Epidemic of cardiovascular risk; focus on policy recommendations for diabetes prevention in ASEAN countries
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The document discusses the prevalence of non-communicable diseases (NCDs) in Malaysia and outlines policy recommendations for diabetes prevention in ASEAN countries. It highlights the importance of national multi-sectoral efforts, commitment to global targets set by the UN, and the implementation of effective interventions for reducing NCD risk factors. Additionally, it emphasizes the need for comprehensive strategies addressing diet, physical activity, and tobacco use to promote healthier lifestyles.
![Cost effective interventions to address
NCDs
Population-based
interventions
addressing
NCD
risk factors
Tobacco use - Excise tax increases
- Smoke-free indoor workplaces and public places
- Health information and warnings about tobacco
- Bans on advertising and promotion
Harmful use
of alcohol
- Excise tax increases on alcoholic beverages
- Comprehensive restrictions and bans on alcohol marketing
- Restrictions on the availability of retailed alcohol
Unhealthy
diet and
physical
inactivity
- Salt reduction through mass media campaigns and reduced salt
content in processed foods
- Replacement of trans-fats with polyunsaturated fats
- Public awareness programme about diet and physical activity
Individual-based
interventions
addressing
NCDs in
primary care
Cancer - Prevention of liver cancer through hepatitis B immunization
- Prevention of cervical cancer through screening (visual
inspection with acetic acid [VIA]) and treatment of pre-cancerous
lesions
CVD and
diabetes
- Multi-drug therapy (including glycaemic control for diabetes
mellitus) for individuals who have had a heart attack or stroke,
and to persons at high risk (> 30%) of a cardiovascular event
within 10 years
- Providing aspirin to people having an acute heart attack
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Epidemic of cardiovascular risk; focus on policy recommendations for diabetes prevention in ASEAN countries
- 1. Ministry of Health Malaysia Epidemic of Cardiovascular Risk: Focus on Policy Recommendations for Diabetes Prevention in ASEAN countries Feisul Idzwan Mustapha MBBS, MPH, AM(M) Public Health Physician, NCD Section, Disease Control Division Ministry of Health, Malaysia 46th Asia-Pacific Academic Consortium for Public Health (APACPH) Conference 17 October 2014 Kuala Lumpur [email protected]
- 2. 2 Global NCD Targets Source of icons: World Heart Federation Champion Advocates Programme
- 3. Proportional mortality, Malaysia (% of total deaths, all ages, both sexes) 3
- 4. Premature mortality due to NCDs, Malaysia 4 The probability of dying between ages 30 and 70 years from the 4 main NCDs is 20%
- 5. DALYs attributable to risk factors 5 Poor Water & Sanitation Underweight Physical Inactivity Alcohol High Cholesterol High BMI Diabetes Mellitus 10.7% 10.8% 8.3% 9.0% 3.1% 4.3% 5.2% 0.1% 0.7% 12.1% 10.8% 0.1% 0.7% 11.4% 5.1% 0.9% 4.3% 0.7% Tobacco High BP 15.0% 10.0% 5.0% 0.0% 5.0% 10.0% 15.0% Male Female Burden of Disease Study Malaysia, slide courtesy of Dr Mohd. Azahadi Omar, Institute for Public Health
- 6. Deaths attributable to risk factors Poor Water & Sanitation Underweight Alcohol Physical Inactivity High BMI High Cholesterol Diabetes Mellitus 19.4% 15.7% 7.0% 7.3% 8.5% 5.0% 2.3% 0.1% 0.2% 22.8% 0.1% 0.2% 1.2% 7.1% 8.2% 8.1% 9.1% 0.3% Tobacco High BP 25% 20% 15% 10% 5% 0% 5% 10% 15% 20% 25% Male Female Burden of Disease Study Malaysia, slide courtesy of Dr Mohd. Azahadi Omar, Institute for Public Health 6
- 7. Outcome Document of the 2014 UN General Assembly High-level Meeting on NCDs First High-level Meeting on NCDs (New York, 19-20 September 2011) 2011 Second high-level Meeting on NCDs (New York, 10-11 July 2014) to take stock of the progress made since 2011 2014 Third High-level Meeting on NCDs to report on progress achieved since 2014 2018 7 Slide courtesy of Dr Shin Hai-rim, WHO Western Pacific Region Office
- 8. 2014 UN Outcome Document on NCDs (resolution A/RES/68/300) • Bottom line: Governments committed themselves to intensify their efforts towards a world free of the avoidable burden of NCDs • Moving forward: Maps out a set of concrete national commitments to be implemented between 2014 and 2018, and provides 3 new global assignments • Towards the world we want: Next milestone in 2018 8 Slide courtesy of Dr Shin Hai-rim, WHO Western Pacific Region Office
