mahidol Award Foundation, and the Royal Thai Government,
together with other international co‐hosts. The conference consists of:
1. Pre‐conference
Side meetings
Field trip
2. Main conference
Keynote speeches
Plenary sessions
Parallel sessions
Synthesis: Summary and recommendations
Poster display
| PRE‐CONFERENCE PROGRAM
Monday 29 January 2019
09:00‐17:30 Side Meetings
Tuesday 30 January 2019
09:00‐17:30 Side Meetings
Wednesday 31 January 2019
06:30–18:00 Field Trip| MAIN CONFERENCE PROGRAM
Thursday 1 February 2019
09:00‐10:30 Opening Session & Keynote Address Opening Session by Her Royal Highness Princess Maha
Chakri Sirindhorn
Keynote Address
⚬ Prince Mahidol Award Laureate 2017
⚬ Prince Mahidol Award Laureate 2017
⚬ Mercedes Tatay, International Medical Secretary, Médecins Sans Frontières, Switzerland
10:30‐11:00 Break
11:00‐12:30 Plenary Session 0 : Political Economy of NCD: Players, Powers and Policy Processes
12:30‐13:30 Lunch
13:30‐14:30 Plenary Session 1 : The Political Economy of the Determinants of NCDs: Accelerating
Actions for Prevention
14:30‐16:30 PS 1.1 : Addressing the Behavioural Determinants of NCDs: Empowering or Victim-
Blaming?
PS 1.2 : Action Beyond the Health Sector – Addressing the Social Determinants of NCDs
PS 1.3 : The Commercial Determinants of Non-Communicable Diseases
PS 1.4 : Interrogating [fiscal/public] Policies and Politics
PS 1.5 : Win-Win Strategy for the Control and Prevention of NCDs and Tackling
Environment and Climate Challenges
16:30‐17:00 Break
Plenary Session 2 : Address Determinants of NCD: the Whole of Government and Systems
17:00‐18:00
Response
Friday 2 February 2019
08:30‐09:30 Plenary Session 3 : Governance of the NCD Response – Who Is in Control?
09:30‐10:00 Break
10:00‐12:00 PS 2.1 : Building Ethical Systems for Public Interest in the National Response to NCDs
PS 2.2 : Intelligence Systems and Institutional Capacities in Response to NCDs
PS 2.3 : Imperative Need for Paradigm Shift of Health Systems: A Holistic Response to
NCD
PS 2.4 : Implementing the ‘Best Buys’ and Effective Interventions at City and Local Level:
Showcasing Multisectoral Action
PS 2.5 : Best Buys, Wasted Buys and Controversies in NCD prevention
12:00‐13:00 Lunch
13:00‐15:00 PS 3.1 : The Prisoner’s Dilemma or the Dilemma’s Prisoners? Challenges at the Frontier of
NCD Control
PS 3.2 : Financing of NCD Response: Reality-Testing Domestic, Blended and ODA Finance
Options
PS 3.3 : What's Law Got to Do with It ?
PS 3.4 : No Progress Without Action: A New Era of Accountability to End Empty Promises
for NCD Prevention and Control
PS 3.5 : Framing NCDs to Accelerate Political Action
15:00‐15:30 Break15:30‐17:30 PS 3.1 : The Prisoner’s Dilemma or the Dilemma’s Prisoners? Challenges at the Frontier of
NCD Control
PS 3.2 : Financing of NCD Response: Reality-Testing Domestic, Blended and ODA Finance
Options
PS 3.3 : What's Law Got to Do with It ?
PS 3.4 : No Progress Without Action: A New Era of Accountability to End Empty Promises
for NCD Prevention and Control
PS 3.5 : Framing NCDs to Accelerate Political Action
Friday 2 February 2019
08:30‐09:30 Plenary Session 3 : Governance of the NCD Response – Who Is in Control?
