APPENDIX TO TECHNICAL NOTE

Transcription

1 (Version dated 1 May 2015) APPENDIX TO TECHNICAL NOTE How WHO will report in 2017 to the United Nations General Assembly on the progress achieved in the implementation of commitments included in the 2011 UN Political Declaration and 2014 UN Outcome Document on NCDs Methodology used to develop the reporting framework for The methodology used to develop the reporting framework for 2017 described in paragraph 5 above takes into account the following: National commitments included in the 2011 Political Declaration and 2014 Outcome Document; Existing indicators for monitoring NCDs at global and regional levels; Existing survey tools and data collection mechanisms. National commitments included in the 2011 Political Declaration and 2014 Outcome Document on NCDs 2. The 2011 Political Declaration included a road map of concrete national commitments from Heads of State and Government (please refer to right-hand column in Annex 2 of the Appendix) covering four priority areas: governance, prevention and reduction of risk factors, health care, and surveillance. It also included one time-bound strategic intervention which world leaders committed to implement by The 2014 Outcome Document on NCDs included an updated roadmap of national commitments from Ministers (please refer to the left-hand column in Annex 2 of the Appendix), taking into account that the World Health Assembly in 2013 (i) adopted the WHO Global Monitoring Framework on NCDs, consisting of nine voluntary global NCD targets for 2025 and 25 outcome indicators, and (ii) endorsed the WHO Global NCD Action Plan , which, in its Appendix 3, includes a menu of policy options and cost-effective inventions for Member States. The 2014 Outcome Document also includes four time-bound strategic interventions which Ministers have committed to implement by 2015 and A crosswalk between the national commitments included in the 2011 Political Declaration and 2014 Outcome Document on NCDs is available in Annex 2 of the Appendix. The crosswalk indicates the following: The majority of national commitments included in the 2011 Political Declaration are also included in the 2014 Outcome Document. Specific national commitments in the area of prevention and reduction of risk factors set out in the 2011 Political Declaration are covered in the 2014 Outcome Document by the national timebound commitment to by 2016, as appropriate, reduce risk factors for NCDs and underlying social determinants through the implementation of interventions and policy options to create Page 1 of 14

2 health-promoting environments, building on guidance set out in Appendix 3 to the WHO Global NCD Action Plan Specific national commitments in the area of health care set out in the 2011 Political Declaration are covered in the 2014 Outcome Document by the national time-bound commitment to by 2016, as appropriate, strengthen and orient health systems to address the prevention and control of NCDs and the underlying social determinants through people-centred primary health care and universal health coverage throughout the life cycle, building on guidance set out in Appendix 3 to the WHO Global NCD Action Plan The 2014 Outcome Document includes a number of new national commitments in the area areas of governance, as well as surveillance, monitoring and evaluation, which were not included in the 2011 Political Declaration. 5. Taking into account, therefore, that the commitments included in the 2011 Political Declaration are a subset of the commitments included in the 2014 Outcome Document, the methodology described in this Appendix will focus on the national commitments included in paragraphs 30, 31 and 32 of the 2014 Outcome Document. Existing survey tools and data collection mechanisms 6. Similar to 2000, 2005, 2010 and , WHO will conduct a global survey to assess national capacity for the prevention and control of NCDs (also referred to as the WHO NCD Country Capacity Survey or CCS) in 2015 and 2017 to assess individual country capacity for NCD prevention and control. The aim of the survey is to support countries in their efforts to assess their strengths and weaknesses related to NCD governance and infrastructure, policy response, surveillance, and health systems response to address NCDs at national level, as well as to provide data for reporting to the World Health Assembly and/or WHO Regional Committees against existing outcome and process indicators at global and national levels, according to agreed timelines. In line with established practices since 2000, the questionnaire is improved during each round of the survey. In 2015, the questionnaire will be modified to take into account the national commitments included in the 2014 Outcome Document. Similarly, the survey methodology will also be updated in 2015 to include more extensive validation on a number of survey item responses to improve accuracy of reporting. 7. Other existing global survey tools relevant to the prevention and control of NCDs include the WHO Report on the Global Tobacco Epidemic 4, the WHO Global Information System on Alcohol and Health, 5 the WHO Global Database on the Implementation of Nutrition Action 6, the WHO Stepwise Approach to NCD Risk Factor Surveillance 7, the Global Tobacco Surveillance System, and the tools used to report on the output indicators for outcome 2.1 included in the WHO Programme Budgets and The table in Annex 1 of the Appendix maps national commitments included in paragraphs 30, 31 and 32 of the 2014 Outcome Document with progress indicators which will be included in the 2015 (and 2017) WHO NCD Country Capacity Assessment Survey to assess progress achieved at country level. This would result in a potential set of 28 progress indicators (included in the third column of the table included in Annex 1 of the Appendix). 1 Paragraph 30(b) of resolution A/RES/68/300 2 Paragraph 30(c) of resolution A/RES/68/300 3 Results from the surveys in 2000, 2005 and 2010 are available at 4 The 2013 report is available at 5 Available at 6 Available at 7 Available at Page 2 of 14

