1. KEY QUESTIONS
•Can we realistically reduce the NCD burden?
•What is the way forward ? What are the
commitments of member States
• What do countries need to implement the
commitments?
International Conference on Healthy lifestyles and NCD prevention in the Arab World and Middle East

2. Four Major Groups of Noncommunicable Diseases
Four major lifestyles related risk factors
Modifiable causative risk factors
Unhealthy Physical Harmful use
Tobacco use
diets inactivity of alcohol
Heart disease and
stroke    
Noncommunicable diseases
Diabetes
   
Cancer
   
Chronic lung
disease 

3. Deaths in the Eastern
Mediterranean Region
(Millions of deaths in 2008)
4.5 M
4.0 M 11%
3.5 M
3.0 M
36%
2.5 M
2.0 M
1.5 M
1.0 M
0.5 M 53%
0.0 M
Communicable, maternal, perinatal and nutritional conditions NCDs Injuries
International Conference on Healthy lifestyles and NCD prevention in the Arab World and Middle East

4. Projections
• NCD mortality will increase by 15% worldwide by 2020. The
greatest increase will occur in Africa followed by the Eastern
Mediterranean Region

5. Deaths from NCDs before 60 in the EMR
(Percentage of total NCD deaths in 2008)
Qatar
Somalia
Kuwait
Yemen
Djibouti
Bahrain
Saudi Arabia
Oman
Sudan
Syrian Arab Republic
Iraq
Pakistan
Libyan Arab Jamahiriya
Egypt
Jordan
Morocco
Iran (Islamic Republic of)
Lebanon
Tunisia
0% 10% 20% 30% 40% 50% 60% 70%
International Conference on Healthy lifestyles and NCD prevention in the Arab World and Middle East

6. Can we realistically reduce the burden?
There is a strategic vision on how to address NCDs
*Surveillance* *Prevention* *Management*
Mapping the Reducing the Strengthen
epidemic of level of health care for
NCDs exposure to people with
risk factors NCDs

7. Can we realistically reduce the NCD burden?
WHO Global Status Report on NCDs (launched April 2011):
Solutions
• A national surveillance framework and
monitoring scheme integrated into
health information systems
• Best buys interventions to prevent NCDs
by reducing risk factors, implemented
through a multisectoral approach
• Practical approaches to improve
management of NCDs, particularly at
the PHC level
International Conference on Healthy lifestyles and NCD prevention in the Arab World and Middle East

8. How is the region doing? Key messages
WHO Country Profiles (launched in September 2011):
 The NCD crisis is far advanced in most countries
 Some encouraging responses in some countries,
but not comprehensive and there are major gaps
 Reliable data is scarce. Surveillance is generally
weak
 Proportion of countries implementing the core
interventions is small
 Some progress to improve health care at PHC but
there are major inequities, monitoring is weak
and training of health workforce is inadequate
 There are large disparities in national capacities
among countries, particularly in policy
development and implementation

9. A framework for NCD surveillance
• Exposures
– Behavioural risk factors: tobacco use, physical inactivity, harmful use
of alcohol and unhealthy diet
– Metabolic risk factors: overweight/obesity, raised blood pressure,
glucose & cholesterol.
– Social determinants: education, material well being, access to
health care
• Outcomes
– Mortality: NCD specific mortality
– Morbidity: cancer incidence and type
• Health System cCapacity and Response
– Interventions and health system capacity: infrastructure, policies
and plans, access to key health care interventions and treatments,
partnerships.