- 9. National commitments included in the 2014 UN Outcome Document on NCDs By 2015, consider setting national targets for NCDs By 2015, consider developing national multisectoral policies and plans Integrate NCDs into health-planning and national development plans By 2016, implement "best buys" to reduce risk factors for NCDs By 2016, implement "best buys" to enable health systems to respond Strengthen national surveillance systems 9 Slide courtesy of Dr Shin Hai-rim, WHO Western Pacific Region Office
- 10. Global assignments included in the 2014 UN Outcome Document on NCDs By 2015, WHO to develop an approach to register and publish contributions of non-State actors towards the 9 global NCD targets WHA68: Framework for country action to mobilize sectors beyond health OECD/DAC: Purpose code to track development assistance for NCDs By 2017, WHO to submit a progress report to UN General Assembly By 2018, UN General Assembly to convene a third High-level Meeting 10 Slide courtesy of Dr Shin Hai-rim, WHO Western Pacific Region Office
- 11. Global accountability framework for NCDs: Milestones during the next three years • WHO publishes global baseline • WHO conducts third survey on national capacities • WHO generates data 2015 • Progress report to WHA on 25 outcome indicators • Progress report to WHA on 9 progress indicators 2016 • Independent evaluation (Global Action Plan) • Progress report to the UN General Assembly 2017 11 Slide courtesy of Dr Shin Hai-rim, WHO Western Pacific Region Office
- 12. NCDs in the post-2015 development agenda: Towards the world we want • 10 September 2014: Member States welcomed the report of the Open Working Group of the UN General Assembly on Sustainable Development Goals • Next 12 months: Proposal shall be the main basis for integrating sustainable development goals into the post-2015 development agenda • Target 3.4: By 2030 reduce by one-third pre-mature mortality from NCDs through prevention and treatment, and promote mental health and well-being 12 Slide courtesy of Dr Shin Hai-rim, WHO Western Pacific Region Office
- 13. WHO Regional Response 2000 2001-03 2004-06 2008 2009-11 Healthy Islands Initiative WPDD Call for Action on Obesity Control Regional plan for integrated CVD and Diabetes Prevention 1998-2003 Regional Tobacco action plan FCTC implementation Regional NCD STEP Surveys Healthy Cities Initiatives addressing NCD and tobacco NCD & Poverty: Pro-Poor Strategy 2006 Regional Action plans for NCD Regional Strategy to Reduce Alcohol related harm Regional Initiative on multi-sectoral intervention for NCD prevention: Obesity Strategy & programme: Breast/cervical cancer control 2012 National multisectoral plans Marketing of foods/ NCD and PHC/Surveillance 2013 Cancer Leadership and LeAd-NCD Regional action plan (2014-2020) 2014 NCD knowledge net work 2nd Lead NCD NCD surveillance 13 Slide courtesy of Dr Shin Hai-rim, WHO Western Pacific Region Office
- 14. Cost effective NCD interventions… • What works, what can we afford, and what should we adopt? • The challenge? Identify interventions that: • are effective; • can lead to measurable declines in NCD death rates quickly (e.g. over 10 years); • are affordable; and • can easily be implemented and sustained. The Lancet. December 8, 2007 Volume 370: Gaziano T, Galea G and Reddy K. Scaling up interventions for chronic disease prevention: the evidence. pp 1939-1946. The Lancet. December 15, 2007. Volume 370: Asaria P, Crisholm D, Mathers C, Ezzati M, Beaglehole R. Chronic disease prevention: health effects and financial costs of strategies to reduce salt intake and control tobacco use. pp 2044-2053. Lim S, et. al. Prevention of cardiovascular disease in high-risk individuals in low-income and middle-income countries: health effects and costs. pp 2054-2061. 14
- 15. Cost effective NCD interventions… • What is effective? The intervention must: • targets behaviours or risk factors that are causally associated with NCDs; and • is proven, through evidence, to lead to favourable changes in behaviours/risk factors, thereby reducing risk of death from NCDs. 15
