«The WHO has proposed a global monitoring framework and a set of targets to monitor progress in reducing the burden of NCDs»
and especially low-income and middle- income ones. It firmly positions NCDs as a development, and not just a health, issue. The declaration is a strongly worded
document that will accelerate international progress on NCDs and provide a framework for saving millions of people from preventable disease and disability due to NCDs. Agreement was reached on several issues such as increased access to affordable, safe, effective and quality medicines, as well as palliative and rehabilitative service, particularly at the community level. It also includes a commitment to accelerate implementation of the framework; convention on tobacco control, to eliminate industrially produced trans fats in food and to implement interventions to reduce consumption of salt, sugar and saturated fats. In addition, member states have agreed to introduce policies and actions aimed at promoting healthy diet and increasing physical activity in the entire population. With this declaration, NCDs will stay on the UN agenda for years to come. It has taken the hard work and determination of many people around the world to achieve this.
TARGETS The WHO has proposed a global monitoring framework and a set of targets to monitor progress in reducing the burden of NCDs. These targets were established following scientific review of the current situation and trends, combined with a critical assessment of feasibility based upon demonstrated country achievement. Mortality and prevalence targets are age-standardised. These targets can be summarised as such:
Outcome targets Premature mortality from NCDs: 25% relative reduction in overall mortality from cardiovascular disease, cancer, diabetes and chronic respiratory disease Diabetes: 10% relative reduction in the prevalence of diabetes.
Exposure targets Tobacco smoking: 40% relative reduction in the prevalence of currently daily tobacco smoking Alcohol: 10% relative reduction in per capita consumption of alcohol, and 10% relative reduction in prevalence of heavy episodic drinking Dietary salt intake: Reduction of mean population intake of salt to less than 5 g/day Obesity: Halt the rise in obesity prevalence Blood pressure/ hypertension: 25% relative reduction in prevalence of raised blood pressure.
Health system targets Prevention of heart attack and stroke in primary care: 80% coverage of multi-drug therapy for people aged 30+ years with a 10-year risk of heart attack or stroke more or equal to 30%, or existing cardiovascular disease Cancer prevention in primary care: Cancer prevention and early detection scaled up to achieve: A. 70% of women between ages 30 to 49 screened for cervical cancer at least once B. 25% increase in the proportion of breast cancers diagnosed in early stages C. Less than 1% prevalence of HBS antigen carriers among children aged ≤ 5 years Policy approaches to dietary risk reduction: Total elimination of the partially hydrogenated vegetable oil (PHVO) from the food supply by 2020, no marketing of foods high in saturated fats, trans fatty acids, sugar or salt to children.
The goal The proposed WHO overall goal of a 25% reduction in preventable NCD mortality by 2025 is readily achievable with a few priority cost-effective interventions. The major indicator should be tobacco reduction - and here we should be ambitious, aiming for an essentially tobacco-free world by 2040 with an interim target of a global adult daily smoking prevalence of less than 15% by 2025, down from the current 22%. The second major indicator should be reduction in population salt intake to the WHO- recommended level of 5 g per person per day by 2025. Achieving this target will have a major impact on reducing population blood pressure and would reduce the need for mass blood pressure medication, which is beyond the resources of many low-income countries. It is time for countries to use the WHO’s new data to cost out their own national NCD plans, pulling together existing plans they might have on the individual diseases and risk factors. ■
AH
REFERENCES References available on request (
magazine@informa.com)
AUTHOR INFO *Dr. Bazargani is a Board Member of the World Heart Federation and Chair of the CVD Prevention Group of the Emirates Cardiac Society. Dr Bazargani also works with the Dubai Heart Center, part of the Dubai Health Authority.
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