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Global status report on noncommunicable diseases 2014

December 31, 2014 World Health Organization

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GLOBAL STATUS REPORT on noncommunicable diseases 2014 “Attaining the nine global noncommunicable diseases targets; a shared responsibility”

Acknowledgements Under the aegis of Assistant Director General, Oleg Chestnov, the following people wrote and produced this report. Office of the Director General (advice and guidance) Anarfi Asamoa-Baah, Deputy Director General, Chris Dye, Ian Smith Lead author Shanthi Mendis. Chapter leads Tim Armstrong, Douglas Bettcher, Francesco Branca, Jeremy Lauer, Cecile Mace, Shanthi Mendis, Vladimir Poznyak, Leanne Riley, Vera Da Costa E Silva, Gretchen Stevens Project manager Kwok Cho Tang WHO staff in Geneva and Lyon Yulia Bakonina, Freddie Bray, Nick Banatvala, Melanie Bertram, Peter Beyer, Monika Bloessner, Alison A’Isha Commar, Edouard Tursan D’Espaignet, Mercedes De Onis, Alexandra Fleischmann, Silvia Franceschi, Etienne Krug, Chizuru Nishida, Colin Mathers, Bente Mikkelsen, Armando Peruga, Dag Rekve, Jane Robertsen, Gojka Roglic, Yasuyuki Sahara, Ruitai Shao, Andreas Ullrich, Meindert Van Hilten, Temo Waqanivalu, Christopher P Wild WHO staff in regional and country offices Regional Directors: African Region-Luis Sambo, Region of the Americas-Carissa Etienne, Eastern Mediterranean Region- Ala Alwan, European Region- Jakab Zsuzsanna, South-East Asia Region-Poonam Singh, Western Pacific Region-Young-soo Shin Other staff : Ibtihal Fadhil, Renu Garg, Gauden Galea, Anselm Hennis, Branca Legitic, Samer Jabbour, Frederiek Mantingh, Hai-Rim Shin, Susan Mercado, Steven Shongwe, Slim Slama, Elena Tsoyi, Cherian Varghese External reviewers and others George Alleyne, Robert Beaglegole, David Bramley, Joy Carrington, Rajiv Chowdhury, Michael Engelgau, Majid Ezzati, Charlie Foster, Oscar Franco, Valentin Fuster, Gerald Gartlehner, Danaei Goodarz, Vilius Grabauskas, Ian Graham, Murad Hassan, John Harold, Corinna Hawkes, Carl Heneghan, Konstantin Kotenko, Liming Li, Alan Lopez, Gabriel Masset, Jean Claude Mbanya, George Mensah, Rob Moodie, Venkat Narayan, Sania Nishtar, Srinath Reddy, Jurgen Rehm, Mike Rayner, Peter Scarborough, Yackoob Seedat, Surendra Shastri, Priya Shetty, Sidney Smith, Isolde Sommer, Laurence Sperling, David Stuckler, Doug Webb, Kremlin Wickramasinghe, David Wood, Qiao Youlin, Salim Yusuf Administrative support Fabienne Besson, Maritha Osekre-Amey, Joel Tarel, Roelof Wuite The printing of this publication was made possible through the generous fi nancial support of the Governments of Norway and the Russian Federation

WHO Library Cataloguing-in-Publication Data Global status report on noncommunicable diseases 2014. 1.Chronic Disease - prevention and control. 2.Chronic Disease - epidemiology. 3.Chronic Disease - mortality. 4.Cost of Illness. 5.Delivery of Health Care. I.World Health Organization. ISBN 978 92 4 156485 4 © World Health Organization 2014 All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications –whether for sale or for non-commercial distribution– should be addressed to WHO Press through the WHO website (www.who.int/about/licensing/copyright_form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Printed in Switzerland

(NLM classification: WT 500)

Contents Message from the Director-General Preface Abbreviations Executive summary Introduction Current status of the global agenda on prevention and control of noncommunicable diseases

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Chapter 1. Global target 1: A 25% relative reduction in the overall mortality from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases

Chapter 2. Global target 2: At least 10% relative reduction in the harmful use of alcohol, as appropriate, within the national context

Chapter 3. Global target 3: A 10% relative reduction in prevalence of insufficient physical activity

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Chapter 4. Global target 4: A 30% relative reduction in mean population intake of salt/sodium

Chapter 5. Global target 5: A 30% relative reduction in prevalence of current tobacco use

Chapter 6. Global target 6: A 25% relative reduction in the prevalence of raised blood pressure or contain the prevalence of raised blood pressure, according to national circumstances

Chapter 7. Global target 7: Halt the rise in diabetes and obesity

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Chapter 8. Global target 8: At least 50% of eligible people receive drug therapy and counselling (including glycaemic control) to prevent heart attacks and strokes

Chapter 9. Global target 9: An 80% availability of the affordable basic technologies and essential medicines, including generics, required to treat major noncommunicable diseases in both public and private facilities

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Chapter 10. Development and implementation of national multisectoral action plans to attain national targets

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Chapter 11. The way forward to attain NCD targets: key messages

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Annexes Annex 1. Global monitoring framework, including 25 indicators and nine voluntary global targets for the prevention and control of noncommunicable diseases

Annex 2. Methods used for estimating the NCD mortality and risk factor data

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Annex 3. List of countries by WHO Regions and World Bank Income Groups

Annex 4. Country estimates of noncommunicable disease mortality and selected risk factors, 2010 (baseline) and latest available data 4.1 Premature NCD Mortality Probability of dying between exact ages 30 and 70 from any of cardiovascular disease, cancer, diabetes, or chronic respiratory disease, 2010 and 2012 4.2 NCD mortality Comparable estimates of NCD mortality (total NCD deaths in 000s; % of NCD deaths occurring under the age of 70; and age-standardized death rate for NCDs per 100 000), 2012 4.3 Alcohol Comparable estimates, per capita consumption, heavy episodic drinking and prevalence of alcohol use disorders (population aged 15+ years), 2010 and 2012 4.4a Insufficient physical activity Comparable estimates of prevalence of insufficient physical activity (adults 18+ years), 2010 4.4b Insufficient physical activity Comparable estimates of prevalence of insufficient physical activity (adolescents 11-17 years), 2010 4.5 Tobacco Comparable estimates of prevalence of current tobacco smoking (population aged 15+ years), 2010 and 2012 4.6 Body mass index Comparable estimates of mean body mass index (adults 18+ years), 2010 and 2014

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4.7a Overweight and Obesity Comparable estimates of prevalence of overweight and obesity (population aged 18+ years), 2010 4.7b Overweight and Obesity Comparable estimates of prevalence of overweight and obesity (population aged 18+ years), 2014 4.8a Raised blood glucose Comparable estimates of prevalence of raised blood glucose (population aged 18+ years), 2010 4.8b Raised blood glucose Comparable estimates of prevalence of raised blood glucose (population aged 18+ years), 2014 4.9a Raised blood pressure Comparable estimates of prevalence of raised blood pressure (population aged 18+ years), 2010 4.9b Raised blood pressure Comparable estimates of prevalence of raised blood pressure (population aged 18+ years), 2014

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Message from the Director-General Dr Margaret Chan Director-General World Health Organization

The world has reached a decisive point in the history of noncommunicable diseases (NCDs) and has an unprecedented opportunity to alter its course. WHO Member States have agreed on a time-bound set of nine voluntary global targets to be attained by 2025. There are targets to reduce harmful use of alcohol, insufficient physical activity, salt/sodium intake, tobacco use and hypertension, halt the rise in diabetes and of obesity, and improve coverage of treatment for prevention of heart attacks and strokes. There is also a target for improved availability and affordability of technologies and essential medicines to manage NCDs. Countries need to make progress on all these targets to attain the overarching target of a 25% reduction of premature mortality from the four major NCDs by 2025. Out of the 38 million deaths due to NCDs in 2012, more than 40% were premature, affecting people under 70 years of age. The majority of premature NCD deaths are preventable. This report gives encouraging evidence that premature NCD deaths can indeed be significantly reduced worldwide. Deaths from cardiovascular diseases have been dramatically reduced in many high-income countries owing to government policies which facilitate the adoption of healthier lifestyles and provision of equitable health care. It is imperative that this favourable shift be sustained and, if possible, accelerated in developed countries and replicated in low- and middle-income countries. NCDs are driven by the effects of globalization on marketing and trade, rapid urbanization and population ageing – factors over which the individual has little control and over which the conventional health sector also has little sway. While individual behaviour change is important, tackling NCDs definitively requires leadership at the highest

levels of government, policy development that involve all government departments, and progress towards universal health coverage. The primary target audience of this report are Ministers of Health. The report provides information on voluntary global targets and how to scale up national efforts to attain them, in a sustainable manner. The 2010 baseline estimates on NCD mortality and risk factors are provided so that countries may begin reporting to WHO on progress made in attaining the targets, starting in 2015. The country case studies on successful prevention and control of NCDs highlighted in the report can be instructive for others facing similar challenges. As discussed in this report, there is an agreed set of very cost-effective – and globally applicable – NCD interventions for attaining all nine targets by 2025. Each country needs to apply them within its specific local conditions and contexts, drawing on the best available evidence. Ministers assembled at the United Nations General Assembly in July 2014, agreed that there are no reasons why any country – low- middle- or high-income – should delay moving forward with their implementation. Delay in taking action will result in worsening of the NCD burden and an increase in health-care costs. The most important message of the second global report on NCDs is that, today, the global community has the chance to change the course of the NCD epidemic. The world now has a truly global agenda for prevention and control of NCDs, with shared responsibilities for all countries based on concrete targets. This is an historic opportunity to tackle the NCD epidemic that no country can afford to miss.

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Preface Dr Oleg Chestnov Assistant Director-General Noncommunicable Disease and Mental Health World Health Organization

Noncommunicable diseases (NCDs) are one of the major health and development challenges of the 21st century, in terms of both the human suffering they cause and the harm they inflict on the socioeconomic fabric of countries, particularly low- and middle-income countries. No government can afford to ignore the rising burden of NCDs. In the absence of evidence-based actions, the human, social and economic costs of NCDs will continue to grow and overwhelm the capacity of countries to address them. Recognizing the devastating social, economic and public health impact of NCDs, in September 2011, world leaders adopted a political declaration containing strong commitments to address the global burden of NCDs and gave several assignments to the World Health Organization (WHO) to help support country efforts. One of them was the development of the WHO Global action plan for prevention and control of noncommunicable diseases 2013–2020 (known as the Global NCD Action Plan), including nine voluntary global targets and a global monitoring framework. The Global NCD Action Plan and the voluntary global targets were adopted by the World Health Assembly in 2013. The nine voluntary global NCD targets underscore the importance of prioritizing country action to reduce harmful use of alcohol, insufficient physical activity, salt/sodium intake, tobacco use and hypertension; halt the rise of obesity and diabetes; and improve coverage of treatment for prevention of heart attacks and strokes and access to basic technologies and medicines. In order to support the implementation of the Global NCD Action Plan, WHO has established a Global coordination mechanism, which will enhance coordination of NCD activities, multi-stakeholder engagement and action across different sectors.

Additional support for the implementation of the Global NCD Action Plan will be provided by the United Nations Interagency Task Force on the Prevention and Control of NCDs, established by the Secretary-General to coordinate the relevant United Nations organizations and other intergovernmental organizations. This second global status report comes at a time when only a decade is left to achieve the internationally agreed voluntary global NCD targets. It is also a time when we can be more optimistic about the future of prevention and control of NCDs, than perhaps at any stage in recent history. In order to attain the global NCD targets, governments, international partners and WHO will need to work together, sharing and exchanging evidence and information and taking necessary steps for reducing gaps in capacity and resources. No country should be left behind, as the world steps decisively into the future to address one of the greatest public health challenges of the 21st century.

Global status report on NCDs 2014

Abbreviations

BMI CTCA DALY ECOSOC HAI HbA1c HiAP ISH MET NCD NGO PAHO PEN SARA TAPS UK UN USA VIA WHA WHO WHO FCTC

body mass index Centre for Tobacco Control in Africa disability-adjusted life-year Economic and Social Council Health Action International haemoglobin A1c health in all policies (WHO framework) International Society of Hypertension metabolic equivalent noncommunicable disease nongovernmental organization Pan American Health Organization (WHO) package of essential noncommunicable disease interventions Service Availability and Readiness Assessment tobacco advertising, promotion and sponsorship United Kingdom of Great Britain and Northern Ireland United Nations United States of America visual inspection with acetic acid World Health Assembly World Health Organization WHO Framework Convention on Tobacco Control

Executive summary

This global status report is the second in a triennial series tracking worldwide progress in prevention and control of noncommunicable diseases (NCDs). The primary target audience of this report are ministers of health. Other target audiences include policy-makers in health and relevant non-health sectors, health officials, nongovernmental organizations, academia, development agencies and civil society. The human, social and economic consequences of NCDs are felt by all countries but are particularly devastating in poor and vulnerable populations. Reducing the global burden of NCDs is an overriding priority and a necessary condition for sustainable development. As the leading cause of death globally, NCDs were responsible for 38 million (68%) of the world’s 56 million deaths in 2012. More than 40% of them (16 million) were premature deaths under age 70 years. Almost three quarters of all NCD deaths (28 million), and the majority of premature deaths (82%), occur in low- and middle-income countries. During 2011–2025, cumulative economic losses due to NCDs under a “business as usual” scenario in low- and middle-income countries have been estimated at US$ 7 trillion. This sum far outweighs the annual US$ 11.2 billion cost of implementing a set of high-impact interventions to reduce the NCD burden. In September 2011, world leaders agreed on a roadmap of concrete commitments to address the global burden of NCDs, including a commitment to establish multisectoral action plans and policies for the prevention and control of NCDs. To accelerate national efforts to address NCDs, in 2013 the World Health Assembly adopted a comprehensive global monitoring framework with 25 indicators and nine voluntary global targets for 2025 (Annex 1). The World Health Assembly also endorsed a set of actions organized around the World Health Organization (WHO) Global action plan for the prevention and control of noncommunicable diseases 2013–2020 ( Global NCD Action Plan 2013–2020) which, when implemented collectively by Member States, international partners and WHO, will help to achieve the commitments made by world leaders in September 2011. The set of actions is organized around six objectives (see Box 1.2), aimed at strengthening national capacity, multisectoral action and boosting international cooperation to reduce exposure to risk factors, strengthen health systems, and monitor progress in attaining the global NCD targets. In July 2014, the United Nations General Assembly conducted a review to assess progress in implementing the 2011 Political Declaration, and recognized the progress achieved at national level since September 2011. Recognizing also that progress in implementing the roadmap of commitments included in the 2011 Political Declaration was insufficient and highly uneven, and that continued and increased efforts are essential, the members of the United Nations committed themselves to a set of measures within four priority areas – governance, prevention, health care, and surveillance and monitoring. These time-bound measures include setting national NCD targets consistent with global targets, developing national NCD multisectoral plans by

Global status report on NCDs 2014

2015, and starting implementation of those plans by 2016, in order to achieve the national targets. This global status report on prevention and control of NCDs (2014), is framed around the nine voluntary global targets. The report provides data on the current situation, identifying bottlenecks as well as opportunities and priority actions for attaining the targets. The 2010 baseline estimates on NCD mortality and risk factors are provided so that countries can report on progress, starting in 2015. In addition, the report also provides the latest available estimates on NCD mortality (2012) and risk factors (2010 and 2014). All ministries of health need to set national NCD targets and lead the development and implementation of policies and interventions to attain them. There is no single pathway to attain NCD targets that fits all countries, as they are at different points in their progress in the prevention and control of NCDs and at different levels of socioeconomic development. However all countries can benefit from the comprehensive response to attaining the voluntary global targets presented in this report.

implementation of the very cost-effective policy options and interventions (“best buys”) would have to be accorded the highest priority.

Global target 2: At least 10% relative reduction in the harmful use of alcohol as appropriate, within the national context In 2012, an estimated 5.9% (3.3 million) of all deaths worldwide and 5.1% of disability-adjusted life years (DALYs) were attributable to alcohol consumption. More than half of these deaths resulted from NCDs. The level of alcohol consumption worldwide in 2010 was estimated at 6.2 litres of pure alcohol per person aged 15 years and over (equivalent to 13.5 g of pure alcohol per day). The prevalence of heavy episodic drinking is associated with the overall levels of alcohol consumption and is highest in the WHO European Region and the Region of the Americas. There are cost-effective policy options to reduce the harmful use of alcohol. They include pricing policies, reduced availability and marketing of alcohol, improved response by health services, and drink-driving policies and countermeasures. Individual interventions such as screening for harmful drinking and treatment of alcohol dependence are also effective, although they are more costly to implement than population-based measures. As discussed in Chapter 2, a certain amount of progress in addressing the harmful use of alcohol has been made since the Global strategy to reduce the harmful use of alcohol was endorsed by the World Health Assembly in 2010. Increasing numbers of countries have developed or reformulated their national alcohol policies and action plans. Of 76 countries with a written national policy on alcohol, 52 have taken steps to operationalize it. Some 160 WHO Member States have regulations on age limits for sale of alcoholic beverages.

Global target 1: A 25% relative reduction in overall mortality from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases Progress in attaining all other targets contributes to the attainment of this overarching target on premature mortality. Chapter 1 presents 2012 mortality data that show that (i) NCDs affect all countries; (ii) their impact is particularly severe in low- and middle-income countries; and (iii) the majority of premature NCD deaths occur in low- and middle-income countries. The ability to meet this target will vary greatly across the world. While low- and middle-income countries could use a target of 25%, high-income countries that are already showing a decline in major NCDs may want to set their targets higher than 25%. Chapter 1 outlines the comprehensive, multisectoral policy actions, interventions and country capacity, including civil/vital registration and surveillance systems, required to attain this target. The shortage of resources in many countries means that

Global target 3: A 10% relative reduction in the prevalence of insufficient physical activity Insufficient physical activity contributes to 3.2 million deaths and 69.3 million DALYs each year. Adults who are insufficiently physically active have a higher risk of all-cause mortality compared with

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Executive summary

those who do at least 150 minutes of moderate-intensity physical activity per week, or equivalent, as recommended by WHO. Regular physical activity reduces the risk of ischaemic heart disease, stroke, diabetes, and breast and colon cancer. In 2010, 23% of adults aged 18 years and over were insufficiently physically active. Women were less active than men and older people were less active than younger people. Globally, 81% of adolescents aged 11–17 years were insufficiently physically active in 2010. Adolescent girls were less active than adolescent boys, with 84% versus 78% not meeting the WHO recommendation of 60 minutes of physical activity per day. Several high-income countries have reported increased physical activity over the past decade as a result of national policies and programmes to improve physical activity. In recent years, more low- and middle-income countries have also set up initiatives to address physical inactivity. Reaching the physical activity target requires multisectoral collaboration between transport, urban planning, recreation, and sports and education departments, to create safe environments that are conducive to physical activity for all age groups.

As discussed in Chapter 4, establishing a baseline of salt intake is key to setting national targets and devising effective consumer campaigns. Sodium-reduction targets need to be established for each category of food, prioritizing the ones that contribute most to population intake. Policies aimed at reducing population-wide salt consumption should be intersectoral and multidisciplinary and include the participation of all relevant stakeholders. They should be applicable to diverse settings and make use of all available tools, including labelling, legislation, product reformulation, fiscal incentives that encourage the production and consumption of foods with reduced sodium content, and consumer education to ensure their effective implementation. Considerable progress has been made in implementing these activities in some countries.

Global target 5: A 30% relative reduction in prevalence of current tobacco use in persons aged 15+ years It is estimated that currently around 6 million people die annually from tobacco use, with over 600 000 deaths due to exposure to second-hand smoke. Measures to ensure reduction in tobacco use include: protecting people from second-hand smoke through national “100% smoke-free” legislation; offering help in quitting tobacco use, warning people about the dangers of tobacco use; enforcing bans on tobacco advertising, promotion and sponsorship; and raising tobacco taxes. Considerable progress has been made in global tobacco control in recent years, in both the number of countries protecting their population and the number of people worldwide protected by effective tobacco-control measures. In 2013, 95 countries had implemented at least one of the four tobacco control “best-buy” interventions (very cost-effective interventions), at the highest level of achievement, and two countries had all four “best-buys” in place at the highest level. Many of the countries making progress in implementing “best-buy” measures were low- or middle-income countries.

Global target 4: A 30% relative reduction in the mean population intake of salt /sodium Excess consumption of dietary sodium is associated with increased risk of hypertension and cardiovascular disease. Globally, 1.7 million annual deaths from cardiovascular causes have been attributed to excess sodium intake. Current estimates suggest that the global mean intake of salt is around 10 g daily (4 g/day of sodium). WHO recommends a reduction in salt intake to less than 5 g/day (2 g/ day of sodium), to reduce blood pressure and the risk of coronary heart disease and stroke. The main source of salt in many countries is processed foods and ready-made meals, while salt added during the preparation of food at home and at the table is significant in others. With the greater availability of processed foods in low- and middle-income countries, sources of sodium are shifting rapidly towards these foods.

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As discussed in Chapter 5, more work is needed in many countries to pass and enforce effective tobacco-control measures. This includes expanding activities to implement “best-buy” demand-reduction measures at the highest level of achievement, where they have not been yet implemented; reinforcing and sustaining existing programmes to incorporate a full range of measures; and, ultimately, implementing the full WHO Framework Convention on Tobacco Control. The achievements of the majority of countries in applying tobacco demand-reduction measures demonstrate that it is possible to tackle the tobacco epidemic irrespective of a country’s size or level of development.

these modifiable risk factors. In addition, integrated programmes need to be established at the primary care level, to improve the efficiency and effectiveness of detection and management of hypertension and other cardiovascular risk factors through a total-risk approach, as recommended by WHO.

Global target 7: Halt the rise in diabetes and obesity Obesity increases the likelihood of diabetes, hypertension, coronary heart disease, stroke and certain types of cancer. Worldwide, the prevalence of obesity has nearly doubled since 1980. In 2014, 11% of men and 15% of women aged 18 years and older were obese. More than 42 million children under the age of 5 years were overweight in 2013. The global prevalence of diabetes in 2014 was estimated to be 9%. Obesity and diabetes can be prevented through multisectoral action that simultaneously addresses different sectors that contribute to the production, distribution and marketing of food, while concurrently shaping an environment that facilitates and promotes adequate levels of physical activity. Diabetes risk can be reduced by moderate weight loss and moderate daily physical activity in persons at high risk. This intervention has been scaled up to the whole population in a small number of high-income countries. However, it is difficult to implement this intervention at scale in low- and middle-income countries, partly because current methods for identifying people at high risk are cumbersome and rather costly. Further research is urgently needed to evaluate the effectiveness of interventions to prevent obesity and diabetes.

Global target 6: A 25% relative reduction in the prevalence of raised blood pressure, or contain the prevalence of raised blood pressure, according to national circumstances Raised blood pressure is estimated to have caused 9.4 million deaths and 7% of disease burden – as measured in DALYs – in 2010. If left uncontrolled, hypertension causes stroke, myocardial infarction, cardiac failure, dementia, renal failure and blindness. There is strong scientific evidence of the health benefits of lowering blood pressure through population-wide and individual (behavioural and pharmacological) interventions. The global prevalence of raised blood pressure (defined as systolic and/or diastolic blood pressure equal to or above 140/90 mmHg) in adults aged 18 years and over was around 22% in 2014. Many modifiable factors contribute to the high prevalence rates of hypertension. They include eating food containing too much salt and fat, inadequate intake of fruits and vegetables, overweight and obesity, harmful use of alcohol, physical inactivity, psychological stress, socioeconomic determinants, and inadequate access to health care. Worldwide, detection, treatment and control of hypertension are inadequate, owing to weaknesses in health systems, particularly at the primary care level. In order to achieve this target, population-wide policies and interventions are required to address

Global target 8: At least 50% of eligible people receive drug therapy and counselling (including glycaemic control) to prevent heart attacks and strokes Cardiovascular disease was the leading cause of NCD deaths in 2012 and was responsible for 17.5 million deaths, or 46% of NCD deaths. Of these deaths, an estimated 7.4 million were due to heart attacks (ischaemic heart disease) and 6.7 million were due to strokes.

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Executive summary

This target to reduce heart attacks and strokes is aimed at improving the coverage of drug treatment and counselling in people with raised cardiovascular risk and established disease. It is an affordable intervention that can be delivered through a primary health-care approach, even in resource-constrained settings There are major gaps in the coverage of this intervention to prevent heart attacks and strokes, particularly in low- and middle-income countries. Poor access to basic services in primary care, lack of affordability of laboratory tests and medicines, inappropriate patterns of clinical practice, and poor adherence to treatment are some of the main reasons for these treatment gaps. This intervention to prevent heart attacks and strokes needs to be part of the basic benefits package for moving towards universal health coverage. In addition, context-specific strategies will be required to address multiple gaps in health systems related to access to basic technologies and medicines, the health workforce, service delivery, health information, and referral, with a special focus on primary care. Several countries have already included this intervention in the basic benefits package, and have taken steps to implement it through a primary health care approach.

Global target 9: An 80% availability of the aﬀordable basic technologies and essential medicines, including generics, required to treat major noncommunicable diseases in both public and private facilities This target includes the basic requirement of technologies and medicines for implementing cost-effective primary care interventions to address cardiovascular disease, diabetes and asthma. The essential medicines include aspirin, a statin, an angiotensin-converting enzyme inhibitor, a thiazide diuretic, a long-acting calcium channel-blocker, a beta-blocker, metformin, insulin, a bronchodilator and a steroid inhalant. The basic technologies include, at least, a blood pressure measurement device, a weighing scale, height measuring equipment, blood sugar and blood cholesterol

measurement devices with strips, and urine strips for albumin assay. These are minimum requirements, without which even basic NCD interventions cannot be implemented in primary care. Currently, there are major gaps in the affordability and availability of basic health technologies and essential medicines, particularly in low- and middle-income countries. The lack of access means that patients delay seeking care and either develop complications unnecessarily or pay high out-of-pocket costs, which can financially devastate households. Sustainable health financing is necessary to ensure adequate and reliable procurement and distribution systems to guarantee the supply of technologies and essential NCD medicines to all levels of health care, including primary care. Consequently, national policies that encourage the availability of basic health technologies and essential medicines should be central to efforts focused on achieving universal health coverage. Drugs must also be used appropriately, so there must be adherence to evidence-based guidelines and education in rational use for both health-care professionals and patients. Policies and interventions to attain the nine targets (see Chapters 1–9), should be given high priority and budgeted in national multisectoral NCD action plans. Chapter 10, on the development of a national multisectoral NCD plan, highlights the key NCD domains that should be covered: governance, prevention and reduction of risk factors, health care, and surveillance and monitoring. To maximize the chances of effective implementation, the process of development of the plan must necessarily engage all stakeholders in health and non-health sectors, including civil society and the private sector. The final chapter presents the way forward to attain the nine voluntary global targets by 2025, and highlights the key messages of this report.

Message 1: Noncommunicable diseases act as key barriers to poverty alleviation and sustainable development The data presented in this report demonstrate that NCDs affect all countries and that the burden of

Global status report on NCDs 2014

death and disease is heavily concentrated in low- and middle-income countries. Loss of productivity due to premature deaths, and the individual and national costs of addressing NCDs, act as important barriers to poverty reduction and sustainable development. Progress in attaining the NCD targets is therefore vital for attaining the sustainable development goals.

Message 2: While some countries are making progress, the majority are oﬀ course to meet the global NCD targets As many motivational case-studies illustrate, countries in which political leaders have shown high commitment are already making significant advances in addressing NCDs. However, progress remains uneven and inadequate. Data presented in this report identify many missed opportunities to strengthen governance, prevention and reduction of risk factors, health care, and surveillance and monitoring, particularly in low- and middle-income countries.

NCDs. All countries need to set national targets and establish a monitoring framework to track progress in attaining them. Since the global targets focus on a limited set of key NCD outcomes, setting national targets and implementing policies and interventions to attain them will enable countries to make the best use of resources. For best results, lessons learnt from implementation should be rapidly incorporated in decision-making, through operational research.

Message 3: Countries can move from political commitment to action by prioritizing high-impact, aﬀordable interventions It is evident that a lack of interventions is clearly not the primary obstacle for inadequate progress in prevention and control of NCDs. High rates of death and disease, particularly in low- and middle-income countries, are a reflection of inadequate investment in cost-effective NCD interventions. Resources should be used strategically to improve NCD outcomes. All countries can move from commitment to action, by prioritized implementation of very cost-effective policies and interventions (“best buys”).

Message 6: Investment in health systems is critical for improving NCD outcomes Analysis of health systems shows that gaps in the key elements of the health system, particularly at the primary care level present obstacles to the provision of equitable health care for people suffering from NCDs. Health-system strengthening – including health financing, governance, the health workforce, health information, access to basic technologies and essential medicines, and health-service delivery – should be a major focus of scaling up NCD prevention and control. The global move towards universal health coverage offers an opportunity to explicitly prioritize very cost-effective NCD interventions in basic benefits packages.

Message 4: All countries need to set national NCD targets and be accountable for attaining them The nine voluntary global targets give a clear signal of where the world can be by 2025 in relation to

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Executive summary

Message 7: Institutional and human resource capacities and ﬁnancial resources for NCD prevention and control require strengthening Attainment of national targets requires institutional and human resources capacity as well as adequate financial resources to deal with the complexity of issues relating to NCD prevention and control, such as interaction with food and agricultural systems, law, trade, transport and urban planning. The competency and capacity of the health workforce to address NCDs will require strengthening, including through incorporation of public health aspects of NCD prevention and control in the teaching curricula for medical, nursing and allied health personnel, and provision of in-service training. While governments must continue to recognize their primary responsibility in responding to the challenge of NCDs, setting their national targets and developing their national plans of action, achieving the global targets will require the efforts and engagement of all sectors of society at national, regional and global levels. There are new global mechanisms in place to accelerate national NCD action. The United Nations Interagency Task Force on the Prevention and Control of NCDs, which the Secretary-General established in June 2013 and placed under the leadership of WHO, is coordinating the activities of the relevant United Nations organizations and other intergovernmental organizations to support the realization of the commitments made by world leaders in the 2011 Political Declaration on NCDs, in particular through the implementation of the WHO Global NCD Action Plan 2013–2020. The Task Force’s terms of reference were adopted by the United Nations Economic and Social Council in July 2014. In September 2014, WHO established the WHO Global Coordination Mechanism on the Prevention and Control of NCDs, to facilitate and enhance coordination of activities, multi-stakeholder engagement and action across sectors at the local, national, regional and

global levels, in order to contribute to the implementation of the WHO Global NCD Action Plan 2013-2020. WHO has a leadership and coordination role to play in promoting and monitoring action against NCDs. As the primary specialized United Nations agency for health, WHO will continue to support national NCD efforts to implement the Global NCD Action Plan 2013–2020. Key areas of continued action in 2015 and beyond include, providing global leadership and offering technical assistance to Member States to set national targets, develop and implement national NCD policies and plans to reach these national targets, and assess trends and monitor progress. In 2015, WHO plans to complete work on a framework to promote country action across health and non-health sectors, as well as on an approach to register and publish contributions of non-state actors to the achievement of the nine voluntary global targets. The global architecture and the commitment of countries to address effectively the NCD epidemic have never been better. Attainment of the nine global NCD targets by 2025 will help to curb the rapid growth and devastating health and socioeconomic impacts of the NCD epidemic. It is a huge task, fraught with many challenges. However, inaction will not be forgiven by future generations. They will have the right to ask why decisive action was not taken, if we allow this chance of altering history to slip through our fingers.

xvii

Introduction: Current status of the global agenda on prevention and control of noncommunicable diseases The adverse human, social and economic consequences of noncommunicable diseases (NCDs) are felt by all societies and economies, but they are particularly devastating in poor and vulnerable populations (1−4). Since the first global status report on NCDs (2010) was published (3), the global agenda on NCDs has moved forward considerably (see Fig I.1). In September 2011, at a United Nations high-level meeting on NCDs, heads of state and government formally recognized these diseases as a major threat to economies and societies and placed them high on the development agenda. That meeting agreed on a bold set of commitments to address the global burden of NCDs (5). In order to translate these commitments into action, in May 2013 the Sixty-sixth World Health Assembly adopted the Global action plan for the prevention and control of noncommunicable diseases 2013−2020 (known as the Global NCD Action Plan) and a comprehensive global monitoring framework, including a set of nine voluntary global targets (see Box I.1) and 25 indicators (see Annex 1) (1). This second World Health Organization global status report on noncommunicable diseases (2014) is structured according to these nine voluntary global targets, which will need to be attained by 2025 if the world is to realize the commitments made in the United Nations’ Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases (5). Fig. I.1 Global milestones in the prevention and control of noncommunicable diseases

Global status report on NCDs 2014

Box I.1 Voluntary global targets for prevention and control of noncommunicable diseases to be attained by 2025 (1) A 25% relative reduction in the overall mortality from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases (2) At least 10% relative reduction in the harmful use of alcohol, as appropriate, within the national context

(3) A 10% relative reduction in prevalence of insuﬃcient physical activity

(4) A 30% relative reduction in mean population intake of salt/sodium

(5) A 30% relative reduction in prevalence of current tobacco use

(6) A 25% relative reduction in the prevalence of raised blood pressure or contain the prevalence of raised blood pressure, according to national circumstances

(7) Halt the rise in diabetes and obesity (8) At least 50% of eligible people receive drug therapy and counselling (including glycaemic control) to prevent heart attacks and strokes (9) An 80% availability of the aﬀordable basic technologies and essential medicines, including generics, required to treat major noncommunicable diseases in both public and private facilities

The 2011 Political Declaration (5) was one of the major global milestones in the prevention and control of NCDs (see Fig. I.1). It reaffirmed the leadership and coordination role of the World Health Organization (WHO) and gave it several timebound assignments, which have been completed, as set out below.. The Global NCD Action Plan builds on key strategies and resolutions (6−16). It has six objectives (see Box I.2), each offering a menu of policy options and actions for implementation by Member States, international partners and WHO.

The overarching goal of the Global NCD Action Plan is to achieve the 2025 voluntary global targets (see Box I.1). There has been remarkable progress in implementing the first objective of the plan. International cooperation and advocacy have raised the priority accorded to prevention and control of NCDs. Addressing NCDs is now recognized as a priority not only for health but also for social development and investments in people (17−28). An NCD target has been incorporated in the sustainable development goals and NCDs are poised to be an integral component of the post-2015 development agenda (29). Progress in implementation of the other objectives

Introduction

Box I.2 Objectives of the Global NCD Action Plan (1) 1. To raise the priority accorded to the prevention and control of NCDs in global, regional and national agendas and internationally agreed development goals, through strengthened international cooperation and advocacy. 2. To strengthen national capacity, leadership, governance, multisectoral action and partnerships to accelerate country response for the prevention and control of NCDs. 3. To reduce modiﬁable risk factors for NCDs and underlying social determinants through creation of health-promoting environments. 4. To 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. 5. To promote and support national capacity for high-quality research and development for the prevention and control of NCDs. 6. To monitor the trends and determinants of NCDs and evaluate progress in their prevention and control.

of the Global NCD Action Plan, and attainment of the global targets, are largely determined by target-oriented action, capacity and resources at country level. The aim of this global status report on NCDs is to further support the implementation of the Global NCD Action Plan by: ■ providing information on voluntary global targets and national NCD targets and advice on how to scale up national efforts to attain them in the context of implementation of multisectoral national action plans; ■ providing the 2010 baseline estimates on NCD mortality and risk factors (see Annexes 2-4), so that countries may begin reporting to WHO on progress made in attaining the targets, starting in 2015; ■ providing the latest available estimates on NCD mortality (2012) and risk factors (see Annexes 2-4); ■ presenting case-studies of successful country and regional action, to demonstrate how implementation barriers could be overcome at the country level to attain national targets (see Chapters 1-11). The primary target audience of this report are ministers of health. Other target audiences include policy-makers in health and relevant non-health sectors, health officials, nongovernmental organizations, academia, development agencies and civil society.

Since the United Nations high-level meeting, WHO – through its governing bodies and with the participation of Member States – has also completed other global assignments (30) that will support the implementation of the action plan at global, regional and country levels. These assignments include the development of: ■ a limited set of action plan indicators for monitoring progress in implementing the Global NCD Action Plan; ■ the terms of reference for the United Nations Interagency Task Force for the Prevention and Control of NCDs, established by the Secretary-General; ■ the terms of reference for the global coordination mechanism for prevention and control of NCDs. The Interagency Task Force has been established to facilitate the response of the United Nations system to country demand for technical assistance. It will be convened by WHO and will report to the Economic and Social Council (ECOSOC) through the Secretary-General (31). The purpose of the global coordination mechanism is to facilitate and enhance coordination of activities, multistakeholder engagement, and action, across sectors at global, regional and national levels. The aim will be to contribute to the implementation of the Global NCD Action Plan, while avoiding

Global status report on NCDs 2014

Box I.3 Key messages of the Global Status Report on Noncommunicable diseases 2014 Message 1 Message 2 Message 3 Message 4 Message 5 Message 6 Message 7 Noncommunicable diseases act as key barriers to poverty alleviation and sustainable development While some countries are making progress, the majority are oﬀ course to meet the global NCD targets Countries can move from political commitment to action by prioritizing high-impact, aﬀordable interventions All countries need to set national NCD targets and be accountable for attaining them Structures and processes for multisectoral and intersectoral collaboration need to be established Investment in health systems is critical for improving NCD outcomes Institutional and human resource capacities and ﬁnancial resources for NCD prevention and control require strengthening.

duplication of efforts and using resources efficiently (32). On 10−11 July 2014, the United Nations General Assembly conducted a comprehensive review, taking stock of progress in implementing the commitments of the Political Declaration (5), identifying ways to address gaps, and reaffirming political commitment to respond to the challenge of NCDs (33). The commitments made by countries in the outcome document include the following: Building on the guidance provided by the WHO Global NCD Action Plan 2013−2020 (1): ■ integrate NCDs into health planning and national development plans; ■ by 2015, set national NCD targets for 2025, consistent with voluntary global targets; ■ by 2015, develop national NCD multisectoral plans to achieve the national targets; ■ by 2016, implement policies and interventions to reduce NCD risk factors and underlying social determinants; ■ by 2016, strengthen and orient health systems to address NCDs, through people-centred primary health care and universal health coverage; ■ report on the progress in attaining the global targets, using the established indicators in the global monitoring framework. Member States have agreed that the United Nations will convene a third high-level meeting on NCDs in 2018 to take stock of national progress

(33). As discussed in this report, much remains to be done in all countries, and especially in donor-dependent nations, to attain the voluntary global targets by 2025 (see Box I.3). There is no single pathway to attain NCD targets that fits all countries, as they are at different points in their progress in the prevention and control of NCDs and at different levels of socioeconomic development. However all countries can benefit from the information and guidance presented in this report, on voluntary global targets and national NCD targets and how to scale up national efforts to attain them.

Introduction

References 1. Global action plan for the prevention and control of noncommunicable diseases 2013−2020. Geneva: World Health Organization; 2013 (http://apps.who. int/iris/bitstream/10665/94384/1/9789241506236_ eng.pdf?ua=1, accessed 3 November 2014). 2. Global strategy for prevention and control of noncommunicable diseases. Geneva: World Health Organization; 2000 (http://apps.who.int/gb/archive/ pdf_files/WHA53/ResWHA53/17.pdf, accessed 3 November 2014). 3. Global status report on noncommunicable diseases 2010. Geneva: World Health Organization; 2011 (http://www.who.int/nmh/publications/ncd_report_ full_en.pdf, accessed 3 November 2014). 4. From burden to “best buys”: reducing the economic impact of non-communicable diseases in low- and middle-income countries. Geneva: World Health Organization and World Economic Forum; 2011 (www.who.int/nmh/publications/best_buys_summary, accessed 3 November 2014). 5. Resolution 66/2. Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. In: Sixty-sixth session of the United Nations General Assembly. New York: United Nations; 2011 (A/67/L.36; http://www. who.int/nmh/events/un_ncd_summit2011/political_ declaration_en.pdf, accessed 3 November 2014). 6. WHO Framework Convention on Tobacco Control. Geneva: World Health Organization; 2003 (http:// whqlibdoc.who.int/publications/2003/9241591013. pdf, accessed 3 November 2014). 7. Resolution WHA57.17. Global strategy on diet, physical activity and health. In: Fift y-seventh World Health Assembly, Geneva, 17−22 May 2004. Geneva: World Health Organization; 2004 (http://apps.who. int/gb/ebwha/pdf_fi les/WHA57/A57_R17-en.pdf, accessed 3 November 2014). 8. Resolution WHA63.13. Global strategy to reduce the harmful use of alcohol. In: Sixty-third World Health Assembly, Geneva, 17−21 May 2010. Geneva: World Health Organization; 2010 (http:// apps.who.int/gb/ ebwha/pdf_files/WHA63/A63_R13-en.pdf, accessed 22 October 2014). 9. Resolution WHA64.9. Sustainable health financing structures and universal health coverage. In: Sixtyfourth World Health Assembly, Geneva, 16−24 May 2011. Geneva: World Health Organization; 2011 (http:// apps.who.int/gb/ebwha/pdf_files/WHA64/A64_R9-en. pdf, accessed 3 November 2014). 10. Global strategy and plan of action on public health innovation and intellectual property. Geneva: World Health Organization; 2011 (http://www.who.int/ phi/publications/Global_Strategy_Plan_Action.pdf, accessed 3 November 2014). 11. Consideration and endorsement of the Brazzaville Declaration on Noncommunicable Diseases. In: Sixty-second session of the Regional Committee for Africa, Luanda, Republic of Angola, 19–23 November 2012. Brazzaville: WHO Regional Office for Africa; 2012 (AFR/RC62/R7; http://apps.who.int/ iris/bitstream/10665/80117/1/AFR-RC62-R7-e.pdf, accessed 3 November 2014). 12. Resolution CSP28.R13. Strategy for the Prevention and Control of Noncommunicable Diseases. In: 28th Pan American Sanitary Conference; 64th Session of the Regional Committee, Washington DC, USA, 17–21 September 2012. Washington, DC: Pan American Health Organization; 2012 (http://www.paho.org/ hq/index.php?option=com_docman&task=doc_ view&gid=19265&Itemid=721, accessed 3 November 2014). 13. Resolution EMR/RC59/R2. The Political Declaration of the United Nations General Assembly on the Prevention and Control of Non-Communicable Diseases: commitments of Member States and the way forward. In: Fift y-ninth session of the Regional Committee for the Eastern Mediterranean, October 2012. Cairo: WHO Regional Office for the Eastern Mediterranean; 2012 (http://applications.emro. who.int/docs/RC_Resolutions_2012_2_14692_ EN.pdf?ua=1, accessed 3 November 2014). 14. Resolution EUR /RC61/12. Action plan for implementation of the European Strategy for the Prevention and Control of Noncommunicable Diseases 2012–2016. In: Sixty-first session of the Regional Committee for Europe, Baku, Azerbaijan 12–15 September 2011. Copenhagen: WHO Regional Office for Europe; 2011 (http://www.euro.who.int/__data/ assets/pdf_file/0003/147729/wd12E_NCDs_111360_ revision.pdf?ua=1, accessed 3 November 2014). 15. Resolution SEA/RC65/R5. Noncommunicable diseases, mental health and neurological disorders. Delhi: WHO Regional Office for South-East Asia; 2012 (http://www.searo.who.int/entity/noncommunicable_ diseases/events/regional_consultation_ncd/ documents/8_3_resolution.pdf, accessed 3 November 2014). 16. Resolution WPR /RC62.R 2. Expanding and intensifying noncommunicable disease prevention and control. Manila: WHO Regional Office for the Western Pacific; 2011 (http://www2.wpro.who.int/NR/ rdonlyres/D80E593C-E7E6-4A4F-B9DF-07B76B284E5A/0/ R2Noncommunicablediseasepreventionandcontrol201112. pdf, accessed 3 November 2014).