09:30‐10:00 Break
10:00‐12:00 PS 2.1 : Building Ethical Systems for Public Interest in the National Response to NCDs
PS 2.2 : Intelligence Systems and Institutional Capacities in Response to NCDs
PS 2.3 : Imperative Need for Paradigm Shift of Health Systems: A Holistic Response to
NCD
PS 2.4 : Implementing the ‘Best Buys’ and Effective Interventions at City and Local Level:
Showcasing Multisectoral Action
PS 2.5 : Best Buys, Wasted Buys and Controversies in NCD prevention
12:00‐13:00 Lunch
13:00‐15:00 PS 3.1 : The Prisoner’s Dilemma or the Dilemma’s Prisoners? Challenges at the Frontier of
NCD Control
PS 3.2 : Financing of NCD Response: Reality-Testing Domestic, Blended and ODA Finance
Options
PS 3.3 : What's Law Got to Do with It ?
PS 3.4 : No Progress Without Action: A New Era of Accountability to End Empty Promises
for NCD Prevention and Control
PS 3.5 : Framing NCDs to Accelerate Political Action
15:00‐15:30 Break
15:30‐17:30 PS 3.1 : The Prisoner’s Dilemma or the Dilemma’s Prisoners? Challenges at the Frontier of
NCD Control
PS 3.2 : Financing of NCD Response: Reality-Testing Domestic, Blended and ODA Finance
Options
PS 3.3 : What's Law Got to Do with It ?
PS 3.4 : No Progress Without Action: A New Era of Accountability to End Empty Promises
for NCD Prevention and Control
PS 3.5 : Framing NCDs to Accelerate Political Action
18:00‐20:30 Welcome Dinner
⚬ Welcome Speech by
- Minister, Ministry of Public Health, Thailand
- President, Mahidol University, Thailand
⚬ Dinner Speech (TBC)Saturday 3 February 2019
09.00‐09.30 Closing Session
⚬ Welcome Speech by
Speech by Margaret Chan, Former Director General, World Health Organization, Switzerland (TBC)
09.30‐10.30 Synthesis: Summary, Conclusion & Recommendations
10.30‐11.00 Statement
11.00‐12.00 Closing Performance
12.00‐13.30 Lunch
14:00‐16:30 International Organizing Committee (IOC) Meeting for PMAC 2019/2019OPENING SESSION & KEYNOTE ADDRESS
OPENING SESSION BY HER ROYAL HIGHNESS PRINCESS MAHA CHAKRI SIRINDHORN
KEYNOTE SPEECHESOpening Session by Her Royal Highness Princess Maha Chakri Sirindhorn
Keynote Address
| KEYNOTE SPEAKER
Brian Druker, Director, Knight Cancer Institute, Oregon Health & Science University, United States of America
Thomas R. Frieden, President and CEO, Resolve to Save Lives, an Initiative of Vital Strategies, United States of
America
Leah Dodds, Research Associate, University of Miami, United States of AmericaPLENARY SESSION 0 POLITICAL ECONOMY OF NCD: PLAYERS, POWERS AND POLICY PROCESSES
| BACKGROUND Noncommunicable diseases (NCD) epidemic constitute one of the major challenges for development in the 21 century, in terms of health and well-being as well as obstacle for socio-economic development in all societies, rich and poor alike. NCD are the leading causes of morbidity and mortality, claiming 40 million out of 56 million annual deaths globally. The number of premature death from NCD continues to rise disproportionately in low income and lower middle income countries where 47% (7 million) of premature deaths from NCDs occur. NCD has got significant global political attention, since adoption of the Political Declaration on NCD prevention and Control at UN General Assembly in 2011; leading to the adoption of nine Global Voluntary Targets in 2013 covering targets on premature mortality, risk reduction and national system response; and the adoption of SDG 3.4 to reduce premature mortality from NCDs by one-third in 2030. However, under a business-as-usual scenario, or without scaling up efforts significantly before 2020, the current rate of decline in the risk of dying prematurely from non-communicable diseases is insufficient to meet the target by 2030. Keeping social and economic significance of NCD epidemic and the progress we made so far, global community has witnessed two wonders. First wonder, there is a major systematic barrier separating what we know and what we do. Evidence shows that most NCDs are preventable, delayable and manageable. Furthermore, evidence also differentiates interventions those do not work from those cost-effective and feasible Best Buys interventions. Population-based preventive intervention can prevent half up to two-third of premature deaths, while effective individual-targeted health care can prevent one-third up to half of premature deaths. Evidence also confirms that investment for only one to three dollars per capita per year could make significant NCD premature mortality decline. The global community fail to close this know-do gap. The second wonder; we know well that most effective interventions lye