10. A package of low-cost "best buy" solutions exist:
but the implementation in the EMR is weak
Interventions NCDs and risk factor Best buys
Population-based Tobacco use  Tax increases
interventions addressing  smoke-free indoor workplaces and public places
NCD risk factors  health information
 and warnings about tobacco
 bans on advertising and promotion
Harmful use of alcohol  Tax increases on alcoholic beverages;
 Comprehensive restrictions and bans on alcohol marketing;
 Restrictions on the availability of retailed alcohol
Unhealthy diet and  Salt reduction through mass media campaigns and reduced
physical inactivity salt content in processed foods;
 Replacement of trans-fats with polyunsaturated fats
 Public awareness programme about diet and physical activity
Individual-based Cancer  Prevention of liver cancer through hepatitis B immunization
interventions addressing  Prevention of cervical cancer through screening and
NCDs in primary care treatment of pre-cancerous lesions
Cardiovascular disease  Multi-drug therapy (including glycaemic control for diabetes
and diabetes mellitus) to individuals who have had a heart attack or
stroke, and to persons with a high risk of a heart attack or
stroke in the next 10 years
 Providing aspirin to people having an acute heart attack

11. Political Declaration of the High-level Meeting
(United Nations General Assembly resolution 66/2)
Strategic areas for Member States:
• To recognize NCDs as a challenge of epidemic
proportions in developed and developing countries
• To promotes health-in-all-policies and
whole-of-government approaches
• To prioritizes actions and expand national capacity to:
– Reduce risk factors for NCDs
– Improve health care within the context of health
system strengthening
– Monitor NCDs and evaluate progress
International Conference on Healthy lifestyles and NCD prevention in the Arab World and Middle East

12. What are the commitments of Member States?
In the area of governance , countries are expected to:
• assess their NCD situation and capacity and put in place
comprehensive multisectoral plans by 22013
• integrate NCDs into health planning processes.
• Strengthen intersectoral action
• explore sustainable resources to Increase and prioritize
budgetary allocations to NCDs

13. What are the commitments of Member States?
(Progress will be assessed during the UNGA in 2014)
In the area of prevention and risk factors reduction , countries
are expected to:
• Accelerate the implementation of the WHO FCTC, particularly
the 6 demand reduction measures
• Implement interventions to reduce salt, trans fat and sugar
• Implement the WHA recommendations on marketing of foods
and non-alcoholic beverages to children
• Promote mass media campaigns on diet and physical activity
• Promote breast feeding and implement the international code
of marketing of breast milk substitutes
• Consider vaccinations to prevent certain cancers

14. What are the commitments of Member States?
In the area of health care , countries are expected to:
• Review health systems, identify gaps and weaknesses and
integrate NCD interventions into PHC
• Prioritise effective interventions for early detection and
treatment
• Improve access to essential diagnostics and medicines
• Explore viable health financing mechanisms like innovative
approaches like tobacco taxation to increase coverage
• Promote the production, training and retention of health
workers

15. What are the commitments of Member States?
In the area of surveillance and monitoring , countries are
expected to:
• Develop national targets and indicators based on WHO
guidance
• Strengthen surveillance and integrate into national health
information systems ( monitoring of risks and determinants,
cause specific mortality, and health system capacity and
response)

16. EXAMPLES OF AREAS REQUIRING FURTHER POLICY GUIDANCE AND
ACTION …
Strengthening surveillance aspects , developing guidance on health
information systems and identifying effective approaches to address
existing gaps
Developing guidance on implementing the best buys, based on
experience and best practices
Refining evidence and summarising lessons learned for best buys
e.g taxation, other forms of sin tax, removal of subsidies from certain
food items
Developing guidance on multisectoral action
Establishing effective approaches to build capacity in
cost/effectiveness analysis for policy making in the region
Developing evidence/based clinical guidelines for common NCD
conditions
International Conference on Healthy lifestyles and NCD prevention in the Arab World and Middle East

17. "This is the second health issue ever to be addressed at a special meeting of the
United Nations General Assembly. We should all work to meet targets to reduce
NCDs. WHO's best buys serve as excellent guidance"
Ban Ki-moon • UN Secretary-General • 19 September 2011
NCDs will remain on the UNGA agenda…2012. Progress will be assessed in
2113, 214 , and beyond….
International Conference on Healthy lifestyles and NCD prevention in the Arab World and Middle East