3 Focus on progress made in the implementation of the four time-bound commitments for 2015 and 2016 included in the 2014 Outcome Document 9. Recognizing also that progress in the prevention and control of NCDs has been insufficient and highly uneven since September 2011, and that continued and increased efforts are essential, in paragraphs 30 of the 2014 Outcome Document Ministers committed themselves to prioritize a set of measures. In particular, the 2014 Outcome Document includes four time-bound measures, which Ministers have committed themselves to prioritize by 2015 and 2016: By 2015, consider setting national targets for 2025 and process indicators based on national situations, taking into account the nine voluntary global targets for NCDs (paragraph 30(a)(i)) By 2015, consider developing or strengthening national multisectoral policies and plans to achieve the national targets by 2025, taking into account the WHO Global NCD Action Plan (paragraph 30(a)(ii)) By 2016, as appropriate, reduce risk factors for NCDs and underlying social determinants through the implementation of interventions and policy options to create health-promoting environments, building on guidance set out in Appendix 3 of the WHO Global NCD Action Plan (paragraph 30(b)) By 2016, as appropriate, strengthen and orient health systems to address the prevention and control of NCDs and underlying social determinants through people-centred primary health care and universal health coverage throughout the life cycle, building on guidance set out in Appendix 3 of the WHO Global NCD Action Plan (paragraph 30(c)). 10. Recognizing the need to accelerate efforts during the next years and focus on the implementation of the four time-bound national commitments for 2015 and 2016 in preparation for the comprehensive review of the United Nations General Assembly in 2018 of the progress achieved in the prevention and control of NCDs, WHO will focus its report in 2017 to the United Nations General Assembly on the progress achieved in the implementation of the time bound commitments. This will result in a set of 10 progress indicators included in the second column of the table included paragraph 5 of the technical note. = = = Page 3 of 14

4 ANNEX I OF THE APPENDIX Potential progress indicators mapped against the national commitments included in the 2014 Outcome Document with existing data source National commitments included in the 2014 Outcome Document 1 By 2015, consider setting national targets for 2025 and process indicators based on national situations, taking into account the nine voluntary global targets for NCD, building on guidance provided by the World Health Organization, to focus on efforts to address the impacts of noncommunicable diseases and to assess the progress made in the prevention and control of NCDs and their risk factors and determinants 2 By 2015, consider developing or strengthening national multisectoral policies and plans to achieve the national targets by 2025, taking into account the WHO Global NCD Action Plan Continue to develop, strengthen and implement, as appropriate, multisectoral public policies and action plans to promote health education and health literacy, with a particular focus on populations with low health awareness and/or literacy 4 Raise awareness about the national public health burden caused by noncommunicable diseases and the relationship between NCDs, poverty and social and economic development 5 Integrate measures to address NCDs into health planning and national development plans and policies, including the design process and implementation of the United Nations Development Assistance Framework 6 Consider establishing, as appropriate to the respective national context, a national multisectoral mechanism, such as a highlevel commission, agency or task force for engagement, policy coherence and mutual accountability of different spheres of policymaking that have a bearing on NCDs, in order to implement health-in-all-policies and whole-of government and whole-of-society approaches, and to monitor and act on the Potential progress indicators (Data source between brackets) Member State has set time-bound national targets and indicators based on WHO guidance (CCS/2015) Member State has a functioning system for generating reliable cause-specific mortality data on a routine basis (country reporting to WHO on mortality data, CCS/2015) Member State has a STEPS survey or a comprehensive health examination survey every 5 years (CCS/2015, STEPS tracking system) Member State has an operational multisectoral national strategy/action plan that integrates the major NCDs and their shared risk factors (CCS/2015) Member State has at least one operational multisectoral policy, strategy or action plan to promote health education and health literacy with a focus on populations with low health awareness and/or literacy ( no existing data source) Member State has at least one public awareness programme implemented to highlight the health burden caused by noncommunicable diseases and the relationship between NCDs, poverty and social and economic development ( no existing data source) Member State has NCDs incorporated into the national development agenda, including in United Nations Development Assistance Frameworks, as appropriate (CCS/2015) Member State has a high-level national multisectoral commission, agency or mechanism to oversee engagement, policy coherence and accountability of sectors beyond health (CCS/2015) Is the progress indicator also used for reporting to the World Health Assembly and/or WHO Regional Committees or included in existing WHO databases or standard publications? Declaration Declaration, as well as the PAHO set of Regional Indicators Declaration, the SEARO regional action plan, as well as the PAHO set of Regional Indicators Yes, included in the set of 9 NCD Action Plan indicators, the 2014 EMRO Framework for Declaration, the SEARO regional action plan, as well as the PAHO set of Regional Indicators Yes, included as an output indicator for WHO Programme Budgets and and the SEARO regional action plan. Declaration Page 4 of 14