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17. Resolution A/67/L.36. Global health and foreign policy. In: Sixty-seventh session of the United Nations General Assembly, 6 December 2012. New York: United Nations; 2012 (http://www.un.org/ga/search/ view_doc.asp?symbol=A/67/L.36&referer=http:// www.un.org/en/ga/info/draft/index.shtml&Lang=E, accessed 3 November 2014). 18. Resolution A/RES/66/288. The future we want. In: Sixty-sixth session of the United Nations General Assembly, 11 September 2012. New York: United Nations; 2012 (http://imuna.org/sites/default/fi les/ ARES66288.pdf, accessed 3 November 2014). 19. Report of the UN System Task Team on the Post-2015 Development Agenda. Realizing the future we want for all. New York: United Nations; 2012 (http://www. un.org/en/development/desa/policy/untaskteam_ undf/report.shtml, accessed 3 November 2014). 20. A new global partnership: eradicate poverty and transform economies through sustainable development. The report of the High-Level Panel of Eminent Persons on the Post-2015 Development Agenda. New York: United Nations; 2013 (http:// www.post2015hlp.org/wp-content/uploads/2013/05/ UN-Report.pdf, accessed 3 November 2014). 21. A life of dignity for all: accelerating progress towards the Millennium Development Goals and advancing the United Nations development agenda beyond 2015. In: Sixty-eighth session of the United Nations General Assembly, 26 July 2013. New York: United Nations; 2013 (A/68/202; http://www.un.org/millenniumgoals/ pdf/A%20Life%20of%20Dignity%20for%20All.pdf, accessed 3 November 2014). 22. Declaration of Port-of-Spain: uniting to stop the epidemic of chronic NCDs. Georgetown: Caribbean Community; 2011 (http://www.caricom.org/jsp/ communications/meetings_statements/declaration_ port_of_spain_chronic_ncds.jsp, accessed 3 November 2014). 23. International Conference on Healthy Lifestyles and Noncommunicable Diseases in the Arab World and the Middle East. The Riyadh Declaration. Cairo: WHO Regional Office for the Eastern Mediterranean; 2012 (http://www.emro.who.int/images/stories/ncd/ documents/Riyadh_Declaration.Final_bilingual. pdf?ua=1, accessed 22 October 2014). 24. Vie n n a D e c l a r at ion on Nut r it ion a nd Noncommunicable Diseases in the Context of Health 2020. WHO Ministerial Conference on Nutrition and Noncommunicable Diseases, Vienna, Austria, 4–5 July 2013. Copenhagen: WHO Regional Office for Europe; 2013 (http://www.euro.who.int/__data/ assets/pdf_file/0003/234381/Vienna-Declaration-onNutrition-and-Noncommunicable-Diseases-in-theContext-of-Health-2020-Eng.pdf?ua=1, accessed 3 November 2014).

25. Seoul Declaration on Noncommunicable Disease Prevention and Control in the Western Pacific Region. Manila: WHO Regional Office for the Western Pacific; 2011 (http://www.who.int/entity/nmh/events/2011/ seoul_decl_20110318.pdf?ua=1, accessed 3 November 2014). 26. Libreville Declaration on Health and Environment in Africa. Brazzaville: WHO Regional Office for Africa; 2008 (http://w w w.afro.who.int/ index.php?option=com_docman&task=doc_ download&gid=3286, accessed 3 November 2014). 27. H o n i a r a C o m mu n i q u é o n t h e P a c i f i c Noncommunicable Disease Crisis. Ninth meeting of Ministers of Health for the Pacific Island Countries, 30 June 2011. Manila: WHO Regional Office for the Western Pacific; 2011 (http://www.wpro.who.int/ noncommunicable_diseases/honiara_communique. pdf, accessed 3 November 2014). 28. Moscow Declaration. First Global Ministerial C on fe re nc e on He a lt hy L i fe s t y le s a nd Noncommunicable Disease Control Moscow, 28−29 April 2011. New York: United Nations; 2011 (http:// www.un.org/en/ga/president/65/issues/moscow_ declaration_en.pdf, accessed 3 November 2014). 29. United Nations General Assembly Resolution A/68/970. Integrated and coordinated implementation of and follow-up to the outcomes of the major United Nations conferences and summits in the economic, social and related fields. Sustainable development: implementation of Agenda 21, the Programme for the Further Implementation of Agenda 21 and the outcomes of the World Summit on Sustainable Development and of the United Nations Conference on Sustainable Development 2014. In: Sixty-eighth session of the United nations General Assembly, 12 August 2014. New York: United Nations; 2014 (A/69/970; http://www.unesco.org/new/fi leadmin/ MULTIMEDIA/FIELD/Santiago/pdf/OpenWorking-Group.pdf, accessed 3 November 2014). 30. Note by the Secretary-General transmitting the report of the Director-General of the World Health Organization on the prevention and control of noncommunicable diseases. In: Sixty-eighth session of the United Nations General Assembly, 10 December 2013. New York: United Nations; 2013 (A/68/650; http://daccess-dds-ny.un.org/doc/UNDOC/GEN/ N13/612/99/PDF/N1361299.pdf?OpenElement, accessed 3 November 2014). 31. United Nations Economic and Social Council Document E/2013/L.23. United Nations Interagency Task Force on the Prevention and Control of Noncommunicable Diseases. Geneva: United Nations; 2013 (http://www.who.int/nmh/events/2013/E.2013.L.23_ tobacco.pdf, accessed 3 November 2014).

Introduction

32. Provisional agenda item 13.1. Prevention and control of noncommunicable diseases. Terms of reference for the global coordination mechanism on the prevention and control of noncommunicable diseases. In: Sixtyseventh World Health Assembly, 19–24 May 2014. Geneva: World Health Organization; 2014 (A67/14 Add.1; http://apps.who.int/gb/ebwha/pdf_files/ WHA67/A67_14Add1-en.pdf, accessed 3 November 2014). 33. Outcome document of the high-level meeting of the General Assembly on the comprehensive review and assessment of the progress achieved in the prevention and control of non-communicable diseases. New York: United Nations; 2014. In: Sixty-eighth session of the United Nations General Assembly, 7 July 2014 (A/68/L.53; http://www.un.org/ga/search/view_doc. asp?symbol=A/68/L.53&L, accessed 3 November 2014).

Key points ■

NCDs currently cause more deaths than all other causes combined and NCD deaths are projected to increase from 38 million in 2012 to 52 million by 2030. Four major NCDs (cardiovascular diseases, cancer, chronic respiratory diseases and diabetes) are responsible for 82% of NCD deaths. Approximately 42% of all NCD deaths globally occurred before the age of 70 years; 48% of NCD deaths in low- and middleincome countries and 28% in high-income countries were in individuals aged under 70 years. A well-functioning civil/vital registration system is vital for monitoring progress towards attainment of global target 1. In order to attain the premature mortality target, cost-effective policies and interventions aimed at attaining the other eight NCD targets, should be prioritized and implemented.

■

1 12 10 8 6 4 2 0 Total NCDs deaths (millions)

Global target 1: A 25% relative reduction in overall mortality from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases

Mortality from noncommunicable diseases A total of 56 million deaths occurred worldwide during 2012. Of these, 38 million were due to NCDs, principally cardiovascular diseases, cancer and chronic respiratory diseases (1). Nearly three quarters of these NCD deaths (28 million) occurred in low- and middle-income countries. The number of NCD deaths has increased worldwide and in every region since 2000, when there were 31 million NCD deaths. NCD deaths have increased the most in the WHO South-East Asia Region, from 6.7 million in 2000 to 8.5 million in 2012, and in the Western Pacific Region, from 8.6 million to 10.9 million (see Fig. 1.1). While the annual number of deaths due to infectious disease is projected to decline, the total annual number of NCD deaths is projected to increase to 52 million by 2030 (2,3). The leading causes of NCD deaths in 2012 were: cardiovascular diseases (17.5 million deaths, or 46.2% of NCD deaths), cancers (8.2 million, or 21.7% of NCD deaths), respiratory diseases, including asthma and chronic obstructive pulmonary disease (4.0 million, or 10.7% of NCD deaths) and diabetes (1.5 million, or 4% of NCD deaths). Thus, these four major NCDs were responsible for 82% of NCD deaths. Fig. 1.1 Total NCD deaths, by WHO region, comparable estimates, 2012

AFR

AMR

SEAR

EUR

EMR

WPR

AFR=African Region, AMR=Region of the Americas, SEAR =South-East Asia Region, EUR=European Region, EMR=Eastern Mediterranean Region, WPR=Western Paciﬁc Region

Global status report on NCDs 2014

Age –standardized NCD death rates by WHO regions are shown in Fig. 1.2. Age-standardized death rates reflect the risk of dying from NCDs, regardless of the total population size or whether the average age in the population is high or low. In 2012, the age-standardized NCD death rate was 539 per 100 000 population globally. The rate was lowest in high-income countries (397 per 100 000) and highest in low-income countries (625 per 100 000) and lower-middle-income countries (673 per 100 000). Regionally, age-standardized death rates for NCDs ranged from 438 per 100 000 in the WHO Region of the Americas to over 650 per 100 000 in the WHO African, South-East Asia and Eastern Mediterranean Regions. Premature death is a major consideration when evaluating the impact of NCDs on a given population, with approximately 42% of all NCD deaths occurring before the age of 70 years in 2012. This represents 16 million deaths – an increase from 2000 when there were 14.6 million NCD deaths before the age of 70 years. The majority of premature deaths (82%), are in low- and middle-income countries. In low- and middle-income countries, a higher proportion (48%) of all NCD deaths are estimated to occur in people under the age of 70 years, compared with high-income countries (28%). Fig. 1.3 shows the proportion of NCD deaths by cause in 2012 among people under the age of 70 years. Cardiovascular diseases were responsible for the largest proportion of NCD deaths under the age of 70 years (37%), followed by cancers (27%), and chronic respiratory diseases (8%). Diabetes was responsible for 4% and other NCDs were responsible for approximately 24% of NCD deaths under the age of 70 years.

Fig. 1.2 Age-standardized NCD death rates (per 100 000 population), all ages, by WHO region, comparable estimates, 2012 (1) 800 Age-standardized NCD death rates (per 100,000 population)

600

400

200

0 AFR AMR SEAR EUR EMR WPR AFR=African Region, AMR=Region of the Americas, SEAR =South-East Asia Region, EUR=European Region, EMR=Eastern Mediterranean Region, WPR=Western Paciﬁc Region

Fig. 1.3 Proportion of global deaths under the age 70 years, by cause of death, comparable estimates, 2012 (1) Communicable maternal, perinatal and nutritional conditions 34% Injuries 14%

NCDs 52% Cardiovascular diseases 37%

Monitoring premature mortality from noncommunicable diseases The premature mortality target is, a 25% reduction in overall mortality from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases by 2025 (referred to as “25×25”). The probability of dying between the ages of 30 and 70 years from these four diseases, is the indicator in the global

Diabetes mellitus 4% Respiratory diseases 8%

Malignant neoplasm 27%

Other NCDs 23%

Chapter 1. Global target 1

monitoring framework that monitors progress in attaining this target by 2025 (4) (see Annex 1). The probability of dying from one of the four main NCDs between ages 30 and 70 by WHO region in shown in Fig. 1.4. The probability of dying from one of the four main NCDs between ages 30 and 70 by country is shown in Fig. 1.5a and Fig. 1.5b. In 2012, a 30-year-old individual had a 19% chance of dying from one of the four main NCDs before his or her 70th birthday. This represents an improvement over 2000, when the same 30-yearold individual would have had a 23% chance of dying from these diseases. This probability varied by region, from 15% in the Region of the Americas to 25% in the South-East Asia Region (see Fig. 1.4), and by country, from greater than 30% in seven low- and middle-income countries to less than 10% in seven countries (Australia, Israel, Italy, Japan, Republic of Korea, Sweden and Switzerland) (see Fig. 1.5a and Fig. 1.5b). Over three quarters of deaths from cardiovascular disease and diabetes, and nearly 90% of deaths from chronic respiratory diseases, occur in low- and middle-income countries. More than two thirds of all cancer deaths occur in low- and middle-income countries (see Fig. 1.6) (6). Lung, breast, colorectal, stomach and liver cancers together cause more than half of cancer deaths. In high-income countries, the leading cause of cancer deaths among both men

Fig. 1.4 Probability of dying from one of the four main noncommunicable diseases between the ages of 30 and 70 years, by WHO region, comparable estimates, 2012 30

Probability of dying from one of the four main NCDs (both sexes: aged 30 to 70 years in %)

AFR

AMR

SEAR

EUR

EMR

WPR

AFR=African Region, AMR=Region of the Americas, SEAR =South-East Asia Region, EUR=European Region, EMR=Eastern Mediterranean Region, WPR=Western Paciﬁc Region

Fig. 1.5a Probability of dying from the four main noncommunicable diseases between the ages of 30 and 70 years, comparable estimates, 2012

* Cardiovascular diseases, cancer, chronic respiratory diseases and diabetes

The designations employed and the presentation of the material in Data Source: World Health Organization this publication do not imply the expression of any opinion Map Production: Health Statistics and Information Systems (HSI) whatsoever on the part of the World Health Organization concerning World Health Organization the legal status of any country, territory, city or area or of its 0 850 1’700 3’400 kilometers authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement.

Global status report on NCDs 2014

Fig. 1.5b Probability of dying from the four main noncommunicable diseases between the ages of 30 and 70 years (%), by individual country, and World Bank income group, comparable estimates, 2012 45%

Australia 9.4

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Chapter 1. Global target 1

45%

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Global status report on NCDs 2014

Crude Cancer death rates (per 100 000 population)

and women is lung cancer, followed by breast cancer among women and colorectal cancers among men. In low- and middle-income countries, cancer levels vary according to the prevailing underlying risks, with cervical cancer, liver cancer and stomach cancer all causing a larger proportion of cancer deaths than in high-income countries. In sub-Saharan Africa, for instance, cervical cancer remains the leading cause of cancer death among women. Population growth and improved longevity are leading to increasing numbers and proportions of older people in many parts of the world. As populations age, annual NCD deaths are projected to rise substantially to 52 million in 2030 (3). Annual cardiovascular disease mortality is projected to increase from 17.5 million in 2012 to 22.2 million in 2030, and annual cancer deaths from 8.2 million to 12.6 million. These increases will occur despite projected decreases in NCD death rates.

Status of civil/vital registration systems A vital registration system that records deaths with sufficient completeness is required to allow estimation of all-cause death rates. Results of the 2013 global survey on assessment of national capacity indicate that 19% of countries (n=178) do not have a system in place for reporting cause-specific mortality in their national health information systems (5). Across income groups, 98% of high-income and 92% of upper-middle-income countries reported having a system for reporting cause-specific Fig. 1.6 Global cancer mortality, by World Bank income group, 2012 (crude mortality rate per 100 000 population) (6) 250 200 150 100 50 0

Key barriers to attaining this target Key barriers to attaining this target include, the lack of a well-functioning civil/vital registration system for monitoring, weak health system infrastructure and inadequate funding for prevention and control of NCDs.

Lowincome

Lowermiddleincome

Uppermiddleincome

HIghincome

Fig. 1.7 Civil registration coverage of cause of death, 2005−2011 (7 )

Chapter 1. Global target 1

mortality, while 70% of lower-middle-income countries and only 45% of low-income countries indicated such capacity. Across WHO regions, a system for generating cause-specific mortality was reported in all countries in the European Region. In all other regions, some of the countries did not have such a system. Seventy four per cent (74%) of countries indicated that cause of death was certified by a medical practitioner. While 77% of countries indicated that hospital-based deaths were included in the reporting registration system, only 72% of countries reported that their registration system also included deaths occurring outside medical facilities. In all, 119 Member States (61%) have reported cause-of-death information to WHO since 2000, and only 97 Member States (50%) report their data regularly (8). Only 34 countries – representing 15% of the world’s population – produce high-quality cause-of-death data, meaning that more than 90% of deaths are registered and fewer than 10% of deaths are coded to ill-defined signs and symptoms (9). As shown in Fig. 1.7, civil registration coverage is less than 50% in many low- and middle-income countries.

Status of health system infrastructure and funding for noncommunicable diseases According to the results of the 2013 NCD country capacity assessment survey, some 94% of 178 countries had a unit, branch, division or department with responsibility for NCDs within the ministry of health or equivalent (5). In all, 80% of countries had at least one full-time staff member working on NCDs; thus, 14% of countries have a unit for NCDs in their health ministry but no full-time staff member dedicated to NCDs. Results showed that 84% of countries reported having funding available for early detection and screening for NCDs, while 89% of countries reported that funding was available for providing health care for NCDs, as well as for primary prevention and health promotion. Funding for surveillance, monitoring and evaluation was reported by a comparatively lower proportion of countries (74%), and was particularly low in the African Region (49%) and Eastern Mediterranean Region (48%) (see Fig. 1.8). Across all countries, only 74% reported having funding for capacity-building, and the availability of funding for rehabilitation services was also moderately low across all regions, with

Fig. 1.8 Percentage of countries with funding for NCD activities, by function, 2013, by WHO region and by World Bank income group (5) Q Primary prevention & health promotion Q Health care and treatment Q Capacity-building Percentage of countries with funding for NCD activities, by function (% of countries) 100%

Q Early detection/screening Q Surveillance, monitoring and evaluation Q Rehabilitation services

80%

60%

40%

20%

0% AFR AMR SEAR EUR EMR WPR Lowincome Lowermiddleincome Uppermiddleincome HIghincome

AFR=African Region, AMR=Region of the Americas, SEAR =South-East Asia Region, EUR=European Region, EMR=Eastern Mediterranean Region, WPR=Western Paciﬁc Region

Global status report on NCDs 2014

only 64% of countries surveyed having funding. Overall, 6% of countries (i.e. 10 countries) reported no funding stream for NCD activities. There was a significant lack of funding available for NCD activities in low-income countries (18% reported no funding) versus the lower-middle-income (7%) and upper-middle-income and high-income countries (2%). Major sources of funding included government revenues (90%), international donors (64%), health insurance (54%) and earmarked taxes on alcohol and tobacco (32%). Low-income countries reported receiving less funding for NCD activities from all sources: 66% of low-income countries received government revenues, compared to more than 90% of countries in other income groups. Similarly, although 28% of low-income countries received funds from health insurance, this still remains markedly lower than in countries in other income groups. Use of earmarked taxes to fund NCD activities was reported by 32% of countries. A comparison of the 172 countries that responded to questions about funding in capacity assessment surveys, conducted in both 2010 (10) and 2013 (5), reveals an improvement since 2010. There was an

increase in the percentage of low-income countries receiving funds from international donors in 2013 (75%) relative to 2010, when the figure was 57%. Similarly, there was an increase in the percentage of countries that reported using earmarked taxes to fund NCD activities (20% in 2010 versus 32% in 2013). The percentage of countries using earmarked funds has increased across all regions except Africa. Various fiscal interventions could be used to raise funds for prevention and control of NCDs. Results of the 2013 NCD country capacity assessment survey (5), show that there is room for improvement (see Fig 1.9). Only about one third of countries had fiscal interventions to raise funds for health. Taxes on tobacco and alcohol were reported by 85% and 76% of countries respectively. Only 11% of countries reported taxation on food with high sugar content, and non-alcoholic beverages, and only 3% reported taxation on high-fat foods. Only in 39% of countries were such policies and interventions intended to raise general revenues. In 34% of countries, they were intended to influence health behaviour. In a few countries, fiscal interventions were intended to raise funds for health, and most of these (5 of the 11 countries) were in the lower-middle-income grouping.

Fig. 1.9 Fiscal interventions to address NCD risk factors, 2013, by WHO region and by World Bank income group. Q Taxation on alcohol Q Taxation on tobacco Q Taxation on high sugar content food and non-alcoholic beverages Q Taxation on high fat foods Q Price subsidies for healthy foods Q Taxation incentives to promote physical activity 100% Fiscal interventions to address NCD risk factors (% of countries)

80%

60%

40%

20%

0% AFR AMR SEAR EUR EMR WPR Lowincome Lowermiddleincome Uppermiddleincome HIghincome

AFR=African Region, AMR=Region of the Americas, SEAR =South-East Asia Region, EUR=European Region, EMR=Eastern Mediterranean Region, WPR=Western Paciﬁc Region

Chapter 1. Global target 1

Actions required to attain this target The “25×25” target was based on analysis of trends in the indicator over recent decades. The experience of high-performing countries during 1980−2010 showed that very substantial declines in NCD death rates can be achieved and that the proposed target is achievable. Based on their past performance, high-income countries may wish to set a national target for reducing premature mortality that is higher than the global target. Countries with good-quality cause-of-death data from a complete registration system may also wish to establish more detailed national targets for specific NCDs. All actions that are required to attain the other eight targets discussed in chapters 2−9, will contribute to the attainment of this target on premature mortality. The risk factor and mortality targets were chosen independently from one another, largely based on experiences of countries that had been successful in reducing any one of the corresponding indicators (11). As policy attention and resources are mobilized towards NCD prevention and control, it is useful to know if selected risk factor targets discussed in subsequent chapters, if achieved, would contribute towards reducing NCD mortality, to achieve the “25×25” target (12). A modelling analysis has been done to answer this important question (13). The results show that, achieving six targets (tobacco, harmful use of alcohol, salt, raised blood pressure, raised blood glucose and obesity) by 2025 together, will reduce premature mortality from the four main NCDs to levels that are close to the 25 x 25 target ( 22% in men and 19% in women). The multifaceted nature of the drivers, causes and determinants of NCDs requires implementation of comprehensive multisectoral policies to reduce premature mortality from NCDs (see Chapter 10). The following 10 key actions will be critical in dismantling barriers and paving the way to attain this target:

1. Obtain explicit high-level/head-of-state commitment, establish/strengthen the NCD unit in the ministry of health, and ensure that NCDs are accorded due consideration in national strategic health planning. 2. Develop a national multisectoral plan, as outlined in Chapter 10, taking into account the WHO Global NCD Action Plan 2013−2020 (14) and regional frameworks and action plans. 3. Establish a high-level interministerial platform/ commission to facilitate and endorse multisectoral collaboration for prevention and control of NCDs. 4. Set national NCD targets, consistent with the nine global targets, covering risk factors, national systems performance, and mortality, based on national situations. 5. Strengthen national surveillance systems for NCDs, including vital registration that is capable of reporting cause of death, cancer registries, and risk factor surveillance, and ensure these are integrated into national health information systems, to enable regular reporting/auditing/ benchmarking and monitoring of progress. 6. Define, finance, prioritize and take to scale the implementation of very cost-effective interventions (see Box 1.1). 7. Strengthen the health system at all levels, with emphasis on primary care, and define and finance a national set of NCD interventions/ services for health promotion/prevention and curative, rehabilitative and palliative care, to achieve universal health coverage dynamically and incrementally. 8. Protect the implementation of public health policies for NCD prevention and control from interference by vested interests, through comprehensive legislation and enforcement of national laws and regulations. 9. Strengthen training of the health workforce and the scientific basis for decision-making, through partnerships and NCD-related research. 10. Mobilize and track domestic and external resources for NCD prevention and

Global status report on NCDs 2014

Box 1.1 WHO “best buys” – (very cost-eﬀective interventions that are also high-impact and feasible for implementation even in resource-constrained settings) (10−12) Tobacco ■ 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 Harmful use of alcohol ■ Regulate commercial and public availability of alcohol ■ Restrict or ban alcohol advertising and promotions ■ Use pricing policies such as excise tax increases on alcoholic beverages Diet and physical activity ■ Reduce salt intake ■ Replace trans fats with polyunsaturated fats ■ Implement public awareness programmes on diet and physical activity ■ Promote and protect breastfeeding Cardiovascular disease and diabetes ■ Drug therapy (including glycaemic control for diabetes mellitus and control of hypertension using a total risk approach) and counselling to individuals who have had a heart attack or stroke and to persons with high risk (≥ 30%) of a fatal and nonfatal cardiovascular event in the next 10 years ■ Acetylsalicylic acid (aspirin) for acute myocardial infarction Cancer ■ Prevention of liver cancer through hepatitis B immunization ■ Prevention of cervical cancer through screening (visual inspection with acetic acid [VIA] linked with timely treatment of pre-cancerous lesions)

control, including through innovative financing mechanisms. A range of policies will be required to strengthen the implementation capacity of countries to attain the voluntary global targets. They are summarized in the Global NCD Action Plan (14). A combination of population-wide and individual interventions need to be selected and implemented, based on the availability of resources (14–16). The selection should be guided by impact, feasibility of implementation, cost-effectiveness and affordability. Complementing population-wide interventions with individual interventions is essential, since highrisk individuals will not be adequately protected by the population-level interventions. Although

individual interventions can have relatively high costs compared to population-wide interventions, the investment in at least the limited set of “best buys” that are recommended in this report can yield a good return. The average annual cost of implementing the very cost-effective interventions (“best buys”, see Box 1.1) is estimated be US$ 11.2 billion (15). On the other hand, the cumulative economic losses due to NCDs in low- and middle-income countries between 2011−2025 under a “business as usual” scenario have been estimated to be a staggering 7 trillion (17). The cost of taking action amounts to an annual investment of under US$ 1 per capita in low-income countries, US$ 1.50 per capita in

Chapter 1. Global target 1

lower-middle-income countries and US$ 3 per capita in upper-middle-income countries. Expressed as a proportion of current health spending, the cost of implementing such a package amounts to 4% in low-income countries, 2% in lower-middle-income countries and less than 1% in upper-middle-income countries (15). In all countries, an increase in investment in NCD prevention and control will be necessary to attain this target. Strengthening surveillance systems, including vital registration, plus multisectoral engagement, population-wide prevention policies, proactive case-finding, and strengthening of health systems with a special focus on primary health care are important goals for all countries. Countries with good economic growth, sound governance, strong NCD policies and health institutions, could achieve the “25×25” target, by scaling up their expenditures on cost-effective programmes in proportion to current allocations. All resource-constrained settings could give priority to targeting additional government spending on very cost-effective high-impact interventions (14,15). Low- and middle-income countries that spend less than what they can afford on health need to explore means of mobilizing more domestic resources for health from general revenues and social insurance contributions (18). In low-income countries, simply increasing health spending along the lines of past expenditure patterns may not be adequate, because the amounts required to address NCDs, in addition to other health priorities such as communicable diseases and maternal and child health, may be beyond any realistic expectation of the financial resources these countries will be able to generate. Development agencies and international partners have a distinct role to play in supporting these countries.

Global status report on NCDs 2014

References 1. World Health Organization. Global Health Estimates: Deaths by Cause, Age, Sex and Country, 2000-2012. Geneva, WHO, 2014. 2. World Health Organization. Projections of mortality and causes of death, 2015 and 2030 (http://www.who. int/healthinfo/global_burden_disease/projections/ en/, http://w w w.who.int/gho/ncd/mortality_ morbidity/en/, accessed 4 November 2014). 3. Mathers CD, Loncar D projections of global mortality and burden of disease 2002–2030. PLoS Med. 2006;3(11):e442. doi:10.1371/journal.pmed.0030442 4. NCD global monitoring framework indicator definitions and specifications. Geneva: World Health Organization; 2014. 5. Assessing national capacity for the prevention and control of noncommunicable diseases. Report of the 2013 global survey. Geneva: World Health Organization; 2014. 6. GLOBOCAN 2012: Estimates Cancer Incidence, Mortality and Prevalence Worldwide in 2012, International Agency for Research on Cancer, Lyon http://globocan.iarc.fr/Default.aspx, accessed 16 December 2014). 7. Global Health Observatory, Civil registration of deaths, coverage of registration. Geneva: World Health Organization; 2014 http://www.who.int/gho/ mortality_burden_disease/registered_deaths/en/, accessed 16 December 2014. 8. World health statistics 2014. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/ bitstream/10665/112738/1/9789240692671_eng.pdf, accessed 4 November 2014). 9. World Health Statistics 2012. Geneva, World Health Organization; 2012. (http://www.who.int/ gho/publications/world_health_statistics/2012/en/, accessed 16 December 2014). 10. Assessing national capacity for the prevention and control of noncommunicable diseases. Report of the 2010 global survey. Geneva: World Health Organization; 2011 (http://www.who.int/cancer/ publications/national_capacity_prevention_ncds.pdf, accessed 4 November 2014). 11. Di Cesare M, Bennett JE, Best N, Stevens GA, Danaei G, Ezzati M. The contributions of risk factor trends to cardiometabolic mortality decline in 26 industrialized countries. Int J Epidemiol. 2013;42(3):838−48. doi:10.1093/ije/dyt063. 12. Peto R, Lopez AD, Norheim OF. Halving premature death. Science. 2014;345(6202):1272. doi:10.1126/ science.1259971. 13. Kontis V, Mathers CD, Rehm J, Stevens GA, Shield KD, Bonita R et al. Contribution of six risk factors to achieving the 25×25 noncommunicable disease mortality reduction target; a modelling study. Lancet. 2014;384(9941):427−37. doi: 10.1016/ S0140-6736(14)60616-4. 14. Global action plan for the prevention and control of noncommunicable diseases 2013−2020. Geneva: World Health Organization; 2013 (http://apps.who. int/iris/bitstream/10665/94384/1/9789241506236_ eng.pdf?ua=1, accessed 3 November 2014). 15. Scaling up action against noncommunicable diseases: how much will it cost? Geneva: World Health Organization; 2011 (http://whqlibdoc.who.int/ publications/2011/9789241502313_eng.pdf, accessed 4 November 2014). 16. Global status report on noncommunicable diseases 2010. Geneva: World Health Organization; 2011 (http:// www.who.int/nmh/publications/ncd_report_full_ en.pdf, accessed 3 November 2014). 17. From burden to “best buys”: reducing the economic impact of non-communicable diseases in low- and middle-income countries. Geneva: World Health Organization and World Economic Forum; 2011 (www.who.int/nmh/publications/best_buys_ summary, accessed 3 November 2014). 18. Evans DB, Etienne C. Health systems financing and the path to universal coverage. Bull World Health Organ. 2010;88(6):402. doi:10.2471/BLT.10.078741.

Chapter 1. Global target 1

Key points ■

There is a causal relationship between harmful use of alcohol and the morbidity and mortality associated with cardiovascular diseases, cancers and liver diseases. In 2012, an estimated 3.3 million deaths, or 5.9 % of all deaths worldwide, were attributable to alcohol consumption. More than half of these deaths resulted from NCDs. Implementing very cost-effective population-based policy options – such as the use of taxation to regulate demand for alcoholic beverages, restriction of availability of alcoholic beverages, and bans or comprehensive restrictions on alcohol advertising – are key to reducing the harmful use of alcohol and attaining this target. Health professionals have an important role to play in reducing the harmful use of alcohol, by identifying hazardous and harmful drinking or alcohol dependence in their patients and by providing brief interventions and treatment as appropriate.

■

Global target 2: At least 10% relative reduction in the harmful use of alcohol, as appropriate, within the national context

Harmful use of alcohol and its impact on health Harmful use of alcohol is associated with a risk of developing noncommunicable diseases, mental and behavioural disorders, including alcohol dependence, as well as unintentional and intentional injuries, including those due to road traffic accidents and violence. There is also a causal relationship between harmful use of alcohol and incidence of infectious diseases such as tuberculosis. Alcohol consumption by an expectant mother may cause fetal alcohol syndrome and pre-term birth complications. In 2012 it was estimated that 3.3 million deaths, or 5.9% of all deaths worldwide, were attributable to alcohol consumption. More than half of these deaths resulted from NCDs – chiefly cardiovascular diseases and diabetes (33.4%), cancers (12.5%) and gastrointestinal diseases, including liver cirrhosis (16.2%). An estimated 5.1% of the global burden of disease –as measured in disability-adjusted life-years (DALYs) – is attributed to alcohol consumption. Cardiovascular diseases, cancers and gastrointestinal diseases (largely due to liver cirrhosis) are responsible for more than one third (37.7%) of this burden (1). Fig. 2.1 Total (recorded and unrecorded) alcohol consumption per capita (aged 15 years and over), in litres of pure alcohol within a calendar year, by WHO region, projected estimates for 2012

* Recorded and unrecorded litres of pure alcohol per year

Global status report on NCDs 2014

Fig. 2.2 Total (recorded and unrecorded) alcohol consumption per capita (aged 15 years and over) within a calendar year, in litres of pure alcohol, by individual country, and World Bank income groups, projected estimates for 2012 18 lts.

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Chapter 2. Global target 2

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Global status report on NCDs 2014

There is a direct link between high levels of alcohol consumption and the risk of cancers of the mouth, nasopharynx, oropharynx, larynx, oesophagus, colon, rectum, liver and female breast (2). At high levels, alcohol consumption is associated with exponentially increasing risk of liver cirrhosis and pancreatitis (3,4). The relationship between alcohol consumption and ischaemic heart and cerebrovascular diseases is complex. Alcohol use is associated with the risk of hypertensive disease, atrial fibrillation and haemorrhagic stroke, yet, on the other hand, lower levels,

and particular patterns, of alcohol consumption in some populations may lower the risk of ischaemic heart disease and ischaemic stroke and associated mortality. However, controversy remains on the potential beneficial effect of low alcohol intake on cardiovascular diseases. Furthermore, beneficial effects of lower levels of alcohol consumption, if any, tend to disappear if the patterns of drinking are characterized by heavy episodic drinking (5), which is highly prevalent in many countries and population groups (1,6).

Table 2.1 Total alcohol consumption per capita (in litres of pure alcohol) and prevalence of heavy episodic drinking (%) in the total population aged 15 years and over, and among drinkers aged 15 years and over, by WHO region and the world, 2010 Among all (15+ years) Per capita consumption 6.0 8.4 3.4 10.9 0.7 6.8 6.2 Prevalence of heavy episodic drinking (%) 5.7 13.7 1.6 16.5 0.1 7.7 7.5 Among drinkers only (15+ years) Per capita consumption 19.5 13.6 23.1 16.8 11.3 15.0 17.2 Prevalence of heavy episodic drinking (%) 16.4 22.0 12.4 22.9 1.6 16.4 16.0

WHO region African Region Region of the Americas South-East Asia Region European Region Eastern Mediterranean Region Western Paciﬁc Region World

Fig. 2.3 Total alcohol consumption per capita, 2010 (in litres of pure alcohol) in the total population aged 15 years and over by WHO region and World Bank income groups 12 Litres of pure alcohol per capita 10 8 6 4 2 0 AFR AMR SEAR EUR EMR WPR Lowincome Lowermiddleincome Uppermiddleincome HIghincome

AFR=African Region, AMR=Region of the Americas, SEAR =South-East Asia Region, EUR=European Region, EMR=Eastern Mediterranean Region, WPR=Western Paciﬁc Region

Chapter 2. Global target 2

The level of alcohol consumption worldwide in 2010 was estimated at 6.2 litres of pure alcohol per person aged 15 years and over (equivalent to 13.5 g of pure alcohol per day). Although alcohol consumption is deeply embedded in the cultures of many societies, WHO estimates for 2010 showed that 48% of the global adult population had never consumed alcoholic beverages and 62% of the population aged 15 years and older had not consumed alcohol during the previous 12 months. The highest levels of alcohol consumption were found in middle- and high-income countries of the WHO European Region and the Region of the Americas (see Fig. 2.1), while the lowest levels were observed in the Eastern Mediterranean and South-East Asia

Regions (see Table 2.1). Projected estimates of total (recorded and unrecorded) alcohol consumption per capita (aged 15 years and over) for 2012, by country is shown in Fig 2.2. There is a wide variation in total alcohol consumption between different countries. Prevalence of heavy episodic drinking in past 30 days, is shown in Fig. 2.4. The prevalence of heavy episodic drinking is associated with the overall levels of alcohol consumption and is highest in the European Region and the Region of the Americas (see Table 2.2, Fig. 2.3) (1). In general, the greater the economic wealth of a country, the more alcohol is consumed and the smaller the number of abstainers is (see Table 2.2).

Table 2.2 Total alcohol per capita consumption, prevalence (%) of current drinkers, and prevalence of heavy episodic drinking among current drinkers, in the total population aged 15 years and over, by World Bank income group and the world, 2010 Per capita consumption 3.1 4.1 7.3 9.6 6.2 Prevalence of current drinkers (%) 18.3 19.6 45.0 69.5 38.3 Prevalence of heavy episodic drinking among drinkers (%) 11.6 12.5 17.2 22.3 16.0

Income group Low-income Lower middle-income Upper middle-income High-income World

Fig. 2.4. Age standardized heavy episodic drinking (aged 15 years and over) in past 30 days (%), 2010

Global status report on NCDs 2014

What are the costeﬀective policies and interventions for reducing harmful use of alcohol? WHO’s Global strategy to reduce the harmful use of alcohol highlights 10 policy areas for multisectoral national action to protect the health of populations and reduce the alcohol-attributable disease burden (7). They include: ■ leadership, awareness and commitment; ■ health services response; ■ community action; ■ drink-driving policies and countermeasures; ■ availability of alcohol; ■ marketing of alcoholic beverages; ■ pricing policies; ■ reducing the negative consequences of drink-driving and alcohol intoxication; ■ reducing the public health impact of illicit alcohol and informally-produced alcohol; ■ monitoring and surveillance. These areas for action are also outlined in the Global NCD Action Plan (8). Some interventions for reducing harmful use of alcohol are very cost-effective, or “best buys” (see Box 1.1). When implemented in health services, individual actions such as screening and brief interventions for hazardous and harmful drinking, and treatment of alcohol dependence, are also effective in reducing the harmful use of alcohol. Such interventions have a good cost-effectiveness profi le, although their implementation requires more resources than those for population-based measures (6,9−12). Health professionals play an important role in reducing the harmful use of alcohol, by assessing and monitoring levels and patterns of alcohol consumption in patients and by intervening with brief interventions, counselling and pharmacotherapy – as appropriate – in cases where hazardous and harmful drinking or alcohol dependence are identified (8,13,14).

Monitoring harmful use of alcohol The three indicators of the global monitoring framework (see Annex 1), for monitoring progress towards attaining this target are: ■ total (recorded and unrecorded) alcohol consumption per capita (aged 15 years and over) within a calendar year, in litres of pure alcohol, as appropriate within the national context; ■ age-standardized prevalence of heavy episodic drinking among adolescents and adults, as appropriate within the national context; heavy episodic drinking among adults is defined as consumption of at least 60 g or more of pure alcohol on at least one occasion in the previous 30 days; ■ alcohol-related morbidity and mortality among adolescents and adults, as appropriate within the national context. Member States may choose to report against the indicator most appropriate to their national circumstances, or against all three indicators if possible. However, total per capita consumption is one of the most reliable indicators of alcohol exposure and is recommended for monitoring progress in reducing the harmful use of alcohol at population level. Effective monitoring of trends in the prevalence of heavy episodic drinking requires a well-developed system for surveillance of alcohol consumption in populations. Shortcomings seen in a number of surveys – such as poor representation of the whole population, under-representation of heavy drinkers in survey samples, use of different indicators and data-collection instruments, and underreporting of alcohol consumption, particularly in societies with stigmatization and social disapproval of drinking – must be minimized. There are significant challenges in measuring and reporting alcohol-related morbidity and mortality, since reporting on these indicators is significantly influenced by the organization and functioning of the health system. Nevertheless, these indicators can be used for monitoring purposes in well-developed and relatively stable health systems.

Chapter 2. Global target 2

Box 2.1 Mongolia: working with civil society to reduce harmful use of alcohol Mongolia’s revised law on alcohol prevention and control includes essential strategies for reducing alcohol-related harm – such as a total ban on alcohol advertising, legislation on the population-density requirement for alcohol sales outlets, increased liability of businesses selling alcohol, and strengthened administrative and deterrence systems for infringements and violations. The law aims to bridge the gaps between regulation and implementation that were observed in the past and to improve coordination of alcohol-related strategies and programmes, by strengthening cooperation between diﬀerent levels of government and other stakeholders. Mongolia set up a national network of 80 governmental and nongovernmental organizations, to increase public awareness, formulate policies and establish a legal environment to reduce the consequences of alcohol use and strengthen implementation of the law. Sources: see references (17).

Progress achieved Since the Global strategy to reduce the harmful use of alcohol (7) was endorsed by the World Health Assembly in 2010, growing numbers of countries have developed or reformulated their national alcohol policies and action plans. Of 76 countries with a written national policy on alcohol, 52 have taken steps to operationalize it (15). Higher minimum legal drinking ages, controls over alcohol sales, fewer outlets (including reduced density of outlets), and limited hours and days of sale reduce both alcohol sales and consumption (16). Some 160 WHO Member States have regulations on age limits for sale of alcoholic beverages, with 18 years as the most frequent age limit for all beverage types and 20−21 years in some countries (e.g. Iceland, Indonesia, Japan, Sweden, the United States of America (USA) (1). A total ban on advertising alcoholic beverages has been considered by the Government of South Africa, as a necessary measure to reduce the burden attributable to alcohol. Efforts of the Government of the Russian Federation to curb the high level of alcohol consumption include strengthening regulations on availability and marketing of alcoholic beverages, including beer; enforcing drink-driving measures; and increasing the minimum retail price for the most common spirit. A new alcohol strategy introduced in the United Kingdom of Great Britain

and Northern Ireland (UK) in 2012 promotes coordinated actions across different government sectors and prioritizes measures with proven effectiveness in reducing alcohol-related harm. Mongolia has established a national network to strengthen the legal environment for prevention and control of alcohol (see Box 2.1) (1).