- 16. Cost effective interventions to address NCDs Population-based interventions addressing NCD risk factors Tobacco use - Excise tax increases - Smoke-free indoor workplaces and public places - Health information and warnings about tobacco - Bans on advertising and promotion Harmful use of alcohol - Excise tax increases on alcoholic beverages - Comprehensive restrictions and bans on alcohol marketing - Restrictions on the availability of retailed alcohol Unhealthy diet and physical inactivity - Salt reduction through mass media campaigns and reduced salt content in processed foods - Replacement of trans-fats with polyunsaturated fats - Public awareness programme about diet and physical activity Individual-based interventions addressing NCDs in primary care Cancer - Prevention of liver cancer through hepatitis B immunization - Prevention of cervical cancer through screening (visual inspection with acetic acid [VIA]) and treatment of pre-cancerous lesions CVD and diabetes - Multi-drug therapy (including glycaemic control for diabetes mellitus) for individuals who have had a heart attack or stroke, and to persons at high risk (> 30%) of a cardiovascular event within 10 years - Providing aspirin to people having an acute heart attack 16
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- 18. Objective 3 GAP NCD 2013-2020: Healthy Diet • Three (3) relevant global targets: • A 30% relative reduction in mean population intake of salt/sodium • A halt in the rise in diabetes and obesity • A 25% relative reduction in the prevalence of raised blood pressure or containment of the prevalence of raised blood pressure according to national circumstances. 18
- 19. Objective 3 GAP NCD 2013-2020: Healthy Diet • Promote and support exclusive breastfeeding for the first six months of life, continued breastfeeding until two years old and beyond and adequate and timely complementary feeding. • Implement WHO’s set of recommendations on the marketing of foods and non-alcoholic beverages to children, including mechanisms for monitoring. 19
- 20. Objective 3 GAP NCD 2013-2020: Healthy Diet • Develop guidelines, recommendations or policy measures that engage different relevant sectors, such as food producers and processors, and other relevant commercial operators, as well as consumers, to: • Reduce the level of salt/sodium added to food (prepared or processed). • Increase availability, affordability and consumption of fruit and vegetables. • Reduce saturated fatty acids in food and replace them with unsaturated fatty acids. • Replace trans-fats with unsaturated fats. • Reduce the content of free and added sugars in food and non-alcoholic beverages. • Limit excess calorie intake, reduce portion size and energy density of foods. 20
- 21. Objective 3 GAP NCD 2013-2020: Healthy Diet • Develop policy measures that engage food retailers and caterers to improve the availability, affordability and acceptability of healthier food products (plant foods, including fruit and vegetables, and products with reduced content of salt/sodium, saturated fatty acids, trans-fatty acids and free sugars). • Promote the provision and availability of healthy food in all public institutions including schools, other educational institutions and the workplace. (e.g. through nutrition standards for public sector catering establishments and use of government contracts for food purchasing) 21
- 22. Objective 3 GAP NCD 2013-2020: Healthy Diet • As appropriate to national context, consider economic tools that are justified by evidence, and may include taxes and subsidies, that create incentives for behaviours associated with improved health outcomes, improve the affordability and encourage consumption of healthier food products and discourage the consumption of less healthy options. • Develop policy measures in cooperation with the agricultural sector to reinforce the measures directed at food processors, retailers, caterers and public institutions, and provide greater opportunities for utilization of healthy agricultural products and foods. 22
- 23. Objective 3 GAP NCD 2013-2020: Healthy Diet • Conduct evidence-informed public campaigns and social marketing initiatives to inform and encourage consumers about healthy dietary practices. Campaigns should be linked to supporting actions across the community and within specific settings for maximum benefit and impact. • Create health- and nutrition-promoting environments, including through nutrition education, in schools, child care centres and other educational institutions, workplaces, clinics and hospitals, and other public and private institutions. • Promote nutrition labelling, according to but not limited to, international standards, in particular the Codex Alimentarius, for all pre-packaged foods including those for which nutrition or health claims are made. 23