5 determinants of NCDs, including social and environmental determinants 7 Enhance the capacity, mechanisms and mandates, as appropriate, of relevant authorities in facilitating and ensuring action across governmental sectors 8 Strengthen the capacity of ministries of health to exercise a strategic leadership and coordination role in policy development that engages all stakeholders across government, non-governmental organizations, civil society and the private sector, ensuring that issues relating to NCDs receive an appropriate, coordinated, comprehensive and integrated response 9 Align international cooperation on NCDs with national plans concerning NCDs in order to strengthen aid effectiveness and the development impact of external resources in support of NCDs 10 Develop and implement national policies and plans, as relevant, with financial and human resources allocated particularly to addressing noncommunicable diseases, in which social determinants are included 11 By 2016, as appropriate, reduce risk factors for NCDs and underlying social determinants through the implementation of interventions and policy options to create health-promoting environments, building on guidance set out in appendix 3 to the Global Action Plan Member State has increased budgetary allocations measured by tracking and reporting on health expenditures on prevention and control of major NCDs, by source, per capita ( no existing data source) Member State has an operational (defined as having at least one full-time staff and funding for the following major NCD activities: primary prevention and health promotion; early detection/screening; health care and treatment; and surveillance, monitoring and evaluation) NCD unit(s)/branch(es)/department(s) within the Ministry of Health, or equivalent (CCS/2015) Member State has a national NCD plans aligned with international cooperation ( no existing data source) Member State has at least one national policy or plan related to NCDs, with financial and human resources allocated, which includes social determinants (no existing data source) Member State has implemented the following four demand-reduction measures of the WHO FCTC at the highest level of achievement: Reduce affordability of tobacco products by increasing tobacco excise taxes; Create by law completely smoke-free environments in all indoor workplaces, public places and public transport Warn people of the dangers of tobacco and tobacco smoke through effective health warnings and mass media campaigns Ban all forms of tobacco advertising, promotion and sponsorship (WHO Report on the Global Tobacco Epidemic) Member State has implemented the following three measures to reduce the harmful use of alcohol 8 as per the WHO Global Strategy to Reduce the Harmful Use of Alcohol 9 : Regulations cover commercial and public availability of alcohol Comprehensive restrictions or bans on alcohol advertising and promotions Pricing policies such as excise tax increases on alcoholic beverages (WHO Global Information System on Alcohol and Health) Declaration Yes, included in the set of 9 NCD Action Plan indicators and the SEARO regional action plan. Yes, included in the set of 9 NCD Action Plan indicators Declaration and the SEARO regional action plan. Yes, included in the Global Status Report on Alcohol and Health and GISAH and the SEARO regional action plan. 8 The word harmful refers only to public-health effects of alcohol consumption, without prejudice to religious beliefs and cultural norms in any way 9 Resolution WHA63.10 Page 5 of 14