Actions required to attain this target Evidence on the effectiveness and cost-effectiveness of policy options to reduce the harmful use of alcohol strongly indicates that countries should prioritize, according to their national contexts, the following action areas: ■ pricing policies; ■ availability of alcohol; ■ marketing of alcoholic beverages; ■ the response of health services; ■ drink-driving policies and countermeasures. The successful implementation by governments of population-based interventions to reduce harmful use of alcohol depends on sustained political commitment and societal support. Effective communication measures are needed to support alcohol-control measures that may restrict individuals’ choices and

Global status report on NCDs 2014

reduce the economic benefits for enterprises involved in alcohol production and sale (4−7). Labelling on alcoholic drinks may help consumers to estimate their alcohol content and potentially choose a drink with less alcohol. Nevertheless, a study in Australia supports the view that standard labelling of drinks, without other changes to packaging and marketing, may serve to help young people choose the strongest drink for the lowest cost (18). Health warnings have been introduced to inform consumers about the risks associated with drinking alcohol and to stimulate reduced consumption. However, international experience shows that health warnings that are poorly visible or have generic messages have a weak impact on drinking behaviour (19). More recent studies recommend direct, more visible and pictorial health warnings, with due consideration of plain packaging for alcohol products, in order to influence recall, perceptions and behaviours (20). Models of a range of fiscal policy scenarios from a number of countries have indicated the high cost effectiveness of taxation and pricing policies in reducing hazardous drinking and alcohol-attributable mortality, as well as in raising revenue (6,9,21,22). Setting a minimum price per unit for alcohol in retail sales can complement taxation measures and result in health benefits, as demonstrated in a statistical model for England (21), and as supported by the impact on alcohol consumption in one province of Canada (22). A total of 154 WHO Member States have some form of excise tax on beer, wine or spirits, but the effectiveness of these measures in protecting population health depends on their scale and their impact on the demand for alcoholic beverages. Drink-driving measures, such as random breath-testing and setting and enforcing low limits (0.02−0.05%) for blood-alcohol concentration are effective in reducing not only road traffic injuries but also alcohol consumption by drivers. Thus, these measures have potential to improve population health outcomes associated with NCDs.

References 1. Global status report on alcohol and health 2014. Geneva: World Health Organization; 2014 (http:// www.who.int/substance_abuse/publications/global_ alcohol_report/msb_gsr_2014_1.pdf?ua=1, accessed 4 November 2014). 2. IARC Monographs 100E. Consumption of alcohol. Lyon: International Agency for Research on Cancer; 2012 (http://monographs.iarc.fr/ENG/Monographs/ vol100E/mono100E-11.pdf, accessed 4 November 2014). 3. Irving HM, Samokhvalov AV, Rehm J. Alcohol as a risk factor for pancreatitis. A systematic review and meta-analysis. JOP. 2009;10:387–92. 4. Rehm J, Baliunas D, Borges GL, Graham K, Irving H, Kehoe T et al. The relation between different dimensions of alcohol consumption and burden of disease – an overview. Addiction. 2010;105(5):817–43. doi:10.1111/j.1360-0443.2010.02899.x. 5. Roerecke M, Rehm J. Irregular heavy drinking occasions and risk of ischemic heart disease: a systematic review and meta-analysis. Am J Epidemiol. 2010;171(6):633–44. doi:10.1093/aje/kwp451. 6. WHO Expert Committee on Problems Related to Alcohol Consumption. Second report. Geneva: World Health Organization; 2007 (WHO Technical Report Series, No. 944; http://www.who.int/substance_abuse/ expert_committee_alcohol_trs944.pdf, accessed 4 November 2014). 7. Global strategy to reduce the harmful use of alcohol. Geneva: World Health Organization; 2010 (http:// www.who.int/substance_abuse/activities/gsrhua/en/, accessed 4 November 2014). 8. Global action plan for the prevention and control of noncommunicable diseases 2013−2020. Geneva: World Health Organization; 2013 (http://apps.who. int/iris/bitstream/10665/94384/1/9789241506236_ eng.pdf?ua=1, accessed 3 November 2014). 9. Evidence for the effectiveness and cost-effectiveness of interventions to reduce alcohol-related harm. Copenhagen: World Health Organization Regional Office for Europe; 2009 (http://www.euro.who.int/ document/E92823.pdf, accessed 4 November 2014). 10. m hGA P i nter vent ion g u ide for ment a l, neurological and substance use disorders in nonspecialized health settings. Geneva: World Health Organization; 2010 (http://whqlibdoc.who.int/ publications/2010/9789241548069_eng.pdf, accessed 4 November 2014). 11. Chisholm D, Rehm J, Ommeren MV, Monteiro M. Reducing the global burden of hazardous alcohol use: a comparative cost-effectiveness analysis. J Stud Alcohol Drugs. 2004;65(6):782−93.

Chapter 2. Global target 2

12. Anderson P, Chisholm D, Fuhr D. Effectiveness and cost-effectiveness of policies and programmes to reduce t he ha r m c aused by a lcohol. Lancet. 2009;373(9682):2234–46. doi:10.1016/ S0140-6736(09)60744-3. 13. Rehm J, Shield K, Rehm M, Gmel GJ, Frick U. Alcohol consumption, alcohol dependence, and attributable burden of disease: potential gains from effective interventions for alcohol dependence. Toronto: Centre for Addiction and Mental Health; 2012 (http:// amphoraproject.net/w2box/data/AMPHORA%20 Reports/CAMH_Alcohol_Report_Europe_2012.pdf, accessed 4 November 2014). 14. Moyer VA and Preventive Services Task Force. Screening and behavioral Services Task Force recommendation statement. Ann Intern Med. 2013;159(3):210−8. doi:10.7326/0003-4819-159-3-201308060-00652. 15. Assessing national capacity for the prevention and control of noncommunicable diseases report of the 2013 global survey. Geneva: World Health Organization; 2014. 16. Gruenewald PJ. Regulating availability: how access to alcohol affects drinking and problems in youth and adults. Alcohol Res Health. 2006;34(2):248–57. doi:SPS-AR&H-39. 17. World Health Organization Western Pacific Region. WHO Representative Office Mongolia. Alcohol initiative (http://www.wpro.who.int/mongolia/ mediacentre/alcohol/en/, accessed 4 November 2014). 18. Jones SC, Gregory P. The impact of more visible standard drink labelling on youth alcohol consumption: helping young people drink (ir) responsibly? Young people’s use of standard drink labelling. Drug Alcohol Rev. 2009;28(3):230–4. 19. Wilkinson C, Room R. Warnings on alcohol containers and advertisements: international experience and evidence on effects. Drug Alcohol Rev. 2009;28(4):426– 35. doi:10.1111/j.1465-3362.2009.00055.x. 20. Al-hamdani M. The case for stringent alcohol warning labels: lessons from the tobacco control experience. J Public Health Policy. 2014;35(1):65–74. doi:10.1057/ jphp.2013.47. 21. Purshouse R, Brennan A, Latimer N, Meng Y, Rafia R. Modelling to assess the effectiveness and costeffectiveness of public health related strategies and interventions to reduce alcohol attributable harm in England using the Sheffield Alcohol Policy Model version 2.0. Report to the NICE Public Health Programme Development Group, 9 November 2009. Sheffield: University of Sheffield School of Public Health and Related Research; 2009 (http://www.ias. org.uk/uploads/pdf/UK%20alcohol%20reports/univsheffield-am.pdf , accessed 4 November 2014).

22. Stockwell T, Zhao J, Giesbrecht N, Macdonald S, Thomas G, Wettlaufer A. The raising of minimum alcohol prices in Saskatchewan, Canada: impacts on consumption and implications for public health. Am J Public Health. 2012;102(12):e103−10. doi:10.2105/ AJPH.2012.301094.

Key points ■

Regular physical activity – at least 150 minutes of moderateintensity physical activity per week for adults – reduces the risk of cardiovascular disease, diabetes, cancer and all-cause mortality. Children and young people aged 5−17 years should accumulate at least 60 minutes of physical activity of moderate to vigorous intensity daily, in order to maintain and improve lung and heart condition, muscular fitness, bone health, cardiovascular and metabolic health biomarkers and mental health. Globally, in 2010, 20% of adult men and 27% of adult women did not meet WHO recommendations on physical activity for health. Amongst adolescents, aged 11−17 years, 78% of boys and 84% of girls did not meet these recommendations. Under the leadership of the health ministries, strategies to improve physical activity should be developed and implemented through multiple sectors, in order to create an enabling environment for active living. Supportive built environment, multicomponent programs including mass media campaigns and use of settings are key to achieving this target. The attainment of this target will contribute to attainment of targets on reducing the prevalence of hypertension, on a 0% increase in diabetes and obesity and, ultimately, on reducing premature mortality from NCDs.

■

Global target 3: A 10% relative reduction in prevalence of insufficient physical activity

Insuﬃcient physical activity and its impact on health Insufficient physical activity is one of the 10 leading risk factors for global mortality, causing some 3.2 million deaths each year (1). In 2010, insufficient physical activity caused 69.3 million DALYs – 2.8% of the total – globally (1). Adults who are insufficiently physically active have a 20−30% increased risk of all-cause mortality compared to those who do at least 150 minutes of moderate-intensity physical activity per week, or equivalent, as recommended by WHO (2). Regular physical activity reduces the risk of ischaemic heart disease, stroke, diabetes and breast and colon cancer. Additionally, regular physical activity is a key determinant of energy expenditure and is therefore fundamental to energy balance, weight control and prevention of obesity (2). The prevalence of insufficient physical activity in men and women aged 18 years and over in different parts of the world is shown in Figs. 3.1 and 3.2 respectively. Fig. 3.1 Age standardized prevalence of insuﬃcient physical activity in men aged 18 years and over, comparable estimates, 2010

The designations employed and the presentation of the material in Data Source: World Health Organization this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning Map Production: Health Statistics and Information Systems (HSI) World Health Organization the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or 0 850 1’700 3’400 kilometers boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement.

* Less than 150 minutes of moderate-intensity physical activity per week, or equivalent

Global status report on NCDs 2014

Fig. 3.2 Age standardized prevalence of insuﬃcient physical activity in women aged 18 years and over, comparable estimates, 2010

* Less than 150 minutes of moderate-intensity physical activity per week, or equivalent

In 2010, 23% of adults aged 18 years and over were insufficiently physically active – i.e. they had less than 150 minutes of moderate-intensity physical activity per week, or equivalent (2). 1 Women were less active than men, with 27% of women and 20% of men not reaching the recommended level of activity. Overall, older people were less active than younger people: 19% of the youngest age group did not meet the recommended level, compared to 55% of the oldest age group. However, young women were slightly less active than middle-aged women. The WHO Eastern Mediterranean Region (31%) and Region of the Americas (32%) had the highest prevalence of insufficient physical activity, while the prevalence was lowest in the South-East Asia (15%) and African (21%) Regions. Across all regions, women were less active than men, with differences in prevalence between men and women of 10% and greater in the Eastern Mediterranean Region and the Region of the Americas (see Fig. 3.3).

Insufficient physical activity in adults increased according to the level of country income (see Fig.3.5). The prevalence in high-income countries (33%) was about double that in low-income countries (17%). Nearly 28% of women from upper-middle-income countries and 38% in high-income countries did not reach WHO’s recommended level of physical activity. The higher levels of activity in low-income and lower-middle-income countries may be explained by high levels of occupational and transport activity in these countries (4). In addition to rising income levels, factors such as increased ownership and use of vehicles, different occupation types, urbanization and industrialization seem to be important determinants of levels and patterns of physical activity (5,6).

Insuﬃcient physical activity among adolescents Compared to their inactive peers, children and adolescents doing at least 60 minutes of physical activity of moderate to vigorous intensity daily have higher levels of cardiorespiratory fitness, muscular endurance and strength. Documented health benefits of regular physical activity among young people also include reduced body fat, more favourable

1. The definition of “insufficient physical activity” differs from that used in the Global status report on noncommunicable diseases 2010 (3). The previous definition was “less than five times 30 minutes of moderate activity per week, or less than three times 20 minutes of vigorous activity per week, or equivalent”. The new definition reflects new evidence on the recommended amount of physical activity for health.

Chapter 3. Global target 3

Figure 3.3 Age-standardized prevalence of insuﬃcient physical activity in adults aged 18 years and over, by WHO region and World Bank income group, men and women, comparable estimates, 2010 Q Males Q Females 45% Prevalence of insuﬃcient physical activity (age-standardized estimates %) 40% 35% 30% 25% 20% 15% 10% 5% 0% AFR SEAR EMR EUR AMR WPR Lowincome Lowermiddleincome Uppermiddleincome HIghincome

AFR=African Region, AMR=Region of the Americas, SEAR =South-East Asia Region, EUR=European Region, EMR=Eastern Mediterranean Region, WPR=Western Paciﬁc Region

cardiovascular and metabolic disease risk profiles, enhanced bone health, and reduced symptoms of anxiety and depression (2). Globally, 81% of adolescents aged 11−17 years were insufficiently physically active in 2010 – i.e. they had less than the 60 minutes of moderate-to-vigorous daily physical activity, as recommended by WHO. Adolescent girls were less active

than adolescent boys, (see Fig. 3.4, 3.6 and 3.7) with 84% versus 78% not meeting WHO recommendations. Estimates of physical activity of adolescents, are for school going adolescents due to lack of data on adolescents in the general population in most countries. As with adults, adolescents from the WHO South-East Asia Region showed by far the lowest

Figure 3.4 Global prevalence of insuﬃcient physical activity for school going adolescent boys aged 11−17 years, comparable estimates, 2010

Prevalence of insuﬃcient physical activity (%)* 60–79.9 80–84.9 85–89.9 ≥90 Data not available Not applicable

* Less than 60 minutes of physical activity per day.

Global status report on NCDs 2014

Figure 3.5 Age-standardized prevalence of insuﬃcient physical activity in adults aged 18 years and over (%), by individual country and World Bank income group, comparable estimates, 2010 70%

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Chapter 3. Global target 3

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Global status report on NCDs 2014

Figure 3.6 Global prevalence of insuﬃcient physical activity for school going adolescent girls aged 11−17 years, comparable estimates, 2010

Prevalence of insuﬃcient physical activity (%)* 60–79.9 80–84.9 85–89.9 ≥90 Data not available Not applicable

* Less than 60 minutes of physical activity per day.

prevalence of insufficient physical activity (74%). Levels of insufficient physical activity were highest in the Eastern Mediterranean Region, the African Region and the Western Pacific Region (88%, 85% and 85% respectively). Adolescent girls were less active than adolescent boys in all WHO regions (see Fig. 3.7). There was no clear pattern of insufficient physical activity among adolescents across income groups; the prevalence was highest in upper-middle-income countries and lowest in lower-middle-income countries (see Fig. 3.7).

What are the cost-eﬀective policies and interventions for reducing insuﬃcient physical activity? Evidence shows that many effective interventions – focusing on policy and environment, mass media, school settings, workplaces, the community and primary health care – can be implemented by policy-makers to increase people’s physical activity (7). Across these categories, multicomponent interventions adapted to local cultural and environmental contexts are the most successful (see Box 3.1).

Interventions that use the existing social structures and participation of all stakeholders reduce barriers to implementation. The physical or built environment plays an important role in facilitating physical activity for large portions of the population, by ensuring that walking, cycling and other forms of non-motorized transport are accessible and safe for all (8). The physical environment also provides sports, recreation and leisure facilities and ensures there are adequate safe spaces for active living, for both children and adults (9). Health messages on stairs promote physical activity, while the use of stairs decreases when no message is displayed. A recent study showed that individual preferences and/or the lack of effort required in using escalators or elevators may lead people to avoid using stairs as a physical activity (10). School-based physical activity interventions show consistent improvements in knowledge, attitudes and behaviour of children and, when tested, in physical and clinical outcomes (8). Workplaces may also reduce individual risk-related behaviours, including physical inactivity, with the potential to reach more than 3.6 billion economically active persons in 2020 (11).

Chapter 3. Global target 3

Monitoring insuﬃcient physical activity The global monitoring framework (see Annex 1), includes two indicators for monitoring insufficient physical activity (12): 1. Prevalence of insufficient physical activity in adolescents, defined as less than 60 minutes of physical activity of moderate to vigorous intensity daily; 2. age-standardized prevalence of insufficient physical activity in persons aged 18 years and over, defined as NOT meeting any of the following criteria: ■ 150 minutes of moderate-intensity physical activity per week; ■ 75 minutes of vigorous-intensity physical activity per week; ■ an equivalent combination of moderate- and vigorous-intensity physical activity, accumulating at least 600 MET-minutes 1 per week. 1. MET refers to metabolic equivalent. It is the ratio of a person’s working metabolic rate relative to the resting metabolic rate. One MET is defined as the energy cost of sitting quietly, and is equivalent to a caloric consumption of 1 kcal per kg per hour.

Progress achieved WHO’s NCD country capacity assessment survey of 2013 showed that, while 80% of countries reported having policies, plans or strategies for addressing physical inactivity, only 56% indicated that these were operational (13). Only a few countries (8%) reported using tax incentives to promote physical activity – including tax exemptions or rebates on sports equipment, fitness programmes or gym membership, and higher taxation on items such as home entertainment equipment that encourage sedentary lifestyles. As a result of implementation of national policies and programmes to improve physical activity, several high-income countries, including Canada and Finland, have reported increased physical activity over the last decade (14,15). In recent years more low- and middle-income countries have set up initiatives to address physical inactivity (see Boxes 3.1−3.3).

Actions required to attain this target All ministries of health need to take leadership in, and responsibility for, implementing national NCD

Figure 3.7 Age-standardized prevalence of insuﬃcient physical activity in school going adolescent boys and girls (11-17 years), by WHO region and World Bank income group, comparable estimates, 2010 Q Adolescent boys Q Adolescent girls 100%

80% % of population

60%

40%

20%

0% AFR AMR SEAR EUR EMR WPR Lowincome Lowermiddleincome Uppermiddleincome HIghincome

AFR=African Region, AMR=Region of the Americas, SEAR =South-East Asia Region, EUR=European Region, EMR=Eastern Mediterranean Region, WPR=Western Paciﬁc Region

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Box 3.1 Walkability is positively associated with physical activity: Curitiba, Brazil In Curitiba, Brazil, adults living in high-walkability areas were found to be more likely to achieve recommended levels of physical activity, both for transport walking and leisure-time physical activity. The proportion of those who walk for transport for ≥150 minutes per week was 21.1% in low-walkability areas, and ranged from 33.5% to 35.0% in high-walkability areas. A total of 12.6% of residents were found to walk for leisure for ≥150 minutes per week. No relationship was found between walkability and income, indicating that walkability is associated with physical activity, regardless of neighbourhood income level. The results of the study conﬁrm ﬁndings from high-income countries that walkability plays an important role in physical activity as daily transport. Thus, policies that inﬂuence the built environment may promote population-level physical activity. Sources: see references (18).

Box 3.2 Partnership and social marketing to promote physical activity in women: Tonga Women in Tonga are more sedentary and obese than men, owing to a range of cultural and socioeconomic factors – such as the fact that sporting activities are often designed for and dominated by men. Recognizing the seriousness of women’s sedentary behaviour, the Tongan ministry of health and Ministry of Internal Aﬀairs, with the support of the Australian Sports Outreach Program, joined with the Tonga Netball Association in a campaign that brought together a broad range of technical skills and networks to deliver a highly targeted intervention. Guided by the Tonga National Strategy to Prevent and Control Non-Communicable Diseases (2010–2015), the partners adopted a social marketing and community mobilization approach known as strategic health communication. This approach aimed to understand the perspective of the target audience and to promote physical activity as “easy, exciting, enjoyable and everywhere”. The campaign used netball as a means of encouraging sport, with beneﬁts to the sports sector. The campaign, branded Kau Mai Tonga: Netipol (Come on Tonga, let’s play netball!), was launched in June 2012 and since then has been delivered in annual phases of community mobilization, large-scale advertising and communication, and interpersonal education. Since the ﬁrst phase, there has been increased participation of women, with more than 20 netball clubs registered, and increased knowledge and awareness of the beneﬁts of physical activity among participants. Sources: see references (19).

action plans consistent with the Global NCD Action Plan (16) and the Global strategy on diet, physical activity and health (17). Achieving the physical activity targets requires multisectoral collaboration and partnership. It is critical to develop a costed national physical activity plan and convene a national physical activity committee or task force with high-level support and resources and with

representation from multiple sectors, agencies, NGOs and the private sector to provide leadership and guidance in implementing the plan. A comprehensive set of policy options to improve physical activity is listed in the Global NCD Action Plan (16). In 2010 WHO developed global recommendations on physical activity for health (2). Countries are urged to adapt these recommendations to

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Box 3.3 Bicycle hire to improve physical activity: Islamic Republic of Iran Tehran, the capital of the Islamic Republic of Iran, has introduced a bicycle-sharing scheme, funded by the municipal government. The scheme aims to reduce congestion on the city’s streets, decrease pollution and provide additional transport. Twelve bicycle “hubs” are positioned across the city in various administrative districts, with each hub having around 40 bicycles. Over 6000 people have subscribed to the scheme, which allows the use of a bicycle for up to 4 h for the equivalent of US$ 2. For many, “Bike House” has made travel through the congested streets of Tehran fast and convenient. However, because of Islamic and cultural considerations, women are unable to participate in the programme. The city of Isfahan has developed a similar scheme and the city-wide travel card includes the option of bicycle hire, along with use of the train, tram and buses. Sources: see references (20,21).

Box 3.4 Sustainable transport: Freiburg, Germany There is growing evidence that dependence on automobile travel contributes to insuﬃcient physical activity, transport-related carbon dioxide emissions, traﬃc congestion, air pollution and road traﬃc accidents. The city of Freiburg in southwestern Germany has been successful in implementing sustainable transport policies that may be transferable to caroriented countries around the world. Over the last three decades, transport policies in Freiburg have encouraged more walking, cycling and use of public transport. During this period, the number of bicycle trips has tripled, travel by public transport has doubled, and the proportion of journeys by automobile has declined from 38% to 32%. Since 1990, motorization rates have levelled oﬀ and per capita carbon dioxide emissions from transport have fallen, despite strong economic growth. Sources: see references (22,23).

the national context as tools for education, measurement, and policy decisions and interventions, while incorporating physical activity into surveillance systems and setting national targets for change. Policy development should be encouraged at national and subnational levels, in cooperation with relevant sectors, to promote physical activity through activities of daily living. Urban planning and active transport policies can improve community walking and cycling opportunities, and education policies can mandate quality physical education and physical activity programmes throughout the school years.

Sustainable transport policies provide opportunities for active and non-motorized travel (see Box 3.4). Urban planning policy and built environment strategies, supported by efforts from parks and recreation authorities, create facilities and opportunities for people to be active. Crime prevention policies create safe environments, and new urban design creates walkable communities and environments that promote physical activity. Policies and programmes to create and preserve built and natural environments that support physical activity are best implemented through settings such as schools, universities, workplaces,

Global status report on NCDs 2014

health-care services, and the local and wider community. Partners in the education sector can create physical activity programmes before, during and after school, and create supportive built environments in schools. The sports sector can encourage regular structured activities, especially among children and adolescents, and can strengthen the link between physical activity, sports and health. Partnerships with communities, the private sector and NGOs can also contribute to developing facilities for physical activity. Partnerships with workplaces and occupational settings can help develop healthy environments, promote physical activity at work and provide incentives and opportunities for active commuting to and from work. As part of the national programme, there is also a need to advocate for physical activity through political engagement, and to mobilize communities through social marketing and mass media campaigns – including education of the public on the benefits of physical activity (e.g. NCD prevention, less air pollution as a result of reduced traffic, sustainable development). Evaluation and validation efforts are required to promote best practices, monitor implementation and assess population reach.

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10. Aksay E. Do simple warning signs enhance the use of stairs? Health Education Journal. 28 November 2013:0017896913511810. doi:10.1177/0017896913511810 (http://hej.sagepub.com/content/73/6/683, accessed 4 November 2014). 11. Task Force on Community Preventive Services. A recommendation to improve employee weight status through worksite health promotion programs targeting nutrition, physical activity, or both. Am J Prev Med. 2009;37(4):358−9. doi:10.1016/j.amepre.2009.07.004. 12. NCD global monitoring framework indicator definitions and specifications. Geneva: World Health Organization; 2014. 13. Assessing national capacity for the prevention and control of noncommunicable diseases. Report of the 2013 global survey. Geneva: World Health Organization; 2014 (http://www.who.int/entity/ cancer/publications/national_capacity_prevention_ ncds.pdf, accessed 4 November 2014). 14. Vuori I, Lankenau B, Pratt M. Physical activity policy and program development: the experience in Finland. Public Health Rep, 2004. 119(3):331−45. 15. Muhajarine N, Labonte R, Winquist BD. The Canadian Index of Wellbeing: key findings from the healthy populations domain. Can J Public Health. 2012;103(5):e342−7. 16. Global action plan for the prevention and control of noncommunicable diseases 2013−2020. Geneva: World Health Organization; 2013 (http://apps.who. int/iris/bitstream/10665/94384/1/9789241506236_ eng.pdf?ua=1, accessed 3 November 2014). 17. Resolution WHA 57.17. Global strategy on diet, physical activity and health. In: Fift y-seventh World Health Assembly, Geneva, 17−22 May 2004. Geneva: World Health Organization; 2004 (WHA57/2004/ REC/1; http://apps.who.int/gb/ebwha/pdf_files/ WHA57/A57_R17-en.pdf, accessed 4 November 2014). 18. Siqueira Reis R, Hino AA, Ricardo Rech C, Kerr J, Curi Hallal P. Walkability and physical activity: findings from Curitiba, Brazil. Am J Prev Med. 2013;45(3):269−75. doi:10.1016/j.amepre.2013.04.020. 19. Ministry of Information and Communications. Kau Mai Tonga campaign wins WHO Health Islands Recognition Award (http://www.mic.gov.to/healtha-ncds/ncds/4493-kau-mai-tonga-ke-tau-netipolocampaign-wins-who-health-islands-recognitionaward, accessed 5 November 2014). 20. Promoting physical activity through the life course. A regional call to action. Cairo : World Health Organization Regional Office for the Eastern Mediterranean; 2014 (http://applications.emro.who. int/dsaf/EMROPUB_2014_EN_1697.pdf?ua=1, accessed 5 November 2014).

21. The Bike-sharing Blog (http://bike-sharing.blogspot. ch/2010/03/tehrans-bike-house-shines-green.html, accessed 5 November 2014). 22. A European vision for sustainable transport. Brussels: European Commission; 2009 (http://ec.europa.eu/ research/transport/news/items/a_european_vision_ for_sustainable_transport_en.htm, accessed 5 November 2014). 23. Buehler R, Pucher J. Sustainable transport in Freiburg: lessons from Germany’s environmental capital. Int J Sustain Transp. 2011;5:43–70.

Key points ■

Globally, 2010, 1.7 million annual deaths from cardiovascular causes have been attributed to excess salt/sodium intake. High salt consumption (more than 5 g per day) contributes to raised blood pressure and increases the risk of heart disease and stroke. Current estimates suggest that the global mean intake of salt is around 10 g of salt daily (4 g/day of sodium). WHO recommends reducing salt consumption to less than 5 g (about 1 teaspoon) per day in adults, to help prevent hypertension, heart disease and stroke. Reducing salt intake has been identified as one of the most costeffective measures for improving population health. Multisectoral collaboration is required to improve access to products with lower sodium content. The attainment of this target will contribute to the attainment of the targets on reducing the prevalence of raised blood pressure and, ultimately, on reducing premature mortality from NCDs.

■

Global target 4: A 30% relative reduction in mean population intake of salt/sodium

Salt/sodium intake and its impact on health Excess consumption of dietary sodium is associated with increased risk of hypertension and cardiovascular disease (1−4). It has been estimated that excess sodium intake was responsible for 1.7 million deaths from cardiovascular causes globally in 2010 (1). The main dietary source of sodium worldwide is salt. However, sodium can be found in other forms, and the main source of dietary sodium consumption depends on the cultural context and dietary habits of the population, but in many countries processed foods are the main source. Considerable evidence, including from clinical trials (5−8), shows that lowering sodium intake can reduce blood pressure.A meta-analysis of 36 studies found that decreased sodium intake resulted in a decrease in resting systolic blood pressure of 3.4 mmHg and a decrease in resting diastolic blood pressure of 1.5 mmHg (8). Sodium consumption is also associated with cardiovascular disease events in persons who consume more than 3.5 g/day of sodium (9−11). WHO recommends a reduction in salt intake to less than 5 g/day (sodium 2 g/ day) to reduce blood pressure and the risk of coronary heart disease and stroke. For children, the recommended maximum level of intake of 2 g/day of sodium for adults should be adjusted downwards on the basis of the energy requirements of children relative to those of adults (12). Current estimates suggest that the global mean intake of salt is around 10 g of salt daily (4 g/day of sodium) (1). Measured data on mean population sodium intake are currently available mainly for high- and middle-income countries. However, additional figures on population intake of salt are becoming available through new population surveillance data, providing a broader picture of the extent of the problem. In many countries, most of the salt consumed comes from processed foods and ready-made meals, while salt added at the table or during food preparation at home is significant in others. With increased processing in the food industry and greater availability of processed foods in both urban and rural areas of low- and middle-income countries, sources of sodium are shifting rapidly towards these foods. Significant regional variations exist (see Fig. 4.1). Intake levels appear highest in south-east and central Asia and parts of Europe. The WHO Region of the Americas, and European and Western Pacific Regions all show levels of consumption that greatly exceed WHO recommendations. Intakes appear lower in Africa but there is uncertainty about the estimates, since data for the WHO African Region are sparse

Global status report on NCDs 2014

Fig. 4.1 Mean sodium intake in persons aged 20 years and over, comparable estimates, 2010

The designations employed and the presentation of the material in Data Source: World Health Organization this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning Map Production: Health Statistics and Information Systems (HSI) Powles J et al BMJ Open 2013;3:e003733 World Health Organization the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or 0 850 1’700 3’400 kilometers boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement.

Box 4.1 Salt-smart Americas The Pan American Health Organization (PAHO) initiative “Cardiovascular disease prevention through population-wide dietary salt reduction” supports countries of the Americas in reducing sodium intake, by providing eﬀective tools, strategies and interventions. These include evaluating population-based salt intake, raising awareness, promoting voluntary salt reduction, regulating salt use in manufacturing, improving food labelling, and promoting food science and health research. Since 2011, public health authorities in Argentina, Brazil and Chile in the south, and Canada, Mexico and the USA in the north have promoted voluntary national reformulation targets and timelines with the food industry. Most of these countries are targeting salt reduction in packaged foods and bread, while Mexico has focused on foods available in the school environment. Argentina has already achieved a 25% reduction in the salt content of bread. Keys to successful outcomes include voluntary salt reduction, education, health promotion, food labelling, regulation, ongoing monitoring, evaluation and reporting, research, and collaboration with the private sector. Sources: see references (18).

and are based on food-consumption data rather than on more accurate measures of sodium excretion.

Monitoring population intake of salt/sodium The indicator for monitoring this target is age-standardized mean population intake of salt (sodium chloride) in grams per day in persons aged 18 years and over (13). Few countries have a baseline level of population salt/sodium intake, or knowledge of the most common sources of sodium in the diet.

Data need to be gathered from a population-based (preferably nationally representative) survey, either as a stand-alone survey or as part of a risk factor survey. For instance, in many countries, the population used for the NCD STEPS survey (14) is used to estimate data on salt consumption. The recommended standard for estimating salt intake is 24-h urine collection; however, other methods such as spot urine, single morning fasting urine and food frequency surveys have been used to obtain estimates at the population level. There may be wide differences in sodium intake within countries,

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Box 4.2 National campaign to reduce salt consumption in Thailand In 2011, The Ministry of Public Health of Thailand, along with other stakeholders, initiated a campaign aimed at reducing salt consumption by 50%. Academics and food producers jointly collaborate to undertake salt-reduction activities. Attention is mainly on foods for children, especially snacks. The academic sector collaborated with the commercial sector to reformulate snack recipes. However, the reformulated products were not acceptable to the public and gradually disappeared from the market. Consequently, a more successful approach was initiated, whereby food producers were asked to reformulate their products themselves. This strategy resulted in many good market products, such as potato chips with sodium reduced by 50%, and instant noodles with sodium reduced by 20% (using potassium chloride). When instant noodles with reduced sodium become widely available, this should have a signiﬁcant impact, since this product is consumed widely – more than 8 million packages a day are sold to people of all socioeconomic classes. Sources: see references (19).

Box 4.3 A regulatory approach to reduce unhealthy food and beverages in the Paciﬁc islands and Kiribati As a means of reducing the availability of products that are high in salt and fat, the Ministry of Health and Medical Services has decided to include maximum levels of sodium and fat in selected processed food items in the draft Food Regulations and Standards. The maximum levels of salt and fat are derived from the “Salt targets in Paciﬁc Foods” that were agreed and mandated by the meeting of Paciﬁc Ministers of Health in 2013 and supported by WHO, to help address the NCD crisis in the Paciﬁc. The draft Food Regulations and Standards also include restrictions on marketing of food and non-alcoholic beverages to children, as well as restrictions on the promotion of breast-milk substitutes and baby-feeding accessories. Sources: see references (20).

especially in emerging economies and in countries with rapidly increasing urbanization and peri-urban populations.

Progress achieved National efforts to reduce population salt consumption are under way in many countries (15–17) (see Boxes 4.1–4.5). Following implementation of national strategies to reduce sodium in manufactured foods, both Finland and the UK have reported significant reductions in sodium levels in manufactured foods, in population sodium intake, and in blood pressure, in both men and women (24–27).

In Finland there is evidence of a 65% reduction in age-adjusted mortality from coronary heart disease over the last four decades. Changes in food manufacturing and public health policies implemented at national level made an important contribution to these mortality reductions (24,25). There is good evidence that regulatory policies to reduce specific nutrients in foods (e.g. salt, trans fatty acids, certain fats) are beneficial, useful and effective in changing population dietary patterns (28). In some countries, mandatory regulation has resulted in changes to the food supply and dietary intake (24,25). Many countries have concluded voluntary agreements with the food industry, through

Global status report on NCDs 2014

Box 4.4 Working with the private sector to reduce salt consumption in Argentina and South Africa The majority of WHO Member States have opted for setting voluntary targets for salt reformulation. However, others, including Argentina and South Africa, have opted for legislative regulation to set speciﬁc targets for various food groups. Both methods of adopting targets involve dialogue with the private sector to facilitate reformulation, and also require consumer awareness to enable informed consumers to make the full use of the enabling environment. Sources: see references (22).

Box 4.5 Salt-reduction campaigns in Bahrain, Kuwait and Qatar The ministry of health of Kuwait established a national salt-reduction programme in January 2013. The Salt and Fat Intake Reduction task force developed and implemented a national strategy to reduce salt consumption, in consultation with nutrition experts and scientists and oﬃcials from Kuwait’s Food Standards Oﬃce, and in collaboration with the food industry. By the end of 2013, one of the food companies had reduced the salt content of bread – including white pitta bread, burger buns and whole-wheat toast – by 20%. Kuwait is exploring ways of reducing the salt content of another commonly consumed food item – cheese. The Qatar government is working with one of the country’s major bakeries to reduce the use of salt by 20%, and Bahrain is setting up a similar campaign. Sources: see references (23).

programmes such as Heart SAFE in New Zealand and the Korea Center for Less Salt campaign in the Republic of Korea, through national initiatives that involve states and local health authorities, or through obtaining signed pledges from the food industry (15). South Africa passed legislation for a phased reduction in salt in targeted processed foods items (21). Finland and the UK provide national examples of the impact of product reformulation policies. In the UK, voluntary measures and close collaboration between the public health and catering sectors have led to substantial improvements in the quality of processed foods and the diet of the population (24,25). There is evidence that mandating the use of “nutrition facts” panels or front-of-pack labels/ icons can improve dietary patterns, by influencing the food industry to reformulate products to meet healthier labelling requirements (15).

Implementing programmes and policies through settings such as schools, workplaces, villages and urban settings has shown an impact on behaviour. In Fiji, yearly renewal of licences for eating outlets are dependent on the outlets’ commitment to, and implementation of, simple salt-reduction actions, such as removing salt-shakers and high-salt sauces from restaurant tables and providing them only on request.

Actions required to attain this target The main sources of sodium in the diet need to be identified, in order to develop an effective strategy and to set targets for implementation – including reformulation of processed foods and out-of-home meals. This information is also needed to track changes in population salt intake and to help target specific population groups.

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Multisectoral collaboration is required to improve access to products with lower sodium. The ministry of health needs to take the lead in establishing platforms for intersectoral collaboration and targets for reformulation of processed foods (both local and imported), as well as to develop national food-labelling regulations in line with the Codex Alimentarius (29). Food manufacturers need to work with the ministry of health to implement reformulation and labelling regulations. Caterers need to be involved in reducing the amount of salt added during the preparation of meals. Country-specific public-awareness and community-mobilization campaigns on salt intake, as well as measures directed towards consumers and caterers, need to be developed and implemented, to increase awareness of sodium in foods and its impact on health. Health-care professionals may need training to convey the right messages and ensure effective communication. In addition, training of food producers, manufacturers and caterers – especially those involved in small and medium-sized businesses – is important for creating enabling environments to ensure that reformulation targets are reached and that consumer-awareness campaigns are successful. In countries where salt added at the table or during food preparation is the main source of sodium in the diet, the use of salt substitutes may also be advocated and promoted (6,7,30). Key measures to reduce salt consumption include (3,4,31): ■ identifying the baseline level of population sodium/salt intake and the main foods contributing to this level; ■ setting a national target for sodium/salt intake, in line with the global target, as part of a national multisectoral salt-reduction plan; ■ establishing sodium-reduction targets for each category of food, prioritizing the ones that contribute most to population intake; ■ working with food manufacturers to progressively reduce sodium/salt incrementally in their products, in line with agreed food group targets;

■

working with restaurants and catering services to reduce the addition of salt during meal preparation; establishing, in line with the Codex Alimentarius (30), consumer-friendly nutrition-labelling regulations that include sodium; considering fiscal tools to encourage the production and consumption of foods with reduced sodium content; establishing policies for food procurement in public institutions that encourage the purchase of products with lower sodium content; establishing national food-based dietary guidelines that incorporate sodium reduction; implementing information campaigns to raise consumer awareness of the need to reduce salt intake, and social marketing to impact on consumers’ behaviour; creating an enabling environment for salt reduction through local policy interventions and promotion of “healthy food” settings such as schools, workplaces, communities and cities; monitoring population sodium intake, sodium content of manufactured products, sources of sodium/salt in the diet, and consumer knowledge, attitudes and behaviours relating to the consumption of products containing sodium/ salt, in order to inform policy decisions.

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21. Hoffman KJ, Tollman SM. Population health in South Africa; a view from the salt mines. Lancet Glob Health. 2013 Aug;1(2):e66-7. doi: 10.1016/ S2214-109X(13)70019-6. 22. Ministerio de Salud Argentina. Argentine initiative to reduce salt consumption (http://www.paho.org/ panamericanforum/wp-content/uploads/2012/08/lesssalt-more-life_PAHO-consortium_ARG.pdf, accessed 5 November 2014). 23. Kuwait News Agency. Health Ministry praises Kuwait firm’s reduction of salt in bread and salt. 12 January 2014 (http://www.kuna.net.kw/ArticleDetails. aspx?id=2355046&language=en, accessed 5 November 2014). 24. Puska P, Vartiainen E, Laatikainen T, Jousilahti P, Paavola M, editors. The North Karelia project: from North Karelia to national action. Helsinki: Helsinki University Printing House; 2009 (https://www.julkari. fi/bitstream/handle/10024/80109/731beafd-b54442b2-b853-baa87db6a046.pdf?sequence=1, accessed 5 November 2014). 25. Vartiainen E, Laatikainen T, Peltonen M, Juolevi A, Männistö S, Sundvall J et al. Thirty-five-year trends in cardiovascular risk factors in Finland. Int J Epidemiol. 2010;39(2):504−18. doi:10.1093/ije/dyp330. 26. Sadler K, Nicholson S, Steer T, Gill V, Bates B, Tipping S et al. National Diet and Nutrition Survey − assessment of dietary sodium in adults (aged 19 to 64 years) in England, 2011. London: Department of Health; 2012 (http://webarchive.nationalarchives. gov.uk/20130402145952/http://media.dh.gov. uk/network/261/files/2012/06/sodium-surveyengland-2011_text_to-dh_final1.pdf, accessed 5 November 2014). 27. Responsibility Deal Food Network – new salt targets: F9 Salt Reduction 2017 pledge & F10 Out of Home Salt Reduction Pledge. London: Department of Health; 2014 (https://responsibilitydeal.dh.gov.uk/responsibilitydeal-food-network-new-salt-targets-f9-salt-reduction2017-pledge-f10-out-of-home-salt-reduction-pledge/, accessed 5 November 2014). 28. Cecchini M, Sassi F, Lauer JA, Lee YY, GuajardoBarron V, Chisholm D. Tackling of unhealthy diets, physical inactivity, and obesity: health effects and cost-effectiveness. Lancet. 2010;376(9754):1775−84. doi:10.1016/S0140-6736(10)61514-0. 29. World Health Organization, Food and Agriculture Organization of the United Nations. Codex Alimentatius. International food standards (http:// www.codexalimentarius.org/standards/en/, accessed 5 November 2014).

30. SaltSwitch: a smart(phone) strategy to support hear healthy food choices. Auckland: National Institute for Health Innovation; 2014 (http://nihi.auckland.ac.nz/ page/current-research/our-nutrition-and-physicalactivity-research/saltswitch-smartphone-strategy-su, accessed 5 November 2014). 31. Global action plan for the prevention and control of noncommunicable diseases 2013−2020. Geneva: World Health Organization; 2013 (http://apps.who. int/iris/bitstream/10665/94384/1/9789241506236_ eng.pdf?ua=1, accessed 12 December 2014).