- 24. Objective 3 GAP NCD 2013-2020: Promoting Physical Activity • Three (3) relevant global targets: • A 10% relative reduction in prevalence of insufficient physical activity. • Halt the rise in diabetes and obesity. • A 25% relative reduction in the prevalence of raised blood pressure or contain the prevalence of raised blood pressure according to national circumstances. 24
- 25. Objective 3 GAP NCD 2013-2020: Promoting Physical Activity • Adopt and implement national guidelines on physical activity for health. • Consider establishing a multi-sectoral committee or similar body to provide strategic leadership and coordination. • Develop appropriate partnerships and engage all stakeholders, across government, NGOs and civil society and economic operators, in actively and appropriately implementing actions aimed at increasing physical activity across all ages. 25
- 26. Objective 3 GAP NCD 2013-2020: Promoting Physical Activity • Develop policy measures in cooperation with relevant sectors to promote physical activity through activities of daily living, including through “active transport,” recreation, leisure and sport, for example: • National and sub-national urban planning and transport policies to improve the accessibility, acceptability and safety of, and supportive infrastructure for, walking and cycling. • Improved provision of quality physical education in educational settings (from infant years to tertiary level) including opportunities for physical activity before, during and after the formal school day. • Actions to support and encourage “physical activity for all” initiatives for all ages. • Creation and preservation of built and natural environments which support physical activity in schools, universities, workplaces, clinics and hospitals, and in the wider community, with a particular focus on providing infrastructure to support active transport i.e. walking and cycling, active recreation and play, and participation in sports. • Promotion of community involvement in implementing local actions aimed at increasing physical activity. 26
- 27. Objective 3 GAP NCD 2013-2020: Promoting Physical Activity • Conduct evidence-informed public campaigns through mass media, social media and at the community level and social marketing initiatives to inform and motivate adults and young people about the benefits of physical activity and to facilitate healthy behaviours. Campaigns should be linked to supporting actions across the community and within specific settings for maximum benefit and impact. • Encourage the evaluation of actions aimed at increasing physical activity, to contribute to the development of an evidence base of effective and cost-effective actions. 27
- 28. National Systems Response to NCDs – ASEAN Countries BRN CAM IND LAO MAL MYN PHI SIN THA VIET Has an operational NCD unit/branch or department within MOH ✓ ✓ ✓ ✗ ✓ ✗ ✓ ✓ ✓ ✗ Has an operational multisectoral & integrated national policy, strategy or action plan ✗ ✗ ✓ ✗ ✓ ✓ ✗ ✗ ✗ ✗ Has an operational policy, strategy or action plan to reduce the harmful use of alcohol ✓ ✓ ✓ ✗ ✗ ✓ ✓ ✗ ✓ ✗ Has an operational policy, strategy or action plan to reduce physical inactivity ✗ ✓ ✓ ✗ ✓ ✓ ✓ ✓ ✓ ✗ Has an operational policy, strategy or action plan to reduce the burden of tobacco use ✗ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ Has an operational policy, strategy or action plan to reduce unhealthy diet and/or promote healthy diets ✗ ✓ ✓ ✗ ✓ ✓ ✓ ✓ ✓ ✓ Has evidence-based national guidelines for the Mx of major NCDs through a primary care approach ✓ ✗ ✓ ✗ ✓ ✓ ✗ ✓ ✓ ✗ Has an NCD surveillance and monitoring system in place to enable reporting for the GMF ✗ ✓ ✗ ✗ ✓ ✗ ✗ ✓ ✓ ✓ Has a national, population-based cancer registry ✓ ✗ ✗ ✗ ✗ ✗ ✗ ✓ ✗ ✗ 28
- 29. ASEAN Task Force for Non- Communicable Diseases (ATFNCD) • Strategic Objective: To ensure access to adequate and affordable healthcare, medical services and medicine, and promote healthy lifestyles for the peoples of ASEAN. • Relevant health elements under ASEAN Socio-Cultural Community (ASCC) Blueprint: • B.4: 2 FOCUS AREA IV: PROMOTES ASEAN HEALTHY LIFESTYLE (NCDs) • B.4.x Promote collaboration in Research and Development on health promotion, healthy lifestyles and risk factors of non- communicable diseases in ASEAN Member States; • B.4.xi Promote the sharing of best practices in improved access to health products including medicines for people in ASEAN • B.4.xxi Strengthen existing health networking in ASEAN Member States in order to push forward an active implementation on health services access and promotion of healthy lifestyles, as well as continually exchange of knowledge, technology and innovation for sustainable cooperation and development; • Expected Outcomes: Ensured accessibility to adequate and affordable health care, medical services and medicine and promote healthy lifestyle for the people of ASEAN 29
