Dr Ala Alwan

Assistant Director-General
Noncommunicable Diseases and Mental Health
World Health Organization

Scope, Objectives and Agenda

 Noncommunicable Diseases and Injuries
Magnitude
• Four major noncommunicable diseases (NCDs):
– Cardiovascular diseases
– Diabetes
– Cancers
– Chronic respiratory diseases
• Four shared modifiable risk factors:
– Tobacco use
– Unhealthy diet
– Physical inactivity
– Harmful use of alcohol

• 60% of deaths globally – 70% if injuries are included -80% in developing countries
• 40-50% are premature
• Magnitude has a major socio-economic impact on developing countries

 NCDs and injuries are still excluded from global discussions on development

ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting

Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
 Injuries
• Cause 10% of all deaths and 16% of all
disability

• Road traffic crashes alone are the leading

cause of death for young people aged 10-
24 years

ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting

Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
 Global Risk Assessment 2009
World Economic Forum

http://www.weforum.org/pdf/globalrisk/globalrisks09/global_risks_2009.pdf
Oil and gas price spike
Retrenchment from globalization
Asset price collapse

NCDs
Fiscal crisis
Flu pandemic
Food crisis

Infectious disease

ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting

Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
 Noncommunicable Diseases & Injuries

www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index.html
Projected global deaths (2030)
12 Cancers

10 Ischaemic
heart disease

Stroke
Deaths (millions)

6 Acute
respiratory
infections

4
Road traffic
accidents
2 Perinatal
HIV/AIDS
TB
0 Malaria
2000 2005 2010 2015 2020 2025 2030
ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting
Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
 Noncommunicable Diseases
Death trends (2015)

www.who.int/chp/chronic_disease_report/media/impact/en/index.html
2005 2006-2015 (cumulative)

Geographical Total NCD NCD Trend: Death

Trend: Death
regions (WHO deaths deaths deaths from infectious
from NCD
classification) (millions) (millions) (millions) disease

Africa 10.8 2.5 28 +6% +27%

Americas 6.2 4.8 53 -8% +17%
Eastern
4.3 2.2 25 -10% +25%
Mediterranean
Europe 9.8 8.5 88 +7% +4%
South-East Asia 14.7 8.0 89 -16% +21%
Western Pacific 12.4 9.7 105 +1 +20%
Total 58.2 35.7 388 -3% +17%

WHO projects that over the next 10 years, the largest increase in
deaths from cardiovascular disease, cancer, respiratory disease and
diabetes will occur in low- and middle-income countries.

ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting

Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
 Noncommunicable Diseases
The poorest people in developing countries are the ones who smoke the most

All smoking prevalence

45
40
35
30
25
%

20
15
10
5
0
Low income Low er-middle Upper-middle income High income
income

Q1 Q2 Q3 Q4 Q5

Source: World Health Survey 2006

Range: from Q1 = poorest quintile to Q5 = Highest income quintile

ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting

Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
 Noncommunicable Diseases
Macro-economic impact

Lost national income from

premature deaths due to heart 2005 2006-2015 (cumulative)

2005)
(WHO Chronic Disease Report,
disease, stroke and diabetes
Lost national income Lost national income
Countries
(billions) (billions)
Brazil 3 49
China 18 558
India 9 237
Nigeria 0.4 8
Pakistan 1 31
Russian Federation 11 303
Tanzania 0.1 3

WHO: "Heart disease, stroke and diabetes alone are estimated to

reduce GDP between 1 to 5% per year in developing countries
experiencing rapid economic growth"

ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting

Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
 Noncommunicable Diseases
The vicious cycle of poverty and NCDs

ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting

Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
NCDs are emerging as a serious
threat to Arab countries
and are undermining development

ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting

Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
 Noncommunicable Diseases
Magnitude in the Middle East
Total deaths: 4.3 million
• Noncommunicable conditions: 50%
www.who.int/healthinfo/global_burden_disease/estimates_regional/en/index.html

Diabetes (2%) • Communicable diseases*: 39%

• Injuries: 11%
Neuropsychiatric disorders (2%)
Digestive diseases (4%)

Intentional injuries (4%) Cardiovascular

diseases (27%)
Respiratory
diseases (4%)