Key points ■

Tobacco use remains the cause of 6 million preventable deaths per year globally. Significant progress has been made in implementing the most cost effective tobacco-control measures but much still remains to be done. The WHO Framework Convention on Tobacco Control provides the roadmap to curb the tobacco epidemic. Tobacco-control efforts must be sustained and reinforced, to have any lasting impact on reducing tobacco prevalence. However, there appears to be some complacency that, coupled with insufficient political will and tobacco industry interference, is hindering efforts to move ahead. The attainment of this target will contribute to attainment of the target on reducing premature mortality from NCDs.

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Global target 5: A 30% relative reduction in prevalence of current tobacco use in persons aged 15+ years

Tobacco use and its impact on health Tobacco use is currently one of the leading causes of preventable deaths in the world. Risks to health result not only from direct consumption of tobacco but also from exposure to second-hand smoke. Tobacco use increases the risk of cardiovascular disease, cancer, chronic respiratory disease, diabetes and premature death. Six million people are currently estimated to die annually from tobacco use, with over 600 000 deaths due to exposure to second-hand smoke (with 170 000 of these deaths among children) (1,2). Tobacco use accounts for 7% of all female and 12% of all male deaths globally (2,3). Unless strong action continues to be taken by countries, the annual toll is projected to increase to 8 million deaths per year by 2030, or 10% of all deaths projected to occur that year (2). As an entirely avoidable death toll, these figures are unacceptable. Tobacco use also imposes an economic burden in the form of increased medical costs and from lost productivity. In most economies, the health cost burden from tobacco also exceeds the total tax revenue(s) collected by the governments from tobacco products. Tobacco use is defined as current use of any tobacco product in either smoked or smokeless form (4). Availability and quality of data on smokeless tobacco use are slowly improving but are insufficient to report globally. Further improvements are needed, especially in the monitoring of use of smokeless tobacco as well as of the novel and emerging tobacco products. Therefore information provided in this report refers primarily to current tobacco smoking among males and females aged 15 years and over. In 2012 there were some 1.1 billion smokers worldwide, with over 8 out of 10 tobacco smokers smoking daily. Manufactured cigarettes, the most common form of smoked tobacco, are used by over 90% of current smokers. In addition, tobacco is smoked in cigars, pipes and other forms, particularly hookahs and bidis in Africa, Asia and the Middle East. Data on these specific forms of smoked tobacco are not yet readily available globally. In some countries the consumption of smokeless tobacco is as high, or higher than smoked forms of tobacco. The age-standardized prevalence of current tobacco smoking in persons aged 15 years and over, by WHO region and World Bank income group, in 2012, is shown in Fig. 5.1. In 2012, the global prevalence of current tobacco smoking among adults was estimated at around 22%, with smoking rates varying widely across

Global status report on NCDs 2014

Fig. 5.1 Age-standardized prevalence of current tobacco smoking in persons aged 15 years and over, by WHO region and World Bank income group, comparable estimates, 2012 Q Males Q Females 50%

40% % of population

30%

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AFR=African Region, AMR=Region of the Americas, SEAR =South-East Asia Region, EUR=European Region, EMR=Eastern Mediterranean Region, WPR=Western Paciﬁc Region

the six WHO regions (see Fig. 5.1). The highest regional average rate for tobacco smoking in 2012 was 30% (in the WHO European Region) while the lowest rate was 12% in the African Region, although it is increasing rapidly. Globally smoking prevalence is about five times higher among men (37%) than among women (7%) (see Fig. 5.2 and Fig. 5.3). Smoking prevalence in both high-income and upper-middle-income countries is broadly similar, although slightly higher in high income countries at 25% and middle-income countries at 22%. Among low-income countries, the average prevalence is lower (18%) (see Fig. 5.4) and, while various forms of tobacco consumption are popular, cigarette smoking accounts for about 80% of all forms of current smoking. In order to reduce the health threat of tobacco, the global target is a 30% relative reduction in prevalence of current tobacco use in persons aged 15 years and over by 2025 (using 2010 as baseline). Most governments have already engaged in strengthening their tobacco control measures, leading to the accelerated implementation of the WHO Framework Convention on Tobacco Control (WHO FCTC) which would enable them to reach this target.

What are the cost-eﬀective policies and interventions for reducing tobacco use? The WHO FCTC (5) and its guidelines (6) represent the global instrument that enables its Parties to attain the tobacco reduction target (4). In fact, during its sixth session in October 2014, the Conference of the Parties to the WHO FCTC called on Parties (7) to set national targets for 2025 for relative reduction of current tobacco use in persons aged 15 years and over, taking into account the global target. It also called on Parties to develop or strengthen national multisectoral policies and plans to achieve national targets on reduction of current tobacco use by 2025, taking into account WHO’s Global action plan for the prevention and control of noncommunicable diseases 2013–2020 (8). A comprehensive set of policy options for tobacco control is listed in the global NCD action plan (8), including the most cost-effective interventions (“best buys”) for tobacco control (Box 1.1) (9). Evidence shows that the very cost-effective WHO FCTC reduction measures for reducing national tobacco use are: ■ reducing the affordability of tobacco products by increasing tobacco excise taxes;

Chapter 5. Global target 5

Fig. 5.2 Age-standardized prevalence of current tobacco smoking in males aged 15 years and over, comparable estimates, 2012

* Current smoking of any tobacco product such as cigarettes, cigars, pipes, etc. It includes both daily and non-daily or occasional smoking.

Fig. 5.3 Age-standardized prevalence of current tobacco smoking in females aged 15 years and over, comparable estimates, 2012

* Current smoking of any tobacco product such as cigarettes, cigars, pipes, etc. It includes both daily and non-daily or occasional smoking.

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creating by law completely smoke-free environments in all indoor workplaces, indoor public places and public transport; alerting people to the dangers of tobacco and tobacco smoke through effective health warnings and mass media campaigns; and banning all forms of tobacco advertising, promotion and sponsorship.

The public health benefits of these measures are far more likely to be realized if they are implemented in an environment where they form part of a comprehensive approach, as envisaged by the WHO FCTC. Full implementation involves adopting other demand reduction measures such as helping tobacco users to quit and regulating tobacco products. Most smokers want to quit when

Global status report on NCDs 2014

Fig. 5.4 Age-standardized prevalence of current tobacco smoking in adults aged 15 years and over (%), by individual country and by World Bank Income group, comparable estimates, 2012 60%

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Chapter 5. Global target 5

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Global status report on NCDs 2014

informed of the health risks. Cessation support and medication increase the likelihood that a smoker will quit successfully, and countries can establish programmes providing low-cost effective interventions for tobacco users to stop. Full implementation of the WHO FCTC also entails supply reduction measures such as combating illicit trade, providing alternative livelihoods to tobacco farmers, and banning the sale or provision of tobacco products by and to minors. Full implementation involves two further important measures: countering tobacco industry interference, and establishing or reinforcing a national multisectoral and interministerial coordinating mechanism for the implementation of the WHO FCTC in each country.

Progress achieved Significant progress has been made in global tobacco control in recent years. While much remains to be done, the successes show that it is possible to turn the tide of tobacco usage when strong national political will and public engagement urge the implementation of effective policies.

Success: one third of the world’s people is protected by at least one of the most cost eﬀective tobacco-control measure The WHO report on the global tobacco epidemic, 2011 (10) indicated that, in 2010, 70 countries had already implemented at least one of the four tobacco-control “best-buy” interventions at the highest level of achievement. By 2013, 95 countries had at least one “best-buy” measure in place at the highest level of achievement, and between 2010 and 2013 a total of 40 countries implemented for the first time one or more “best-buy” measures at the highest level. In 2010, no country had all four “best buys” implemented, yet by 2013 two countries – Turkey (see Box 5.1) and Madagascar – had all four “best buys” in place at the highest level of achievement, and a further six countries had implemented three

Monitoring tobacco use The global monitoring framework indicators (see Annex 1), for monitoring progress towards attaining this target are (4): 1. prevalence of current tobacco use among adolescents; 2. age-standardized prevalence of current tobacco use among persons aged 18+ years.

Box 5.1 Reducing tobacco demand in Turkey Turkey was the ﬁrst country to attain the highest level of coverage in all of the WHO “best-buy” demand-reduction measures for reducing tobacco prevalence. In 2012, the country increased the size of health-warning labels to cover 65% of the total surface area of each tobacco or cigarette packet. Tobacco taxes cover 80% of the total retail price, and there is currently a total ban on tobacco advertising, promotion and sponsorship nationwide. The result of these concerted efforts has been a signiﬁcant decrease (13.4% relative decline) in the smoking rates of a country that has a long tradition of tobacco use and high smoking prevalence. This progress is a sign of the Turkish government’s sustained political commitment to tobacco control, exemplifying collaboration between government, WHO and other international health organizations, and civil society. Sources: see references (11).

Chapter 5. Global target 5

Box 5.2 Standardized packaging in Australia Australian oﬃcials announced in July 2014 that the nation’s daily smoking rate among people aged 14 years and over had declined from 15.1% to 12.8% between 2010 and 2013. The drop in the smoking rate shows that the standardized packaging law enforced at the end of 2012 – as well as the 25% tax increase instituted in 2010 – works. Australian law requires tobacco products to be sold in drab packages with large graphic images of tobacco-related diseases. Inclusion of the brand name is allowed but without logos. Sources: see references (12).

Box 5.3 Graphic health warnings in Thailand In June 2014, the Supreme Administrative Court of Thailand allowed the implementation of a new regulation requiring packs of cigarettes sold in the country to display graphic health-warning labels covering 85% of both sides of the packets. This is a major step towards implementing this measure, which was signed by the ministry of health in March 2013, but it has come under ﬁre from the tobacco industry and lobbyists. The implementation, originally planned for October 2013, was delayed by a court’s decision to suspend implementation of the new warnings until the legal process was over; however, in June 2014 the Supreme Administrative Court ruled against the temporary suspension. If successfully introduced permanently, the law will make Thailand’s packet warnings the largest in the world, leading the way to further reducing the tobacco industry’s control over advertising. Sources: see references (13).

out of four “best buys” at the highest level. Many of the countries making progress in implementing “best-buy” measures were low- or middle-income countries, showing that cost is not the main barrier to tobacco reduction.

Protecting people from the harms of tobacco smoke In 2013, 46 countries (including 35 low- and middle-income counties) had complete smoking bans in indoor working places, public transportation and indoor public places. Sixteen countries have adopted comprehensive smoke-free legislation since 2010. Conversely, the number of countries with very weak or no smoke-free laws fell from 92 to 74 between 2010 and 2013, although the improvement does not necessarily mean that they are implementing at the highest level of achievement. A new trend is visible as countries increasingly extend their smoke-free policies to cover outdoor settings such as beaches, public parks, outdoor cafes and markets, and even some streets, as well as settings that

However: some tobacco-control measures have become more established than others Although many countries have made a great deal of progress since 2010 in both introducing and implementing effective tobacco-control measures, some still have made little to no headway in fighting the tobacco epidemic. Additionally, some “best-buy” demand-reduction measures remain more widely implemented than others.

Global status report on NCDs 2014

Box 5.4 Finland, Ireland, New Zealand, Paciﬁc islands and the UK (Scotland): aiming at a tobacco endgame Some governments have outlined a strategic plan to further reduce tobacco prevalence to a deﬁned low level – usually close to zero – within a ﬁxed period, using the “tobacco endgame approach”. Strategies that can result in an endgame involve full implementation of the WHO FCTC (5), with fundamental denormalization not just of tobacco use but of the tobacco industry, by removing proﬁtability and by making the industry liable for damages. Furthermore, the focus on disadvantaged groups and policy action with tobacco control address the wider social determinants of inequalities and health. A commitment to a tobacco endgame has been made by Finland, Ireland, New Zealand, Paciﬁc islands and the UK (Scotland), which have publicly announced a target year to end tobacco use in their populations. These countries are committed to decreasing tobacco use to below 5% by the target year. Sources: see references (15).

Box 5.5 A knowledge hub for tobacco control in Africa As part of the Africa project funded by the Bill & Melinda Gates Foundation, WHO has set up the ﬁrst knowledge hub for tobacco control in the Centre for Tobacco Control in Africa (CTCA) in Kampala, Uganda. CTCA provides technical assistance to a number of countries in sub-Saharan Africa, on tobacco-control policies, legislation and programmes. Sources: see references (16).

were not traditionally covered by such regulations, such as prisons and private vehicles when carrying children.

Enforcing bans on tobacco advertising, promotion and sponsorship While 133 countries had banned some forms of tobacco advertising, promotion and sponsorship (TAPS) in 2013, only 27 had completely banned all its forms, nine more than in 2010. Low-income countries have taken greater action to ban TAPS completely (19%) than have high- and middle-income countries (6% and 16% respectively). The number of countries with a very weak or no ban on TAPS fell from 77 in 2010 to 62 in 2013.

Warning about the dangers of tobacco By 2013, 38 countries had legislated strong warning labels occupying at least 50% of the surface of cigarette packages. 19 of these countries had done this since 2010. Middle-income countries are the most likely to have established strong warning-label requirements (27% of middle-income countries have done so). In addition, the number of countries with very weak or no pack health warnings dropped from 91 to 68 between 2010 and 2013. There has been a move towards very large pictorial warnings (occupying, in general, more than 60% of principal display areas) on tobacco packages, and standardized (or plain) packaging in line with the obligations of the WHO FCTC (5).

Raising taxes on tobacco The most cost-effective tobacco-control intervention is to increase the price of tobacco products by raising tobacco tax, but this measure has progressed slowly since 2010. In 2010, 27 countries were levying taxes high enough to represent at least 75% of the retail price of cigarettes but by 2013 this had increased only

Chapter 5. Global target 5

Box 5.6 Mobile cessation (mCessation) in Costa Rica Costa Rica has had a campaign to lower smoking rates for several years. To increase public outreach, it was decided to use the growing mobile telephone user base to connect with smokers and help them quit, using mCessation methods. In collaboration with the WHO-ITU mHealth initiative, Costa Rica launched its ﬁrst-ever mobile-based smoking-cessation programme, «Quit Smoking» (Dejar de fumar), to support existing cessation services within the health system. The programme is based on text messaging, using standardized protocols and adapted to the country context. Further monitoring and evaluation is required to validate ﬁndings, but initial results indicate that mobile-based smoking-cessation programmes can be used successfully to help smokers quit in Costa Rica. Sources: see references (17).

to 32 countries. Low-income countries, although in greater need of government funding for tobacco-control and health programmes, are least likely to have sufficiently high tax rates; only one low-income country has achieved high taxes on cigarettes. In addition, the number of countries with a low tax share of the retail price (below 25%), or no tobacco taxes, increased from 29 in 2010 to 37 in 2013. Progress has been notable in some countries (see Boxes 5.2−5.6). The next step is to encourage other countries to follow suit, by highlighting the effectiveness of existing examples of tobacco-control policies and by offering additional support to adopt and implement such policies.

The successes of most countries in applying tobacco demand-reduction measures demonstrate that it is possible to tackle the tobacco epidemic regardless of size or income. Most progress in protecting people with these measures has been made by low- and middle-income countries, which remain at greatest risk from efforts of the tobacco industry to increase tobacco use. Despite the achievements in some countries in establishing effective tobacco-control measures, no country has entirely succeeded in protecting its population from the effects of tobacco. Efforts must be accelerated in all countries to save even more lives.

Conclusion There has been great progress in global tobacco-control efforts in recent years, in both the number of countries protecting their people and the number of people worldwide protected by effective tobacco-control measures. However, more work is needed in many countries, in order to focus efforts on passing and enforcing effective tobacco-control measures. This will include expanding activities to implement “best-buy” demand-reduction measures at the highest level of achievement, reinforcing and sustaining current programmes to incorporate a range of measures and, ultimately, implementing the full WHO FCTC (5).

Actions required to achieve this target Parties to the WHO FCTC (5) reported in 2014 an overall implementation of 54% of the substantive obligations of the treaty (18). Despite significant progress and global commitment to reduce tobacco consumption under the obligations of the convention, including the increase in countries implementing tobacco-control “best buys” at the highest level, significant challenges remain for achieving the global target of reducing tobacco use by 30%. The challenges to the successful implementation of tobacco-control policies range from insufficient political will and weak intersectoral cooperation, to weak implementation or enforcement capacities.

Global status report on NCDs 2014

The first challenge to tobacco control is a direct result of strong political and public commitment at the time of the WHO FCTC negotiation and some early and positive responses. However, after initial success with a number of the WHO FCTC obligations, especially in areas such as smoke-free policies and large pictorial health warnings, there appears to be some complacency which is hindering efforts to move ahead and leading to “tobacco-control fatigue”. Some countries have begun to discuss how to lower the prevalence of smoking below 5%, in what it is called the “tobacco endgame approach”. However, while discussion of the endgame as a motivational tool for continuing reduction of the tobacco epidemic in some countries is of great importance in overcoming complacency, it should not be mistaken for an announcement of the end of the tobacco epidemic, because much remains to be done. The second challenge has been the difficulty of ensuring that some “best-buy” policies at the highest level of achievement are actually adopted by governments. The problem is typically due either to poor political will or to interference from the tobacco industry, or both. There is good evidence that tobacco taxation offers the best potential for impact on reduction rates, yet it is one of the least implemented measures in national efforts, with only 32 of 195 countries having developed complete policies on tobacco taxation, demonstrating the need for stronger political engagement (3,19). Greater priority needs to be given to developing new strategies to support whole-of-government action in adopting and implementing sound national policies in accordance with all provisions of the WHO FCTC (5). The different elements affecting these broader national challenges to global tobacco control can be broken down under the subheadings that follow.

multisectoral partnerships in specialized areas of tobacco-control policies such as international trade, eliminating illicit trade in tobacco products, and other related activities that serve to facilitate the ground-level adoption and enforcement of tobacco-control policies.

Revitalizing political and public willpower Countries need to remain aware that tobacco continues to be a significant threat to public health, avoiding a sense that the worst is over, which, as mentioned above, is leading to problems of complacency in implementation efforts. There is also increasing fatigue in communication efforts, which risks a resurgence of tobacco use among communities and individuals, as a result of it ceasing to be considered a major health concern. While attainment of the tobacco-reduction target is achievable, a more audacious strategy may be needed to revitalize political and public willpower to advance progress.

Countering tobacco industry interference Tobacco industry interference is one of the key challenges to the creation and implementation of tobacco-reduction measures. It continues to undermine control efforts globally, and more needs to be done to counter its negative influence. In fact, during the reporting cycle of the WHO FCTC, which ended at the beginning of 2014, the challenge mentioned most frequently by Parties to the convention was tobacco industry interference. The tobacco industry continues to use legal challenges (often employed without success) to national tobacco-control measures, including litigation or support for litigation under multilateral and bilateral trade and investment agreements, to prevent, delay or weaken implementation of tobacco-control measures. Both the threat and active pursuit of legal challenges appear to be becoming more prominent, as Parties continue to implement the WHO FCTC. Article 5.3 of the treaty (5) clearly mandates Parties to the convention to prevent tobacco industry interference in tobacco control and public health. The tobacco industry is experienced in fostering partnerships with a range of sectors and interest

Increasing implementation support As progress in approval of the WHO FCTC policies (5) continues, many countries face the challenges of implementation and enforcement. These may include providing additional support and guidance to countries, building and engaging in

Chapter 5. Global target 5

groups, which has enabled it to put increasing pressure on tobacco-control measures, by diversifying the angles from which they are able to encourage dissent. A clear area of improvement for tobacco-control efforts is in redressing this imbalance by extending preventative action to other sectors such as finance, international trade and agriculture. Additionally, countries should seek to implement clear monitoring systems for industry activities across all sectors, to gauge the extent of influence and map potential obstructions to tobacco-control policies.

Approaching tobacco as a multisectoral problem for the whole government A focus on tobacco as an exclusively public health concern limits the chance for success in attaining the global target. Th is limited focus is causing implementation problems in cross-sectoral areas of tobacco-reduction measures, including minimal dialogue between finance, trade and health ministries in many countries. Tobacco control is multisectoral, and therefore requires an increase in intersectoral discussions and actions. These may include policy focus on the relation between tobacco controls and international trade, or alternative livelihoods for tobacco farmers. A unifocal approach to tobacco control misses opportunities for synergistic programmes with other communicable and noncommunicable disease programmes, such as for tuberculosis or respiratory diseases. It also misses the conspicuous need to integrate tobacco-control efforts within the wider health-development agenda.

Global status report on NCDs 2014

References 1. Oberg M, Jaakkola MS, Woodward A, Peruga A, PrüssUstün A. Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries. Lancet. 2011;377(9760):139−46. doi:10.1016/S0140-6736(10)61388-8. 2. WHO global report. Mortality attributable to tobacco. Geneva: World Health Organization; 2012 (http:// www.who.int/tobacco/publications/surveillance/ rep_mortality_attributable/en/, accessed 5 November 2014). 3. WHO report on the global tobacco epidemic 2013. Geneva: World Health Organization; 2013 (http:// www.who.int/tobacco/global_report/2013/en/, accessed 5 November 2014). 4. NCD global monitoring framework: indicator definitions and specifications. Geneva: World Health Organization; 2014. 5. WHO Framework Convention on Tobacco Control. Geneva: World Health Organization; 2003 (http:// whqlibdoc.who.int/publications/2003/9241591013. pdf, accessed 5 November 2014). 6. Guidelines for implementation of the WHO FCTC Article 5.3 | Article 8 | Articles 9 and 10 | Article 11 | Article 12 | Article 13 | Article 14. Geneva: World Health organization; 2013 (http://apps.who.int/ iris/bitstream/10665/80510/1/9789241505185_eng. pdf?ua=1, accessed 5 November 2014). 7. Conference of the Parties to the WHO Framework Convention on Tobacco Control, Sixth session decision “Towards a stronger contribution of the Conference of the Parties to achieving the noncommunicable disease global target on reduction of tobacco use” http://apps. who.int/gb/fctc/E/E_cop6.htm 8. Global action plan for the prevention and control of noncommunicable diseases 2013−2020. Geneva: World Health Organization; 2013 (http://apps.who. int/iris/bitstream/10665/94384/1/9789241506236_ eng.pdf?ua=1, accessed 3 November 2014). 9. Scaling up action against noncommunicable diseases: how much will it cost? Geneva: World Health Organization; 2011 (http://whqlibdoc.who.int/ publications/2011/9789241502313_eng.pdf, accessed 4 November 2014). 10. WHO report on the global tobacco epidemic, 2011: warning about the dangers of tobacco. Geneva: World Health Organization; 2011 (http://www.who.int/ tobacco/global_report/2011/en/, accessed 5 November 2014). 11. Tobacco control in Turkey: story of commitment and leadership. Copenhagen: World Health Organization Regional Office for Europe; 2012 (http://www.euro. who.int/__data/assets/pdf_fi le/0009/163854/e96532. pdf?ua=1, accessed 5 November 2014). 12. Standardised packaging of tobacco: report of the independent review undertaken by Sir Cyril Chantler http://www.kcl.ac.uk/health/10035TSO-2901853-Chantler-Review-ACCESSIBLE. PDF?utm_source=rss&utm_medium=rss&utm_ campaign=standardised-packaging-of-tobacco-reportof-the-independent-review-undertaken-by-sir-cyrilchantler-pdf, accessed 6 November 2014). 13. WHO Framework Convention on Tobacco Control. Thailand – new regulations on graphic health warnings introduced (http://www.who.int/fctc/implementation/ news/news_thai/en/, accessed 6 November 2014). 14. European tobacco control status report 2013. Copenhagen: World Health Organization Regional Office for Europe; 2013 (http://www.euro.who.int/__ data/assets/pdf_file/0011/235973/European-TobaccoControl-Status-Report-2013-Eng.pdf?ua=1, accessed 6 November 2014). 15. The Smokefree Coalition. Tupeka kore/Tobacco free Aotearoa/New Zealand by 2020 (http://www.sfc.org. nz/thevision.php, accessed 6 November 2014). 16. World Health Organization. Tobacco Free Initiative. African tobacco control (http://www.who.int/tobacco/ control/capacity_building/africa/activities/en/, accessed 6 November 2014). 17. ITU. Be he@lthy be mobile. http://www.itu.int/ en/ITU-D/ICT-Applications/eHEALTH/Pages/ mHealth_CostaRica_smoking.aspx (accessed 6 November 2014). 18. 2014 global progress report on implementation of the WHO Framework Convention on Tobacco Control. Geneva: World Health Organization; 2014 (http:// www.who.int/fctc/reporting/2014globalprogressreport. pdf?ua=1, accessed 5 November 2014). 19. Raising tax on tobacco: what you need to know. Geneva: World Health Organization; 2014 (http:// www.who.int/campaigns/no-tobacco-day/2014/ brochure/en/, accessed 5 November 2014).

Chapter 5. Global target 5

Key points ■

Raised blood pressure is one of the leading risk factors for global mortality and is estimated to have caused 9.4 million deaths and 7% of disease burden – as measured in disability-adjusted lifeyears − in 2010. The global prevalence of raised blood pressure (defined as systolic and/or diastolic blood pressure ≥140/90 mmHg) in adults aged 18 years and over was around 22% in 2014. Reducing the incidence of hypertension through implementation of population-wide policies to reduce behavioural risk factors, including harmful use of alcohol, physical inactivity, overweight, obesity and high salt intake, is essential to attaining this target. Control of hypertension through a total cardiovascular risk approach is more cost effective than treatment decisions based on individual risk factor thresholds only. A total-risk approach needs to be adopted for early detection and cost-effective management of hypertension, to prevent heart attacks, strokes and other complications. The attainment of this target will contribute to attainment of the target on reducing premature mortality from NCDs.

■

Global target 6: A 25% relative reduction in the prevalence of raised blood pressure or contain the prevalence of raised blood pressure, according to national circumstances

Raised blood pressure and its impact on health Raised blood pressure is one of the leading risk factors for global mortality and is estimated to have caused 9.4 million deaths and 7% of disease burden – as measured in DALYs − in 2010 (1). Raised blood pressure is a major cardiovascular risk factor. If left uncontrolled, hypertension causes stroke, myocardial infarction, cardiac failure, dementia, renal failure and blindness, causing human suffering and imposing severe financial and service burdens on health systems (2,3). Scientific studies have consistently shown the health benefits of lowering blood pressure through population-wide and individual (behavioural and pharmacological) interventions (4−6). For instance, a reduction in systolic blood pressure of 10 mmHg is associated with a 22% reduction in coronary heart disease and 41% reduction in stroke in randomized trials (5), and a 41–46% reduction in cardiometabolic mortality (6) in epidemiological studies. The global prevalence of raised blood pressure (defined as systolic and/or diastolic blood pressure ≥140/90 mmHg) in adults aged 18 years and over was around Fig. 6.1 Age-standardized prevalence of raised blood pressure in males aged 18 years and over (deﬁned as systolic and/or diastolic blood pressure equal to or above 140/90 mm Hg), comparable estimates, 2014

<25 25–29.9 ≥30

Data not available Not applicable

* systolic and/or diastolic blood pressure ≥140/90 mmHg.

The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement.

Data Source: World Health Organization – NCD RisC (NCD RISk factor Collaboration) Map Production: Health Statistics and Information Systems (HSI) World Health Organization 0 850 1’700 3’400 kilometers

Global status report on NCDs 2014

22% in 2014. The proportion of the world’s population with high blood pressure or uncontrolled hypertension fell modestly between 1980 and 2010. However, because of population growth and ageing, the number of people with uncontrolled hypertension has risen over the years.

Age-standardized prevalence of raised blood pressure in men and women is shown in Figs. 6.1 and 6.2 respectively. Across the WHO regions, the prevalence of raised blood pressure was highest in Africa, at 30% for all adults combined. The lowest prevalence of raised blood pressure was in

Fig. 6.2 Age-standardized prevalence of raised blood pressure in females aged 18 years and over (deﬁned as systolic and/or diastolic blood pressure equal to or above 140/90 mm Hg), comparable estimates, 2014

Prevalence of raised blood pressure (%)* <25 25–29.9 ≥30 Data not available Not applicable The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement.

*systolic and/or diastolic blood pressure ≥140/90 mmHg

Fig. 6.3 Age-standardized prevalence of raised blood pressure in adults aged 18 years and over (deﬁned as systolic and/or diastolic blood pressure equal to or above 140/90 mm Hg), by WHO region and World Bank income group, comparable estimates, 2014 Q Males Q Females 35% 30% 25% % of population 20% 15% 10% 5% 0% AFR AMR SEAR EUR EMR WPR Lowincome Lowermiddleincome Uppermiddleincome HIghincome

AFR=African Region, AMR=Region of the Americas, SEAR =South-East Asia Region, EUR=European Region, EMR=Eastern Mediterranean Region, WPR=Western Paciﬁc Region

Chapter 6. Global target 6

the Region of the Americas, at 18% (see Fig. 6.3). Men in this region had higher prevalence (21%) than women (16%). In all WHO regions, men have slightly higher prevalence of raised blood pressure than women. Fig. 6.5 shows the age-standardized prevalence of raised blood pressure in adults aged 18 years and over by country and World Bank income group in 2014. In general, the prevalence of raised blood pressure was higher in low-income countries compared to middle-income and high-income countries (see Fig 6.5). Many factors contribute to the high prevalence rates of hypertension(see Fig. 6.4): ■ eating food containing too much salt and fat; not eating enough fruits and vegetables; ■ overweight and obesity; ■ harmful use of alcohol; ■ physical inactivity; ■ ageing; ■ genetic factors; ■ psychological stress; ■ socioeconomic determinants;

inadequate access to health care. Hypertension is not an inevitable consequence of ageing. In the majority of cases, the exact cause of hypertension is unknown, but the presence of several of the above factors, increase the risk of developing the condition. Most of these factors are modifiable. ■

What are the cost-eﬀective policies and interventions to reduce the prevalence of raised blood pressure? In order to achieve this target, a comprehensive set of population-wide and individual interventions and policies is required to address the modifiable risk factors listed above. Very cost-effective population-wide interventions are available to reduce harmful use of alcohol (see Chapter 2), physical inactivity (see Chapter 3), population intake of salt/ sodium (see Chapter 4), overweight and obesity and intake of saturated fats (see Chapter 7), and to increase the consumption of fruits and vegetables

Figure 6.4 Main contributory factors to high blood pressure and its complications (3)

Social Social determinants determinants and and drivers drivers Globalization Urbanization Ageing Income Education Housing

Behaviour Social risk determinants factors and drivers Unhealthy diet Tobacco use Physical inactivity Harmfull use of Alcohol

Metabolic Social risk determinants factors and drivers High blood pressure Obesity Diabetes Raised blood lipids

Social Cardiovascular determinants disease and drivers Heart attack Strokes Heart failure

Global status report on NCDs 2014

Fig. 6.5 Age-standardized prevalence of raised blood pressure in adults aged 18 years and over (deﬁned as systolic and/or diastolic blood pressure equal to or above 140/90 mm Hg) (%), by individual country, and by World Bank Income group, comparable estimates, 2014 50%

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Chapter 6. Global target 6

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Global status report on NCDs 2014

(see Box 1.1). These interventions should be implemented to prevent hypertension and to shift the population distribution of blood pressure to an optimal profile (7). In addition, there must be equitable access to individual interventions, particularly at primary health-care level. People with hypertension are often asymptomatic until they develop end-organ damage (2,3). Consequently, proactive cost-effective approaches must be adopted for early detection of hypertension. Evidence indicates that targeted screening for total cardiovascular risk with blood pressure measurement (and blood glucose testing) is more cost effective than screening the whole population for a single risk factor, and is more likely to identify individuals at high cardiovascular risk for lower cost (8−10). In settings with access to well-developed primary health-care systems (i.e. where physicians can identify patients at high risk of developing diseases when they see them for other reasons, and can intervene when necessary), adding an organized screening programme to usual practice may not be required. Indeed, in such settings, systematic screening of the population has not resulted in a reduction in incidence of ischaemic heart disease compared to control groups that have access to usual care (11,12). There are several barriers to accurate and affordable blood pressure measurement, particularly in low-and middle income countries (13). These include: ■ The absence of accurate, easily-obtainable, inexpensive devices for blood pressure measurement; ■ The frequent marketing of non-validated blood pressure measuring devices; ■ The relatively high cost of blood pressure devices given the limited resources available; ■ Limited awareness of the problems associated with conventional blood pressure measurement techniques; ■ A general lack of trained manpower and limited training of personnel. The health system must be able to manage those detected with hypertension, using affordable approaches, particularly in resource-constrained

settings (14). A total-risk approach is needed to improve the efficiency and effectiveness of detection and management of hypertension (2,3,15). Decisions on drug treatment should be underpinned by evidence and based on total cardiovascular risk (15,16). Evidence of benefit for lowering blood pressure levels at or above 160/100 mmHg with drug treatment and non-pharmacological measures is very clear (2,3,15). Lower degrees of persistent hypertension (≥140/90 mm Hg) with moderate-to-high cardiovascular risk also require drug treatment (2,3,15). On the other hand, there is no evidence to justify drug treatment of persons with borderline hypertension and very low cardiovascular risk. People in this category, however, would benefit from the population-wide interventions alluded to above (2,3).

Monitoring the prevalence of raised blood pressure In the global monitoring framework (17, see Annex 1), the indicator for monitoring the prevalence of raised blood pressure is the age-standardized prevalence of raised blood pressure among persons aged 18+ years (7). Raised blood pressure is defined as systolic blood pressure ≥140mmHg and/or diastolic blood pressure ≥90 mmHg among persons aged 18+ years. For monitoring of progress, data should be gathered from a population-based (preferably nationally representative) survey in which blood pressure was measured (not self-reported).

Progress achieved High-income countries have begun to reduce hypertension through strong public health policies to reduce salt in processed food (see Chapter 4), improve the availability and affordability of fruits and vegetables (18), and create environments that promote physical activity (see Chapter 3). Declining trends in blood pressure, together with declines in smoking, body mass index (BMI) and serum cholesterol, may have accounted for nearly half the decline in cardiovascular mortality in some

Chapter 6. Global target 6

high-income countries (4). However, shortcomings in public health policies to address intake of salt and fruits and vegetables, physical inactivity, and overweight and obesity have resulted in rising trends in blood pressure in low- and middle-income countries. The country capacity assessment survey conducted in 2013 indicates many gaps in the implementation of public health policies that are key to prevention of hypertension (see Table 6.1) (19). High-income countries had the highest percentage of national policies, plans or strategies. The percentage of countries reporting policies, plans or strategies on behavioural risk factors was generally lowest in the WHO African Region, except for policies, plans or strategies on harmful use of alcohol, which were reported in an even lower percentage of countries in the Eastern Mediterranean Region (see Fig. 6.6). The number of people with undetected and uncontrolled hypertension has increased worldwide

because of population growth and ageing (4). Studies in high-income countries report that about one fift h of people with hypertension are unaware of their condition, about one quarter do not receive treatment and only around half have their blood pressure under control (20,21). The situation is much worse in low- and middle-income countries, where only about half of those with hypertension are aware of their status, only a fraction receive treatment, and the majority do not have their blood pressure under control (22,23). In general, awareness, treatment and control are lower in people with lower levels of literacy and socioeconomic status.

Actions required to attain this target There are significant health and economic gains in attaining this target. Worldwide, the high prevalence of hypertension contributes significantly to preventable cardiovascular events. As already

Fig. 6.6 Policies, plans and strategies to address behavioural risk factors of hypertension, by WHO region and World Bank income level QTobacco use; strategy or action plan or policy – operational QUnhealthy diet; strategy or action plan or policy – operational QPhysical inactivity; strategy or action plan or policy – operational QOverweight and obesity; strategy or action plan or policy – operational QHarmful use of alcohol; strategy or action plan or policy – operational 100%

80% Number of countries

60%

40%

20%

0% AFR AMR SEAR EUR EMR WPR Lowincome Lowermiddleincome Uppermiddleincome HIghincome

AFR=African Region, AMR=Region of the Americas, SEAR =South-East Asia Region, EUR=European Region, EMR=Eastern Mediterranean Region, WPR=Western Paciﬁc Region

Global status report on NCDs 2014

Box 6.1 Non-physician health workers implement the total-risk approach using hypertension as an entry point in Bhutan In Paro and Bumthang districts of Bhutan, trained non-physician health workers carried out cardiovascular risk assessment and management in primary care, using hypertension as an entry point. In this project, initiated in 2009, simpliﬁed protocols of the WHO package of essential noncommunicable disease (PEN) interventions were used to implement a total-risk approach. Regular audits checked the adequacy of human resources, availability of equipment and laboratory reagents, adherence to clinical protocols, and maintenance of stock registers. A performance assessment in 2013 showed that implementation of the total-risk approach in primary health care in Bhutan led to signiﬁcant improvement in blood pressure and diabetes control, and reduction in cardiovascular risk . In collaboration with ministries of health, WHO has initiated similar projects in primary care in some 30 resource-constrained settings. Sources: see references (24,25).

discussed, in most countries, many people with raised blood pressure are unaware that they have hypertension, and detection and control rates are suboptimal. Once hypertension develops, it may require lifelong treatment with medicines. Because of the high prevalence, drug treatment can be costly and is a challenge for resource-constrained settings. However, neglecting treatment entails interventions that are even more costly, such as cardiac bypass surgery, carotid artery surgery and renal dialysis, draining both individual and government budgets. The only solution is to control hypertension using an affordable total-risk approach, and concurrently take action to reduce its incidence. The actions that are needed to attain this target, are listed under the subheadings that follow.

Establish integrated programmes for hypertension and diabetes in primary care Integrated NCD programmes can be established at the primary care level, using WHO guidelines and tools (24). One objective of an integrated programme is to reduce total cardiovascular risk to prevent heart attack, stroke, kidney failure and other complications of hypertension and diabetes. Hypertension and diabetes often coexist and they cannot be dealt with in isolation. Adopting this comprehensive approach ensures that limited resources are used for the treatment of those at medium and high risk. It also prevents unnecessary drug treatment of people with borderline hypertension and very low cardiovascular risk. Inappropriate drug treatment exposes people to unwarranted harmful effects and increases the cost of health care. Both should be avoided. Investments are needed to improve health-service infrastructure and human and financial resources, to create a health-care system that is capable of deploying and sustaining equitable and quality-assured programmes for addressing cardiovascular risk (see Chapter 8). Appropriate communication and awareness-creation strategies are essential to ensure high coverage and follow-up care. Information systems should be in place to facilitate monitoring and evaluation of inputs and outcomes. Effective

Implement public health policies to reduce the incidence of hypertension Top priority should be accorded to implementation of public health policies to reduce exposure to behavioural risk factors: harmful use of alcohol (see Chapter 2), physical inactivity (see Chapter 3), high salt intake (see Chapter 4) and tobacco use (see Chapter 5). Policies to address overweight and obesity (see Chapter 7) also have a significant impact on the incidence of hypertension.

Chapter 6. Global target 6

training and reorientation of health-care workers, including non-physician health workers, are critical for improving provider performance and competency. With adequate training and supervision, non-physician health workers can play a key role in cardiovascular risk assessment and management, particularly in primary health care (see Box 6.1).

have the potential to reach a significant proportion of employed adults for early detection of hypertension, diabetes and other illnesses.

Strategies to enhance adherence The control of hypertension and cardiovascular risk, rely on individuals being adherent to measures to reduce behavioural risk factors and drug treatment as prescribed. Adherence requires a strategic policy to address the issue at the outset. Patients should be educated upon diagnosis and adherence enhancing strategies should be implemented to ensure ongoing control of cardiovascular risk. Where measurement devices are affordable, self-monitoring of blood pressure is recommended for the management of hypertension and diabetes (24). As with other NCDs, evidence-based approaches to strengthen self-care can facilitate early detection of hypertension, adherence to medication, and healthy behaviours, better control, and awareness of the importance of seeking medical advice when necessary. Self-care is important for all, but it is particularly useful for persons who have limited access to health services due to geographical, physical or economic reasons.

Promote workplace wellness programmes The United Nations high-level meeting on NCD prevention and control in 2011 called on the private sector to “promote and create an enabling environment for healthy behaviours among workers (26), 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”. Workplace wellness programmes should focus on promoting worker health through the reduction of individual risk-related behaviours (e.g. tobacco use, unhealthy diet, harmful use of alcohol, physical inactivity and other health-risk behaviours). These programmes

Global status report on NCDs 2014

References 1. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990– 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2224−60. doi:10.1016/S0140-6736(12)61766-8. 2. A global brief on hypertension. Silent killer, global public health crisis. Geneva: World Health Organization; 2013 (http://apps.who. int/iris/bitstream/10665/79059/1/WHO_DCO_ WHD_2013.2_eng.pdf, accessed 5 November 2014). 3. Prevention of cardiovascular disease: guidelines for assessment and management of cardiovascular risk. Geneva: World Health Organization; 2007 (http:// www.who.int/cardiovascular_diseases/guidelines/ Full%20text.pdf, accessed 5 November 2014). 4. Danaei G, Finucane MM, Lin JK, Singh GM, Paciorek CJ, Cowan MJ et al; Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Blood Pressure). National, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5.4 million participants. Lancet. 2011;377(9765):568−77. doi: 10.1016/S0140-6736(10)62036-3. 5. Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ. 2009;338:b1665. doi:10.1136/bmj.b1665. 6. Di Cesare M, Bennett JE, Best N, Stevens GA, Danaei G, Ezzati M. The contributions of risk factor trends to cardiometabolic mortality decline in 26 industrialized countries. Int J Epidemiol. 2013;42(3):838−48. doi:10.1093/ije/dyt063. 7. Global action plan for the prevention and control of noncommunicable diseases 2013−2020. Geneva: World Health Organization; 2013 (http://apps.who. int/iris/bitstream/10665/94384/1/9789241506236_ eng.pdf?ua=1, accessed 3 November 2014). 8. WHO guideline for screening of cardiovascular risk including diabetes. Geneva: World Health Organization; 2014 (in press). 9. Lawson KD, Fenwick EA, Pell AC, Pell JP. Comparison of mass and targeted screening strategies for cardiovascular risk: simulation of the effectiveness, cost-effectiveness and coverage using a cross-sectional survey of 3921 people. Heart. 2010;96(3):208−12. doi:10.1136/hrt.2009.177204. 10. Baker J, Mitchell R, Lawson K, Pell J. Ethnic differences in the cost-effectiveness of targeted and mass screening for high cardiovascular risk in the UK: cross-sectional study. Heart. 2013;99(23):1766−71. doi:10.1136/heartjnl-2013-304625. 11. Jørgensen T, Jacobsen RK, Toft U, Aadahl M, Glümer C, Pisinger C. Effect of screening and lifestyle counselling on incidence of ischaemic heart disease in general population: Inter99 randomised trial. BMJ. 20149;348:g3617. doi:10.1136/bmj.g3617. 12. Krogsbøll LT, Jørgensen KJ, Larsen CG, Gøtzsche PC. General health checks in adults for reducing morbidity and mortality from disease. Cochrane systematic review and meta-analysis. BMJ. 2012;345:e7191. doi:10.1136/bmj.e7191. 13. Affordable technology. Blood pressure measuring devices for low resource settings. Geneva: World Health Organization; 2005. 14. Ndindjock R, Gedeon J, Mendis S, Paccaud F, Bovet P. Potential impact of single-risk-factor versus total risk management for the prevention of cardiovascular events in Seychelles. Bull World Health Organ. 2011;89(4):286−95. doi:10.2471/BLT.10.082370. 15. Prevention and control of noncommunicable diseases: guidelines for primary health care in lowresource settings; diagnosis and management of type 2 diabetes and management of asthma and chronic obstructive pulmonary disease. Geneva: World Health Organization; 2012 (http://apps.who.int/iris/ bitstream/10665/76173/1/9789241548397_eng.pdf, accessed 5 November 2014). 16. Sundström J, Arima H, Woodward M, Jackson R, Karmali K, Lloyd-Jones D et al; Blood Pressure Lowering Treatment Trialists’ Collaboration. Blood pressure-lowering treatment based on cardiovascular risk: a meta-analysis of individual patient data. La ncet. 2014;384(9943):591−8. doi:10.1016/ S0140-6736(14)61212-5. 17. NCD global monitoring framework indicator definitions and specifications. Geneva: World Health Organization; 2014. 18. Ganann R, Fitzpatrick-Lewis D, Ciliska D, Peirson LJ, Warren RL, Fieldhouse P et al. Enhancing nutritional environments through access to fruit and vegetables in schools and homes among children and youth: a systematic review. BMC Res Notes. 2014;7:422. doi:10.1186/1756-0500-7-422. 19. Assessing national capacity for the prevention and control of noncommunicable diseases; report of the 2013 global survey. Geneva: World Health Organization; 2014.