6 12 By 2016, as appropriate, strengthen and orient health systems to address the prevention and control of NCDs and the underlying social determinants through people-centred primary health care and universal health coverage throughout the life cycle, building on guidance set out in appendix 3 to the Global Action Plan 13 Consider the possible linkages between NCDs and some communicable diseases, such as HIV/AIDS, call for the integration, as appropriate, of responses to HIV/AIDS and NCDs, and in this regard call for attention to be given to people living with HIV/AIDS, especially in countries with a high prevalence of HIV/AIDS, in accordance with national priorities 14 Continue to promote the inclusion of prevention and control of NCDs within programmes for sexual and reproductive health and maternal and child health, especially at the primary healthcare level, as well as communicable disease programmes, such as those addressing tuberculosis, as appropriate 15 Consider the synergies between major NCD and other conditions as described in appendix 1 to the Global Action Plan in order to develop a comprehensive response for the prevention and control of noncommunicable diseases that also recognizes the conditions in which people live and work 16 Assess progress towards attaining the voluntary global targets and report on the results using the indicators established in the comprehensive global monitoring framework, according to the agreed timelines, and use results from monitoring of the 25 indicators and 9 voluntary targets and other sources of data to inform and guide policy and programming, aiming to maximize the impact of interventions and investments on NCD outcomes Member State has implemented the following four measures to reduce unhealthy diets: Adopted national policies to reduce population salt/sodium consumption (CCS/2015) Adopted national policies that limit saturated fatty acids and virtually eliminate industrially produced trans fatty acids in the food supply (CCS/2015) WHO set of recommendations on marketing of foods and non-alcoholic beverages to children (CCS/2015) Legislation /regulations fully implementing the International Code of Marketing of Breast-milk Substitutes (WHO Global Database on Implementation of Nutrition Action) Member State has implemented at least one recent national public awareness programme on diet and/or physical activity (CCS/2015) Member State has evidence-based national guidelines/protocols/standards for the management of major NCDs through a primary care approach, recognized/approved by government or competent authorities (CCS/2015) Member State has provision of drug therapy, including glycaemic control, and counselling for eligible persons at high risk to prevent heart attacks and strokes, with emphasis on the primary care level (WHO STEPS and CCS/ 2015) Member State has guidelines/protocols/standards for the integration of NCDs in the responses to HIV/AIDS, especially in countries with high HIV/AIDS prevalence (no existing data source) Member State has guidelines/protocols/standards for the inclusion of NCDs within programmes for sexual and reproductive health, maternal and child health, and communicable diseases such as tuberculosis, especially at the primary health-care level (no existing data source) Member State has at least one guideline/ protocol/standard addressing the synergy between major NCDs and other conditions such as mental disorders, communicable diseases, demographic change and disabilities, violence and unintentional injuries (no existing data source) Member State has NCD surveillance and monitoring systems in place to enable reporting against the nine voluntary global NCD targets (includes EMRO indicators: A functioning system for generating reliable cause-specific mortality data on a routine basis and a STEPS survey or a comprehensive health examination survey every 5 years) Member State has an operational population-based cancer registry. (CCS/2015, country reporting to WHO on mortality data, and STEPS tracking system ) Yes, included in the set of 25 outcome indicators of the WHO Global Monitoring Framework for NCDs and the 2014 EMRO Framework for Action to implement the 2011 Political Declaration and two are included in the SEARO regional action plan. Yes, included in the set of 9 NCD Action Plan indicators Yes, included in the set of 25 outcome indicators of the WHO Global Monitoring Framework on NCDs Yes, included in the set of 9 NCD Action Plan indicators Declaration Page 6 of 14

7 17 Contribute information on trends in NCDs to the World Health Organization, according to the agreed timelines on progress made in the implementation of national action plans and on the effectiveness of national policies and strategies, coordinating country reporting with global analyses 18 Develop or strengthen, as appropriate, surveillance systems to track social disparities in NCDs and their risk factors as a first step to addressing inequalities, and pursue and promote gender-based approaches for the prevention and control of NCDs on the basis of data disaggregated by sex, age and disability, in an effort to address the critical differences in the risks of morbidity and mortality from NCDs for women and men 19 Continue to strengthen international cooperation in support of national, regional and global plans for the prevention and control of NCDs, inter alia, through the exchange of best practices in the areas of health promotion, legislation, regulation, strengthening of health systems, training of healthcare personnel and the development of appropriate health-care infrastructure and diagnostics and by promoting the development and dissemination of appropriate, affordable and sustainable transfer of technology on mutually agreed terms for the production of affordable, safe, effective and quality medicines and vaccines, while recognizing the leading role of the World Health Organization as the primary specialized agency for health in that regard 20 Continue to strengthen international cooperation through rth-south, South-South and triangular cooperation in the prevention and control of NCDs to promote at the national, regional and international levels an enabling environment to facilitate healthy lifestyles and choices, bearing in mind that South-South cooperation is not a substitute for, but rather a complement to, rth-south cooperation 21 Continue to explore the provision of adequate, predictable and sustained resources, through domestic, bilateral, regional and multilateral channels, including traditional and voluntary innovative financing mechanisms Member State contributes, on a routine basis, data and information on trends related to NCDs and their risk factors stratified by age, sex and socioeconomic group, and provide information on progress made in implementation of national strategies and plans (WHO country consultation on risk factor data and routine mortality reporting to WHO) Member State collects data and information on trends related to NCDs and their risk factors stratified by age, sex and socioeconomic group (CCS/2015) Member State contributes to exchanges of best practices in areas of health promotion, legislation, regulation, strengthening of health systems, training of health-care personnel and the development of appropriate health-care infrastructure and diagnostics (no existing data source) Member State participates in at least one activity designed to promote international cooperation through rth-south, South-south or triangular cooperation in prevention and control of NCDs (no existing data source) Member State has increased budgetary allocations measured by tracking and reporting on health expenditures on prevention and control of major NCDs, by source, per capita (no existing data source) Yes, Included in the strategic line 4 of Plan of action on NCDs in the Americas and the SEARO regional action plan. Yes, Included in the strategic line 4 of within Plan of action on NCDs in the Americas Yes, in resolution CD52.R9 on Plan of Action on NCDs for the Americas Declaration Page 7 of 14