Malignant
neoplasms (7%)

Unintentional injuries (7%) Infectious and parasitic

diseases (17%)

Perinatal conditions (10%) Respiratory infections (10%)

Including maternal and perinatal conditions and nutritional deficiencies *

ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting

Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
Top-10 countries in diabetes prevalence in the world
(2007)

Rank and country Age- adjusted prevalence of diabetes in

20-79 yr age group (%)
1. Nauru 30.7
2. United Arab Emirates 19.5
3. Saudi Arabia 16.7
4. Bahrain 15.2
5. Kuwait 14.4
6. Oman 13.1
7. Tonga 12.9
8. Mauritius 11.1
9. Egypt 11.0
10. Mexico 10.6

ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting

Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
 NCDs and injuries are preventable
We know what works

We have cost-effective interventions:

•Tobacco control interventions

•Measures to improve healthy dietary and physical activity patterns

•Early detection and effective treatment of cancer

•Treatment of hypertension, diabetes

•Treatment of heart disease and stroke

•Intersectoral injury prevention measures

ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting

Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
 The global response to address
noncommunicable diseases

ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting

Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
2008-2013 Action Plan for the Global Strategy
Six Objectives of the Action Plan

1. Integrating NCD prevention into the

development agenda, and into policies
across all government departments
2. Establishing/strengthening national policies
and programmes
3. Reducing/preventing risk factors
4. Prioritizing research on prevention and
health care
5. Strengthening partnerships
6. Monitoring NCD trends and assessing
progress made at country level

Under each of the 6 objectives, there are sets of

actions for member states, WHO Secretariat and
international partners.
ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting
Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
 Noncommunicable Diseases
The NCD gap in the development agenda
(Health ODA* Commitments 2006 by major subsector)

ODA = Official Development Assistance provided by 24 OECD/DAC donor countries, as well as the EC *
STD & HIV/AIDS Control $4.75
US$ Billions Infectious Disease Control $2.10
Health Policy/Management $1.93
Basic Health Care $1.80
Reproductive Health Care $1.30
Basic Health Infrastructure $0.70
Medical Research $0.60
Medical Services $0.20
Family Planning $0.20
Basic Nutrition $0.10
Health Training $0.08
Health Education $0.00
Water supply/sanitation-large systems $2.70
Water Policy/Management $2.00
Basic drinking water supply & sanitation $1.00
River development $0.30
Waste management/disposal $0.20
Water resources protection $0.10
Water Education/Training $0.00 Total = $20.9 billion
ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting
Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
 President of the 61st World Health Assembly
MDGs … failed to identify noncommunicable conditions, in spite of the … …
fact that these diseases account for fully 70% of the global mortality… most
of the morbidity and mortality caused are preventable … a serious omission
… I propose we seriously consider an MDG+, which would set goals for the
ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting
.NCCs, Addressing
as wenoncommunicable
have done for
diseases other … challenges
and injuries
(Doha, Qatar, 10-11 May 2009)
 Global NCD Action Plan 2008-2013
Milestones
Objective 1: To raise the priority accorded to noncommunicable
diseases in development work at global and national level

• Regional Ministerial Meeting on Health Literacy (Beijing, 29-

30 April 2009)
• Regional Ministerial Meeting on NCDs, Poverty and
Development (Qatar, 10-11 May 2009)
• ECOSOC High Level Segment on Global Health (Geneva, 6-
8 July 2009)

ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting

Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
What do we want to achieve from this meeting?
• Review the magnitude and trends of NCDs and
injuries with special emphasis on socio-economic
impact

• Discuss successful approaches and interventions

to address NCDs and injuries and identify cost-
effective measures to improve access of the poor
and vulnerable populations to proper health care

• Discuss ways and means of integrating the

prevention of NCDs and injuries into national,
regional and global development initiatives

ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting

Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
What do we want to achieve from this meeting?...

• Recommend key actions for countries to incorporate

NCD prevention into poverty reduction strategies
and relevant social and economic policies

• Recommend mechanisms to involve all government

departments to ensure that NCD and injury
prevention receives a cross-sectoral response

A Call for action by the international community and

development agencies to respond to the needs of
countries in scaling up action against NCDs and
injuries
ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting
Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)