outside health care system boundary. Therefore, collaboration within and beyond public sector, or so-called Whole-of-Government and Whole-of-Society approaches are needed. Effective multisectoral coordination and collaboration are still a rare case in reality. “Political economy” recently emerges as an innovative tool to better addressing policy agenda and program, beyond linear technocratic approach. It focuses on both politics and economics and interaction between them; power and resources, how they are distributed and contested and the resulting implications for development outcome; it also considers underlying interests, incentives, rents/rent distribution, historical legacies, prior experiences, social trends and how factors effect or impede change.1 Meanwhile, OECD2 describes “Political economy analysis is concerned with the interaction of political and economic processes in a society: the distribution of power and wealth between different groups and individuals, and the processes that create, sustain and transform these relationships overtime”. While policy direction to tackle NCD is pretty clear, governments often find it difficult to safeguard the health and well-being of their population, in the context of multiple stakeholders with different and common values and interests, unevenly distributed influence, and with restricted capability. Report to the third High Level Meeting of UN General Assembly on NCD Prevention and Control identifies five groups of challenge which hamper the global progress of effort to tackle NCD epidemic. These are 1) weak and non-integrated political actions; 2) ineffective health system response; 3) inadequate national capacity; 4) insufficient international finance on NCD; and 5) industry interference. Arguably, these five major challenges are all about policy process of domestic and international stakeholders, policy actors as well as powers and interactions between them, leading to system competency to deal with NCD in any society. Aims to foster and enhance global momentum for NCD prevention and control, PMAC 2019 introduces an unconventional outlook on NCD epidemic, through political economy perspective. At the outset, this Plenary is to set the scene and provides conceptual platforms to articulate all three sub-themes; better understanding of NCD determinants through political economy lens (sub-theme 1), promote comprehensive system approach to address NCD (sub-theme 2), and lastly, 3) unfold hindrance of and strategize roles of governments (sub-theme 3). -------------
1 World Bank, How-to notes: political economy assessment at sector and project levels (2011)
2 DFID. Political economy: how to note (2009)
| OBJECTIVES
To introduce and provide overarching conceptual fundamental for the whole PMAC 2019, covering all three sub-
themes, in particular how political economy is important but neglected for NCD prevention and control
To discuss how the whole society approach could better address political economy of NCDs| MODERATOR
Timothy Evans, Senior Director, Health, Nutrition and Population, The World Bank, United States of America
| KEYNOTE SPEAKER
Michael R. Reich, Taro Takemi Research Professor of International Health Policy, Harvard T.H. Chan School of Public
Health, United States of America
| PANELIST
Rocco Renaldi, Secretary General, International Food and Beverage Alliance, Belgium
Naveen Rao, Managing Director, The Rockefeller Foundation, United States of America
Takao Toda, Vice President for Human Security and Global Health, Japan International Cooperation Agency (JICA),
Japan
Margaret Chan, President of Global Health Forum, BFA, Boao Forum for Asia, China
Sicily K. Kariuki, Cabinet Secretary (Minister), Ministry of Health, KenyaPLENARY SESSION 1
THE POLITICAL ECONOMY OF THE DETERMINANTS OF NCDS: ACCELERATING ACTIONS
FOR PREVENTION| BACKGROUND
Noncommunicable diseases (NCDs), such as cardiovascular diseases, cancer, chronic obstructive pulmonary disease,
diabetes and mental illnesses are the leading causes of morbidity and mortality, claiming 41 million out of 56 million annual
deaths globally in 2016. The global premature deaths from NCDs, that is, the deaths between the ages of 30 and 69, are of
particular concern: In 2016, 15 million people died prematurely, and nearly 85% of these deaths took place in low- and
middle-income countries.
NCDs have been recognized as a significant development challenge and human rights issue, as they impede social and
economic development and are driven by underlying social, economic, political, environmental, and cultural factors.