Chapter 6. Global target 6

20. Liddy C, Singh J, Hogg W, Dahrouge S, Deri-Armstrong C, Russell G et al. Quality of cardiovascular disease care in Ontario, Canada: missed opportunities for prevention − a cross sectional study. BMC Cardiovasc Disord. 2012;12:74. doi:10.1186/1471-2261-12-74. 21. Joff res M, Falaschetti E, Gillespie C, Robitaille C, Loustalot F, Poulter N et al. Hypertension prevalence, awareness, treatment and control in national surveys from England, the USA and Canada, and correlation with stroke and ischaemic heart disease mortality: a cross-sectional study. BMJ Open. 2013;3(8):e003423. doi:10.1136/bmjopen-2013-003423. 22. Chow CK, Teo KK, Rangarajan S, Islam S, Gupta R, Avezum A et al.; PURE (Prospective Urban Rural Epidemiology) study investigators. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA. 2013;310(9):959−68. doi:10.1001/jama.2013.184182. 23. Iwelunmor J, Airhihenbuwa CO, Cooper R, Tayo B, Plange-Rhule J, Adanu R et al. Prevalence, determinants and systems-thinking approaches to optimal hypertension control in West Africa. Global Health. 2014;10:42. doi:10.1186/1744-8603-10-42. 24. Implementation tools: package of essential noncommunicable (WHO-PEN) disease interventions for primary health care in low-resource settings. Geneva: World Health Organization; 2013 (http:// www.who.int/cardiovascular_diseases/publications/ implementation_tools_WHO_PEN/en/, accessed 5 November 2014). 25. Wangchuk D, Virdi NK, Garg R, Mendis S, Nair N, Wangchuk D, Kumar R. Package of essential non-communicable disease (PEN) interventions in primary health-care settings of Bhutan: a performance assessment study. WHO South-East Asia Journal of Public Health, 2014, 3 (2) 26. Resolution 66/2. Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. In: Sixtysixth session of the United Nations General Assembly. New York: United Nations; 2011 (A/67/L.36; http:// www.who.int/nmh/events/un_ncd_summit2011/ political_declaration_en.pdf, accessed 3 November 2014).

Key points ■

Worldwide, obesity has more than doubled since 1980, and in 2014, 11% of men and 15% of women aged 18 years and older were obese. An estimated 42 million children under the age of 5 years were overweight in 2013. The global prevalence of diabetes was estimated to be 9% in 2014. Obesity can be prevented through multisectoral population-based interventions that promote physical activity and consumption of a healthy diet, throughout the life-course. Research is urgently needed to evaluate the effectiveness of interventions to prevent and control obesity. The attainment of this target will contribute to attainment of targets on reducing the prevalence of hypertension and on reducing premature mortality from NCDs.

■

■ ■

■

Global target 7: Halt the rise in diabetes and obesity

Overweight and obesity and their impact on health The link between obesity, poor health outcomes and all-cause mortality is well established. Obesity increases the likelihood of diabetes, hypertension, coronary heart disease, stroke, certain cancers, obstructive sleep apnoea and osteoarthritis. It also negatively affects reproductive performance. Overweight and obesity – i.e. BMI ≥25 kg/m2 and ≥30 kg/m2 respectively – were estimated to account for 3.4 million deaths per year and 93.6 million DALYs in 2010 (1). To achieve optimal health, the median BMI for adult populations should be in the range 21–23 kg/m2, while the goal for individuals should be to maintain a BMI in the range 18.5−24.9 kg/m2. The risk of comorbidities increases with a BMI in the range 25.0−29.9 kg/m2, and the risk is moderate to severe with a BMI greater than 30 kg/m2 (2).

Prevalence of overweight and obesity in adults Obesity has been increasing in all countries. In 2014, 39% of adults aged 18 years and older (38% of men and 40% of women) were overweight. The worldwide prevalence of obesity nearly doubled between 1980 and 2014. In 2014, 11% of men and 15% of women worldwide were obese. Thus, more than half a billion adults worldwide are classed as obese. Age-standardized estimates on prevalence of obesity in males and females, aged 18 years and over are shown in Figs. 7.1 and 7.2, respectively. The prevalence of overweight and obesity is highest in the Region of the Americas (61% overweight or obese in both sexes, and 27% obese) and lowest in the South-East Asia Region (22% overweight in both sexes, and 5% obese) (see Fig. 7.3). In the European and Eastern Mediterranean Regions and Region of the Americas, over 50% of women are overweight, and in all three regions roughly half of overweight women are obese (25% in the European region, 24% in the Eastern Mediterranean Region, 30% in the Region of the Americas). In all WHO regions, women are more likely to be obese than men. In the African, South-East Asia and Eastern Mediterranean regions,, women have roughly double the obesity prevalence of men. Fig. 7.5 shows the age-standardized prevalence of obesity in adults aged 18 years and over, by country, and World Bank income groups in 2014. The prevalence of overweight and obesity increases with the income level of countries. The prevalence of obesity in high-income and upper-middle-income countries is more than double that of low- income countries. (see Fig. 7.3

Global status report on NCDs 2014

and 7.5). Although the Western Pacific Region ranks low in prevalence of obesity, the Pacific countries show high rates similar to the Americas.

Prevalence of overweight and obesity in children Overindulgence in high calorie food and indoor leisure activities (e.g. television viewing, internet, and computer games) alone or in combination with

factors that dissuade walking and other outdoor activities, contribute to childhood obesity. The prevalence of overweight pre-school aged children is increasing fastest in low- and lower-middle-income countries (see Figs. 7.4 and 7.6) (3). In 2013, an estimated 42 million children (6.3%) aged under 5 years were overweight (3). The latest estimates show that the global prevalence of overweight and obesity in children aged under 5 years has increased from around 5% in 2000

Fig. 7.1 Age-standardized prevalence of obesity in men aged 18 years and over (BMI ≥30 kg/m2), 2014

<5 5–14.9 15–24.9 * BMI ≥ 30 kg/m2

≥25 Data not available Not applicable

Fig. 7.2 Age-standardized prevalence of obesity in women aged 18 years and over (BMI ≥30 kg/m2), 2014

<5 5–14.9 15–24.9 * BMI ≥30 kg/m2

≥25 Data not available Not applicable

Chapter 7. Global target 7

to 6% in 2010 and 6.3% in 2013 (4). The prevalence of childhood overweight is increasing worldwide, but especially in Africa and Asia. Between 2000 and 2013, the prevalence of overweight in children aged under 5 years increased from 11% to 19% in some countries in southern Africa and from 3% to 7% in South-East Asia (UN region). In 2013, there were an estimated 18 million overweight children aged under 5 years

in Asia, 11 million in Africa and 4 million in Latin America and the Caribbean. There was little change in the prevalence of overweight in children in Latin America and the Caribbean over the last 13 years, but countries with large populations had levels of 7% and higher. It is estimated that the prevalence of overweight in children aged under 5 years will rise to 11% worldwide by 2025 if current trends continue (4).

Fig. 7.3 Age-standardized prevalence of obesity in adults aged 18 years and over (BMI ≥30 kg/m2), by WHO region and World Bank income group, comparable country estimates, 2014 Q Males Q Females 35% 30% 25% % of population 20% 15% 10% 5% 0% AFR AMR SEAR EUR EMR WPR Lowincome Lowermiddleincome Uppermiddleincome HIghincome

AFR=African Region, AMR=Region of the Americas, SEAR =South-East Asia Region, EUR=European Region, EMR=Eastern Mediterranean Region, WPR=Western Paciﬁc Region

Fig. 7.4 Age-standardized prevalence of overweight in children under ﬁve years of age, comparable estimates, 2013

Data Source: World Health Organization – <5 ≥20 The designations employed and the presentation of the material in NCD RisC (NCD RISk factor Collaboration) this publication do not imply the expression of any opinion 5–9.9 Data not available whatsoever on the part of the World Health Organization concerning Map Production: Health Statistics and Information Systems (HSI) World Health Organization the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or 10–14.9 Not applicable 0 850 1’700 3’400 kilometers boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. 15–19.9 * Percentage of overweight (weight-for-height above +2 standard deviations of the WHO Child Growth Standards median).

Global status report on NCDs 2014

Fig. 7.5 Age-standardized prevalence of obesity in adults aged 18 years and over, (BMI ≥30 kg/m2) (%), by individual country, and World Bank Income group, 2014 50%

Andorra 29.5 Antigua and Barbuda 30.9

a 28.6

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High-income

6.2 Ba hra Ba in 35 rb .1 ad os 31 .3

Austra li

Bah a

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Sw itz er Sw lan ed d en 19 20 Sp .4 ain .5 23. 7 Slov enia 25.1 Slova kia 2 5.7 Singapo re 6.2

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20%

10%

.1 i 18 lg m Be a l 8 .0 ssa a2 aru ad D n Ca ei 7 .8 un le 2 Br Chi 3.3 tia 2 Croa

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23 Cyprus

Saudi Arabia 34.7 vis 28.3 Saint Kitts and Ne .1 tion 24 Federa Russian .8 5 rea of Ko blic Repu 2.3 ar 4 .1 Qat l 20 ga u t r .2 Po 25 nd a l .9 Po 30 an Om 0%

.8 Czech Republic 26

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Denmark 19.3 Equatori al Guine a 17.5 Eston ia 22 .6 Finl and 20.6 Fra nce Ge 23. rm 9 an y2 Gr 0.1 ee ce 22 .9

.8 22 d lan 5 .6 Ice d2 la n Ire 5.3 el 2 Isra 21.0 Italy

7 Kuwait 39.

Japan

Latvia 23.7

3.3

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Bangla

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Chapter 7. Global target 7

50%

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40%

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Global status report on NCDs 2014

There has been an increasing global recognition of the need for effective strategies to prevent and control childhood overweight and obesity. In 2012, the World Health Assembly agreed a target of no increase in childhood overweight by 2025 (5). To accelerate WHO’s efforts to address the issue, in May 2014 the Director-General of WHO established a high-level Commission on Ending Childhood Obesity.

Diabetes/raised blood glucose and its impact on health Diabetes is a well-recognized cause of premature death and disability, increasing the risk of cardiovascular disease, kidney failure, blindness and lower-limb amputation (6). People with impaired glucose tolerance and impaired fasting glycaemia are also at risk of future development of diabetes and cardiovascular disease (7). In recent decades, the prevalence of diabetes has been increasing globally, and has been particularly accelerated in low- and middle-income countries. Th is rise is largely driven by modifiable risk factors – particularly physical activity, overweight and obesity (8). A few high-income countries have documented a levelling-off of obesity prevalence in children (9,10),

although the beneficial effect of this on diabetes risk will take time, unless a similar change occurs in adults. Population ageing is also an important factor, as glucose intolerance increases with age. Much of the diabetes burden can be prevented or delayed by behavioural changes favouring a healthy diet and regular physical activity. Diabetes was directly responsible for 1.5 million deaths in 2012 and 89 million DALYs. The global prevalence of diabetes (defined as a fasting plasma glucose value ≥7.0 mmol/L [126 mg/dl] or being on medication for raised blood glucose) was estimated to be 9% in 2014. The prevalence of diabetes was highest in the WHO Region of the Eastern Mediterranean Region (14% for both sexes) and lowest in the European and Western Pacific Regions (8% and 9% for both sexes, respectively) (see Figs. 7.7 and 7.8). In general, low-income countries showed the lowest prevalence and upper-middle-income countries showed the highest prevalence of diabetes for both sexes (see Fig. 7.9).

Monitoring the rates of obesity and diabetes Indicators in the global monitoring framework (11) for monitoring progress in attaining this target are:

Fig. 7.6 Prevalence of overweight in children aged under 5 years, by WHO region and World Bank income group, comparable estimates, 2013 14% 12% 10% % of population 8% 6% 4% 2% 0% AFR AMR SEAR EUR EMR WPR Lowincome Lowermiddleincome Uppermiddleincome HIghincome

AFR=African Region, AMR=Region of the Americas, SEAR =South-East Asia Region, EUR=European Region, EMR=Eastern Mediterranean Region, WPR=Western Paciﬁc Region

Chapter 7. Global target 7

1. age-standardized prevalence of raised blood glucose/diabetes among persons aged 18+ years, or on medication for raised blood glucose; 2. age-standardized prevalence of overweight and obesity in persons aged 18+ years; 3. prevalence of overweight and obesity in adolescents.

The measurement of overweight in children under 5 years is included in the global monitoring framework on maternal, infant and young child nutrition (12). Overweight is defined as having a weight-for-height above two standard deviations from the median. WHO defines overweight in school-aged children and adolescents (persons aged 10–19 years)

Fig. 7.7 Age-standardized prevalence of diabetes, (Fasting glucose ≥ 7.0 mmol/L, or on medication for raised blood glucose or with a history of diagnosis of diabetes), in men aged 18 years and over, comparable estimates, 2014

≤8 8.1–10 10.1–15 15.1–17

≥17.1 Data not available Not applicable

* Deﬁned as fasting blood glucose ≥ 7 mmol/l or on medication for raised blood glucose or with a history of diagnosis of diabetes.

Fig. 7.8 Age-standardized prevalence of diabetes (Fasting glucose ≥ 7.0 mmol/L, or on medication for raised blood glucose or with a history of diagnosis of diabetes), in women aged 18 years and over, comparable estimates, 2014

≤8 8.1–10 10.1–15 15.1–17

≥17.1 Data not available Not applicable

* Deﬁned as fasting blood glucose ≥ 7 mmol/l or on medication for raised blood glucose or with a history of diagnosis of diabetes.

Global status report on NCDs 2014

Fig. 7.9 Age-standardized prevalence of diabetes in adults aged 18 years and over, (Fasting glucose ≥ 7.0 mmol/L, or on medication for raised blood glucose or with a history of diagnosis of diabetes) (%), by individual country, and World Bank Income group, 2014 30% 25%

High-income

20%

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15%

10%

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Chapter 7. Global target 7

30%

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Global status report on NCDs 2014

Box 7.1 Hungary − impact assessment of the Public Health Product Tax On 19 July 2011 Hungary passed the law “Act CIII of 2011 on the Public Health Product Tax” related to tax on food and drink components with a high risk for health. The tax liability of a product depends on its sugar, salt and caﬀeine content. One year later, an impact assessment was conducted, based on surveys of the public and manufacturers. Results show that 40% of responding manufacturers changed the product formula to reduce the taxable ingredient. The sale of products subject to tax decreased by 27% and people consumed 25−35% fewer products subject to tax than one year earlier. Sources: see references (25).

as one standard deviation BMI-for-age (equivalent to BMI 25 kg/m2 at 19 years), and obesity in the same group as two standard deviations BMI-for-age (equivalent to BMI 30 kg/m2 at 19 years) from the median (13). The WHO STEPwise approach to Surveillance of NCD Risk Factors (STEPS) is used by many countries to track national prevalence data for obesity and raised blood glucose in adults (14). In some countries, demographic and health surveys also collect data on BMI. WHO’s Global school-based student health survey (15) is used in many countries to measure and monitor overweight and obesity in adolescents; while data in children aged under 5 years are collected routinely through demographic and health surveys, multiple indicator cluster surveys, and other surveys. The national target can be fi xed according to the epidemiological profi le of each country and what might be achievable. The national target can aim to halt the epidemic and ultimately reverse the trend. Countries may consider an immediate focus on reducing the incidence of obesity in children and adolescents, and a longer-term target of reducing the prevalence in adults. A zero increase in diabetes incidence rather than prevalence would be confirmation that modifiable risk factors are being controlled successfully. However, this is a much stricter target and measurement of the number of new cases would be too complex, since diabetes is asymptomatic and undiagnosed in 30−80% of cases (16).

What are the cost-eﬀective policies and interventions for reducing the prevalence of obesity and diabetes ? Although evidence on what works as a package of interventions for obesity prevention is limited, much is known about promotion of healthy diets and physical activity, which are key to attaining the obesity and diabetes targets. Evidence of population-wide policies and settings-based and individual-based interventions that have worked in different countries is described below.

Population-wide policies Evidence suggests that changes in agricultural subsidies to encourage fruit and vegetable production could be beneficial in increasing the consumption of fruits and vegetables and improving dietary patterns (17). Evidence strongly supports the use of such subsidies and related policies to facilitate sustained long-term production, transportation and marketing of healthier foods (17). Price is often reported as a barrier to the purchase and consumption of healthy foods (18). Pricing strategies that increase incentives for purchasing healthier food options also increase the purchase of those options (19). Taxation schemes that produce large changes in price can change purchasing habits and are likely to improve health (20,21). Hungary introduced a “junk food tax” on foods high in sugar, salt and caffeine (see Box 7.1), and

Chapter 7. Global target 7

Box 7.2 Brazil – healthy school food policy Brazil’s national school feeding programme, launched in 1955, is mentioned in the country’s constitution and covers nearly 47 million children. Its objectives are to contribute to the growth, development and learning capabilities of students, to support the formation of healthy habits through food and nutrition education, and to promote local family farming through food purchase. School meals meet national nutrition standards, with mandatory inclusion of fruits and vegetables. The national programme requires that schools purchase locally grown or manufactured products, stimulating the local economy. Brazilian law requires that 70% of the food served to children in school meal programmes is unprocessed (e.g. rice, beans, meat, ﬁsh, fruits or vegetables) and 30% is locally sourced. Regular government purchases from family farms have led to improved quality of unprocessed food and increased availability and consumption of fruits and vegetables by school children. Sources: see references (34,35).

France introduced a tax on sweetened drinks (22). In 2013, the Mexican congress passed taxes on soda and junk food (23). Several other countries are also considering such taxes (24). Trade and regulatory measures have also proven effective in reducing the availability of unhealthy foods and changing population dietary patterns (26,27). In 2000, Fiji banned the supply of mutton flaps (high in fat) under the Trading Standards Act (26). In Mauritius, the focus of regulation was the reduction of saturated fatty acids in cooking oil and its replacement with soybean oil. The policy is estimated to have changed consumption patterns favourably and reduced average total cholesterol levels (27). Measuring the impact of these approaches on obesity and diabetes is of utmost importance. There is ample evidence that marketing of foods and non-alcoholic beverages influences children’s knowledge, attitudes, beliefs and preferences. Based on this evidence, WHO has developed a set of recommendations and an implementation framework on the marketing of foods and non-alcoholic beverages to children (28). This aims to assist Member States to design and implement new policies, or strengthen existing ones, on food-marketing communications to children. To facilitate implementation, WHO has developed a regional nutrient profile model in the European Region, to guide the marketing of food and non-alcoholic beverages to

children. Other WHO regions are developing their own nutrition profile models. Nutrition labelling can be useful in orienting consumers to products that contribute to a healthier diet. There is evidence that simple, front-of-pack labels on packaged foods, or point-of-purchase information in grocery stores, cafeterias or restaurants, can be beneficial, as can menu labelling to support healthier options (29–31). There is also evidence that combining nutrition labelling with environmental and/or nutrition education measures can be even more effective in changing consumer behaviour and consumption patterns (30). Consumer awareness of healthy diet and physical activity can be achieved through sustained media and educational campaigns aimed at increasing consumption of healthy foods, or reducing consumption of less healthy ones and increasing physical activity. These campaigns have greater impact and are more cost-effective when used within multicomponent strategies (24).

Settings-based interventions Settings-based interventions can be effective in preventing and controlling diabetes and obesity. A settings-based approach reaches families and communities where they live, work and play. Settings include schools, universities, workplaces, communities, and health-care and religious settings.

Global status report on NCDs 2014

The school is an important setting for promoting healthy diets and physical activity. WHO’s Health Promoting Schools Initiative (32) and the Nutrition-Friendly School Initiative (33) were developed to address the double burden of undernutrition and overweight/obesity that many countries face. A “whole of school” approach focused on improving both diet and physical activity (including provision of a healthy food option in school cafeterias, a supportive environment for physical activity, and specialized educational curricula) can be very effective in improving dietary patterns both inside and outside school (24,30,31). Provision of fresh fruit and vegetables to students at school can influence dietary behaviour outside school without extra cost (see Box 7.2) (22). Worksite interventions addressing diet and physical activity are effective in changing behaviours and health-related outcomes (36,37). Workplace vending machine prompts, labels or icons can be successful in changing dietary patterns, when combined with increased availability of healthier food options (24). Healthy-eating messages in cafeterias and restaurants have been shown to stimulate consumption of healthy food − provided that healthy food items are made available as part of the intervention (38).

for reversing or stopping the increasing prevalence of overweight and obesity. There is some evidence that diabetes incidence, prevalence and mortality have been reduced where external circumstances imposed a lowering of the caloric intake and an increase in physical activity on the whole population (41,42).

Actions required to attain this target The target of no increase in prevalence of obesity and diabetes is closely linked with the target of decreasing physical inactivity (see Chapter 3). To maintain a healthy weight, there must be a balance between energy consumed (through diet) and energy expended (through physical activity). Failure to breastfeed, or a shorter duration of breastfeeding, are also associated with a higher risk of overweight later in life (43). To prevent obesity, multisectoral population-based action is required, focusing on prenatal, infancy and childhood health actions targeting the most vulnerable groups. The ministry of health will need to take leadership and engage with other relevant government sectors in a national multisectoral action plan (see Chapter 10). Policies should simultaneously address different sectors that contribute to the production, distribution and marketing of food, while concurrently shaping an environment that facilitates and promotes adequate levels of physical activity (44–47). For the management of obesity, low-energy diets are effective in the short term, but reducing inactivity, increasing walking, and developing an activity programme can increase the effectiveness of obesity therapy. Treating associated health risks and established complications is important. In addition, there needs to be strengthening of health systems to address obesity and diabetes as clinical entities through primary health-care services for early detection and management. Regular monitoring of the prevalence of obesity and diabetes should be instituted as part of routine NCD surveillance.

Individual interventions Diet and physical activity counselling through primary health care have the potential to change behaviours related to obesity and diabetes (39). The provision of dietary counselling, especially as a component of a total-risk approach, has the potential to be beneficial (39). Positive results of effective risk-factor control can be seen in a short time, since any reduction in body weight and increase in physical activity has a beneficial effect on the risk of diabetes. This intervention has been scaled up to the whole population in a few high-income countries, and encouraging results on feasibility have been reported from Finland (40). However, it has not been implemented at scale in low- and middle-income countries. There is currently no evidence on the effectiveness of large-scale interventions on the whole population

Chapter 7. Global target 7

The agenda for attaining this target could implement and evaluate the following: ■ multisectoral population-based policies to influence production, marketing and consumption of healthy foods; ■ fi scal policies to increase the availability and consumption of healthy food and reduce consumption of unhealthy ones; ■ promotion of breast feeding and healthy complementary feeding according to WHO recommendations (12); ■ policies and interventions to attain the target on reducing physical inactivity; ■ education and social marketing campaigns focused on impacting dietary and physical activity behaviour in both children and adults; ■ implementation of restrictions on marketing of foods and beverages that are high in sugar, salt and fat to children; ■ measures to create healthy eating environments in settings (schools, workplaces, universities, religious settings, villages, cities) and communities, including disadvantaged communities; ■ research to generate evidence on the effectiveness of individual and population-wide interventions to prevent and control obesity and diabetes. To be effective, proposed actions need to be specific to the country or region and should take into account the available resources and the cultural and ethnic differences. It is important to make decisions regarding policy options and priority areas locally, and to engage all relevant stakeholders. WHO has developed a tool to identify and prioritize childhood obesity-prevention policies and interventions (48).

Global status report on NCDs 2014

11. NCD global monitoring framework indicator definitions and specifications. Geneva: World Health Organization; 2014. 12. WHA resolution 65/6. Maternal, infant and young child nutrition. In: Sixty-fifth World Health Assembly, Geneva, 21–26 May 2012. Geneva: World Health Organization; 2012 (http://apps.who.int/gb/ebwha/ pdf_files/WHA65/A65_R6-en.pdf, accessed 6 November 2014). 13. de Onis M, Lobstein T. Defining obesity risk status in the general childhood population: Which cut-offs should we use? Int J Pediatr Obes. 2010;5(6):458−60. doi:10.3109/17477161003615583. 14. World Health Organization. Chronic diseases and health promotion. STEPwise approach to surveillance (STEPS) (http://www.who.int/chp/steps/en/, accessed 5 November 2014). 15. World Health Organization. Global school-based student health survey (GSHS) (http://www.who.int/ chp/gshs/en/, accessed 6 November 2014). 16. Beagley J, Guariguata L, Weil C, Motala AA. Global estimates of undiagnosed diabetes in adults. Diabetes Res Clin Pract. 2014;103(2):150−60. doi:10.1016/j. diabres.2013.11.001. 17. Wallinga D. Agricultural policy and childhood obesity: a food systems and public health commentary. Health Aff (Millwood). 2010;29(3):405−10. doi:10.1377/ hlthaff.2010.0102. 18. Waterlander WE, de Mul A, Schuit AJ, Seidell JC, Steenhuis IH. Perceptions on the use of pricing strategies to stimulate healthy eating among residents of deprived neighbourhoods: a focus group study. Int J Behav Nutr Phys Act. 2010;7:44. doi:10.1186/1479-5868-7-44. 19. Phipps EJ, Braitman LE, Stites SD, Wallace SL, Singletary SB, Hunt LH. The use of financial incentives to increase fresh fruit and vegetable purchases in lower-income households: results of a pilot study. J Health Care Poor Underserved. 2013;24(2):864−74. doi:10.1353/hpu.2013.0064. 20. My tton OT, Clarke D, Rayner M. Ta xing unhealthy food and drinks to improve health. BMJ. 2012;344:e2931−8. doi:10.1136/bmj.e2931. 21. Sharma A, Hauck K, Hollingsworth B, Siciliani L. The effects of taxing sugar-sweetened beverages across different income groups. Health Econ. 2014 Sep;23(9):1159-84. doi:10.1002/hec.3070. 22. Villanueva T. European nations launch tax attack on unhealthy foods. CMAJ. 2011;183(17):E1229–30. doi:10.1503/cmaj.109-4031. 23. Mexico enacts soda tax in effort to combat world’s highest obesity rate. The Guardian, 16 January 2014 (http://www.theguardian.com/world/2014/jan/16/ mexico-soda-tax-sugar-obesity-health, accessed 5 November 2014).

24. Cecchini M1, Sassi F, Lauer JA, Lee YY, GuajardoBarron V, Chisholm D. Tackling of unhealthy diets, physical inactivity, and obesity: health effects and cost-effectiveness. Lancet. 2010;376(9754):1775−84. doi:10.1016/S0140-6736(10)61514-0. 25. Act CIII of 2011 on the Public Health Product Tax. . Budapest: Hungarian National Institute for Health and Development; 2013 (http://www.oefi.hu/NETA_ hatasvizsgalat.pdf, accessed 6 November 2014). 26. Snowdon W, Thow AM. Trade policy and obesity prevention: challenges and innovation in the Pacific Islands. Obes Rev. 2013;13(Suppl 2):150−8. doi:10.1111/ obr.12090. 27. Uusitalo U, Feskens EJ, Tuomilehto J, Dowse G, Haw U, Fareed D et al. Fall in total cholesterol concentration over five years in association with changes in fatty acid composition of cooking oil in Mauritius: cross sectional survey. BMJ. 1996;313:1044−6. 28. Set of recommendations on the marketing of foods and non-alcoholic beverages to children. Geneva: World Health Organization; 2010 (http://www.who. int/dietphysicalactivity/publications/recsmarketing/ en/, accessed 5 November 2014). 29. Capacci S, Mazzocchi M, Shankar B, Macias JB, Verbeke W, Pérez-Cueto FJ et al. Policies to promote healthy eating in Europe: a structured review of policies and their effectiveness. Nutr Rev. 2012;70(3):188−200. doi: 10.1111/j.1753-4887.2011.00442.x. 30. School policy framework: implementation of the WHO global strategy on diet, physical activity and health. Geneva: World Health Organization 2008 (http:// www.who.int/dietphysicalactivity/SPF-en-2008.pdf, accessed 1 December 2014). 31. Branca F, Nikogosian H, Lobstein T, editors. The challenge of obesity in the WHO European Region and the strategies for response. Copenhagen: World Health Organization Regional Office for Europe; 2007 (http://www.euro.who.int/__data/assets/ pdf_fi le/0008/98243/E89858.pdf?ua=1, accessed 5 November). 32. Health promoting schools. A healthy setting for living, learning and working. Geneva: World Health Organization; 1998 (http://www.who.int/school_ youth_health/media/en/92.pdf, accessed 6 November 2014). 33. World Health Organization. Nutrition-friendly schools initiative (http://www.who.int/nutrition/ topics/nutrition_friendly_schools_initiative/en/, accessed 6 November 2014). 34. Fraser B. Latin American countries crack down on junk food. Lancet. 2013;382:385−6. 35. State of school feeding worldwide. Rome: World Food Programme; 2013 (http://documents.wfp.org/ stellent/groups/public/documents/communications/ wfp257481.pdf, accessed 6 November 2014) (34).

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36. Task Force on Community Preventive Services. A recommendation to improve employee weight status through worksite health promotion programs targeting nutrition, physical activity, or both. Am J Prev Med. 2009;37(4):358−9. doi:10.1016/j.amepre.2009.07.004. 37. Preventing noncommunicable diseases in the workplace through diet and physical activity. WHO/World Economic Forum report of a joint event. Geneva: World Health Organization/World Economic Forum; 2008 (http://whqlibdoc.who.int/ publications/2008/9789241596329_eng.pdf?ua=1, accessed 5 November 2014). 38. Uglem S, Stea TH, Raberg Kjøllesdal MK, Frölich W, Wandel M. A nutrition intervention with a main focus on vegetables and bread consumption among young men in the Norwegian National Guard. Food Nutr Res. 2013 Oct 21:57. doi:10.3402/fnr.v57i0.21036 (http:// www.ncbi.nlm.nih.gov/pmc/articles/PMC3805840/, accessed 5 November 2014). 39. Package of essential noncommunicable (WHO PEN) disease interventions for primary health care in lowresource settings. Geneva: World Health Organization; 2013 (http://w w w.who.int/nmh/publications/ essential_ncd_interventions_lr_settings.pdf, accessed 5 November 2014). 40. Tuomilehto J, Lindström J, Eriksson JG, Valle TT, Hämäläinen H, Ilanne-Parikka P et al; Finnish Diabetes Prevention Study Group. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344(18):1343−50. 41. Uusitupa M, Tuomilehto J, Puska P. Are we really active in the prevention of obesity and type 2 diabetes at the community level? Nutr Metab Cardiovasc Dis. 2011;21(5):380−9. doi:10.1016/j.numecd.2010.12.007. 42. Franco M, Bilal U, Orduñez P, Benet M, Morejón A, Caballero B et al. Population-wide weight loss and regain in relation to diabetes burden and cardiovascular mortality in Cuba 1980−2010: repeated cross sectional surveys and ecological comparison of secular trends. BMJ. 2013;346:f1515. doi:10.1136/bmj. f1515. 43. Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M et al; Maternal and Child Nutrition Study Group. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427−51. doi:10.1016/ S0140-6736(13)60937-X. 44. Hawkes C, Jewell J, Allen K. A food policy package for healthy diets and the prevention of obesity and diet-related non-communicable diseases: the NOURISHING framework. Obes Rev. 2013;14 (Suppl 2):159−68. doi:10.1111/obr.12098.

45. Interventions on diet and physical activity: what works. Summary report. Geneva: World Health Organization; 2009 (http://www.who.int/dietphysicalactivity/ summary-report-09.pdf, accessed 5 November 2014). 46. Global recommendations on physical activity for health. Geneva: World Health Organization; 2010 (http://www.who.int/dietphysicalactivity/factsheet_ recommendations/en/, accessed 5 November 2014). 47. Population-based approaches of childhood obesity prevention. Geneva: World Health Organization; 2012 (http://apps.who.int/iris/ bitstream/10665/80149/1/9789241504782_eng.pdf, accessed 1 December 2014). 48. Prioritizing areas for action in the field of populationbased prevention of childhood obesity. A set of tools for Member States to determine and identify priority areas for action. Geneva: World Health Organization; 2012 (http://apps.who.int/iris/ bitstream/10665/80147/1/9789241503273_eng.pdf, accessed 5 November 2014).

Key points ■

Cardiovascular disease was the leading cause of NCD deaths in 2012 and was responsible for 17.5 million deaths. Heart attacks and strokes can be prevented if high-risk individuals are detected early and treated. A very cost-effective intervention, which can be implemented in primary care even in resource-constrained settings, is available for prevention of heart attacks and strokes. Prevention of heart attacks and strokes through a total cardiovascular risk approach is more cost-effective than treatment decisions based on individual risk factor thresholds only, and should be part of the basic benefits package for pursuing universal health coverage. Integrated programmes based on a total-risk approach need to be established in primary care, using hypertension, diabetes and other cardiovascular risk factors as entry points. Achieving this target requires strengthening of the key components of the health system including sustainable healthcare financing, to ensure access to basic health technologies and essential NCD medicines. The attainment of this target will contribute to attainment of the target on reducing premature mortality from NCDs.

■

Global target 8: At least 50% of eligible people receive drug therapy and counselling (including glycaemic control) to prevent heart attacks and strokes

Cardiovascular disease: heart disease and stroke Of the 17.5 million deaths due to cardiovascular disease in 2012, an estimated 7.4 million were due to heart attacks (ischaemic heart disease) and 6.7 million were due to strokes (1). Over the last four decades, the rate of death from cardiovascular diseases has declined in high-income countries, owing to reductions in cardiovascular risk factors and better management of cardiovascular disease (2). Recent studies indicate that, although the risk-factor burden is lower in low-income countries, the rates of major cardiovascular disease and death are substantially higher in low-income countries than in high-income countries (3). Currently, over 80% of cardiovascular deaths occur in low- and middle-income countries. In 2012, heart disease and stroke were among the top three causes of years of life lost due to premature mortality globally (4). The current high rates of premature cardiovascular death are unacceptable because very cost-effective interventions are available to prevent heart disease and stroke (5−7). The target to reduce heart attacks and strokes aims to improve the coverage of drug treatment and counselling to prevent heart attacks and strokes in people with raised cardiovascular risk and established disease. It is an affordable intervention that can be delivered through a primary health-care approach, even in resource-constrained settings (8−12).

What are the cost-eﬀective policies and interventions to prevent heart attacks and strokes? First heart attacks and strokes can be prevented if high-risk individuals are detected early and treated (6). For eligible persons aged 40–79 years, a regimen of aspirin, statin and two agents to lower blood pressure has been estimated to avert about one fifth of cardiovascular deaths, with 56% of deaths averted in people under 70 years (13). This intervention can be delivered to persons with raised cardiovascular risk (including those with hypertension, diabetes and other cardiovascular risk factors with medium-to-high cardiovascular risk) through integrated primary care programmes (9−11).

Global status report on NCDs 2014

Fig. 8.1 WHO/ISH risk prediction chart Age

Male Non-smoker Smoker Non-smoker

Female Smoker

(years)

(mm Hg)

SBP 180

160 140 120 180

40 4 5 6 7 8 4 5 6 7 8 4 5 6 7 8 4 5 6 7 8

160 140 120

Cholesterol (mmol/l)

An approach that addresses total cardiovascular risk is more cost effective than approaches that make treatment decisions based on individual risk-factor thresholds only (e.g. hypertension, hypercholesterolaemia) (6,9). A total-risk approach recommended by WHO enables integrated management of hypertension, diabetes and other cardiovascular risk factors in primary care, and targets available resources at persons most likely to develop heart attacks, strokes and diabetes complications (10,11). In addition to first attacks, recurrent heart attacks and strokes also need to be prevented in those with established disease (secondary prevention). These persons face considerably greater risk of recurrent vascular events and are much more likely to die in a recurrent event. Aspirin, beta-blockers and angiotensin-converting enzyme inhibitors, together with smoking cessation, could prevent up to three quarters of recurrent heart attacks and strokes (7). However, a sole focus on secondary prevention is insufficient to attain this target, as a considerable number of heart attacks and strokes are first attacks

and many persons do not survive the first attack, particularly in low- and middle-income countries with weak emergency health services. It has been proposed that administration of a fixed-dose combination of aspirin, statin and antihypertensive medications (polypill) to all individuals aged over 55 years, regardless of cardiovascular risk status, is a suitable approach for preventing heart attacks and strokes (14). However, there is no definite evidence to support such mass drug treatment, and the efficacy, long-term risks, sustainability and cost effectiveness of the polypill remain to be proven. Overall, results of clinical trials conducted to date show that fixed-dose combination therapy is associated with modest increases in adverse events, but better adherence to treatment, compared to multiple single agents (15). As yet, there are no clinical trials with any fixed-dose combinations that are powered to show differences in morbidity and mortality. Further research, including cost-effectiveness studies, is necessary before considering widespread use of fixed-dose combinations. Furthermore, the use of a

Chapter 8. Global target 8

polypill should not undermine comprehensive public health approaches to NCD prevention and control, or efforts to strengthen health systems in low- and middle-income countries.

Monitoring coverage to prevent heart attacks and strokes The indicator for monitoring this target in the global monitoring framework (12, see Annex 1) is the proportion of eligible persons receiving drug therapy and counselling (including glycaemic control) to prevent heart attacks and strokes. Eligible persons are those aged 40 years and older with a 10-year cardiovascular disease risk ≥30% (based on WHO/ISH risk-prediction charts, see Fig 8.1), including those with existing cardiovascular disease. Drug therapy is defined as taking medications for primary and secondary prevention of heart attacks and strokes, based on WHO recommendations (6,7,9,10). This includes medications for controlling diabetes, hypertension, blood cholesterol and blood coagulation, based on WHO recommendations. Counselling is defined as receiving advice from a doctor or other health worker to quit using tobacco or not start, reduce salt in the diet, eat at least five servings of fruit and/or vegetables per day, reduce fat in the diet, start or do more physical activity, maintain a healthy body weight, or lose weight. Data on monitoring coverage of this essential health service should be gathered from a population-based (preferably nationally representative) multiple risk factor survey, that also records the history of cardiovascular disease, and counselling and drug therapy to reduce cardiovascular risk including the use of statins.

Progress achieved In the global capacity assessment survey conducted in 2013, 85% of countries reported offering risk-factor and disease management in their primary healthcare systems (16). Low-income countries were less likely to have these services at the primary care level. Overall, 94% of countries indicated that they were

able to screen for diabetes, with 92% having staff generally available to do the testing, but the availability of tests and staff was low in low-income countries. For instance, while 80% of all countries reported having tests and procedures to assay cholesterol, only 34% of low-income countries reported having these available, compared to 77% of lower-middle-income countries and 100% of high-income countries. While the majority of countries (76%) reported having guidelines for management of cardiovascular disease, only about one third reported having fully implemented the guidelines. More detailed studies reveal significant gaps in the provision of interventions to prevent heart attacks and stroke, even in high-income countries. In a study conducted in 22 European countries, the proportion of patients with heart disease and prevalent diabetes reaching the treatment targets was 20% for blood pressure, 53% for low-density lipoprotein cholesterol and 22% for haemoglobin A1c (HbA1c) (17). In another European study on secondary prevention and risk-factor control in patients after ischaemic stroke, 50% of patients did not achieve optimal risk-factor targets (18). Not surprisingly, a much worse situation has been documented in low- and middle-income countries (19,20). In one study, the percentage of those with heart attacks who received beta-blockers was 48%, angiotensin-converting enzyme inhibitors 40%, and statins only 21% (19). In a more recent study in three countries in SouthEast Asia, over 80% of patients received no effective drug treatment after heart attacks and strokes (20). Poor access to basic services in primary care, lack of affordability of laboratory tests and medicines, inappropriate patterns of clinical practice, and poor adherence to treatment were some of the main reasons for the treatment gaps. In low- and middle-income countries, the primary care level of the health system, which has to play a critical role in delivering these interventions, is often the weakest. An evaluation of the capacity of primary care facilities to implement interventions to prevent heart attacks, strokes and other NCD complications in eight low- and middle-income countries showed major deficits in health financing, service delivery, access to basic technologies and medicines, medical

Global status report on NCDs 2014

Box 8.1 Phased scale-up of total-risk approach for prevention of heart attacks and strokes in primary care In order to attain this health-system target on prevention of heart attacks and strokes, several low- and middle-income countries (e.g. Bahrain, Benin, Bhutan, Democratic People’s Republic of Korea, Eritrea, Ethiopia, Fiji, Guinea, Indonesia, Kiribati, Kyrgyzstan, Lebanon, Myanmar, Philippines, Republic of Moldova, Samoa, Sierra Leone, Solomon islands, Sri Lanka, Sudan, Tajikistan, Togo, Tonga, Turkey, Uzbekistan, Viet Nam) have taken steps to strengthen primary care for integration of NCD services. They have assessed the capacity of primary care for implementing a total-risk approach. Primary care workers, including family practitioners, are being trained to assess and manage cardiovascular risk, using tools of the WHO Package of essential noncommunicable (PEN) disease interventions for primary health care in low-resource settings (22). Some countries have planned national scale-up through a phased approach, as outlined below: Phase 1: Conduct situation analysis ■ Create a conducive policy environment: include prevention of heart attacks and strokes through the total-risk approach in the essential services package and set national targets Phase 2: Address key gaps and strengthen the health system as far as possible Phase 3: Achieve optimum NCD care within the constraints of the situation ■ Estimate the cost of scale-up and track resources ■ Identify/correct missed opportunities ■ Integrate vertical disease-speciﬁc primary care programmes (e.g. on hypertension, diabetes) Phase 4: Systematic scale-up and monitoring ■ Strengthen supply and quality of services, with emphasis on primary care ■ Improve demand for primary care ■ Find innovative solutions to overcome barriers to improving supply and demand ■ Monitor performance and progress towards attaining the target Sources: see references (22-25,32).

information systems, and the health workforce (21). Overall, in most low- and middle-income countries, coverage of this essential individual intervention for prevention of heart attacks and strokes is low, with very slow progress in scaling up. However, as many country examples demonstrate (see Boxes 8.1−8.4), if there is sufficient political commitment and sustainable action, the current situation can be changed gradually, by strengthening the health system, with a special focus on primary care.