8 ANNEX 2 National commitments: Cross-walk between the 2011 UN Political Declaration and 2014 UN Outcome Document on NCDs National commitments included in the 2014 UN Outcome Document on NCDs Paragraph number National commitments included in the 2011 Political Declaration on NCDs Paragraph number In the area of governance 1 National engagement Commit to addressing NCDs as a matter of priority in national development plans, as appropriate within national contexts and the international development agenda, and to take the following measures with the engagement of all relevant sectors, including civil society and communities, as appropriate: 2 National targets 3 National policies and plans 4 National advocacy 5 National planning processes 6 National mechanisms 7 National capacities 8 Social determinants By 2015, consider setting national targets for 2025 and process indicators based on national situations, taking into account the nine voluntary global targets for NCDs, building on guidance provided by the WHO, to focus on efforts to address the impacts of NCDs and to assess the progress made in the prevention and control of NCDs and their risk factors and determinants By 2015, consider developing or strengthening national multisectoral policies and plans to achieve the national targets by 2025, taking into account the WHO Global Action Plan for the Prevention and Control of NCDs Raise awareness about the national public health burden caused by NCDs and the relationship between NCDs, poverty and social and economic development Integrate measures to address NCDs into health planning and national development plans and policies, including the design process and implementation of the United Nations Development Assistance Framework Consider establishing, as appropriate to the respective national context, a national multisectoral mechanism, such as a high-level commission, agency or task force for engagement, policy coherence and mutual accountability of different spheres of policymaking that have a bearing on NCDs, in order to implement health-in-all-policies and whole-of government and whole-ofsociety approaches, and to monitor and act on the determinants of NCDs, including social and environmental determinants Enhance the capacity, mechanisms and mandates, as appropriate, of relevant authorities in facilitating and ensuring action across governmental sectors Strengthen the capacity of Ministries of Health to exercise a strategic leadership and coordination role in policy development that engages all stakeholders across government, non-governmental organizations, civil society and the private sector, ensuring that issues relating to NCDs receive an appropriate, coordinated, comprehensive and integrated response Develop and implement national policies and plans, as relevant, with financial and human resources allocated particularly to addressing NCDs, in which social determinants are included 30 Pursue all necessary efforts to strengthen nationally driven, sustainable, cost-effective and comprehensive responses in all sectors for the prevention of NCDs, with the full and active participation of people living with these diseases, civil society and the private sector, where appropriate 30 (a) (i) Consider the development of national targets and indicators based on national situations, building on guidance provided by WHO, to focus on efforts to address the impacts of NCDs and to assess the progress made in the prevention and control of NCDs and their risk factors and determinants 30 (a) (ii) Promote, establish or support and strengthen, by 2013, as appropriate, multisectoral national policies and plans for the prevention and control of NCDs, taking into account, as appropriate, the Action Plan for the Global Strategy for the Prevention and Control of NCDs and the objectives contained therein, and take steps to implement such policies and plans 30 (a) (iv) 30 (a) (v) Strengthen and integrate, as appropriate, NCDs into health-planning processes and the national development agenda of each Member State 30 (a) (vi) 30 (a) (vii) 30 (a) (viii) 30 (a) (x) 45 (i) (a) Page 8 of 14