Therefore, responding to NCDs and their shared risk factors, such as tobacco use, unhealthy diets, physical inactivity and
harmful use of alcohol, along with environmental risk factors (e.g. air pollution), is not simply a matter of changing
individual health behaviours in isolation. The international community has increasingly come to recognise that technical
solutions to development problems will not work if they are not aligned with political economy concerns.1
Leadership and action from the health sector is critical to respond to NCDs. However, there is a need for robust and coherent
national policies and strategies in all sectors with an increased focus on the social, environmental and commercial causes of
NCDs, requiring a whole-of-society and whole-of-government approach to address the underlying determinants. Intersectoral
collaboration encompassing both health and relevant non-health sectors is necessary in combating NCDs at global, regional,
national and local levels. The approach has been endorsed at the highest political level and is reflected in political
documents, such as the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and
Control of Noncommunicable Diseases, the WHO Global Action Plan for the Prevention and Control of Noncommunicable
Diseases 2013-2020 and the 2030 Agenda for Sustainable Development.2
Although progress on chronic NCD prevention and control has been slow, there is now strengthened global support for
action. The three High-level Meetings on NCDs have contributed to rising political attention to preventing chronic diseases
globally. However, for countries to make progress in the implementation of high-level commitments, domestic solutions
need to reflect local historical, political, cultural and institutional legacies.3
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1Global Health Estimates 2016: Deaths by Cause, Age, Sex, by Country and Region, 2000-2016. Geneva, World Health Organization; 2018
2 Fox AM, Reich MR (2015) The politics of universal health coverage in low- and middle-income countries: a framework for evaluation and action,
Journal of Health Politics, Policy and Law 40(5) 1023-60.
3 Bump JB (2010) The long road to universal health coverage: a century of lessons for development strategy. Seattle, WA:PATH
| OBJECTIVES
To review the multi-level determinants of NCDs – biological, social, economic, behavioural, environmental,
commercial, fiscal and political – using a political economy framework
To discuss strategies in tackling the major risk factors (unhealthy diets, tobacco use, harmful use of alcohol, physical
inactivity and environmental pollution) and the underlying determinants, focusing on the implementation of cost-
effective interventions to achieve SDG3.4 and other NCD-related targets
To share and learn from national, regional and global experiences in addressing the main risk factors of NCDs and
their social, economic, commercial, fiscal and political determinants
To provide examples of strategies on how to scale up best NCD prevention practices in different contextsTo identify knowledge gaps and approaches to address them To formulate key policy recommendations and actions to implement the proposed solutions
| MODERATOR
Tea Collins, Adviser, WHO Global Coordination Mechanism on Noncommunicable Diseases, World Health
Organization, Switzerland
| PANELIST
Theresa Marteau, Director of Behaviour and Health Research Unit, Department of Public Health and Primary Care,
University of Cambridge, United Kingdom
Sania Nishtar, Founder and President, Heartlife, Pakistan
Timothy Evans, Senior Director, Health, Nutrition and Population, The World Bank, United States of America
Michael Marmot, Director, Institute of Health Equity, Department of Epidemiology and Public Health, University
College London, United KingdomPARALLEL SESSION 1.1
ADDRESSING THE BEHAVIOURAL DETERMINANTS OF NCDS: EMPOWERING OR VICTIM-
BLAMING?