Actions required to attain this target A comprehensive set of policy options for attaining this target is listed under objective 4 (Strengthen

and orient health systems to address the prevention and control of NCDs) of the Global NCD Action Plan (5). Many challenges need to be overcome in implementing these policy options. One challenge is to give priority and wider coverage to this very cost-effective high-impact NCD intervention (“best buy”), in moving towards universal health coverage. A second is to address health-system gaps through mechanisms that are sensitive to specific contexts. A third is to develop innovative approaches to expand coverage and track progress as health systems gain capacity in service delivery. Informed decisions need to be made about the sequence of action and the pace at which services are expanded, on the basis of a situation analysis.

Chapter 8. Global target 8

Box 8.2 High-level commitment to strengthen primary care for prevention of heart attacks and strokes in Paciﬁc Island countries At a joint meeting in July 2014, Economic and Health Ministers of Paciﬁc Island countries agreed to improve the eﬃciency and impact of existing health budgets, by reallocating scarce health resources to targeted primary and secondary prevention of cardiovascular disease and diabetes, including implementation of WHO PEN (22). Sources: see references (23).

Box 8.3 Health-system strengthening to improve NCD outcomes: Bahrain, the West Bank and Gaza Strip, Philippines Bahrain’s ministry of health has taken steps to improve NCD services through a primary health-care approach. In line with the protocols of WHO PEN (22), primary care clinics have been strengthened to address NCDs. The clinics are run by teams consisting of a certiﬁed family physician, a trained NCD nurse and a health educator. Clinics cover a wide range of activities, including assessment of risk factors, early detection and management of NCDs and complications, and provision of counselling on diet, physical activity, weight control, smoking cessation and self-care. This approach has improved coverage of key NCD interventions and patient satisfaction. The ministry of health of the Palestinian Authority adopted WHO PEN (22), in an attempt to move away from a vertical approach. The programme has been piloted in two districts in the West Bank and Gaza Strip. Reviews have included a register review, clinical audit and staﬀ satisfaction surveys, and routine service data have been used to engage staﬀ in analysing trends and quality of performance. Results indicate that on-site training, backed with regular structured supervision and clinical audits, are key elements in improving the quality of care and promoting a sense of accountability. In Pateros, Metro Manila, Philippines, key activities to introduce the WHO PEN package (22) have been implemented, including: baseline assessment of capacity, consultation with stakeholders, procurement of essential technologies and medicines, training of health-care providers and computerization of the health information system. Cardiovascular risk assessment has been integrated with other public health programmes. The referral system has been strengthened by involving referral doctors during training and drafting a referral protocol. High-visibility NCD days were organized by community health volunteers, to improve community awareness of the availability of services and to promote compliance. Sources: see references (22,24,25).

Give priority to attaining this target in moving towards universal health coverage Attainment of this target requires priority to be accorded to the prevention of heart attacks and strokes, along the route to attaining universal health coverage. Many low- and middle-income

countries are making progress in advancing the universal health coverage agenda (see Box 8.5). They are increasingly recognizing that NCD programmes that are focused on inpatient care may neither fully protect against financial risk nor cover services that improve health cost effectively, and that coverage of essential interventions in primary

Global status report on NCDs 2014

Box 8.4. Expansion of access to primary health care in Brazil Progress on prevention and control of NCDs reported from Brazil can be ascribed largely to political commitment, a focus on social determinants of health, implementation of a comprehensive national health system with strong social participation, and expansion of access to primary health care. Age-adjusted NCD mortality is falling by 1.8% per year, with declines primarily for cardiovascular and chronic respiratory diseases. The prevalence of diabetes, hypertension and obesity, however, is rising, owing to unfavourable changes in diet and physical activity. Source: see reference (26).

Box 8.5 Coverage of NCD services in the context of progressive realization of universal health coverage Some low- and middle-income countries are making progress towards providing the entire population with universal access to a beneﬁt package that includes essential NCD interventions. Other countries have introduced reforms to expand health insurance coverage to include essential NCD services. Diﬀerent approaches are used for raising prepaid revenues, pooling risk, and purchasing services. Progress can be seen in increasing enrolment in government health insurance, a movement towards expanded beneﬁts packages, and decreasing out-of-pocket spending, accompanied by an increasing government share of spending on health. Source: see reference (27,32).

care will yield greater impacts on population health than inpatient services. Various pathways for achieving universal health coverage have been described (28,29). Coverage of the entire population for a defi ned set of very cost-effective high-impact interventions – addressing NCDs, injuries, infectious diseases, and maternal and child health – could be the first step. To attain the target, this publicly financed basic benefit package must include very cost-effective interventions, namely prevention of heart attacks and strokes through a total-risk approach (10,11). A more advanced approach could provide an expanded package of interventions, such as the expanded list of cost-effective interventions in the Global NCD Action Plan (5) (see Appendix 3 of the plan). This second package could be financed through a broader range of traditional and innovative financing mechanisms, including general taxation revenue, payroll taxes, mandatory

premiums and co-payments. Exempting the poor (at least those earning less than US$ 1.25 a day) from contributing to both packages should be considered, not only because health is a human right but also because it is a smart approach to equitable distribution of national wealth.

Address gaps and reorient health systems to address noncommunicable diseases As alluded to above, context-specific strategies will be required to address multiple gaps in health systems related to financing, access to basic technologies and medicines, the health workforce, service delivery, health information and referral. Special attention should be given to strengthening primary care coverage and improving the quality of services at primary level. Health workers require training in assessing and managing total cardiovascular risk, based on evidence-based clinical protocols and risk-assessment tools, and using hypertension and

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diabetes as entry points (9,10). A comprehensive approach is required to increase staffing ratios, shift certain NCD tasks to lower cadres, and improve the performance of health workers in general practice and family medicine, to address NCDs. Essential technologies (e.g. accurate devices for blood pressure measurement, risk-assessment charts, weighing scales, height measuring equipment, blood sugar and blood cholesterol measurement devices with strips, and urine strips for albumin assay) and, medicines (e.g. at least aspirin, a statin, a thiazide diuretics, an angiotensin-converting enzyme inhibitor, a long acting calcium-channel blocker, a beta-blocker, metformin and insulin ) have to be available and affordable. Efforts are required to make progress on attaining the NCD target, on availability and affordability of these, and other essential NCD medicines and basic technologies (see Chapter 9). Adherence to simplified guidelines, evidence-based protocols and evidence-based support for self-care (10,11,30) needs to be ensured. Health-information and referral systems require strengthening, to improve follow-up of patients, to monitor inequalities, and to coordinate between health-care providers, primary care facilities and secondary and tertiary hospitals.

policy-makers and service providers, to improve the quality of health care, including for NCDs. However, studies that have directly examined the impact of financial incentives on improving healthcare processes and outcomes have reported mixed results. The role of provider and patient incentives in improving quality of care and clinical outcomes in persons with raised cardiovascular risk needs to be explored and evaluated. A structured and standardized external audit process could be important for monitoring the expanding role of primary care in preventing heart attacks, strokes and complications of diabetes. Audits of primary care centres to analyse databases on coverage of essential NCD interventions, together with review of physical conditions of the premises and of referral links and patient records chosen at random, could provide useful information for developing context-specific solutions to deficiencies in service delivery. Facility-level quality-improvement audits carried out by primary care teams could also gather information for teambased analysis of performance problems and joint solutions to problems.

Learning lessons from experience, innovation and adaptation, to resource limitations Systematic screening for total cardiovascular risk (including hypertension, diabetes and other risk factors), with access to diagnosis and treatment, can advance progress towards attaining this target. Targeted screening for total cardiovascular risk, with blood glucose testing and blood pressure and blood cholesterol measurement, is more cost effective than screening the whole population, and is more likely to identify individuals at high cardiovascular risk, for lower cost (31). WHO tools are available to estimate the costs of widening coverage; the rate of expansion can be adjusted according to the availability of resources (11). The quality of services provided, particularly in primary care, requires monitoring. Pay-for-performance programmes have been adopted by

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References 1. World Health Organization. Global Health Estimates: Deaths by Cause, Age, Sex and Country, 2000-2012. Geneva, WHO, 2014. 2. O’Flaherty M, Buchan I, Capewell S. Contributions of treatment and lifestyle to declining CVD mortality: why have CVD mortality rates declined so much since the 1960s? Heart. 2013;99:159−62. doi:10.1136/ heartjnl-2012-302300. 3. Yusuf S, Rangarajan S, Teo K, Islam S, Li W, Liu L et al; PURE Investigators. Cardiovascular risk and events in 17 low-, middle-, and high-income countries. N Engl J Med. 2014;371(9):818−27. doi:10.1056/ NEJMoa1311890. 4. World health statistics 2014. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/ bitstream/10665/112738/1/9789240692671_eng.pdf, accessed 4 November 2014). 5. Global action plan for the prevention and control of noncommunicable diseases 2013−2020. Geneva: World Health Organization; 2013 (http://apps.who. int/iris/bitstream/10665/94384/1/9789241506236_ eng.pdf?ua=1, accessed 3 November 2014). 6. Prevention of cardiovascular disease. Guideline for assessment and management of cardiovascular risk. Geneva: World Health Organization; 2007 (http:// www.who.int/cardiovascular_diseases/publications/ Prevention_of_Cardiovascular_Disease/en/, accessed 6 November 2014). 7. Prevention of recurrent heart attacks and strokes in low and middle income populations: evidence-based recommendations for policy makers and health professionals. Geneva: World Health Organization; 2003 (http://www.who.int/cardiovascular_diseases/ resources/pub0402/en/, accessed 6 November 2014). 8. Package of essential noncommunicable (PEN) disease interventions for primary health care in low-resource settings. Geneva: World Health Organization; 2010 (http://whqlibdoc.who.int/ publications/2010/9789241598996_eng.pdf, accessed 6 November 2014). 9. Prevention and control of noncommunicable diseases: guidelines for primary health care in low-resource settings. Geneva: World Health Organization; 2012. 10. Implementation tools: package of essential noncommunicable (WHO-PEN) disease interventions for primary health care in low-resource settings. Geneva: World Health Organization; 2013 (http:// www.who.int/cardiovascular_diseases/publications/ implementation_tools_WHO_PEN/en/, accessed 5 November 2014). 11. Scaling up action against noncommunicable diseases: how much will it cost? Geneva: World Health Organization; 2011 (http://whqlibdoc.who.int/ publications/2011/9789241502313_eng.pdf, accessed 4 November 2014). 12. NCD global monitoring framework indicator definitions and specifications. Geneva: World Health Organization; 2014. 13. Lim SS, Gaziano TA, Gakidou E, Reddy KS, Farzadfar F, Lozano R et al. Prevention of cardiovascular disease in high-risk individuals in low-income and middleincome countries: health effects and costs. Lancet. 2007;370:2054–62. 14. Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80%. BMJ. 2003;326:1419. 15. Castellano JM, Sanz G, Fuster V. Evolution of the polypill concept and ongoing clinical trials. Can J Cardiol. 2014;30(5):520−6. doi:10.1016/j. cjca.2014.02.016. 16. Assessing national capacity for the prevention and control of noncommunicable diseases report of the 2013 global survey. Geneva: World Health Organization; 2014. 17. Gyberg V, Kotseva K, Dallongeville J, Backer GD, Mellbin L, Rydén L et al.; EUROASPIRE Study Group. Does pharmacologic treatment in patients with established coronary artery disease and diabetes fulfil guideline recommended targets? A report from the EUROASPIRE III cross-sectional study. Eur J Prev Cardiol. 1 April 2014 (Epub ahead of print). 18. Heuschmann PU, Kircher J, Nowe T, Dittrich R, Reiner Z, Cifkova R et al. Control of main risk factors after ischaemic stroke across Europe: data from the stroke-specific module of the EUROASPIRE III survey. Eur J Prev Cardiol. 19 August 2014 Aug 19. pii: 2047487314546825 (Epub ahead of print). 19. Mendis S, Abegunde D, Yusuf S, Ebrahim S, Shaper G, Ghannem H et al. WHO study on prevention of recurrences of myocardial infarction and stroke (WHOPREMISE). Bull World Health Organ. 2005;83(11):820–9. 20. Yusuf S, Islam S, Chow CK, Rangarajan S, Dagenais G, Diaz R et al; Prospective Urban Rural Epidemiology (PURE) study investigators. Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middleincome, and low-income countries (the PURE Study): a prospective epidemiological survey. Lancet. 2011;378(9798):1231−43. doi:10.1016/ S0140-6736(11)61215-4.

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21. Mendis S, Al Bashir I, Dissanayake L, Varghese C, Fadhil I, Marhe E et al. Gaps in capacity in primary care in low-resource settings for implementation of essential noncommunicable disease interventions. I nt J Hy per tens. 2012; 2012:58 4 0 41. doi: 10.1155/2012/584041. 22. Package of essential noncommunicable (PEN) disease interventions for primary health care in low-resource settings. Geneva: World Health Organization; 2010 (http://whqlibdoc.who.int/ publications/2010/9789241598996_eng.pdf, accessed 6 November 2014). 23. Towards healthy islands: Pacific noncommunicable disease response. In: Tenth Pacific Health Ministers meeting, Apia, Samoa, 2–4 July 2013. Manila: World Health Organization Western Pacific Region; 2013 (PIC10/3; http://www.wpro.who.int/southpacific/pic_ meeting/2013/documents/PHMM_PIC10_3_NCD. pdf, accessed 7 November 2014). 24. Health Annual Report Palestine 2012. Nablus: Ministry of Health, Palestinian Health Information Center; 2012 (http://www.moh.ps/attach/502.pdf, accessed 7 November 2014). 25. Reg iona l consu lt at ion on st reng t hen i ng noncommunicable diseases (NCD) prevention and control in primary health care. Beijing China, 14–17 August 2012. Manila: World Health Organization Western Pacific Region; 2012 (WPR/ DHP/NCD(1)/2012; http://www.wpro.who.int/ noncommunicable_diseases/documents/RegCon_ StrengtheningNCDinPHC.pdf, accessed 7 November 2014). 26. Schmidt MI, Duncan BB, Silva GA, Menezes AM, Monteiro CA, Barreto SM et al. Chronic noncommunicable diseases in Brazil: burden and current challenges. Lancet. 2011;377:1949–61. doi:10.1016/ S0140-6736(11)60135-9. 27. Lagomarsino G, Garabrant A, Adyas A, Muga R, Otoo N. Moving towards universal health coverage: health insurance reforms in nine developing countries in Africa and Asia. Lancet. 2012;380(9845):933−43. doi:10.1016/S0140-6736(12)61147-7. 28. Jamison DT, Summers LH, Alleyne G, Arrow KJ, Berkley S, Binagwaho A et al. Global health 2035: a world converging within a generation. Lancet. 2013;382(9908):1898−955. doi:10.1016/ S0140-6736(13)62105-4. 29. Making fair choices on the path to universal health coverage. Final report of the WHO Consultative Group on Equity and Universal Health Coverage. Geneva: World Health Organization; 2014 (http://apps.who. int/iris/bitstream/10665/112671/1/9789241507158_ eng.pdf?ua=1, accessed 6 November 2014).

30. Self-care of cardiovascular disease, diabetes, cancer and chronic respiratory disease. Geneva: World Health Organization; 2013. 31. Screening for cardiovascular risk and diabetes. Geneva: World Health Organization; 2014. 32. Adoption of the Philippine Package of essential noncommunicable disease interventions (PHIL PEN) in the implementation of the Philippine Health`s primary care benefit package (http://www.philhealth. gov.ph/circulars/2013/circ20_2013.pdf, accessed 7 November 2014).

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Key points ■

The national health strategy should include access to health technologies and essential medicines as an objective and should specify a mechanism for monitoring, evaluation and review of the availability and affordability of basic health technologies and NCD medicines. Achieving this target requires sustainable health-care financing, to ensure adequate procurement of basic health technologies and essential NCD medicines. Country efforts to improve access should first focus on basic health technologies and essential medicines for NCDs, and the national essential medicines list should be the basis for procurement, reimbursement and training of health-care workers. Reliable procurement and distribution systems are needed to guarantee the supply of essential NCD medicines and technologies to all levels of health care, including primary care, and to regional and remote communities. Mechanisms must be in place to ensure that quality-assured generic medicines are procured; prescribers and consumers need to have confidence in the generic medicines in circulation. Evidence-based treatment guidelines and protocols should be promoted and implemented, to support the appropriate use of essential NCD medicines. The attainment of this target will contribute to attainment of targets on reducing the prevalence of hypertension, on improving coverage of treatment for prevention of heart attacks and strokes and, ultimately, on reducing premature mortality from NCDs.

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Global target 9: An 80% availability of the affordable basic technologies and essential medicines, including generics, required to treat major noncommunicable diseases in both public and private facilities

Availability and aﬀordability of basic technologies and medicines Effective delivery of individual interventions for NCDs requires strengthening of the health system at all levels of care. Weaknesses and inefficiencies are currently encountered in all components of health systems, including supply of essential medicines and technologies (1−4). Priority actions for addressing the NCD crisis include delivering cost-effective and affordable essential medicines and technologies for all priority disorders, and strengthening health systems to provide patient-centred care across different levels of the health system, starting with primary care (4,5). This target includes the basic requirement of medicines and technologies for implementing cost-effective primary care interventions and for addressing cardiovascular disease, diabetes and asthma (6). The core essential medicines include at least aspirin, a statin, an angiotensin-converting enzyme inhibitor, a thiazide diuretic, a long-acting calcium-channel blocker, a beta-blocker, metformin, insulin, a bronchodilator and a steroid inhalant. The basic technologies include, at least, a blood pressure measurement device, a weighing scale, height measuring equipment, blood sugar and blood cholesterol measurement devices with strips, and urine strips for albumin assay. These are minimum requirements for implementing essential NCD interventions in primary care. Availability is defined as the percentage of public and private primary health-care facilities that have all of these medicines and technologies, indicated above. Cancer medicines are not included in this indicator because of the difficulty of implementing treatment interventions for cancer in primary care in resource-constrained settings. However, this should not undermine efforts to improve access to essential medicines for treating cancer. Treatment interventions and protocols for cancer should be identified, specifying the level of care at which these cancer medicines can be safely administered.

Progress achieved Substantial information exists on availability and affordability of essential medicines, particularly in low- and middle-income countries. A large number of country studies have been conducted using a standard validated methodology developed by

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Fig. 9.1 Median availability of selected lowest-priced generic medicines, in the public and private sector, by World Bank income group, 2007−2012 max min 100 90 80 Median % availability 70 60 50 40 30 20 10 0 Public (n = 10) Private (n = 12) Public (n = 14) Private (n = 14) Public (n = 11) Private (n = 11) Public (n = 2) Private (n = 3) 54.1 70.0 68.0 56.1 59.7 69.1 70.0 60.0

— median

Low-income

Lower-middle-income

Upper-middle-income

HIgh-income

WHO and Health Action International (HAI) (7). The availability and prices of medicines are investigated through visits to public and private-sector facilities in each country, and availability is reported as the percentage of facilities where a product is found on the day of data collection. A summary of the results of medicine-availability studies conducted between 2007 and 2012 using WHO/HAI survey methods is shown in Fig. 9.1 (8). There is a consistent pattern of lower availability of medicines in public sector facilities compared to the private sector, and lower availability in low-income and lower-middle-income countries. While the basket of medicines surveyed in each country is not the same, the basket of medicines in each case is a mix of medicines used to treat communicable diseases and NCDs, as well as to provide symptomatic and pain relief. Further analysis of these WHO/HAI studies in 40 low- and middle-income countries has compared the availability of 15 medicines used for acute

conditions with 15 medicines for chronic diseases (see Table 9.1) (9). These summary measures across a selection of 15 medicines conceal the extent of some of the problems of availability of specific medicines for the prevention and treatment of NCDs. An analysis of the availability of selected cardiovascular medicines (atenolol, captopril, losartan and nifedipine) in 36 countries concluded that availability in the public sector was poor (26.3%) compared to the private sector (57.3%) (10). A survey of the availability of asthma medicines listed on the WHO model list of essential medicines (11) found that, while salbutamol inhalers were available in 82.4% of private pharmacies, 54.8% of national procurement centres and 56.3% of public hospitals, the availability of beclometasone 100 μg puff inhalers, a cornerstone of the management of asthma, was much lower (41.7%, 17.5% and 18.8% respectively) (12).

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Table 9.1 Mean availability of medicines used for acute and chronic conditions in 40 low- and middle-income countries Mean availability (%) of medicines Sector and product type (number of countries) Public sector Generic products (n = 35) Private sector Generic products (n = 40) CI: conﬁdence interval. Source: see reference (9). Acute conditions (95% CI) Chronic conditions (95% CI) Difference (%) in mean availability (95% CI) P

53.5 (46.2–60.8)

36.0 (27.4–40.6)

17.5 (6.5–28.6)

0.001

66.2 (60.4–72.1)

54.7 (47.6–61.9)

11.5 (2.4–20.6)

0.007

Access to insulin is problematic in many countries, complicated by the cost of syringes and diagnostic tools for initial diagnosis and follow-up that are essential for monitoring and adjusting treatment (13). Gaps in availability and affordability of basic technologies and medicines are particularly severe at the primary care level (14) and are major barriers to implementation of essential NCD interventions. The results of these studies demonstrate the lower availability of key NCD medicines in the public sector. The consequence is that patients are forced to obtain medicines in the private sector, where prices are generally higher and may be unaffordable for many. WHO/HAI surveys have also addressed the prices patients must pay for medicines and whether these are affordable (8). The measurement of affordability is not straightforward (15). The approach used in the WHO/HAI surveys is to use the salary of the lowest-paid unskilled government worker to establish the number of days’ wages needed to purchase courses of treatment for common conditions. Because chronic diseases need ongoing treatment, the affordability of a 30-day supply of medicines is used to indicate monthly medicine expenditures. Data from WHO/HAI surveys between 2007 and 2012 (8) were used to compare the affordability of two medicines used in managing NCDs – salbutamol inhaler 100 μg per dose for asthma (assuming one inhaler per month) and captopril tablets for hypertension (assuming 25 mg twice daily per month). The results (see Fig. 9.2) illustrate wide variability between studies. If one day’s salary is

deemed a measure of affordability of a medicine, then, in many cases, medicines are unaffordable. The situation is often worse in countries where a large proportion of the population earns much less than the lowest-paid government worker.

Monitoring the availability and aﬀordability of basic technologies and essential medicines The indicator for monitoring this target in the global monitoring framework (see Annex 1) is the availability and affordability of quality safe and efficacious essential noncommunicable disease medicines, including generics and basic technologies in both public and private facilities. Many countries have already collected ad hoc facility-based information about prices and availability, using the WHO/HAI methodology (8,9). However, assessing progress towards targets requires regular measurement and the collection of valid and reliable data. Routine monitoring systems should be established, in order to provide regular facility-based assessments of the availability of key medicines and health technologies. These systems need to provide information from the public and private sectors and from urban and rural locations, so that equity of access to these essential commodities can be assessed. For routine monitoring to be feasible, data

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Global status report on NCDs 2014 Fig. 9.2 Number of days’ wages needed by the lowest-paid unskilled government worker to pay for 30 days’ treatment for hypertension and asthma, private sector, 2007–2012 Q Captopril tablets* Q Salbutamol inhaler* Republic of Moldova LPG Republic of Moldova OB Afghanistan LPG Afghanistan OB United Republic of Tanzania LPG Iran (Islamic Republic of ) China (e) LPG China (e) OB India (d) LPG Oman LPG Bolivia (Plurinational State of ) OB Bolivia (Plurinational State of ) LPG Nicaragua LPG Congo LPG Congo OB Mauritius LPG Mauritius OB Colombia LPG Colombia OB Haiti LPG Haiti OB Russian Federation (c) LPG Russian Federation (c) OB Ecuador LPG Ecuador OB Brazil (b) OB Mexico (a) LPG Kyrgyzstan OB Kyrgyzstan LPG Indonesia OB Burkina Faso LPG Burkina Faso OB Sao Tomé and Principe OB Democratic Republic of the Congo LPG Democratic Republic of the Congo OB

***

15 Number of days’ wages**

Source: World Health Organization/Health Action International, using data from medicine price and availability surveys conducted between 2007 and 2012 using the WHO/HAI methodology (http://www.haiweb.org/medicineprices). * Captopril 25mg tab x 2/day; Salbutamol 100 mcg/dose inhaler, 200 doses. ** Number of days’ wages needed by the lowest-paid unskilled government worker to pay *** If one days’ wages of a lowest-paid government worker is deemed as a measure of aﬀordability of medicine, then in many cases medicines are unaﬀordable. (a) Rio Grande do Sul State, (b) Tatarstan Province, (c) Delhi (National Capital Territory), (d) Shaanxi Province. OB=Originator Brand, LPG= Lowest-Priced Generic

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collection needs to be simple, focusing on a smaller number of key medicines and adding minimal cost to the health system. This monitoring is important, not only to assess progress towards the target of 80% availability, but also to identify potential problems in procurement and in-country distribution of medicines and to develop interventions to address any system failures identified. WHO’s Service Availability and Readiness Assessment (SARA) is another mechanism for assessing the availability of key medicines and health commodities (16). This extensive survey uses statistically representative samples of country health facilities. Analyses are stratified by location (urban, rural) and facility type (dispensary, clinic, health centre, hospital), allowing detailed assessment of in-country differences in medicines availability. However, the scope of SARAs and the large numbers of health facilities surveyed make these surveys resource intensive and expensive. To date, SARAs have largely been conducted in Africa and, where SARA data exist, they should be used to inform decision-making and to identify areas where interventions are required to improve access to medicines. Assessing the affordability of medicines requires regular measurement of the prices patients must pay for medicines in both public and private sectors. Affordability can be computed by using the daily wage of the lowest-paid unskilled government worker for each country and the cost of a year’s supply of medicines. In measuring affordability, financing arrangements for medicines in each country may need to be considered. Some countries may make medicines freely available in the public sector or have health insurance systems in place. The out-of-pocket costs for NCD medicines should be monitored. It is also important to consider those who are unable to access care or purchase medicines. Household surveys remain an important tool for understanding the sources of care in the community and the barriers to accessing care and treatments, including essential NCD medicines and health technologies. WHO has standardized methods for conducting household surveys to measure access to and use of medicines (17).

Actions required to attain this target Commitment to this target, and regular public reporting of progress – regionally, nationally and globally – will hold governments accountable for meaningful progress in improving access to, and affordability of, essential NCD medicines and health technologies (18).

Health-care ﬁnancing Achieving this target requires adequate and sustainable health-care fi nancing. The ministry of health has a pivotal role in promoting access to quality-assured, affordable essential medicines and should work with the ministry of finance to secure adequate funding for health care in general, and essential NCD medicines and technologies in particular.

Regulatory systems Strong regulatory systems are necessary to ensure the availability of quality-assured NCD medicines. Effective regulatory authority performance requires an appropriate legislative framework, commitment to good governance, administrative structures supported by technical capacity, and political commitment to enforce compliance with established norms and standards for manufacture, distribution and supply of medicines and health technologies. The affordability of NCD medicines for both government and patients depends heavily on the use of generic products. Policies that promote the use of affordable generic medicines are important, as is ensuring the quality of generic medicines in circulation in the country. Quality-assurance systems and educational campaigns promoting the use of generic medicines are needed to reassure prescribers, patients and consumers that low price does not mean inferior medicines.

Rational selection and use In addition, there should be rational selection of cost-effective NCD essential medicines and technologies, efficient and effective procurement and distribution systems for quality-assured products,

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and implementation of evidence-based guidelines to support rational use of these medicines and technologies at all levels of care. These essential medicines should be available at the primary health-care level. While treatment may be initiated at higher levels of health care, patients need easy access to these medicines if they are to adhere to long-term treatment regimens. Efforts to improve the availability of quality-assured products in the market should be supported by programmes to promote their use. The evidence-based treatment guidelines and protocols for primary care should be disseminated and implemented (6,19). Relatively little is known of rational use of medicines and adherence of prescribing to national treatment protocols in the private sector, so this is an important area for further research. While attention often focuses on procurement, supply, availability and pricing measures for essential medicines (supply side), rational use of medicines is critical to cost-effective and appropriate use. Health-care professionals and consumers need accurate information on medicines. Setting-specific studies are required to understand why prescribers and consumers choose particular medicines (demand side) and to assess the adherence of prescribing practices to evidence-based treatment guidelines.

Procurement systems and pricing policies Along with effective and efficient procurement systems, pricing policies can promote affordable access to treatment. Countries need to consider regulation of the mark-ups and fees in the pharmaceutical supply chain, not only for distributors and wholesalers but also for retail outlets. Supported by policies to allow generic substitution, dispensing fees should encourage the use of low-price generic medicines. Tax exemptions or reductions can be considered – particularly for essential medicines and health technologies – to enhance the affordability of medicines for consumers (20).

professionals and civil society. The pharmaceutical industry has the responsibility to produce and supply medicines, including those for NCDs, meeting appropriate standards of quality, promoting use in line with marketing approval, and providing balanced and truthful information to healthcare professionals. Health-care professionals have responsibility for the optimal care of patients and for judicious use of scarce resources in managing them. Medicines must be prescribed appropriately, in accordance with evidence-based treatment protocols, and the costs of treatments should be considered. Consumers have a responsibility to use medicines wisely and in accordance with recommendations from health-care professionals. In some settings, international stakeholders play an important role in supporting the strengthening of country health systems, through strengthening of drug-manufacturing capacities of countries; training and strengthening of procurement and supply systems; monitoring of prices, availability and affordability of medicines; and promoting interventions to improve access. Donations of medicines must be appropriate, targeted and consistent with WHO guidelines. Medicines benefit packages must include essential NCD medicines. Countries may require support to develop sustainable financing mechanisms, including targeted subsidies or health insurance systems that ensure affordable access to NCD medicines and technologies.

Multi-stakeholder action Local stakeholders in the pharmaceutical sector include the pharmaceutical industry, health-care

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References 1. The World Health Report 2010. Health systems fi nancing: the path to universal coverage. Geneva: World Health Organization; 2010 (http://www. who.int/whr/2010/whr10_en.pdf?ua=1, accessed 6 November 2014). 2. The World Health Report 2008. Primary health care − now more than ever. Geneva: World Health Organization; 2008 (http://www.who.int/whr/2008/ en/, accessed 6 November 2014). 3. The World Health Report 2006. Working together for health. Geneva: World Health Organization; 2006 (http://www.who.int/whr/2006/en/, accessed 6 November 2014). 4. Beaglehole R, Bonita R, Horton R, Adams C, Alleyne G, Asaria P et al.; NCD Alliance. Priority actions for the non-communicable disease crisis. Lancet. 2011;377(9775):1438−47. doi: 10.1016/ S0140-6736(11)60393-0. 5. Hogerzeil HV, Liberman J, Wirtz V, Kishore SP, Selvaraj S, Kiddell-Monroe R et al. Promotion of access to essential medicines for non-communicable diseases: practical implications of the UN political declaration. Lancet. 2013;381:680–9. doi:10.1016/ S0140-6736(12)62128-X 6. Package of essential noncommunicable (PEN) disease interventions for primary health care in low-resource settings. Geneva: World Health Organization; 2010 (http://whqlibdoc.who.int/ publications/2010/9789241598996_eng.pdf, accessed 6 November 2014). 7. Measuring medicine prices, availability, affordability and price components, 2nd ed. Geneva and Amsterdam: World Health Organization and Health Action International; 2008 (http://www.who.int/ medicines/areas/access/OMS_Medicine_prices.pdf, accessed 6 November 2014). 8. Health Action International. Medicine prices, availability, affordability and price components (http://www.haiweb.org/medicineprices, accessed 7 November 2014). 9. Cameron A, Roubos I, Ewen M, Mantel-Teeuwisse AK, Leufkens HGM, Laing RO. Differences in the availability of medicines for chronic and acute conditions in the public and private sectors of developing countries. Bull World Health Organ. 2011;89:412–21. doi:10.2471/BLT.10.084327. 10. van Mourik MS, Cameron A, Ewen M, Laing RO. Availability, price and affordability of cardiovascular medicines: a comparison across 36 countries using WHO/HAI data. BMC Cardiovasc Disord. 2010;10:25. doi:10.1186/1471-2261-10-25. 11. WHO model list of essential medicines, 18th list. Geneva: World Health Organization; 2013 (http://www.who.int/medicines/publications/ essentialmedicines/18th_EML_Final_web_8Jul13. pdf, accessed 7 November 2014). 12. Babar ZU, Lessing C, Mace C, Bissell K. The availability, pricing and affordability of three essential asthma medicines in 52 low- and middle-income countries. Pharmacoeconomics. 2013;31(11):1063−82. doi:10.1007/s40273-013-0095-9. 13. Beran D, McCabe A, Yudkin JS. Access to medicines versus access to treatment: the case of type 1 diabetes. Bull World Health Organ. 2008;86(8) 648–9. doi:10.2471/BLT.07.048710. 14. Mendis S, Al Bashir I, Dissanayake L, Varghese C, Fadhil I, Marhe E et al. Gaps in capacity in primary care in low-resource settings for implementation of essential noncommunicable disease interventions. Int J Hypertens. 2012;58:40–1. doi:10.1155/2012/584041. 15. Niens LM, Van de Poel E, Cameron A, Ewen M, Laing R, Brouwer WB. Practical measurement of affordability: an application to medicines. Bull World Health Organ. 2012;90(3):219−27. doi:10.2471/ BLT.10.084087. 16. O’Neill K, Takane M, Sheffel A, Abou-Zahr C, Boerma T. Monitoring service delivery for universal health coverage: the Service Availability and Readiness Assessment. Bull World Health Organ. 2013;91:923−31. doi:http://dx.doi.org/10.2471/BLT.12.116798. 17. Manual for the household survey to measure access and use of medicines. Geneva: World Health Organization; 2008 (http://www.who.int/ medicines/areas/coordination/household_manual_ february_2008.pdf, accessed 6 November 2014). 18. NCD global monitoring framework indicator definitions and specifications. Geneva: World Health Organization; 2014. 19. Prevention and control of noncommunicable diseases: guidelines for primary health care in low-resource settings. Geneva: World Health Organization; 2012. 20. WHO guideline on country pharmaceutical pricing policies. Geneva: World Health Organization; 2013 (http://www.who.int/childmedicines/publications/ WHO_GPPP.pdf, accessed 6 November 2014).

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Key points ■

A national multisectoral NCD action plan with national targets provides the framework for addressing NCDs and their risk factors through a coherent public health approach. Multisectoral action – working together across sectors for the common goal of prevention and control of NCDs – is central to the success of national NCD efforts and attainment of national targets. Strategic planning requires concrete national targets, with estimates of the health impacts of reaching the targets and the financial resources needed to meet them.

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Development and implementation of national multisectoral action plans to attain national targets

A national multisectoral NCD action plan with national targets A national multisectoral action plan with national targets is a necessary framework for addressing NCDs and their risk factors through a public health approach (1−3). Instead of one plan per disease, a comprehensive NCD plan, with a clear budget and an integrated monitoring framework, makes possible the coherent national policy response required to attain national targets. Where external aid plays a significant role, the NCD action plan is key to aligning external and internal financial and technical inputs to achieve national targets for the prevention and control of NCDs (4). In the outcome document of the July 2014 United Nations General Assembly review of NCDs (5) and the September 2011 political declaration on NCDs (1), countries committed to strengthening multisectoral policies and plans by 2015 and setting national targets for the prevention and control of NCDs by 2016. As of December 2013, only 43 countries had an operational, integrated, multisectoral national plan consistent with the Global NCD Action Plan 2013–2020 (2,6). All countries need to develop, update and implement multisectoral action plans with national targets and prioritize attainment of them by 2025.

Why are national targets a priority? National targets, consistent with voluntary global targets, help to focus action on achieving a defined impact in key areas for NCD prevention and control. National targets must be realistic about what is feasible and what can be achieved in a given national context. Setting targets can help to reinforce political commitment and strategic response and to mobilize resources for the prevention and control of NCDs. Factors that require consideration when setting national targets include: ■ achievability in the epidemiological context of the country; ■ the feasibility of implementing evidence-based interventions to achieve the target; ■ the potential to set a baseline and monitor over time; ■ the estimated size of the population in need; ■ the current baseline levels of exposure to risk;

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Fig. 10.1 Key elements in the development of a national multisectoral NCD action plan

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● Building on what is ongoing

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● Balanced and evidence based content

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Inclusive process

Practicality and reality

Prioritize activities

Resource planning

National Multisectoral NCD Action Plan

the current level of services and potential rate of scale-up if there are additional investments in human resources and infrastructure. Because a combination of preventive and curative interventions is essential to curb the NCD epidemic, targets for both prevention and treatment should be considered. If reliable current data are lacking, countries can use WHO’s comparable estimates of data as a starting point (see Annexes 3 and 4). Once national targets are set, the preventive and curative activities discussed in Chapters 1−9 should be prioritized in the national action plan and resourced for implementation. Countries may adopt all or some of the 25 indicators in the global monitoring framework (7, see Annex 1) and may include others, as appropriate, for monitoring the progress of national NCD efforts. In addition, it would be useful to develop a set of national process indicators to identify and address obstacles to scale-up. Process indicators can be based on critical obstacles that need to be overcome in the implementation of national action plans, such as predictable financing, human-resource and system constraints, and participation of non-health sectors. ■

operational elements that improve the potential for effective implementation (see Fig. 10.1) (8). These elements are discussed in turn.

Inclusive process National NCD action plans are more likely to be implemented effectively if they are developed in collaboration with a full range of partners, both within and outside the health sector, who can significantly contribute to implementation. These include all non-state actors: communities, grass-roots advocates, professionals, nongovernmental and civil society organizations, academia, the media and the private sector.

Practicality and reality National targets are more likely to be attained if the multisectoral NCD action plan: ■ is developed with full input by those who will implement it; ■ has policies and actions that are compatible with country capacity and resources; ■ has concrete measures for strengthening capacity and resources through mobilization of government and partners; ■ has policy directions anchored in political and legal commitments that ensure long-term sustained efforts.

What are the key elements of a national multisectoral NCD action plan? When developing a national action plan, attention should be paid to political, technical and

Building on what is ongoing The multisectoral national NCD action plan should be based on the findings of a situation analysis, with

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a special focus on the nine areas of the voluntary global targets. The results of the situation analysis should be shared with stakeholders, to build consensus on both the findings and the approaches to be adopted. The situation analysis can be usefully broadened to encompass areas with a bearing on NCD prevention and control, such as primary health-care reforms, moves towards universal health coverage, multisectoral collaboration and the social determinants of health.

Prioritize activities It is difficult to implement policies and interventions to address all NCDs simultaneously, owing to resource constraints. Priority-setting determines which policies and interventions should be addressed first, which may mean that some current activities should be scaled back to allow for higher-priority activities. For instance, policies and activities on the four major NCDs and their modifiable risk factors need to be addressed first, followed by activities relating to common comorbidities and other NCDs. The main consideration in priority-setting is often cost effectiveness, but other valid concerns should also be considered, such as equity, avoiding impoverishment due to catastrophic health-care payments, and the capital investment required. A rational, systematic and transparent approach to prioritization can help ensure that the objectives are met as early as possible and that available resources are used efficiently. Prioritization is needed both at the technical level and geographically.

health care, including health-system targets; and (iv) leadership and governance arrangements for implementation, including: ■ the roles and responsibilities of institutions and stakeholders; ■ accountability (performance monitoring, outcome measurement, continued improvement in the planning process and timely corrective measures); ■ implementation research and adaptation to changing circumstances; ■ regulatory and legal frameworks to ensure sustainability; ■ collaboration with other sectors to ensure that health is taken into consideration in all policies; ■ links with the donor community, as appropriate.

Resource planning The multisectoral NCD action plan should be linked upstream to the national health plan and broader national strategies for development and poverty alleviation, and downstream to subnational operational plans and budgets. Based on available resources, a feasible path needs to be mapped out to take the country from the current position (defined in the situation analysis) to the desired objectives (defined by priority-setting). This requires setting national NCD targets with estimates of the health impacts of reaching the targets and the financial resources needed to meet them. The sequence of these elements, and whether they appear in the national NCD action plan or other planning documents, depends on the country context. In principle, the full range of issues should be covered.

Balanced and evidence-based content The national multisectoral NCD action plan should present, in a balanced and coherent manner appropriate to the country context, the key elements of NCD prevention and control, namely: ■ the vision, principles, goals and national targets, consistent with the Global NCD Action Plan 2013−2020 (2) and corresponding regional frameworks; ■ policy directions and priority interventions to address: (i) surveillance and monitoring; (ii) prevention, including prevention targets; (iii)

Key steps in development of a national multisectoral NCD action plan The development of a national multisectoral NCD action plan involves several steps (see Fig. 10.2), as detailed next.