9 National commitments included in the 2014 UN Outcome Document on NCDs Paragraph number National commitments included in the 2011 Political Declaration on NCDs Paragraph number 9 National resources 10 Aligning international cooperation with national plans Continue to explore the provision of adequate, predictable and sustained resources, through domestic, bilateral, regional and multilateral channels, including traditional and voluntary innovative financing mechanisms Continue to strengthen international cooperation in support of national, regional and global plans for the prevention and control of NCDs, inter alia, through the exchange of best practices in the areas of health promotion, legislation, regulation, strengthening of health systems, training of health-care personnel and the development of appropriate health-care infrastructure and diagnostics and by promoting the development and dissemination of appropriate, affordable and sustainable transfer of technology on mutually agreed terms for the production of affordable, safe, effective and quality medicines and vaccines, while recognizing the leading role of WHO as the primary specialized agency for health in that regard Continue to strengthen international cooperation through rth-south, South- South and triangular cooperation in the prevention and control of NCDs to promote at the national, regional and international levels an enabling environment to facilitate healthy lifestyles and choices, bearing in mind that South-South cooperation is not a substitute for, but rather a complement to, rth-south cooperation Align international cooperation on NCDs with national plans concerning NCDs in order to strengthen aid effectiveness and the development impact of external resources in support of NCDs Pursue and promote gender-based approaches for the prevention and control of NCDs founded on data disaggregated by sex and age in an effort to address the critical differences in the risks of morbidity and mortality from NCDs for women and men Recognize where health disparities exist between indigenous peoples and non-indigenous populations in the incidence of NCDs and their common risk factors, and that these disparities are often linked to historical, economic and social factors, and encourage the involvement of indigenous peoples and communities in the development, implementation and evaluation of NCD prevention and control policies, plans and programmes, where appropriate, while promoting the development and strengthening of capacities at various levels and recognizing the cultural heritage and traditional knowledge of indigenous peoples and respecting, preserving and promoting, as appropriate, their traditional medicine, including conservation of their vital medicinal plants, animals and minerals 32 Explore the provision of adequate, predictable and sustained resources, through domestic, bilateral, regional and multilateral channels, including traditional and voluntary innovative financing mechanisms According to national priorities, and taking into account domestic circumstances, increase and prioritize budgetary allocations for addressing NCD risk factors and for surveillance, prevention, early detection and treatment of NCDs and the related care and support, including palliative care 30 (g) (h) (a) (ix) 45 (e) 45 (g) 45 (d) 45 (c) Page 9 of 14

10 In the area of prevention and reduction of risk factors 11 Risk factors By 2016, as appropriate, reduce risk factors for NCDs and underlying social determinants through the implementation of interventions and policy options to create health-promoting environments, building on guidance set out in Appendix 3 to the WHO Global NCD Action Plan (b) Advance the implementation of multisectoral, cost-effective, populationwide interventions in order to reduce the impact of the common NCD risk factors namely tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol, through the implementation of relevant international agreements and strategies, and education, legislative, regulatory and fiscal measures, without prejudice to the right of sovereign nations to determine and establish their taxation policies and other policies, where appropriate, by involving all relevant sectors, civil society and communities, as appropriate Encourage the development of multisectoral public policies that create equitable health-promoting environments that empower individuals, families and communities to make healthy choices and lead healthy lives Accelerate implementation by States parties of the WHO FCTC, recognizing the full range of measures, including measures to reduce consumption and availability, and encourage countries that have not yet done so to consider acceding to the Convention, recognizing that substantially reducing tobacco consumption is an important contribution to reducing NCDs and can have considerable health benefits for individuals and countries and that price and tax measures are an effective and important means of reducing tobacco consumption Advance the implementation of the WHO Global Strategy on Diet, Physical Activity and Health, including, where appropriate, through the introduction of policies and actions aimed at promoting healthy diets and increasing physical activity in the entire population, including in all aspects of daily living, such as giving priority to regular and intense physical education classes in schools, urban planning and re-engineering for active transport, the provision of incentives for work-site healthy-lifestyle programmes, and increased availability of safe environments in public parks and recreational spaces to encourage physical activity Promote the implementation of the WHO Global Strategy to Reduce the Harmful Use of Alcohol, while recognizing the need to develop appropriate domestic action plans, in consultation with relevant stakeholders, for developing specific policies and programmes, including taking into account the full range of options as identified in the Global Strategy, as well as raise awareness of the problems caused by the harmful use of alcohol, particularly among young people, and call upon WHO to intensify efforts to assist Member States in this regard; Promote the implementation of the WHO Set of Recommendations on the Marketing of Foods and n-alcoholic Beverages to Children, including foods that are high in saturated fats, trans-fatty acids, free sugars or salt, recognizing that research shows that food advertising geared to children is extensive, that a significant amount of the marketing is for foods with a high content of fat, sugar or salt and that television advertising influences children s food preferences, purchase requests and consumption patterns, (a) 43 (c) 43 (d) 43 (e) 43 (f) Page 10 of 14