| BACKGROUND It is emphasized from the outset that the multiplicity of inter-dependent determinants of NCDs need to be considered and addressed together as part of a comprehensive framework. This session, however, will focus on the behavioural determinants of NCDs, which encompass individual lifestyle factors, and the promotion of health and nutrition literacy and behavior change communication to address them. Four major NCD risk factors have significant behavioural dimensions at the level of the individual: tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets. NCDs impose a disproportionate burden that on poorer populations in upper income countries and across all populations in low and middle income countries. Given the evidence of greater impact of the behavioural determinants on populations with low socio- economic status, these groups require greater focus and appropriately tailored approaches. Despite the proliferation of health information on the Internet, there is often a lack of evidence-based and tailored information that is easily available to the general public, while on the other hand the public is receiving a huge amount of marketing information on unhealthy products from the various industries. Health literacy refers, broadly, to the ability of individuals to “gain access to, understand and use information in ways which promote and maintain good health” for themselves, their families and their communities. Health literacy is particularly important in order to prevent and control NCDs and their shared risk factors. For example, people with higher levels of health literacy are better able to understand available nutrition information and to be empowered to make healthier choices, thus contributing to preventing both undernutrition and overweight and associated NCDs. At the same time, the availability and affordability of healthier choices and the socio-cultural contexts need to be considered and addressed – aspects covered in other parallel sessions. A strand of narrative that has dominated the (industry promoted) discourse is that NCDs are primarily caused by poor individual choices on lifestyles, and that the strategy to prevent them is focused primarily on promoting healthy lifestyles, placing the onus (or blame) on the individual. This narrative still holds sway in certain contexts and among certain stakeholders – for example, in case of Governments which choose or are influenced to avoid addressing the wider socio- cultural, commercial and policy determinants, or among private sector stakeholders and the researchers they fund, which have vested interests in preventing those wider determinants from being addressed. The session will aim to explore this aspect of the narrative and reiterate that behavior change interventions support and complement strategies that address wider determinants of health. Social and behavior change communication – often in the form of “health education” - is one of the health promotion strategies to modify the behavioural risk factors through the life course and improve health and nutrition literacy. “Health education” is often the dominant form of behavior modification strategy in many countries. It should be considered one strategy among a comprehensive package which includes the legislative and policy measures addressed in other parallel sessions of the conference. It should be based on a thorough analysis of the epidemiological situation in each country by identifying the distribution of risk factors among different population groups and developing a national risk profile. Analysis of the social norms, socio-economic factors and motivators that influence individual behaviours should also be assessed, as well as the channels and communication approaches that are most likely to be accessed and successful among different groups. It should also assess the relative importance to different groups – including children and adolescents – of prevailing marketing of unhealthy foods and beverages, tobacco and alcohol. Another tactic to change individual behaviour is “nudging” to encourage people to make healthy choices, be more active, and eat better, among others, drawing on behavioural insight theory. The session will emphasize the critical importance of starting early with health education interventions - during pregnancy, in early childhood and in adolescence - to create positive health related behaviours. It will discuss the evidence of the impact of early interventions on later NCDs. This session will summarize the evidence on behavioural determinants in terms of data on prevalence of smoking, alcohol consumption, physical inactivity, unhealthy diets in different contexts – e.g. lower, middle and upper income countries, by
income, age, sex etc - and evidence on various education/communication approaches to modify them. It will consider the
question raised by the title of the session, whether behavior change interventions are empowering or victim-blaming. It will
showcase examples of best practices, innovations and documented success from a range of countries in modifying NCD-
related behaviours across the life course as well as potentially addressing failed strategies, and will identify knowledge gaps
for further research and suggest recommendations going forward.