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Fig. 10.2 Key steps in development of an NCD action plan

Mobilize commitment and resources

Conduct situation analysis

Map and engage internal and external stakeholders

Determine priorities, targets, roles and cost

Prepare the draft action plan Disseminate and revise

Obtain endorsement of the plan

1. Advocate for placing NCD prevention and control high on the political agenda, and obtain explicit government commitment and resources for development and implementation of the action plan. 2. Conduct a situation analysis to assess current and projected NCD burdens, other health challenges, barriers to NCD prevention and control, capacity to respond to current and future demands, social expectations, performance gaps in responding to needs and expectations, and what is ongoing and what has been achieved already. 3. Map and engage internal and external stakeholders, namely: relevant divisions in the ministry of health, ministries outside health (agriculture, communication, education, employment, energy, environment, fi nance, food, foreign affairs, housing, justice and security, labour, social welfare, social and economic development, sports, tax and revenue,

trade and industry, transport, urban planning, youth affairs), the legislature, the media, donors, development partners, civil society and the private sector. Share the results of the situation analysis with stakeholders, and together identify barriers and pragmatic solutions. Conduct consultations, as appropriate, with internal and external stakeholders and expert groups, to identify priority policies and interventions, national targets for 2025 based on the voluntary global targets (2), roles and responsibilities of different stakeholders, the cost of implementation of the action plan, and resource gaps. Prepare a draft national action plan, disseminate it to all stakeholders, obtain input and revise it. Obtain official endorsement of the document action plan.

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Key domains of a national multisectoral NCD action plan In addition to the elements and steps already described, a technically sound NCD action plan includes several thematic domains. By grouping them into domains – i.e. governance, prevention, health care, and surveillance and monitoring – activities can be organized and rendered coherent and mutually reinforcing. This comprehensive approach is necessary for programmatic, administrative, economic, technical and ethical reasons (1−3,9). ■

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Governance Governance mechanisms and structures, with strong leadership, clear reporting lines and full government involvement, are key to coordination of the implementation of the national action plan, in order to build human, financial and regulatory capacity, and to promote multisectoral partnerships and accountability for enforcement strategies, monitoring and evaluation. Accountability involves budget allocation, assessing the performance of other stakeholders (United Nations agencies, civil society, academia, donors and the corporate sector), tracking resources, measuring results, engaging in transparent review, and taking remedial action as necessary. A menu of policy options for strengthening accountability and capacity for accountability can be found under objective 2 of the Global NCD Action Plan 2013−2020 (2). Strategic actions include: ■ developing a national multisectoral NCD action plan with national targets and a monitoring framework consistent with the Global NCD Action Plan 2013−2020 (2); ■ ensuring that the national multisectoral NCD action plan is harmonized with national health and development plans; ■ tracking total health expenditure and expenditure on prevention and control of NCDs by financing source; ■ establishing a high-level commission/mechanism for engagement, policy coherence and mutual ■

accountability of different areas of policy-making that have a bearing on prevention and control of NCDs; strengthening the capacity of the public health workforce and public health organizations to perform the functions required for accountability; systematically enforcing evidence-based legislation, regulations and fiscal policies; mobilizing United Nations country teams to strengthen links between NCD strategies and those for universal health coverage, addressing social determinants of health and sustainable development; integrating strategies into the design and implementation of the United Nations Development Assistance Framework (10).

Prevention The objective of NCD prevention is to reduce exposure of the population to NCD risk factors and underlying social determinants of those risk factors (1,2,9). Supportive environments that protect health and promote healthy behaviour can be created if existing public health policies and tools to address risk factors are implemented within the framework of the national multisectoral action plan. Appropriate policies are required to reduce exposure to modifiable NCD risk factors includes: ■ increase public awareness of behavioural risk factors and their impact on health; ■ address affordability, availability and access, through fiscal policies (taxes and price adjustments), production policies (agriculture and manufacture) and access policies; ■ denormalize and treat unhealthy behaviours. Adequate investment and appropriate incentives and disincentives are required to enforce regulation, fiscal measures and laws. Responsibilities for creating environments conducive to health go beyond the traditional health sector to many other sectors, and include local government, municipalities, schools, workplaces and businesses. A menu of policy options for strengthening population-wide prevention can be found

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under objective 3 of the Global NCD Action Plan 2013−2020 (2). Strategic actions include: ■ implementing policy options to reduce exposure to risk factors in order to make progress towards national targets, giving priority to very cost-effective interventions (see Box 1.1); ■ taking measures to reduce inequalities in the social and physical environment (e.g. access to healthy foods, walking paths and cycle tracks, smoke-free environments, job opportunities and education), in order to reduce behavioural risk factors and other health determinants; ■ establishing a multi-stakeholder and intersectoral group, including representatives of the executive, legislative and judiciary authorities, to implement population-wide prevention policies; ■ establishing multisectoral partnerships, giving due consideration to non-state actors; ■ identifying, publicizing and addressing interference by commercial entities, particularly those associated with tobacco, alcohol, non-alcoholic beverages and unhealthy foods.

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NCD interventions, with a special focus on vulnerable populations; strengthening all components of the health system for screening, early detection, diagnosis, treatment, self-care and palliative care, with an emphasis on primary health care and access to essential medicines and basic technologies; increasing domestic investment in health and establishing viable health-financing mechanisms, including innovative financing approaches (e.g. tobacco and alcohol taxation).

Surveillance and monitoring Surveillance and monitoring measure progress and provide the basis for accountability of stakeholders, including governments’ commitments to their populations. Underinvestment in health information systems has left gaps in data collection, analysis and the use of data for public health decision-making. Countries should establish a harmonized system for generating national NCD-relevant health information: vital registration, risk factor and disease surveillance and response, service statistics, and health management and fi nancial information. In addition, assessment of health equity requires measurement of changes over time in disparities in health status, health care, and the physical and social determinants of health. A menu of policy options for strengthening surveillance and monitoring can be found under objective 6 of the Global NCD Action Plan 2013−2020 (2). Strategic actions include: ■ setting national targets, consistent with global targets, according to national circumstances; ■ developing and institutionalizing surveillance, monitoring and health information systems, to track trends in risk factors and assess progress in implementing policies, strategies and interventions; ■ using indicators of the global monitoring framework, disaggregated for sex and other equity considerations, to monitor progress towards the 2025 targets; ■ strengthening a national civil registration system for registration of births, deaths and causes of death;

Health care People need access to a health system that prevents, detects and treats NCDs effectively through primary health care, in the context of universal health coverage. Health systems require strengthening and should move towards universal health coverage, to ensure that people do not fall into poverty because of the cost of health services. Efficiency should be improved at all levels of care, with a special focus on primary care. A menu of policy options for strengthening health systems can be found under objective 4 of the Global NCD Action Plan 2013−2020 (2). Strategic actions include: ■ incorporating prevention and control of NCDs in efforts to move towards universal health coverage; ■ providing financial support for the phased implementation of a package of cost-effective essential

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Figure 10.3 Schematic representation of the modular structure of the OneHealth Tool (12)

National Hospital Health centre Outreach Community

Increasing coverage of eﬀective interventions

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developing and maintaining disease registries, particularly for cancer; undertaking periodic data collection on the key behavioural and metabolic risk factors and other determinants, and contributing data on a routine basis to assist with monitoring the global status of NCDs; mobilizing information and communication technologies to support national health information systems; strengthening technical and institutional capacity to manage and implement NCD surveillance and monitoring systems integrated into health information systems.

Implementation of the national multisectoral NCD action plan Implementation of the national NCD action plan requires:

Immunization Water and sanitation Reproductive health Malaria Child health Tuberculosis HIV Nutrition NCDs Others Infrastructure Health information Human resources Governance

Supply chain Health ﬁnancing

Lives saved; healthier populations

Strenghtening health systems Considering costs within an envelope of

Financial aﬀordability Human resources and institutions that are capable of designing, implementing, monitoring and evaluating appropriate policies ; ■ effective management of public expenditure across all levels of government; ■ sufficient implementation capacity; ■ strategic planning; ■ a sound fiscal policy (to ensure sustainability). Given the importance of taking local needs, capacities and challenges into account in the development and implementation of the action plan, a blueprint approach is unlikely to help. In most settings, and especially in resource-constrained environments, an incremental approach is required – i.e. starting with priority actions to attain national targets in each domain. The actions chosen should be based on a realistic assessment of current capacities and a clear vision for the future. There is a solid case for tackling NCDs from the perspective of health and development. However, if governments are to draw more heavily on ■

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stretched budgets to invest in combating NCDs, the approaches they choose must offer compelling value for money. Low- and middle-income countries will need to increase spending, in order to expand the scope of health services to include, at a minimum, very cost-effective NCD interventions (“best-buys”; see Box 1.1). These interventions should be implemented in every setting, as soon as possible, in order to save lives, prevent disease and reduce costs to the health system. However, cost-effectiveness data alone will not be sufficient to operationalize the national NCD action plan. Countries also need a clear vision, supported by robust strategic planning, in order to evaluate which approaches they should invest in, how much they will cost, and what the health impact of different approaches will be. WHO has estimated that some US$ 170 billion is required to bring “best-buy” NCD interventions to scale in all low- and middle-income countries over the period 2011−2025 (equivalent to US$ 1−3 per capita) (11). What is now required is an understanding of how the costs of scaling up NCD approaches match the realities of country resources and the capacity of health-care systems. The United Nations’ OneHealth Tool is software designed to cost policy scenarios at country level, to strengthen health-system analysis (see Fig. 10.3) (12). The OneHealth Tool is intended to inform the development of national strategic health plans by assessing cost, impact and financial parameters for strengthening health systems and meeting health needs in low- and middle-income countries. The tool encompasses the four building blocks of a national action plan: governance, prevention, treatment and care, and surveillance and monitoring (12). The purpose of the OneHealth Tool is to enable national planners to make informed decisions about feasible goals over the next 3-, 5- and 10-year periods. The tool explicitly takes account of existing infrastructure, human resources and finances, to help establish realistic scale-up targets and identify bottlenecks. Intervention-specific delivery costs are based on the population served, while health-system costing is based on geographical area or population-level norms.

The key strength of the OneHealth Tool is its ability to pull different programmatic areas together and to generate a consolidated analysis across health-system, health-impact and ﬁnancial space. At the same time, realistic planning needs to take health-system capacity into account. Scaling up services by a factor of 50%, or even by 10% over the next 5−10 years, may require investments in the medicines supply chain, health worker availability and deployment, and the establishment of management and supervisory processes.

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References 1. Resolution 66/2. Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. In: Sixtysixth session of the United Nations General Assembly. New York: United Nations; 2011 (A/67/L.36; http:// www.who.int/nmh/events/un_ncd_summit2011/ political_declaration_en.pdf, accessed 3 November 2014). 2. Global action plan for the prevention and control of noncommunicable diseases 2013−2020. Geneva: World Health Organization; 2013 (http://apps.who. int/iris/bitstream/10665/94384/1/9789241506236_ eng.pdf?ua=1, accessed 3 November 2014). 3. Global status report on noncommunicable diseases 2010. Geneva: World Health Organization; 2011 (http://www.who.int/nmh/publications/ncd_report_ full_en.pdf, accessed 3 November 2014). 4. The Paris Declaration on Aid Effectiveness and the Accra Agenda for Action. Paris: Organisation for Economic Co-operation and Development; 2005/2008 (http://www.oecd.org/dac/effectiveness/34428351.pdf, accessed 3 November 2014). 5. Outcome document of the high-level meeting of the General Assembly on the comprehensive review and assessment of the progress achieved in the prevention and control of non-communicable diseases. New York: United Nations; 2014. In: Sixty-eighth session of the United Nations General Assembly, 7 July 2014 (A/68/L.53; http://www.un.org/ga/search/view_doc. asp?symbol=A/68/L.53&L, accessed 3 November 2014). 6. Assessing national capacity for the prevention and control of noncommunicable diseases. Report of the 2013 global survey. Geneva: World Health Organization; 2014 7. NCD global monitoring framework indicator definitions and specifications. Geneva: World Health Organization; 2014. 8. Framework for national health policies, strategies and plans. Copenhagen: World Health Organization Regional Office for Europe; 2010 (EUR/RC60/ TD.2; http://www.euro.who.int/__data/assets/pdf_ fi le/0008/120995/RC60_etechdoc2.pdf, accessed 6 November 2014). 9. Health in all policies (HiAP) framework for country action. Geneva: World Health Organization; 2014 ( ht t p://w w w.who.i nt /c a rd iova sc u la r_ diseases/140120HPRHiAPFramework.pdf?ua=1, accessed 6 November 2014). 10. United Nations Development Group. United Nations Development Assistance Framework (http://www. undg.org/?P=232, accessed 9 November 2014). 11. Scaling up action against noncommunicable diseases: how much will it cost? Geneva: World Health Organization; 2011 (http://whqlibdoc.who.int/ publications/2011/9789241502313_eng.pdf, accessed 4 November 2014). 12. World Health Organization. OneHealth Tool (http:// www.who.int/choice/onehealthtool/en/, accessed 6 November 2014).

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11 Message 1 Message 2 Message 3 Message 4 Message 5 Message 6 Message 7

The way forward to attain NCD targets: key messages

The report aims to support countries in fulfilling the time-bound commitments they have made in the outcome document of the United Nations General Assembly NCD review in July 2014 (1). The commitments include setting national targets and developing national multisectoral plans to achieve those targets by 2015, implementing policies and interventions to reduce NCD risk factors and underlying social determinants, and orienting health systems to address NCDs through people-centred primary health care and universal health coverage by 2016. The key messages of the report and proposed actions are to be tailored to each country, according to context. The preceding chapters discussed cost-effective ways of using available resources to attain the nine global NCD targets, even in limited-resource settings. Guidance is provided on the nine voluntary global targets and on cost-effective interventions required to attain them (see Chapters 1−9). The development of national multisectoral action plans to provide integrated public health frameworks for implementing the interventions is discussed in Chapter 10. The report also provides 2010 estimates of country-specific NCD mortality and risk factors, which will be used as the baseline for reporting on progress in attaining the national targets, starting in 2015. This final chapter highlights the 7 key messages of this report (See Box 11.1), and overarching actions and accountability required to make progress in attaining the nine voluntary global targets and national targets by 2025. As part of the

Box 11.1 Key messages of the Global Status Report on Noncommunicable diseases 2014 Noncommunicable diseases act as key barriers to poverty alleviation and sustainable development While some countries are making progress, the majority are oﬀ course to meet the global NCD targets Countries can move from political commitment to action by prioritizing high-impact, aﬀordable interventions All countries need to set national NCD targets and be accountable for attaining them Structures and processes for multisectoral and intersectoral collaboration need to be established Investment in health systems is critical for improving NCD outcomes Institutional and human resource capacities and ﬁnancial resources for NCD prevention and control require strengthening.

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Table 11.1 Status of implementation of the Global action plan for the prevention and control of noncommunicable diseases 2013−2020 (3), based on results of the 2013 NCD country capacity survey (4) Process indicators Countries with at least one operational multisectoral national policy, strategy or action plan that integrates several NCD and shared risk factors in conformity with the global and regional NCD action plans 2013–2020 Countries that have operational NCD unit(s)/branch(es)/department(s) within the ministry of health or equivalent Countries with an operational policy, strategy or action plan to reduce harmful use of alcohol within the national context Countries with an operational policy, strategy or action plan to reduce physical inactivity and/or promote physical activity Countries with an operational policy, strategy or action plan to reduce the burden of tobacco use in line with the WHO Framework Convention on Tobacco Control Countries with an operational policy, strategy or action plan to reduce unhealthy diet and/or promote healthy diets Countries with evidence-based national guidelines/protocols/standards for management of major NCDs through a primary care approach recognized/approved by government or competent authorities Countries with an operational national policy and plan on NCD-related research, including community-based research and evaluation of the impact of interventions and policies Countries with NCD surveillance and monitoring systems that enable reporting against the nine voluntary global NCD targets Number of countries 70

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Data not yet available 42

narrative, the chapter also outlines WHO’s role in supporting these actions, based on the organization’s mandate to support prevention and control of NCDs at global, regional and national levels.

Message 1: Noncommunicable diseases act as key barriers to poverty alleviation and sustainable development The data presented in this report show that NCDs affect all countries (see Chapter 1). The burden of death and disease is heavily concentrated in the world’s poorest countries. Death and disease due to NCDs matter in their own right, but they also act as important barriers to poverty reduction

and sustainable development. Beyond the direct impact of ill-health on household living standards through out-of-pocket expenditures, the impact of NCDs on adults of productive age indirectly affects national income through reduced productivity and a reduction in the number of hours that people can engage in work. Prevention and control of NCDs contribute to many of the sustainable development goals (2).

Proposed actions ■

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Advocate at global, regional and national levels for a strong position to be accorded to NCDs within the sustainable development goals framework. Embed indicators of prevention and control of NCDs within the sustainable development goals accountability framework.

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Integrate NCDs into national health plans and national development plans.

Message 2: While some countries are making progress, the majority are oﬀ course to meet the global NCD targets A certain amount of progress has been made in addressing NCDs since the adoption of the Political Declaration of the High-level Meeting of the [United Nations] General Assembly in 2011 (3). However, progress remains uneven and the response does not match growing needs, particularly in low- and middle-income countries. As the recent NCD country capacity survey indicates (see Table 11.1), there are many missed opportunities to strengthen governance, prevention, health care, and surveillance and monitoring (4). Urgent action is required to address the gaps in these key NCD domains.

favour rapid unsustainable interventions. Available resources need to be used strategically to improve NCD outcomes by investing in very cost-effective interventions and policy options to reduce population exposure to behavioural risk factors – harmful use of alcohol, physical inactivity, tobacco use and high salt consumption. Similarly, it is essential to invest in very cost-effective individual interventions to reach people at high risk and those with established disease. The coverage of these interventions has to be scaled up to attain targets. Concurrent research and analysis are needed to ensure lessons learnt from implementation are taken into account in decision-making, to enable mid-course corrections.

Proposed actions ■

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Proposed actions ■

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Develop or update national multisectoral NCD action plans, consistent with the Global NCD Action Plan (5) and regional NCD frameworks. Align international cooperation on NCDs with national multisectoral NCD action plans, in order to strengthen aid effectiveness and the development impact of external resources.

Intensify efforts to track financial resources for NCD prevention and control. Produce high-quality case-studies to better understand why progress has not been made. Give priority to implementation of very cost-effective population-wide and individual interventions (“best buys”, see Box 1.1), to attain targets Support and facilitate research related to implementation and its translation into practice, in order to enhance the knowledge base for country action.

Message 3: Countries can move from political commitment to action by prioritizing high-impact, aﬀordable interventions The available cost-effective, high-impact interventions constitute a powerful arsenal for prevention and control of NCDs. As the full benefit of many NCD interventions can be reaped only over decades, the time-lag may make them less popular with politicians who focus on short-term political cycles and

Message 4: All countries need to set national NCD targets and be accountable for attaining them The nine voluntary global targets identify priority areas in prevention and control of NCDs. Together with the Global NCD Action Plan 2013−2020 (5), they give a clear indication of where the world should be in 2025 in relation to NCDs. This report presents policy options and interventions to attain the NCD targets in countries at all levels of economic development and at different stages of the NCD epidemic. National targets help to garner political support and facilitate benchmarking and monitoring of results. Because the targets focus on a limited set of key NCD outcomes, monitoring of

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progress towards the targets shows what is achievable and where faster progress can be made with limited resources. Furthermore, focusing attention on national progress using disaggregated data collection, as measured by the monitoring framework, helps countries to consider whether the benefits of progress are distributed equitably.

Message 6: Investment in health systems is critical for improving NCD outcomes NCDs require continuity of long-term care rather than the episodic treatment of acute incidences that characterizes health care in most low- and middle-income countries. Analysis of health systems shows that key elements of the health system – including health financing, governance, the health workforce, health information, medical products and technologies, and health-service delivery – present obstacles to scale-up of NCD care. As discussed in Chapter 8-10, strategizing to overcome these barriers should be a major focus of investment in scaling up NCDs because rolling out even the most basic of interventions will be hampered if a functioning health system is not in place. Emerging and expanding universal health coverage schemes provide potential levers to prioritize NCDs while balancing other competing health priorities and health-system objectives.

Proposed actions ■

■

Set national targets, consistent with global targets – as discussed in this report – and monitor progress towards their attainment. Contribute information on NCD mortality and risk factors to WHO, for global analyses.

Message 5: Structures and processes for multisectoral and intersectoral collaboration need to be established Collaboration across sectors outside health (multisectoral collaboration) and between government and non-state actors (intersectoral collaboration) is key to equitable prevention and control of NCDs and to attaining national targets. Mechanisms for multisectoral and intersectoral collaboration need to be embedded in the planning stage of NCD programmes, and should continue through implementation, enactment of public policies and monitoring and evaluation. A high-level, multisectoral structure may be created, with broad representation or with a specific health focus – such as to curb childhood obesity, encourage healthy urban planning, promote physical activity, or improve access to medicines and technologies. Multisectoral action for prevention and control of NCDs can be facilitated using the key components of the Health in all policies (HiAP) framework for country action (6).

Proposed actions ■

■

Include NCD interventions in universal health coverage schemes, giving priority to very cost-effective interventions. Use transparent processes to prioritize NCD interventions, based on considerations of health impact, cost effectiveness and equity. Provide affordable access to essential technologies and medicines for management of NCDs Identify and address health-system barriers to NCD care, with a special focus on strengthening patient centered primary health care.

Proposed action ■

Establish a high-level commission/mechanism and an accountability framework to strengthen multisectoral and intersectoral collaboration, to support prevention and control of NCDs.

Message 7: Institutional and human resource capacities and ﬁnancial resources for NCD prevention and control require strengthening Attainment of national targets will require institutional and human capacity and adequate financial

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resources at country level. Establishing public health institutions could help to deal with the complexity of issues relating to NCD prevention and control – such as interaction with food and agricultural systems, law, trade, urban planning and commercial influence. The competency and capacity of the health workforce will require strengthening to address NCDs, including through incorporation of public health aspects of NCD prevention and control in teaching curricula for medical, nursing and allied health personnel, and provision of in-service training. Policies and legal frameworks will be required to promote the retention of health workers in rural areas, particularly in primary care. Capacity-building is also important for other sectors. For instance, training of food producers, manufacturers and caterers, especially those involved in small and medium-sized businesses, is important for the attainment of targets 4 and 7. Training inspectors to enforce smoke-free and drinking-driving policies is a strategic component of interventions to attain targets related to tobacco use and harmful use of alcohol.

(5), operating at global, regional and country levels, including through the United Nations Interagency Task Force and the innovative global mechanism that has been set up to improve coordination (7,8). WHO’s regional committees for Africa, the Americas, South East Asia, Europe, Eastern Mediterranean and the Western Pacific have adopted regional policy frameworks (9−14) consistent with the Global NCD Action Plan (5), to further advance ongoing work (see Box 11.2). Key areas of continuing action include setting norms and standards, providing technical support to Member States to strengthen national capacity, strategic planning and resource tracking, and global coordination and monitoring. Arrangements to meet country needs and support national efforts through bilateral and multilateral channels will be strengthened further. As NCDs are one of the leadership priorities within the programmatic reform of WHO, the organization will need to continue to strengthen its support for NCD prevention and control, in order to obtain maximum impact with the limited resources available.

Proposed action ■

■

Implement policy options to strengthen national capacity and the competence of human resources for the prevention and control of NCDs proposed in the Global NCD Action Plan (5). Allocate adequate financial resources for NCD prevention and control and, track total health expenditure and expenditure on prevention and control of NCDs by financing source. Prioritize allocation of financial resources for implementation of `best buy` interventions and policies to attain national NCD targets.

Accountability is key for attainment of targets The highest level of political engagement will be required to develop a country framework for accountability. This implies the development of transparent processes for monitoring, review and action. At national level, a functioning health information system that collects, analyses and reports on expenditure and health data, including on indicators of the global monitoring framework, is essential for monitoring progress. Reviews need to be based on evidence gathered through monitoring, and should provide feedback on progress as the basis for mutual accountability between governments and other stakeholders. WHO already has an accountability framework. In 2013, the Sixty-sixth World Health Assembly (in Resolution WHA66.10) requested the Director-General of WHO to report on progress in attaining the nine voluntary global targets to the Health Assemblies in 2016, 2021 and 2026 (15). WHO will invite Member States to contribute data

WHO’s role in prevention and control of noncommunicable diseases As the principal international agency for health, WHO will continue to play a key role in prevention and control of NCDs. It will continue its efforts to implement the Global NCD Action Plan 2013−2020

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Box 11.2 Progress in prevention and control of NCDs in WHO regions since 2011: key milestones, activities and achievements (number of countries/territories are shown in parentheses) African Region ■ National NCD reporting systems were integrated into health management information systems (n=33). ■ WHO PEN was piloted (n=5). ■ Pilot studies on cancer screening were carried out. ■ STEPS surveys (n=7), global school-based health surveys (n=3) and adult tobacco surveys (n=4) were carried out. ■ Legislation was enacted to ban smoking in public places and to ban tobacco advertisement, promotion and sponsorship (n=10); laws were passed requiring health warnings on tobacco packages (n=8); tax changes on tobacco products were implemented (n=5). ■ South Africa passed legislation for phased reduction of salt in targeted processed-food items. ■ Mauritius imposed tax on sugar contained in manufactured sugar-sweetened drinks. Region of the Americas ■ Country cooperation strategies were developed (20); global school-based student health surveys were was implemented (n=14); PanAm STEP was ﬁnalized (n=5); national plans were developed and national targets were established (n=4). A virtual course on NCDs was developed and implemented. ■ In line with the WHO FCTC, smoke-free legislation was adopted (n=3); bans on advertisement, promotion and sponsorship were adopted n=6); and at least one Global Tobacco Surveillance System component was completed (n=8). ■ National policies were developed on healthy diet, school food programmes and physical activity (n=9); Mexico approved a tax on sugary drinks and energy-dense snacks; laws were passed regulating marketing/labelling of sugar, salt and fat in snacks and beverages (n=4); bicycle use for transportation was promoted (n=9). ■ The Pan American Forum on NCDs was launched, as a platform to promote collaboration between multiple actors. Eastern Mediterranean Region ■ High priority was given to NCDs in national development plans and health strategies (n=15). Lebanon, Morocco, Sudan and Yemen have been supported to develop national multisectoral NCD action plans. ■ Countries are now implementing health-warning measures on tobacco use (n=11). Countries of the Gulf Cooperation Council initiated a process of adopting a uniﬁed regulation for implementing pictorial health warnings on tobacco products. ■ WHO PEN and nationally approved guidelines have been implemented, and the degree of integration of NCD in primary health care assessed (n=7). ■ STEPS surveys were conducted (n=4) and more planning is under way (n=3). Comprehensive review and assessment of national cancer control programmes has been carried out (n=8). European Region Health information systems were strengthened, through implementation of STEPS in Kyrgyzstan, Republic of Moldova, Turkmenistan and Uzbekistan. ■ NCD strategies and plans were developed/strengthened in Armenia, Azerbaijan, Belarus, Bulgaria, Estonia, Georgia, Kyrgyzstan, Lithuania, Republic of Moldova, Tajikistan, Turkmenistan, Ukraine and Uzbekistan. ■ Country assessments of health-system challenges and opportunities for better NCD outcomes were implemented in Belarus, Estonia, Hungary, Kyrgyzstan, Republic of Moldova, Tajikistan and Turkey. ■ Primary care was strengthened to address NCDs through implementation of WHO PEN in Moldova,Tajikistan and Uzbekistan. ■

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South-East Asia Region ■ NCDs were recognized as a major priority in all 11 countries. ■ National targets were set in Bangladesh, Democratic People’s Republic of Korea, India, Maldives, Myanmar, Nepal, Sri Lanka and Timor Leste, and multisectoral action plans are being developed. ■ The WHO PEN package has been introduced into primary health-care systems in Bhutan, Democratic People’s Republic of Korea, Indonesia, Myanmar and Sri Lanka. ■ Pictorial warnings covering a signiﬁcant area on tobacco product packages have been implemented in Bangladesh (50%), India (40%), Indonesia (40%), Thailand (85%) and Nepal (75%). ■ At least one round of an NCD risk factor survey was completed in all countries. ■ In addition to the nine voluntary global targets, the South-East Asia Region has adopted an additional target on reducing household air pollution. Western Paciﬁc Region ■ National multisectoral action plans were developed in Brunei Darussalam, Cambodia, Lao People’s Democratic Republic, China, Malaysia, Mongolia and all Paciﬁc Island countries. ■ STEPS surveys were conducted (n=7), as were global school-based student health surveys (n=11). ■ National targets aligned to the global targets were established in all Paciﬁc Island countries, with the addition of the Tobacco Free Paciﬁc target (5% reduction in tobacco use by 2025). Tobacco control has already yielded results, with 70% of Paciﬁc Island countries meeting the target of a 10% reduction in tobacco prevalence in adults. ■ Salt reduction was initiated in 10 countries. Mongolia has demonstrated a 10% reduction in salt content in bread in a year, and Fiji has shown a 15% reduction in salt for a common brand of noodles. ■ WHO PEN was introduced in Cambodia, Lao People’s Democratic Republic, Mongolia, Philippines, Viet Nam and Paciﬁc Island countries.

Fig. 11.1 WHO accountability framework of on NCD prevention and control a. Progress in implementation of the Global NCD Action Plan WHO to report to the World Health Assembly (WHA), based on country reporting using the 9 process indicators adopted by the WHA GLOBAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES

2015

WHA68 (2016)

2017

WHA73 (2021)

2025

WHA78 (2026)

b. Progress in attaining the global targets using 2010 baseline WHO to report to the World Health Assembly (WHA), based on country reporting using the global monitoring framework indicators

2015

WHA68 (2016)

2017

WHA73 (2021)

2025

WHA78 (2026)

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and information on trends in 2015, 2020 and 2025, in respect of the 25 indicators and progress towards the nine targets, using the 2010 data in this report as the baseline (see Fig. 11.1). All the elements required for mutual accountability for NCD prevention and control at global and national levels are not in place yet. There are time-bound assignments for WHO and commitments by governments on NCD prevention and control. However, there are no commitments as yet by other key stakeholders. Work is in progress to develop an approach that can be used to register and publish contributions of the private sector, philanthropic entities and civil society to the achievement of the voluntary global targets by 2015. Recognizing the need to continue to strengthen international cooperation in the prevention and control of NCDs, Ministers committed themselves in the 2014 Outcome Document (1), to invite the Development Assistance Committee of the Organization for Economic Cooperation and Development to consider developing a purpose code for NCDs in order to improve tracking of official development assistance in support of national efforts for the prevention and control of NCDs. Accountability of all stakeholders will be central for the attainment of global and national NCD targets.

References 1. Outcome document of the high-level meeting of the General Assembly on the comprehensive review and assessment of the progress achieved in the prevention and control of non-communicable diseases. New York: United Nations; 2014. In: Sixty-eighth session of the United Nations General Assembly, 7 July 2014 (A/68/L.53; http://www.un.org/ga/search/view_doc. asp?symbol=A/68/L.53&L, accessed 3 November 2014). 2. Sustainable development goals. United Nations sustainable development knowledge platform http:// sustainabledevelopment.un.org/?menu=1300 3. United Nations General Assembly Resolution A/ RES/66/2. Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. New York (NY): United Nations; 2012 (http://daccessdds-ny.un.org/doc/UNDOC/GEN/N11/458/94/PDF/ N1145894.pdf?OpenElement, accessed 24 October 2014). 4. Assessing national capacity for the prevention and control of noncommunicable diseases: report of the 2013 global survey. Geneva: World Health Organization; 2014. 5. Global action plan for the prevention and control of noncommunicable diseases 2013−2020. Geneva: World Health Organization; 2013 (http://apps.who. int/iris/bitstream/10665/94384/1/9789241506236_ eng.pdf, accessed 24 October 2014). 6. Health in all policies (HiAP) framework for country action. Geneva: World Health Organization; 2014 ( ht t p://w w w.who.i nt /c a rd iova sc u la r_ diseases/140120HPRHiAPFramework.pdf?ua=1, accessed 24 October 2014). 7. United Nations Economic and Social Council Document E/2013/L.23. United Nations Interagency Task Force on the Prevention and Control of Noncommunicable Diseases. Geneva: United Nations; 2013 (http://www.who.int/nmh/events/2013/E.2013.L.23_ tobacco.pdf, accessed 3 November 2014). 8. Provisional agenda item 13.1. Prevention and control of noncommunicable diseases. Terms of reference for the global coordination mechanism on the prevention and control of noncommunicable diseases. In: Sixtyseventh World Health Assembly, 19–24 May 2014. Geneva: World Health Organization; 2014 (A67/14 Add.1; http://apps.who.int/gb/ebwha/pdf_files/ WHA67/A67_14Add1-en.pdf, accessed 3 November 2014).

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9. WHO Regional Committee for Africa. Resolution AFR/RC62/R7. Consideration and endorsement of the Brazzaville Declaration on Noncommunicable Diseases. Brazzaville: WHO Regional Office for A f rica; 2012 (ht tp://apps.who.int/iris/ bitstream/10665/80117/1/AFR-RC62-R7-e.pdf, accessed 22 October 2014). 10. 28th Pan American Sanitary Conference; 64th Session of the Regional Committee. Resolution CSP28.R13. Strategy for the Prevention and Control of Noncommunicable Diseases. Washington (DC): Pan American Health Organization; 2012 (http://www.paho.org/hq/index.php?option=com_ docman&task=doc_view&gid=19265&Itemid=721, accessed 27 May 2014). 11. Regional Committee for the Eastern Mediterranean. Resolution EMR/RC59/R2. The Political Declaration of the United Nations General Assembly on the Prevention and Control of Non-Communicable Diseases: commitments of Member States and the way forward. Cairo: WHO Regional Office for the Eastern Mediterranean; 2012 (http://applications. emro.who.int/docs/RC_Resolutions_2012_2_14692_ EN.pdf?ua=1, accessed 27 May 2014). 12. WHO Regional Committee for Europe. Resolution EUR/RC61/12. Action plan for implementation of the European Strategy for the Prevention and Control of Noncommunicable Diseases 2012–2016. Copenhagen: WHO Regional Office for Europe; 2011 (http://www. euro.who.int/__data/assets/pdf_file/0003/147729/ wd12E_NCDs_111360_revision.pdf?ua=1, accessed 22 October 2014). 13. WHO Regional Committee for South-East Asia. Resolution SEA/RC65/R5. Noncommunicable diseases, mental health and neurological disorders. Delhi: WHO Regional Office for South-East Asia; 2012 (http://www.searo.who.int/entity/noncommunicable_ diseases/events/regional_consultation_ncd/ documents/8_3_resolution.pdf, accessed 22 October 2014). 14. WHO Regional Committee for the Western Pacific. Resolution WPR/RC62.R2. Expanding and intensifying noncommunicable disease prevention and control. Manila: WHO Regional Office for the Western Pacific; 2011 (http://www2.wpro.who.int/NR/rdonlyres/ D80E593C-E7E6-4A4F-B9DF-07B76B284E5A/0/ R2Noncommunicablediseasepreventionandcontrol201112. pdf, accessed 22 October 2014).

15. Resoution 66.10. Follow-up to the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. In: Sixty-sixth session of the United Nations General Assembly. New York: United Nations; 2011 (WHA66.10; http://apps.who.int/gb/ebwha/pdf_files/ WHA66/A66_R10-en.pdfA/67/L.36, accessed 10 November 2014).

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Annexes

Global status report on NCDs 2014

Annex 1. Comprehensive global monitoring framework, including 25 indicators, and a set of 9 voluntary global targets for the prevention and control of noncommunicable diseases Framework element Mortality and morbidity Premature mortality from noncommunicable disease (1) A 25% relative reduction in overall mortality from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases (1) Unconditional probability of dying between ages of 30 and 70 from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases Target Indicator

Additional indicator Risk factors Behavioural risk factors Harmful use of alcohol1 (2) At least 10% relative reduction in the harmful use of alcohol2, as appropriate, within the national context

(2) Cancer incidence, by type of cancer, per 100 000 population

(3) Total (recorded and unrecorded) alcohol per capita (aged 15 + years old) consumption within a calendar year in litres of pure alcohol, as appropriate, within the national context (4) Age-standardized prevalence of heavy episodic drinking among adolescents and adults, as appropriate, within the national context (5) Alcohol-related morbidity and mortality among adolescents and adults, as appropriate, within the national context (6) Prevalence of insuﬃciently physically active adolescents deﬁned as less than 60 minutes of moderate to vigorous intensity activity daily (7) Age-standardized prevalence of insuﬃciently physically active persons aged 18 + years (deﬁned as less than 150 minutes of moderate-intensity activity per week, or equivalent) (8) Age-standardized mean population intake of salt (sodium chloride) per day in grams in persons aged 18 + years

Physical inactivity

(3) A 10% relative reduction in prevalence of insuﬃcient physical activity

Salt/sodium intake

(4) A 30% relative reduction in mean population intake of salt/ sodium intake3

Tobacco use

(5) A 30% relative reduction in prevalence of current tobacco use in persons aged 15+ years

(9) Prevalence of current tobacco use among adolescents (10) Age-standardized prevalence of current tobacco use among persons aged 18+ years

Biological risk factors Raised blood pressure (6) (6) A 25% relative reduction in the prevalence of raised blood pressure or contain the prevalence of raised blood pressure, according to national circumstances (11) Age-standardized prevalence of raised blood pressure among persons aged 18+ years (deﬁned as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg) and mean systolic blood pressure

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Annex 1.

Framework element Diabetes and obesity4

Target (7) Halt the rise in diabetes and obesity

Indicator (12) Age-standardized prevalence of raised blood glucose/ diabetes among persons aged 18 + years (deﬁned as fasting plasma glucose concentration ≥ 7.0 mmol/l (126 mg/dl) or on medication for raised blood glucose ) (13) Prevalence of overweight and obesity in adolescents (deﬁned according to the WHO growth reference for schoolaged children and adolescents, overweight – one standard deviation body mass index for age and sex, and obese – two standard deviations body mass index for age and sex) (14) Age-standardized prevalence of overweight and obesity in persons aged 18+ years (deﬁned as body mass index ≥ 25 kg/m² for overweight and body mass index ≥ 30 kg/m² for obesity) (15) Age-standardized mean proportion of total energy intake from saturated fatty acids in persons aged 18+ years5 (16) Age-standardized prevalence of persons (aged 18 + years) consuming less than ﬁve total servings (400 grams) of fruit and vegetables per day (17) Age-standardized prevalence of raised total cholesterol among persons aged 18+ years (deﬁned as total cholesterol ≥5.0 mmol/l or 190 mg/dl); and mean total cholesterol concentration

Additional indicators

National systems response Drug therapy to prevent heart attacks and strokes (8) At least 50% of eligible people receive drug therapy and counselling (including glycaemic control) to prevent heart attacks and strokes (9) An 80% availability of the aﬀordable basic technologies and essential medicines, including generics, required to treat major noncommunicable diseases in both public and private facilities 18) Proportion of eligible persons (deﬁned as aged 40 years and older with a 10-year cardiovascular risk ≥30%, including those with existing cardiovascular disease) receiving drug therapy and counseling (including glycaemic control) to prevent heart attacks and strokes (19) Availability and aﬀordability of quality, safe and eﬃcacious essential noncommunicable disease medicines, including generics, and basic technologies in both public and private facilities

Essential noncommunicable disease medicines and basic technologies to treat major noncommunicable diseases Additional indicators

(20) Access to palliative care assessed by morphineequivalent consumption of strong opioid analgesics (excluding methadone) per death from cancer (21) Adoption of national policies that limit saturated fatty acids and virtually eliminate partially hydrogenated vegetable oils in the food supply, as appropriate, within the national context and national programmes (22) Availability, as appropriate, if cost-eﬀective and aﬀordable, of vaccines against human papillomavirus, according to national programmes and policies (23) Policies to reduce the impact on children of marketing of foods and non-alcoholic beverages high in saturated fats, trans-fatty acids, free sugars, or salt (24) Vaccination coverage against hepatitis B virus monitored by number of third doses of Hep-B vaccine (HepB3) administered to infants (25) Proportion of women between the ages of 30–49 screened for cervical cancer at least once, or more often, and for lower or higher age groups according to national programmes or policies

1. Countries will select indicator(s) of harmful use as appropriate to national context and in line with WHO’s global strategy to reduce the harmful use of alcohol and that may include prevalence of heavy episodic drinking, total alcohol per capita consumption, and alcohol-related morbidity and mortality among others. 2. In WHO’s global strategy to reduce the harmful use of alcohol the concept of the harmful use of alcohol encompasses the drinking that causes detrimental health and social consequences for the drinker, the people around the drinker and society at large, as well as the patterns of drinking that are associated with increased risk of adverse health outcomes. 3. WHO’s recommendation is less than 5 grams of salt or 2 grams of sodium per person per day. 4. Countries will select indicator(s) appropriate to national context. 5. Individual fatty acids within the broad classiﬁcation of saturated fatty acids have unique biological properties and health eﬀects that can have relevance in developing dietary recommendations.

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136

Annex 2. Methods used for estimating the NCD mortality and risk factor data The mortality and risk factor data presented in this report were estimated by WHO and collaborating partners using standard methods to maximize cross-country comparability. They are not necessarily the official statistics of Member States. The 2012 probability of dying between ages 30 and 70 years from the four main NCDs was estimated using age-specific death rates (in 5-year age groups, e.g. 30-34… 65-69, for those between 30 and 70) of the combined four main NCD categories, for each Member State (5). Using the life table method, the risk of death between the exact ages of 30 and 70, from any of the four causes and in the absence of other causes of death, was calculated using the equation below. The ICD codes used are: Cardiovascular disease: I00-I99, Cancer: C00-C97, Diabetes: E10-E14, and Chronic respiratory disease: J30-J98. * Five-year death rates (5 Mx) were first calculated: Total deaths from four NCD causes between exact age x and exact age x+5 Total population between exact age x and exact age x+5

Mortality Age- and sex-specific all-cause mortality rates were estimated for 2000-2012 from revised life tables, published in World Health Statistics 2014 (1). Total number of deaths by age and sex were estimated for each country by applying these death rates to the estimated resident populations prepared by the United Nations Population Division in its 2012 revision (2). Causes of death were estimated for 2000-2012 using data sources and methods that were specific for each cause of death (3). Vital registration systems which record deaths with sufficient completeness and quality of cause of death information were used as the preferred data source. Mortality by cause was estimated for all Member States with a population greater than 250,000. These NCD mortality estimates are based on a combination of country life tables, cause of death models, regional cause of death patterns, and WHO and UNAIDS programme estimates for some major causes of death (not including NCDs). Detailed information on methods for mortality and causes of death estimates were published previously (3). Age-standardized death rates for cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes were calculated using the WHO standard population (4). Proportional mortality (% of total deaths, all ages, and of both sexes) for communicable, maternal, perinatal and nutritional conditions; injuries; cardiovascular disease; cancer; chronic respiratory disease; diabetes; and other NCDs is reported for 2012 (5).