11 12 Prevention Continue to develop, strengthen and implement, as appropriate, multisectoral public policies and action plans to promote health education and health literacy, with a particular focus on populations with low health awareness and/or literacy while taking into account existing legislation and national policies, as appropriate Promote the development and initiate the implementation, as appropriate, of cost-effective interventions to reduce salt, sugar and saturated fats and eliminate industrially produced trans-fats in foods, including through discouraging the production and marketing of foods that contribute to unhealthy diet, while taking into account existing legislation and policies Encourage policies that support the production and manufacture of, and facilitate access to, foods that contribute to healthy diet, and provide greater opportunities for utilization of healthy local agricultural products and foods, thus contributing to efforts to cope with the challenges and take advantage of the opportunities posed by globalization and to achieve food security Promote, protect and support breastfeeding, including exclusive breastfeeding for about six months from birth, as appropriate, as breastfeeding reduces susceptibility to infections and the risk of undernutrition, promotes the growth and development of infants and young children and helps to reduce the risk of developing conditions such as obesity and NCDs later in life, and in this regard strengthen the implementation of the International Code of Marketing of Breast-milk Substitutes9 and subsequent relevant World Health Assembly resolutions Promote increased access to cost-effective vaccinations to prevent infections associated with cancers, as part of national immunization schedules Promote increased access to cost-effective cancer screening programmes, as determined by national situations Promote multisectoral and multi-stakeholder engagement in order to reverse, stop and decrease the rising trends of obesity in child, youth and adult populations, respectively Scale up, where appropriate, a package of proven, effective interventions, such as health promotion and primary prevention approaches, and galvanize actions for the prevention and control of NCDs through a meaningful multisectoral response, addressing risk factors and determinants of health 30 (a) (iii) Develop, strengthen and implement, as appropriate, multisectoral public policies and action plans to promote health education and health literacy, including through evidence-based education and information strategies and programmes in and out of schools and through public awareness campaigns, as important factors in furthering the prevention and control of NCDs, recognizing that a strong focus on health literacy is at an early stage in many countries 13 Private sector With a view to strengthening its contribution to NCD prevention and control, call upon the private sector, where appropriate, to: a) Take measures to implement WHO set of recommendations to reduce the impact of the marketing of unhealthy foods and non-alcoholic beverages to children, while taking into account existing national 43 (g) 43 (h) 43 (i) 43 (j) 43 (k) 45 (f) 43 (l) 43 (b) 44 Page 11 of 14

12 In the area of health care 14 Health systems By 2016, as appropriate, strengthen and orient health systems to address the prevention and control of NCDs and the underlying social determinants through people-centred primary health care and universal health coverage throughout the life cycle, building on guidance set out in appendix 3 to the WHO Global NCD Action Plan Essential medicines and technologies legislation and policies b) Consider producing and promoting more food products consistent with a healthy diet, including by reformulating products to provide healthier options that are affordable and accessible and that follow relevant nutrition facts and labelling standards, including information on sugars, salt and fats and, where appropriate, trans-fat content; c) Promote and create an enabling environment for healthy behaviours among workers, including by establishing tobacco-free workplaces and safe and healthy working environments through occupational safety and health measures, including, where appropriate, through good corporate practices, workplace wellness programmes and health insurance plans d) Work towards reducing the use of salt in the food industry in order to lower sodium consumption e) Contribute to efforts to improve access to and affordability of medicines and technologies in the prevention and control of NCDs 30 (c) Pursue, as appropriate, comprehensive strengthening of health systems that support primary health care and deliver effective, sustainable and coordinated responses and evidence-based, cost-effective, equitable and integrated essential services for addressing NCD risk factors and for the prevention, treatment and care of NCDs, acknowledging the importance of promoting patient empowerment, rehabilitation and palliative care for persons with NCDs and of a life course approach, given the often chronic nature of NCDs Promote the production, training and retention of health workers with a view to facilitating adequate deployment of a skilled health workforce within countries and regions, in accordance with the WHO Global Code of Practice on the International Recruitment of Health Personnel According to country-led prioritization, ensure the scaling-up of effective, evidence-based and cost-effective interventions that demonstrate the potential to treat individuals with NCDs, protect those at high risk of developing them and reduce risk across populations Recognize the importance of universal coverage in national health systems, especially through primary health care and social protection mechanisms, to provide access to health services for all, in particular for the poorest segments of the population According to national priorities, give greater priority to surveillance, early detection, screening, diagnosis and treatment of NCDs and prevention and control, and to improving accessibility to safe, affordable, effective and quality medicines and technologies to diagnose and to treat them; provide sustainable access to medicines and technologies, including through the development and use of evidence-based guidelines for the treatment of NCDs, and efficient procurement and distribution of medicines in countries; and strengthen viable financing options and promote the use of affordable 45 (b) 45 (j) 45 (m) 45 (n) 45 (l) Page 12 of 14