| OBJECTIVES
To examine the current state of evidence on various behavioural determinants of NCDs
To explore the evidence on strategies to address various behavioural determinants: what works, what does not work,
and why; plus suggestions for national strategies
To discuss examples of national strategies to address behavioural determinants, particularly from LMICs
To analyze the political economy of “promoting healthy lifestyles” and explore whether strategies are empowering or
victim-blaming
To identify knowledge gaps and research priorities| MODERATOR
Jane Badham, Managing Director, JB Consultancy, South Africa
| KEYNOTE SPEAKER
Theresa Marteau, Director of Behaviour and Health Research Unit, Department of Public Health and Primary Care,
University of Cambridge, United Kingdom
Karen Glanz, George A. Weiss University Professor, Schools of Medicine and Nursing, University of Pennsylvania,
United States of America
| PANELIST
Lori Foster, Professor of Industrial-Organizational Psychology, North Carolina State University, United States of
America
Supreda Adulyanon, Chief Executive Officer, Thai Health Promotion Foundation, Thailand
Roy William Mayega, Lecturer, Department of Epidemiology and Biostatistics, Makerere University, Uganda
Nithya Solomon, Executive Lead, Innovation Office, Victorian Health Promotion Foundation, Australia
Elin Bergstrom, Policy Officer, EAT Foundation, Norway
Carolina Casas, Regional Director of Education and Research, Sesame Workshop, Latin America, ColombiaPARALLEL SESSION 1.2
ACTION BEYOND THE HEALTH SECTOR – ADDRESSING THE SOCIAL DETERMINANTS OF
NCDS| BACKGROUND The social determinants of health have been described as “the causes of the causes” of illness. They affect people’s health and well-being in the environment into which “they are born, grow up, live, work and age.” Key behavioural pathways leading to NCDs and jeopardizing the achievement of SDG3.4 (by 2030, reduce by one third premature mortality and promote mental health and well-being) have long been identified, and frequently the focus in NCD prevention has been on improving diet, reducing smoking prevalence and harmful use of alcohol, and increasing physical activity, as well as managing conditions following diagnosis. Much of this work is within the remit of public health and health professionals. As low- and middle-income countries strive to address NCDs as a major threat to sustainable development, a social determinants approach is increasingly highlighted as one of the important focus areas due to its relevance to all sectors. Social determinants of NCDs include: socio-economic context; inequality; level of education; gender; ethnicity; social norms; cultural beliefs and practices; social exclusion; income; employment; access to health services; and transportation; social and community support networks, including social cohesion. In addition, public policies (policy coherence) and the economic and political structures and accompanying ideologies shape the adverse circumstances negatively influencing health.1 By definition, the social determinants of health are the result of human action and therefore their transformation requires human efforts involving intersectoral and coherent public policies that can be implemented through the whole-of-society and whole-of-government approach for health equity. The social determinants approach is central to achieving not only SDG targets, including SDG 3.4 on the one third reduction of premature mortality from NCDs, but other related targets as well, such as SDG 3.8 on enhancing universal health coverage. However, aligning policies, regulations and actions across various sectors and stakeholders has proved to be a challenge, as countries strive to implement their NCD commitments and achieve universal health coverage. Interventions on the social determinants of NCDs can be defined through using analysis of the determinants in shaping interventions across the life-course in order to enable children, young adults and elderly to live up to their full potential and have control over their lives. Taking action to improve the conditions of daily life well before birth, during early childhood, at school age, during reproductive and working ages, are particularly important to improve populations’ mental health and to reduce the risk of those mental health disorders that are associated with health inequalities.2 These interventions may include poverty-reduction strategies, social protection measures, community engagement, including addressing social norms and cultural beliefs, enhanced health literacy and tailored health promotion approaches. Furthermore, social determinants of health underpin the implementation of all SDGs due to their interlinked nature and the need for policy coherence and intersectoral interventions, most of which fall outside the health sector. The health sector, an important social determinant itself, also has an important role within the Health-in-all Policies, whole- of-government and whole-of-society frameworks to act as a facilitator of policy development and coordination across sectors and stakeholders. As a backbone of health systems, medical professionals have a critical role in the prevention and control of NCDs. Therefore, it is important to ensure that healthcare workers are trained to have clinical competency in global health and primary care and understand the preventive strategies for NCDs and their social determinants. Current medical and nursing curricula, particularly in low- and middle-income countries, have not kept pace with the changing dynamics of public health, health policy and health demographics. As a result, medical education in these countries does not adequately cover the prevention and control of NCDs. Medical education and training should be reoriented by introducing competency-based, health system-connected curricula that reflect national needs and priorities. In addition, continuous education should incorporate knowledge of social determinants for NCD prevention to respond to the demands of evolving health systems, changing disease patterns and growing patient expectations.
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1 Raphael D. The Social Determinants of Noncommunicable Diseases: A Political Perspective. Global Handbook on Noncommunicable Diseases and
Health Promotion 2013: pp95-113.