- 30. ATFNCD Workplan • STRATEGY I: Revitalise and implement ‘ASEAN Healthy Life Style 2002 • Engage in advocacy opportunities at regional/international platforms • Policy advocacy on NCD concerns that includes but not limited to: • Labeling and standards for healthy low salt food • Ethical advertising of food products for children • Alcohol consumption reduction • Strategy II: Facilitating enabling environment for ensuring promotion of healthy lifestyle for the people of ASEAN • Networking among ASEAN Cancer Data and Registry Information System • Key indicators on Healthy Lifestyle especially on 4 selected NCDs • Regional Workshop to harmonize guidelines on physical activity in collaboration with WHO • Regional framework for NCD screening and management 30
- 31. Consultation on Overweight, Obesity, Diabetes and Law in the Western Pacific Region, April 2014 • Co-organised by the International Development Law Organisation (IDLO), University of Sydney (Faculty of Law and Boden Institute of Obesity, Nutrition and Exercise) and WHO WPRO. • Several themes and areas for action were identified : • Generating and sharing evidence for action • Capacity-building: Strengthen the linkages between health and the law, building the capacity of each profession to understand and work with one another. Suggestions for achieving this included: • Training the legal and health workforces through changes to academic curricula; • Conducting workshops and forums to encourage greater dialogue between government and civil society, and • Developing a multidisciplinary group of public health law experts. 31
- 32. Consultation on Overweight, Obesity, Diabetes and Law in the Western Pacific Region, April 2014 • Promising interventions: In-depth technical advice on specific promising interventions, including • Regulation and taxation of sugar-sweetened beverages; • Restriction of marketing unhealthy food products and beverages to children; • Requirements for interpretative front-of-pack labelling on packaged foods; and • Legislation to facilitate environments that are conducive to physical activity. • Social mobilization: The support and participation of civil society is crucial to the development, implementation and enforcement of innovative legal approaches to overweight, obesity and diabetes. • Actions to address industry interference: Clear guidelines are needed to avoid conflicts of interest and to ensure that government interactions with the food industry are transparent and constructive, and do not jeopardise public health goals. 32
- 33. 65th Regional Committee Meeting for the Western Pacific, 13-17 Oct 2014 • One of the main agenda items is Tobacco free initiative: Regional Action Plan 2015–2019 • Malaysia made a strong statement on this issue 33 “I think it will be fool hardy for us to expect that the tobacco industry will not interfere. By virtue of being the Tobacco industry itself it is their duty to interfere and they will continue to interfere”
- 34. 65th Regional Committee Meeting for the Western Pacific, 13-17 Oct 2014 Malaysia’s stand: • We cannot handle the issue of tobacco without looking at the trade and economical aspects of tobacco • Malaysia is quite consistent in this idea that we should try to exclude tobacco in all forms of trade agreements e.g. in TPPA. • Must address issue of illicit tobacco and transboundary smuggling – need multisectoral involvement. • Increasing excise duty. • Need to gather further evidence to support policy implementation. 34
- 35. 65th Regional Committee Meeting for the Western Pacific, 13-17 Oct 2014 35 Involvement of Public Health Physician trainees: First time ever for Malaysia
- 36. 6th Session of the Conference of Parties (COP) to the WHO Framework Convention on Tobacco Control (FCTC) – 13-18 Oct 2014 36 • Malaysia continues to fight for carving out tobacco from trade agreements. • Met with strong opposition from several countries. • Malaysia is currently hosting a drafting group on this issue.
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- 38. Thank you [email protected] Facebook: Feisul Mustapha 38