13 16 HIV/AIDS Consider the possible linkages between NCDs and some communicable diseases, such as HIV/AIDS, call for the integration, as appropriate, of responses to HIV/AIDS and NCDs, and in this regard call for attention to be given to people living with HIV/AIDS, especially in countries with a high prevalence of HIV/AIDS, in accordance with national priorities 17 Reproductive health 18 Other conditions 19 Monitor progress Continue to promote the inclusion of prevention and control of NCDs within programmes for sexual and reproductive health and maternal and child health, especially at the primary health-care level, as well as communicable disease programmes, such as those addressing tuberculosis, as appropriate Consider the synergies between major NCDs and other conditions as described in Appendix 1 to the WHO Global NCD Action Plan in order to develop a comprehensive response for the prevention and control of NCDs that also recognizes the conditions in which people live and work In the area of surveillance, monitoring and evaluation Monitor the trends and determinants of NCDs and evaluate progress in their prevention and control Assess progress towards attaining the voluntary global targets and report on the results using the indicators established in the comprehensive WHO global medicines, including generics, as well as improved access to preventive, curative, palliative and rehabilitative services, particularly at the community level Promote access to comprehensive and cost-effective prevention, treatment and care for the integrated management of NCDs, including, inter alia, increased access to affordable, safe, effective and quality medicines and diagnostics and other technologies, including through the full use of trade-related aspects of intellectual property rights (TRIPS) flexibilities Improve diagnostic services, including by increasing the capacity of and access to laboratory and imaging services with adequate and skilled manpower to deliver such services, and collaborate with the private sector to improve affordability, accessibility and maintenance of diagnostic equipment and technologies Encourage alliances and networks that bring together national, regional and global actors, including academic and research institutes, for the development of new medicines, vaccines, diagnostics and technologies, learning from experiences in the field of HIV/AIDS, among others, according to national priorities and strategies Strengthen health-care infrastructure, including for procurement, storage and distribution of medicine, in particular transportation and storage networks to facilitate efficient service delivery Recognize further the potential and contribution of traditional and local knowledge, and in this regard respect and preserve, in accordance with national capacities, priorities, relevant legislation and circumstances, the knowledge and safe and effective use of traditional medicine, treatments and practices, appropriately based on the circumstances in each country 30 (d) Call for the integration, as appropriate, of responses to HIV/AIDS and NCDs, and in this regard call for attention to be given to people living with HIV/AIDS, especially in countries with a high prevalence of HIV/AIDS, in accordance with national priorities 30 (e) Promote the inclusion of NCD prevention and control within sexual and reproductive health and maternal and child health programmes, especially at the primary health-care level, as well as other programmes, as appropriate, and also integrate interventions in these areas into NCD prevention programmes 30 (f) 30 (g) 30 (g) (i) 45 (p) 45 (q) 45 (r) 45 (s) 45 (h) (o) Page 13 of 14

14 20 Data and information 21 Surveillance and information systems monitoring framework, according to the agreed timelines, and use results from monitoring of the 25 indicators and 9 voluntary targets and other sources of data to inform and guide policy and programming, aiming to maximize the impact of interventions and investments on NCD outcomes Contribute information on trends in NCDs to WHO, according to the agreed timelines on progress made in the implementation of national action plans and on the effectiveness of national policies and strategies, coordinating country reporting with global analyses; Develop or strengthen, as appropriate, surveillance systems to track social disparities in NCDs and their risk factors as a first step to addressing inequalities, and pursue and promote gender-based approaches for the prevention and control of NCDs on the basis of data disaggregated by sex, age and disability, in an effort to address the critical differences in the risks of morbidity and mortality from NCDs for women and men 30 (g) (ii) 30 (g) (iii) Strengthen, as appropriate, country-level surveillance and monitoring systems, including surveys that are integrated into existing national health information systems and include monitoring exposure to risk factors, outcomes, social and economic determinants of health, and health system responses, recognizing that such systems are critical in appropriately addressing NCDs Strengthen, as appropriate, information systems for health planning and management, including through the collection, disaggregation, analysis, interpretation and dissemination of data and the development of population-based national registries and surveys, where appropriate, to facilitate appropriate and timely interventions for the entire population (k) Page 14 of 14