2 World Health Organization and Calouste Gulbenkian Foundation. Social determinants of mental health. Geneva, WHO 2014.
| OBJECTIVES
Take stock of available evidence on interventions and public policies to address the social determinants and promote
social equity in different contexts for the prevention and control of NCDs
Highlight the importance of early childhood interventions to prevent NCDs throughout the life-course
Explore the role of the social determinants of health as modifiable risk factors that, if addressed, could lead to major
health improvements in socially disadvantaged and marginalized groups, such as people living with mental health
and substance abuse disorders
Highlight the role of medical education in preparing healthcare workers with clinical competencies to address NCDs
and their social determinants
Highlight examples (delivery platforms, NCD-specific actions) of the successful implementation of the social
determinants of health approach through policy coherence and action across sectors, departments, health agencies
and community groups for NCD prevention
Understand the role of enhanced health literacy for action on the social determinants of NCDs| MODERATOR
Michael Marmot, Director, Institute of Health Equity, Department of Epidemiology and Public Health, University
College London, United Kingdom
| PANELIST
Johan Carlson, Director General, Public Health Agency of Sweden, Sweden
Mary Bassett, Director, Harvard FXB Center for Health and Human Rights, United States of America
Anselm Hennis, Director, Noncommunicable Diseases and Mental Health, Pan American Health Organization, United
States of America
Carrie Brooke-Sumner, Implementation Adviser, South African Medical Research Council, South Africa
Dina Tadros, Medical Doctor, Ludwig Maximilian University Munich, Germany
Monika Arora, Executive Director, HRIDAY (Secretariat of Healthy India Alliance), New Delhi-110049, IndiaPARALLEL SESSION 1.3 THE COMMERCIAL DETERMINANTS OF NON-COMMUNICABLE DISEASES
| BACKGROUND
Key risk factors of NCDs are strongly associated with patterns of consumption and easy access to unhealthy products.
Corporate influence is usually exerted through five main channels: increasing control over production and investment by
large corporates; increasing control over marketing, particularly marketing to children, to increase the appeal and
acceptability of unhealthy products; lobbying, which can negatively influence policies related to plain packaging and
minimum drinking ages; corporate social responsibility strategies, to enhance positive image and extensive supply chains to
exert influence all over the world.
From the NCD perspective, health outcomes are determined by influencing the social environment in which people live and
work: the availability, cultural practices and prices of unhealthy products. Hence, the rise of non-communicable diseases is a
manifestation of a global economic system that currently prioritises wealth creation over health creation. Many problems
and solutions to address the risk factors lie outside the health sector, in the domains of finance, trade and investment
policies.
Commercial determinants of health are a sub-set of the social determinants of health with which they interact, such as
education, occupation, income, ethnicity, race, access to healthcare and structural determinants (socio-economic and
political context) and affect individuals throughout the life course, as they shape disease risk factors and ultimately disease
across the life span. The life-course approach to analysing the social determinants also provides an opportunity to identify
potential entry points for action.
This session will entail a detailed analysis of the key commercial drivers of NCDs. It will present the main strategies and
approaches used by the private sector to promote choices detrimental to health. These will include marketing, trade and
foreign direct investment. The session will also examine the role played by different institutions in facilitating or regulating
these, especially Governments, as well as other stakeholders including multilateral organizations and civil society.
| OBJECTIVES
To analyse the role industry plays in the commercial determinants of NCDs, including food/beverage, tobacco, alcohol
and extractive industries
To showcase a few exemplary interventions that have successfully addressed selected commercial determinants
(E.g. regulation of marketing, including to children, and labelling of sugary beverages, unhealthy foods, tobacco and
alcohol; enactment of regulations to contain pollution from mines, power plants, factories and cars).
Some of the questions to address may include:
What are the commercial drivers influencing the risk factors of NCDs in different contexts? What is the role of
industry (e.g. food and beverage, tobacco, alcohol, extractive industries) in influencing the commercial
determinants?
What are the common strategies of marketing to children and adolescents (e.g. particularly digital marketing) and
mechanisms to reduce exposure to NCD risk factors, notably alcohol, tobacco and unhealthy foods and beverages?
How have governments engaged with industry to mitigate the risk to health and enhance public health benefits?
What has worked and what has not?
What is the role played by different institutions in facilitating or regulating the commercial determinants, including
Governments, and other stakeholders such as WTO, multilateral organizations and civil society?You can also read