* 5

Mx =

For each five-year age group, the probability * of death from the four NCDs (5 qx) was calculated using the following formula: * 5 x

q =

Mx ∗ 5 * 1+5 Mx ∗ 2.5

* 5

The unconditional probability of death, for the 30-70 age range, was calculated last: 65 * 40 30 * q = 1 – ∏ (1 – 5 qx)

x=30

Metabolic/biological risk factors Estimates for metabolic/biological risk factors (BMI, overweight and obesity, blood glucose/diabetes and blood pressure) were produced for the standard year 2010 to serve as baselines for reporting against the NCD global voluntary targets, and for the year 2014. The crude adjusted estimates in Annex 4 are based on aggregated data provided to WHO and Global

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Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group and obtained through a review of published and unpublished literature. The inclusion criteria for estimation analysis included data that had come from a random sample of the general population, with clearly indicated survey methods (including sample sizes) and risk factor definitions. Using regression modeling techniques , adjustments were made for the following factors so that the same indicator could be reported for a standard year (in this case 2010 and 2014) in all countries: standard risk factor definition, standard set of age groups for reporting; standard reporting year, and representativeness of population. Crude adjusted rates and age-standardized comparable estimates were produced. This was done by adjusting the crude age-specific estimates to the WHO Standard Population (4) that reflects the global age and sex structure. This adjusts for the differences in age/sex structure between countries. Uncertainty in estimates was analysed by taking into account sampling error and uncertainty due to statistical modeling. The estimates included in the WHO Regional groupings and World Bank Income groupings are the age-standardized comparable estimates. Data reported as of October 2014 were included in the estimation process. Further detailed information on the methods and data sources used to produce these estimates is available from WHO. The following risk factor indicators, with definitions, were included: ■

■

Prevalence of obesity in persons aged 18+ years (defined as body mass index ≥ 30 kg/m²)

Physical inactivity Estimates for adult prevalence of insufficient physical activity were produced by WHO for the standard year 2010. Insufficient physical activity was defined as the percentage of adults aged 18+ years not meeting the WHO recommendations on Physical Activity for Health (6), which is, doing less than 150 minutes of moderate physical activity per week, or equivalent. Prevalence of insufficient physical activity was estimated from population-based surveys meeting the following criteria: (i) provide survey data for the definition of doing less than 150 minutes of moderate physical activity per week (or equivalent), or doing less than 5 times 30 minutes of moderate physical activity per week (or equivalent); (ii) survey data cover all domains of life, including work/household, transport and leisure time; (iii) include randomly selected participants of the general population who were representative of the national or a defined subnational population; (iv) present prevalence by age and sex, with a sample size of each sex-age group of at least a sample size of 50 participants. Countries with no surveys were excluded from the analysis. Regression models were applied to adjust for the definition (for those countries where only the definition of doing less than 5 times 30 minutes of moderate physical activity per week (or equivalent) was available), for survey coverage (for those countries where only urban data was available), and to estimate missing age groups (for those countries where data did not cover the full age range). To further enable comparison among countries, age-standardized comparable estimates of insufficient physical activity were produced. This was done by adjusting the crude estimates to the WHO Standard Population (4) that closely reflects the age and sex structure of most low and middle income countries. This corrects for the differences in age/sex structure between countries. Uncertainty in estimates was analysed by taking into account sampling error and uncertainty due to statistical modeling. The estimates included in the WHO Regional groupings and World Bank Income

Prevalence of raised blood pressure among persons aged 18+ years (defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg) Prevalence of raised blood glucose/diabetes among persons aged 18+ years (defined as fasting plasma glucose concentration ≥ 7.0 mmol/l (126 mg/dl) or on medication for raised blood glucose or with a history of diagnosis of diabetes) Mean Body Mass Index (BMI). Prevalence of overweight and obesity in persons aged 18+ years (defined as body mass index ≥25 kg/m²)

■

■ ■

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Annex 2.

groupings are the age-standardized comparable estimates. Data reported as of October 2014 were included in the estimation process. Further detailed information on the methods and data sources used to produce these estimates is available from WHO. The following risk factor indicator, with definition, was included: ■ Prevalence of insufficiently physically active persons aged 18+ years (defined as less than 150 minutes of moderate-intensity activity per week, or equivalent)

Tobacco smoking A statistical model based on a negative binomial regression was used to estimate the prevalence of tobacco smoking using information from country surveys available in WHO. Tobacco smoking includes cigarettes, cigars, pipes, hookah, shisha, water-pipe and any other form of smoked tobacco. National surveys that report tobacco prevalence and were completed in countries from 1990 up to 30 June 2014 were used for the estimation. An important limitation of the data is that information on tobacco use in a country may be collected from various surveys that may have different primary uses and at times different methods of collecting the information. The model applies several adjustments to try to overcome these limitations. Where survey data are missing for any age group, the model uses data from the country’s other surveys to estimate the age pattern of tobacco use. For ages that the country has never surveyed, the average age pattern seen in countries in the same geographical region is applied to the country’s data. The model adjusts for differing definitions of tobacco use (for example, current versus daily use, or tobacco smoking versus cigarette smoking) using available data from the country’s other surveys to gauge the relationship between indicators of tobacco use by age and sex and over time and derives likely values for the missing indicators. For tobacco use indicators that the country has never reported, the average relationships seen in countries in the same geographical region are applied to the country’s data.

Despite best efforts to generate estimates for countries, this is not always possible and there are some countries with insufficient survey data (whether no surveys, or too few or too old) to calculate a contemporary time point estimate. The outputs from the model are tobacco smoking prevalence estimates with 95% confidence intervals, as well as age-specific rates by sex. The 2012 age-specific rates were applied to the World Standard population to produce age-standardised smoking rates for WHO Regions and World Bank grouping of countries into High, Middle and Low income countries. 1 The WHO Standard Population is a fictitious population whose age distribution is largely reflective of the global population age structure. The age-standardized rates are hypothetical numbers which are only meaningful when comparing standardized rates from one country with standardized rates from another country. Further detailed information on the methods and data sources used to produce these estimates is available from WHO.

Harmful use of alcohol Total alcohol per capita (15+ years) consumption, in litres of pure alcohol, 2010 [95% CI] The recorded three-year average APC for 2008–2010 and the unrecorded consumption for 2010 were added to arrive at the total consumption in litres of pure alcohol (7). The comparison of this total with the weighted average of the total consumption for each region is shown in the country profile. For male and female per capita consumption, we used proportion of alcohol consumed by men versus women plus the demographics for 2010.

1. Geographic regions as defined by UN sub-regions ; please refer to pages ix to xiii of World Population Prospects: The 2010 Revision published by the UN Department of Economic and Social Affairs in 2011 at http://esa.un.org/wpp/Documentation/pdf/ WPP2010_Volume-I_Comprehensive-Tables.pdf. Please note that, for the purposes of this analysis, the Eastern Africa subregion was divided into two regions: Eastern Africa Islands and Remainder of Eastern Africa; and the Melanesia, Micronesia and Polynesia subregions were combined into one subregion.

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Recorded APC (three-year average): Using the recorded APC data from 2008, 2009 and 2010, three-year averages were computed. Tourist consumption was removed to provide a better estimate for APC in countries with at least as many tourists as inhabitants. The tourist consumption estimates are based on the following assumptions: i) Tourists/ visitors consume alcohol as they do at home (i.e. with the same average alcohol per capita consumption); ii) The average length of stay by tourists/visitors was 14 days (except for Estonia, Luxembourg, and the Republic of Moldova, where there is a lot of cross-border shopping with shorter average length of stay). Recorded APC is defined as the recorded amount of alcohol consumed per capita (15+ years) over a calendar year in a country, in litres of pure alcohol. The indicator only takes into account the consumption which is recorded from production, import, export, and sales data often via taxation. Recorded APC is calculated as the sum of beverage-specific alcohol consumption of pure alcohol (beer, wine, spirits, other). The “other alcoholic beverages” category consists of such types as fortified wine, fermented beverages, sorghum, maize, and ready-to-drink. The first priority in data sources is given to government statistics; second are country-specific alcohol industry statistics (Canadean, IWSR-International Wine and Spirit Research, OIV-International Organisation of Vine and Wine, Wine Institute, historically World Drink Trends) in the public domain if based on interviews in countries; third is the Food and Agriculture Organization of the United Nations’ statistical database (FAOSTAT); and fourth is economic operators if desk review. In order to make the conversion into litres of pure alcohol, the alcohol content (% alcohol by volume) is considered to be as follows: Beer (barley beer 5%), Wine (grape wine 12%; must of grape 9%, vermouth 16%), Spirits (distilled spirits 40%; spirit-like 30%), and Other (sorghum, millet, maize beers 5%; cider 5%; fortified wine 17% and 18%; fermented wheat and fermented rice 9%; other fermented beverages 9%). Unrecorded APC: Unrecorded APC in litres of pure alcohol in 2010 was based on empirical

investigations and the judgement of experts. A special exercise to collect in-depth information on unrecorded alcohol from all venues (i.e., cross-border shopping, surrogate alcohol use, illegal and legal home production, smuggling) was conducted to improve the accuracy of unrecorded data.

Total alcohol per capita (15+ years) consumption, in litres of pure alcohol, projected estimates for 2012 [95% CI] Projected estimates for total alcohol consumption data for 2012 took into account data that were available for that year for some countries. For other countries, they were derived using fractional polynomial regression models with year as independent variable. As data on per capita consumption change rapidly over time, the regression model for each country was chosen based on the results of regression models that used data from 2005 onward, 2000 onward, 1990 onward, and 1960 onward. Models were chosen based on a sensitivity analysis that assessed the ability of these models to predict data from 2005 onward when these data were excluded (models were adjusted to use data from 2000 onward, 1995 onward, 1985 onward, and 1960 onward respectively for the sensitivity analyses).

Age-standardized heavy episodic drinking (15+ years, population), past 30 days (%), 2010 [95% CI] The number of males in the population multiplied by the percentage of heavy drinkers in the population. The number of male heavy drinkers divided by the number of male drinkers equals the percentage of male heavy episodic drinkers among male drinkers. Similar calculations are done for HED among females and the total population. Surveys carried out in the time period 2006–2010. HED is defined as having consumed at least 60 grams or more of pure alcohol on at least one occasion in the past 30 days. Values for countries with no available surveys were imputed via multiple regression based on region, year of survey, per capita consumption, pattern of drinking score, demographic indicators (including religion) and economic wealth (GDPPPP) as predictors.

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Age-standardized alcohol use disorders (15+ years), 12 month prevalence (%), 2010 [95% CI] Data on the prevalence of people with AUD (including harmful use and alcohol dependence), were modelled using regression models. Where available, the original survey data on the previously-mentioned measures of interest were used instead of the predicted estimates. The regression models used data collected through a systematic search of all survey data on the previously-mentioned measures of interest (from 2000 onward) and took into account per capita consumption, population structure, the size of Muslim population within the country, the region of the country, and the year from which the survey data were obtained. Data on gross domestic product (adjusted for purchase power parity) were obtained from the World Bank (World Bank, 2013). The validity of the predicted estimates was assessed by comparing predicted estimates to the survey data.

References: 1. World Health Organization. World Health Statistics 2014. Geneva: WHO; 2014. 2. United Nations Population Division. World population prospects - the 2012 revision. 2013. New York, United Nations. 3. WHO methods and data sources for country‐ level causes of death 2000‐2012. World Health Organization, Geneva 2014. 4. Ahmad OB et al. Age Standardization of Rates: A New WHO Standard (Technical Report). GPE Discussion Paper Series: No.31. Geneva, World Health Organization, 2001. 5. WHO. Global Health Estimates: Deaths by Cause, Age, Sex and Country, 2000-2012. Geneva, World Health Organization, 2014. 6. WHO Global Recommendations on Physical Activity for Health. Geneva, World Health Organization, 2010. Available at: http://www.who.int/dietphysicalactivity/ factsheet_recommendations/en/ 7. Global status report on alcohol and health 2014. Geneva: World Health Organization; 2014 (http:// www.who.int/substance_abuse/publications/global_ alcohol_report/msb_gsr_2014_1.pdf?ua=1, accessed 4 November 2014).

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Annex 3. List of countries by WHO regions Africa Algeria Angola Benin Botswana Burkina Faso Burundi Cabo Verde Cameroon Central African Republic Chad Comoros Congo Côte d’Ivoire Democratic Republic of the Congo Equatorial Guinea Eritrea Ethiopia Gabon Gambia Ghana Guinea Guinea-Bissau Kenya Lesotho Liberia Madagascar Malawi Mali Mauritania Mauritius Mozambique Namibia Niger Nigeria Rwanda Sao Tome and Principe Senegal Seychelles Sierra Leone South Africa South Sudan Swaziland Togo Uganda United Republic of Tanzania Zambia Zimbabwe Argentina Bahamas Barbados Belize Bolivia (Plurinational State of) Brazil Canada Chile Colombia Costa Rica Cuba Dominica Dominican Republic Ecuador El Salvador Grenada Guatemala Guyana Haiti Honduras Jamaica Mexico Nicaragua Panama Paraguay Peru Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Suriname Trinidad and Tobago United States of America Uruguay Venezuela (Bolivarian Republic of) The Americas Antigua and Barbuda Eastern mediterranean Afghanistan Bahrain Djibouti Egypt Iran (Islamic Republic of) Iraq Jordan Kuwait Lebanon Libya Morocco Oman Pakistan Qatar Saudi Arabia Somalia Sudan Syrian Arab Republic Tunisia United Arab Emirates Yemen

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Europe Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan the former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom of Great Britain and Northern Ireland Uzbekistan Bhutan

South-East Asia Bangladesh Democratic People’s Republic of Korea India Indonesia Maldives Myanmar Nepal Sri Lanka Thailand Timor-Leste Australia

Western Pacific Brunei Darussalam Cambodia China Cook Islands Fiji Japan Kiribati Lao People’s Democratic Republic Malaysia Marshall Islands Micronesia (Federated States of) Mongolia Nauru New Zealand Niue Palau Papua New Guinea Philippines Republic of Korea Samoa Singapore Solomon Islands Tonga Tuvalu Vanuatu Viet Nam

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List of countries by World Bank Income Groups (2013) Country Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic Democratic People's Republic of Korea ISO 3 code AFG ALB DZA AND AGO ATG ARG ARM AUS AUT AZE BHS BHR BGD BRB BLR BEL BLZ BEN BTN BOL BIH BWA BRA BRN BGR BFA BDI CPV KHM CMR CAN CAF TCD CHL CHN COL COM COG COK CRI CIV HRV CUB CYP CZE PRK WHO region, 2013 EMR EUR AFR EUR AFR AMR AMR EUR WPR EUR EUR AMR EMR SEAR AMR EUR EUR AMR AFR SEAR AMR EUR AFR AMR WPR EUR AFR AFR AFR WPR AFR AMR AFR AFR AMR WPR AMR AFR AFR WPR AMR AFR EUR AMR EUR EUR SEAR World Bank Income Group Classification, 2013 Low-income Upper-middle-income Upper-middle-income High-income Upper-middle-income High-income Upper-middle-income Lower-middle-income High-income High-income Upper-middle-income High-income High-income Low-income High-income Upper-middle-income High-income Upper-middle-income Low-income Lower-middle-income Lower-middle-income Upper-middle-income Upper-middle-income Upper-middle-income High-income Upper-middle-income Low-income Low-income Lower-middle-income Low-income Lower-middle-income High-income Low-income Low-income High-income Upper-middle-income Upper-middle-income Low-income Lower-middle-income Upper-middle-income Upper-middle-income Lower-middle-income High-income Upper-middle-income High-income High-income Low-income

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Country Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho

ISO 3 code COD DNK DJI DMA DOM ECU EGY SLV GNQ ERI EST ETH FJI FIN FRA GAB GMB GEO DEU GHA GRC GRD GTM GIN GNB GUY HTI HND HUN ISL IND IDN IRN IRQ IRL ISR ITA JAM JPN JOR KAZ KEN KIR KWT KGZ LAO LVA LBN LSO

WHO region, 2013 AFR EUR EMR AMR AMR AMR EMR AMR AFR AFR EUR AFR WPR EUR EUR AFR AFR EUR EUR AFR EUR AMR AMR AFR AFR AMR AMR AMR EUR EUR SEAR SEAR EMR EMR EUR EUR EUR AMR WPR EMR EUR AFR WPR EMR EUR WPR EUR EMR AFR

World Bank Income Group Classification, 2013 Low-income High-income Lower-middle-income Upper-middle-income Upper-middle-income Upper-middle-income Lower-middle-income Lower-middle-income High-income Low-income High-income Low-income Upper-middle-income High-income High-income Upper-middle-income Low-income Lower-middle-income High-income Lower-middle-income High-income Upper-middle-income Lower-middle-income Low-income Low-income Lower-middle-income Low-income Lower-middle-income Upper-middle-income High-income Lower-middle-income Lower-middle-income Upper-middle-income Upper-middle-income High-income High-income High-income Upper-middle-income High-income Upper-middle-income Upper-middle-income Low-income Lower-middle-income High-income Lower-middle-income Lower-middle-income High-income Upper-middle-income Lower-middle-income

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Country Liberia Libya Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (Federated States of) Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Korea Republic of Moldova Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia

ISO 3 code LBR LBY LTU LUX MDG MWI MYS MDV MLI MLT MHL MRT MUS MEX FSM MCO MNG MNE MAR MOZ MMR NAM NRU NPL NLD NZL NIC NER NGA NIU NOR OMN PAK PLW PAN PNG PRY PER PHL POL PRT QAT KOR MDA ROU RUS RWA KNA LCA

WHO region, 2013 AFR EMR EUR EUR AFR AFR WPR SEAR AFR EUR WPR AFR AFR AMR WPR EUR WPR EUR EMR AFR SEAR AFR WPR SEAR EUR WPR AMR AFR AFR WPR EUR EMR EMR WPR AMR WPR AMR AMR WPR EUR EUR EMR WPR EUR EUR EUR AFR AMR AMR

World Bank Income Group Classification, 2013 Low-income Upper-middle-income High-income High-income Low-income Low-income Upper-middle-income Upper-middle-income Low-income High-income Upper-middle-income Lower-middle-income Upper-middle-income Upper-middle-income Lower-middle-income High-income Lower-middle-income Upper-middle-income Lower-middle-income Low-income Low-income Upper-middle-income Upper-middle-income Low-income High-income High-income Lower-middle-income Low-income Lower-middle-income Upper-middle-income High-income High-income Lower-middle-income Upper-middle-income Upper-middle-income Lower-middle-income Lower-middle-income Upper-middle-income Lower-middle-income High-income High-income High-income High-income Lower-middle-income Upper-middle-income High-income Low-income High-income Upper-middle-income

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Annex 3.

Country Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand the former Yugoslav Republic of Macedonia Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom of Great Britain and Northern Ireland United Republic of Tanzania United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe

ISO 3 code VCT WSM SMR STP SAU SEN SRB SYC SLE SGP SVK SVN SLB SOM ZAF SSD ESP LKA SDN SUR SWZ SWE CHE SYR TJK THA MKD TLS TGO TON TTO TUN TUR TKM TUV UGA UKR ARE GBR TZA USA URY UZB VUT VEN VNM YEM ZMB ZWE

WHO region, 2013 AMR WPR EUR AFR EMR AFR EUR AFR AFR WPR EUR EUR WPR EMR AFR AFR EUR SEAR EMR AMR AFR EUR EUR EMR EUR SEAR EUR SEAR AFR WPR AMR EMR EUR EUR WPR AFR EUR EMR EUR AFR AMR AMR EUR WPR AMR WPR EMR AFR AFR

World Bank Income Group Classification, 2013 Upper-middle-income Lower-middle-income High-income Lower-middle-income High-income Lower-middle-income Upper-middle-income Upper-middle-income Low-income High-income High-income High-income Lower-middle-income Low-income Upper-middle-income Lower-middle-income High-income Lower-middle-income Lower-middle-income Upper-middle-income Lower-middle-income High-income High-income Lower-middle-income Low-income Upper-middle-income Upper-middle-income Lower-middle-income Low-income Upper-middle-income High-income Upper-middle-income Upper-middle-income Upper-middle-income Upper-middle-income Low-income Lower-middle-income High-income High-income Low-income High-income High-income Lower-middle-income Lower-middle-income Upper-middle-income Lower-middle-income Lower-middle-income Lower-middle-income Low-income

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Annex 4. Country estimates of noncommunicable diseases mortality and selected risk factors, 2010 (baseline) and latest available data

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4.1 Premature NCD mortality – Probability of dying between exact ages 30 and 70 from any of cardiovascular disease, cancer, diabetes, or chronic respiratory disease, 2010 and 2012 Country name Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Region EMR EUR AFR EUR AFR AMR AMR EUR WPR EUR EUR AMR EMR SEAR AMR EUR EUR AMR AFR SEAR AMR EUR AFR AMR WPR EUR AFR AFR AFR WPR AFR AMR AFR AFR AMR WPR AMR AFR AFR WPR AMR AFR EUR AMR EUR 2010 31.3% 19.3% 22.4% ... 24.7% ... 17.8% 30.6% 9.9% 12.4% 25.2% 13.3% 14.3% 18.0% 14.7% 28.9% 12.7% 15.1% 22.1% 21.0% 18.6% 18.1% 20.4% 19.8% 16.7% 25.0% 23.4% 24.4% 15.7% 17.6% 20.2% 11.2% 18.7% 23.8% 12.4% 19.5% 13.3% 24.0% 19.7% ... 12.6% 23.2% 18.2% 17.2% 10.3% 2012 30.5% 18.8% 22.1% ... 24.2% ... 17.5% 29.7% 9.4% 12.0% 23.3% 13.8% 13.3% 17.5% 13.8% 26.2% 12.2% 14.4% 22.1% 20.5% 18.3% 17.5% 20.9% 19.4% 16.8% 24.0% 23.8% 24.3% 15.1% 17.7% 19.9% 10.7% 18.5% 23.2% 11.9% 19.4% 12.4% 23.5% 19.8% ... 12.2% 23.3% 17.7% 16.5% 9.5%

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Annex 4.1: Premature NCD mortality … Indicates no data were available Country name Czech Republic Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Region EUR SEAR AFR EUR EMR AMR AMR AMR EMR AMR AFR AFR EUR AFR WPR EUR EUR AFR AFR EUR EUR AFR EUR AMR AMR AFR AFR AMR AMR AMR EUR EUR SEAR SEAR EMR EMR EUR EUR EUR AMR WPR EMR EUR AFR WPR EMR EUR WPR EUR EMR 2010 17.8% 28.0% 23.7% 13.7% 19.2% ... 16.9% 12.2% 25.1% 17.3% 24.1% 25.4% 20.4% 15.9% 31.4% 11.8% 11.5% 14.6% 19.3% 21.8% 13.0% 19.9% 12.3% ... 13.9% 21.0% 22.3% 37.1% 24.0% 16.1% 24.5% 9.5% 26.1% 23.8% 18.1% 23.3% 11.5% 10.4% 10.4% 17.4% 9.6% 20.2% 34.4% 18.4% ... 12.0% 28.8% 25.7% 25.3% 13.3% 2012 17.0% 27.1% 23.6% 13.3% 18.8% ... 14.8% 11.9% 24.5% 16.9% 23.4% 24.2% 18.8% 15.2% 30.8% 11.2% 11.4% 15.0% 19.1% 21.6% 12.3% 20.3% 12.9% ... 13.5% 20.9% 22.4% 37.2% 23.9% 15.7% 24.0% 10.2% 26.2% 23.1% 17.3% 23.7% 11.1% 9.5% 9.8% 17.0% 9.3% 19.8% 33.9% 18.1% ... 11.8% 28.5% 24.2% 24.1% 12.4%

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Global status report on NCDs 2014 … Indicates no data were available Country name Lesotho Liberia Libya Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (Federated States of) Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Korea Republic of Moldova Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Region AFR AFR EMR EUR EUR AFR AFR WPR SEAR AFR EUR WPR AFR AFR AMR WPR EUR WPR EUR EMR AFR SEAR AFR WPR SEAR EUR WPR AMR AFR AFR WPR EUR EMR EMR WPR AMR WPR AMR AMR WPR EUR EUR EMR WPR EUR EUR EUR AFR AMR AMR 2010 24.5% 21.3% 18.5% 23.1% 12.0% 24.3% 18.2% 20.1% 17.6% 25.9% 11.7% ... ... 24.7% 16.8% ... ... 32.5% 22.7% 23.4% 17.9% 24.3% 21.5% ... 22.3% 12.6% 11.6% 19.1% 19.9% 19.8% ... 11.3% 18.8% 20.5% ... 12.9% 26.3% 19.0% 13.0% 27.6% 20.5% 12.4% 14.1% 10.5% 30.2% 23.2% 30.2% 19.5% ... ... 2012 23.9% 21.2% 17.6% 22.4% 11.4% 23.4% 18.7% 19.6% 15.9% 25.6% 11.6% ... ... 24.0% 15.7% ... ... 32.0% 22.2% 22.8% 17.3% 24.3% 20.0% ... 21.6% 12.2% 10.7% 19.4% 19.6% 19.8% ... 10.7% 17.8% 20.5% ... 12.5% 26.4% 18.5% 11.2% 27.9% 20.0% 11.9% 14.2% 9.3% 26.5% 22.6% 29.9% 19.1% ... ...

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Annex 4.1: Premature NCD mortality … Indicates no data were available Country name Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand the former Yugoslav Republic of Macedonia Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United Republic of Tanzania United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe Region AMR WPR EUR AFR EMR AFR EUR AFR AFR WPR EUR EUR WPR EMR AFR AFR EUR SEAR EMR AMR AFR EUR EUR EMR EUR SEAR EUR SEAR AFR WPR AMR EMR EUR EUR WPR AFR EUR EMR EUR AFR AMR AMR EUR WPR AMR WPR EMR AFR AFR 2010 ... ... ... ... 17.1% 16.8% 24.7% ... 27.2% 10.9% 20.6% 13.5% 24.2% 19.6% 27.7% 20.3% 10.9% 18.3% 17.5% 13.6% 24.1% 10.4% 9.7% 19.3% 29.1% 16.7% 22.8% 25.6% 19.9% ... 26.7% 17.6% 19.4% 40.6% ... 21.3% 28.3% 19.8% 12.4% 16.6% 14.7% 17.7% 31.3% ... 16.0% 17.5% 23.3% 18.6% 20.2% 2012 ... ... ... ... 16.7% 16.7% 24.5% ... 27.5% 10.5% 19.4% 12.6% 24.1% 19.1% 26.8% 19.8% 10.8% 17.6% 17.4% 13.6% 21.4% 9.9% 9.1% 19.1% 28.8% 16.2% 22.1% 23.7% 20.2% ... 26.2% 17.2% 18.4% 40.8% ... 21.2% 28.2% 18.9% 12.0% 16.1% 14.3% 17.1% 31.0% ... 15.7% 17.4% 23.1% 18.1% 19.3%

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4.2 NCD mortality – Comparable estimates of NCD mortality (total NCD deaths in 000s; % of NCD deaths occurring under the age of 70; and age-standardized death rate for NCDs per 100 000), 2012 Total NCD deaths (`000s) Country name Region Males Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus EMR EUR AFR EUR AFR AMR AMR EUR WPR EUR EUR AMR EMR SEAR AMR EUR EUR AMR AFR SEAR AMR EUR AFR AMR WPR EUR AFR AFR AFR WPR AFR AMR AFR AFR AMR WPR AMR AFR AFR WPR AMR AFR EUR AMR EUR 43.0 12.8 89.6 ... 35.7 ... 128.0 18.0 67.0 33.6 25.3 0.8 1.3 277.5 0.8 53.0 46.7 0.4 15.7 1.5 21.1 16.3 2.4 518.3 0.6 50.8 23.9 17.4 0.9 21.4 37.0 109.3 6.5 19.0 40.9 4568.7 71.5 1.1 6.8 ... 9.2 42.7 23.1 40.2 2.8 Females 48.3 13.6 79.3 ... 36.7 ... 127.4 15.9 66.0 38.6 23.3 0.8 0.9 244.8 0.7 55.5 47.5 0.4 16.7 1.3 21.4 16.0 3.6 459.9 0.5 48.7 27.6 14.8 0.9 22.5 37.1 110.2 6.7 17.6 38.2 4008.3 71.8 1.1 6.7 ... 8.4 34.8 23.2 35.7 2.8 Males 72.4% 33.6% 51.5% ... 77.3% ... 42.1% 36.9% 28.4% 31.4% 50.7% 44.2% 56.6% 49.0% 44.6% 50.5% 29.1% 42.3% 71.5% 57.5% 58.1% 37.9% 63.1% 50.7% 58.4% 40.1% 75.0% 75.4% 35.8% 62.6% 70.7% 31.9% 63.7% 74.0% 41.6% 39.7% 48.4% 69.4% 63.5% ... 43.2% 74.0% 37.2% 38.8% 32.6% Females 68.8% 23.4% 44.2% ... 72.6% ... 27.3% 21.5% 18.9% 15.6% 34.2% 29.8% 45.3% 49.6% 32.4% 21.5% 16.9% 41.6% 62.6% 59.6% 52.0% 22.5% 45.3% 41.4% 51.4% 21.0% 66.8% 67.9% 26.1% 56.8% 64.9% 22.1% 56.3% 68.3% 29.5% 31.9% 43.2% 63.0% 56.9% ... 35.1% 74.5% 17.3% 29.9% 17.1% NCD deaths under age 70 (% of all NCD deaths)

154

Annex 4.2: NCD mortality

… Indicates no data were available Age-standardized death rate per 100 000 (Males) Chronic respiratory diseases 74.0 42.4 34.7 ... 95.3 ... 51.3 64.7 27.8 21.9 30.1 12.1 49.3 119.6 13.9 37.1 38.9 46.4 58.2 120.5 46.7 36.4 40.5 49.2 62.9 48.0 60.2 52.2 85.9 40.0 46.8 28.0 98.4 54.0 34.5 89.6 45.9 51.1 74.3 ... 31.1 55.4 29.4 22.4 25.4 Cardiovascular disease 498.0 447.4 434.6 ... 376.4 ... 247.8 606.9 110.6 177.8 523.5 292.5 195.9 178.7 159.8 674.4 140.3 201.6 367.4 187.1 308.7 352.1 277.5 258.9 232.8 498.6 395.6 329.0 330.4 202.5 283.9 112.2 249.8 310.2 145.2 313.8 178.2 356.2 337.6 ... 163.0 332.3 291.7 214.4 155.2 Age-standardized death rate per 100 000 (Females) Chronic respiratory diseases 59.6 27.8 22.9 ... 58.6 ... 24.7 26.5 18.0 10.6 16.5 4.4 36.5 92.7 5.3 5.2 16.6 8.9 31.6 84.9 33.9 20.7 24.2 29.9 36.5 20.5 40.5 38.8 26.3 29.1 29.9 18.6 65.9 48.4 19.8 66.7 29.1 40.0 38.8 ... 25.9 36.5 9.8 15.3 14.5 Cardiovascular disease 520.9 417.6 359.9 ... 369.8 ... 148.4 367.7 75.6 119.0 377.6 169.6 176.1 152.6 102.6 339.6 86.9 180.8 371.1 203.4 236.9 273.2 349.5 177.7 189.8 331.8 355.6 292.1 195.2 170.4 284.8 68.1 237.8 300.4 90.4 286.1 128.0 303.9 329.3 ... 118.4 338.8 193.6 157.2 117.9

All NCDs 869.2 714.2 779.8 ... 812.4 ... 599.4 1091.3 359.9 447.6 800.8 602.8 536.8 564.1 499.3 1015.8 449.3 542.9 816.0 558.7 696.9 612.0 577.3 617.7 521.2 813.3 842.5 807.4 637.6 442.6 709.1 378.6 602.6 778.6 453.3 650.6 432.2 766.9 674.2 ... 442.3 830.5 655.6 491.1 389.8

Cancers 142.2 142.5 83.9 ... 97.9 ... 166.5 277.1 135.9 152.3 145.0 131.8 80.4 94.9 179.3 182.2 167.5 114.4 104.8 80.8 106.0 146.8 110.5 142.9 94.1 175.7 95.7 130.2 68.2 111.7 75.2 138.9 91.8 90.5 139.3 193.3 100.2 101.6 82.7 ... 127.4 123.1 222.8 161.4 115.8

Diabetes 33.5 6.4 76.3 ... 39.5 ... 21.7 35.7 11.6 16.7 13.9 45.4 96.9 30.8 43.3 2.0 7.7 63.1 47.3 32.2 40.4 13.1 40.6 39.0 59.7 14.2 44.7 42.8 26.8 11.9 48.1 12.3 22.8 45.6 18.3 11.9 16.0 49.5 31.2 ... 18.6 49.0 16.7 13.7 24.8

All NCDs 829.4 625.1 645.2 ... 732.0 ... 370.9 653.5 253.0 288.4 556.9 370.9 473.1 531.9 334.2 481.4 283.1 410.5 718.3 592.7 586.3 430.3 627.7 429.4 433.6 499.2 743.1 658.7 379.0 355.8 644.8 268.0 509.8 653.9 298.6 508.5 335.2 636.0 595.3 ... 346.2 753.1 375.7 359.1 278.6

Cancers 110.6 105.3 78.0 ... 86.1 ... 109.1 175.3 90.6 99.7 88.5 88.1 65.4 79.9 117.7 79.0 102.0 57.3 82.6 79.8 109.9 80.8 70.6 100.2 80.3 99.2 92.4 142.4 62.0 92.7 73.9 104.0 76.2 88.6 99.0 98.0 85.0 105.0 62.2 ... 97.3 100.5 112.8 109.1 74.7

Diabetes 39.0 7.4 58.7 ... 44.4 ... 14.4 31.9 7.7 10.8 14.9 38.9 84.3 28.7 41.2 1.7 5.7 73.4 48.1 36.0 48.5 17.6 73.0 38.9 65.9 11.5 69.7 35.1 19.9 15.6 55.5 7.5 24.0 43.7 12.5 17.7 16.8 41.4 36.2 ... 19.5 59.0 10.8 17.7 21.1

155

Global status report on NCDs 2014 … Indicates no data were available Total NCD deaths (`000s) Country name Region Males Czech Republic Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea–Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho EUR SEAR AFR EUR EMR AMR AMR AMR EMR AMR AFR AFR EUR AFR WPR EUR EUR AFR AFR EUR EUR AFR EUR AMR AMR AFR AFR AMR AMR AMR EUR EUR SEAR SEAR EMR EMR EUR EUR EUR AMR WPR EMR EUR AFR WPR EMR EUR WPR EUR EMR AFR 47.7 91.4 105.3 23.7 1.5 ... 16.6 28.1 232.1 12.7 1.5 7.7 6.5 118.6 2.8 22.6 238.7 2.6 2.5 22.7 375.9 40.7 52.7 ... 19.2 18.4 2.9 2.1 20.6 11.3 58.6 0.8 3270.8 578.2 164.0 57.2 12.1 17.1 253.6 7.7 506.6 10.8 66.1 50.6 ... 2.8 15.5 11.4 12.4 10.5 3.3 Females 48.4 89.0 110.4 24.3 1.4 ... 17.9 26.5 211.4 13.7 1.2 7.2 7.1 91.9 2.0 24.1 244.7 2.9 2.3 24.0 414.6 46.6 48.5 ... 18.4 18.3 2.9 2.1 22.3 10.5 61.4 1.0 2598.0 527.6 138.0 45.7 11.7 18.0 274.7 7.7 441.0 8.8 66.2 47.8 ... 1.7 13.7 10.9 14.7 7.0 4.4 Males 41.1% 58.5% 73.9% 33.9% 64.1% ... 45.6% 41.7% 57.0% 46.6% 71.6% 77.9% 43.4% 63.8% 67.4% 34.3% 32.5% 50.4% 73.4% 35.8% 28.8% 68.5% 26.9% ... 52.7% 71.9% 71.4% 72.2% 57.6% 49.4% 45.4% 28.2% 62.0% 54.0% 41.8% 57.0% 31.9% 29.7% 23.1% 37.3% 27.2% 54.5% 60.3% 67.8% ... 49.7% 59.6% 57.5% 42.9% 33.3% 55.1% Females 21.3% 35.3% 67.1% 21.9% 58.5% ... 38.7% 38.3% 42.1% 42.4% 65.4% 68.3% 18.3% 61.8% 58.1% 16.5% 16.2% 41.2% 71.4% 19.2% 14.7% 57.1% 14.1% ... 50.4% 67.2% 65.3% 58.2% 52.7% 45.8% 23.7% 18.4% 52.2% 43.0% 38.8% 42.5% 22.7% 18.7% 12.8% 27.1% 14.7% 51.6% 36.1% 63.4% ... 51.0% 40.2% 48.2% 19.1% 27.7% 47.3% NCD deaths under age 70 (% of all NCD deaths)

156

Annex 4.2: NCD mortality

Age-standardized death rate per 100 000 (Males) Chronic respiratory diseases 23.1 229.5 82.0 40.4 40.6 ... 14.7 29.3 54.5 29.6 97.2 56.8 20.2 103.0 75.0 19.8 18.7 67.6 49.3 39.3 27.1 36.4 34.2 ... 26.9 50.2 61.1 35.1 23.5 50.4 42.0 25.1 188.5 85.4 33.3 44.8 33.0 24.1 23.5 26.4 26.2 44.2 70.7 21.9 ... 10.0 69.9 84.6 17.8 23.8 133.2 Cardiovascular disease 299.3 480.5 350.8 134.6 298.5 ... 187.0 170.3 515.9 191.9 382.1 388.1 387.4 183.9 494.1 197.3 111.8 248.5 306.2 545.3 171.6 320.0 210.2 ... 139.2 288.1 355.1 709.7 394.1 240.1 383.7 118.8 348.9 407.5 371.0 523.8 147.5 105.0 129.7 265.5 108.0 358.9 808.1 219.6 ... 243.7 660.4 368.7 512.4 267.5 301.9

Age-standardized death rate per 100 000 (Females) Chronic respiratory diseases 10.0 92.2 46.2 32.9 32.9 ... 14.7 18.5 31.5 29.8 57.1 33.7 3.8 11.6 29.9 8.1 8.1 38.9 28.1 15.7 14.1 29.6 22.5 ... 19.5 36.4 37.1 15.2 14.2 30.8 18.4 20.1 124.9 34.2 24.3 27.6 20.1 14.4 10.0 9.3 8.9 20.7 24.8 17.5 ... 17.0 35.0 77.4 3.7 14.4 65.4 Cardiovascular disease 191.9 277.8 361.5 85.5 256.9 ... 208.7 130.3 387.7 155.0 329.6 282.2 199.5 141.1 264.0 104.1 65.0 234.4 292.0 349.3 116.2 350.0 145.2 ... 108.6 332.0 379.7 451.0 374.8 164.4 229.4 87.2 264.6 337.0 329.6 336.7 93.5 70.1 85.4 204.3 58.9 293.5 515.2 191.2 ... 233.5 462.3 326.6 266.5 160.4 309.9

All NCDs 589.8 1061.9 762.5 481.1 678.5 ... 396.5 455.3 928.0 533.9 798.8 809.7 752.3 556.1 973.1 467.9 412.7 530.5 650.5 808.7 447.8 688.5 459.3 ... 453.8 717.7 794.9 1337.2 758.6 497.4 807.5 337.2 785.0 774.6 609.0 876.6 414.6 367.2 382.1 604.0 333.3 715.2 1245.3 558.7 ... 399.8 1033.5 762.7 895.7 472.4 713.9

Cancers 188.2 196.6 120.5 179.9 75.4 ... 111.5 111.7 145.9 107.9 78.7 83.8 216.2 63.5 76.0 124.5 179.8 57.1 73.3 134.4 152.3 93.3 157.0 ... 108.9 119.7 95.0 230.4 112.4 106.8 253.0 127.4 79.0 132.6 112.6 116.5 149.2 129.1 150.8 156.8 144.9 132.8 217.1 148.4 ... 73.4 118.9 174.3 238.1 105.7 88.1

Diabetes 12.9 17.1 30.3 16.9 47.6 ... 18.2 24.5 13.5 34.1 42.2 55.1 6.8 24.7 170.1 5.6 9.0 26.8 41.3 9.7 11.9 41.9 6.6 ... 39.6 41.4 47.3 129.5 61.8 16.4 14.2 4.9 30.2 48.9 15.1 51.0 8.9 23.3 13.1 60.2 5.4 60.8 10.6 42.6 ... 21.3 8.6 24.3 24.6 24.7 53.7

All NCDs 362.0 587.5 693.0 342.3 589.4 ... 394.4 369.9 665.4 430.4 657.7 579.2 358.4 404.2 654.5 285.2 234.8 483.0 608.4 481.4 295.1 652.8 284.9 ... 371.3 649.1 736.5 863.7 695.9 392.6 459.1 287.8 586.6 600.2 529.5 584.6 286.5 265.3 242.5 448.1 173.5 568.1 754.4 476.8 ... 419.1 680.8 611.5 459.4 301.4 644.9

Cancers 109.2 122.3 103.4 137.8 91.3 ... 81.6 106.0 100.5 112.0 70.3 97.5 103.6 107.2 119.0 86.9 95.5 53.3 56.6 76.9 98.9 72.6 82.8 ... 110.0 74.2 83.5 134.8 96.7 104.6 137.8 112.9 66.3 94.8 81.4 102.6 107.3 95.7 90.2 96.3 73.2 93.8 122.5 136.8 ... 78.4 86.0 105.6 115.7 91.8 63.8

Diabetes 9.5 15.3 35.6 8.5 40.6 ... 30.9 27.4 12.7 44.0 37.3 36.8 4.3 24.2 134.7 3.0 5.6 32.3 55.7 7.4 8.6 37.3 4.7 ... 45.6 44.9 54.2 142.1 87.8 15.2 10.8 5.0 22.7 71.9 18.9 38.3 4.7 17.6 9.5 79.7 2.5 60.1 10.1 28.1 ... 33.6 10.3 33.8 19.1 9.2 87.3

157

Global status report on NCDs 2014 … Indicates no data were available Total NCD deaths (`000s) Country name Region Males Liberia Libya Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (Federated States of) Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Korea Republic of Moldova Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa AFR EMR EUR EUR AFR AFR WPR SEAR AFR EUR WPR AFR AFR AMR WPR EUR WPR EUR EMR AFR SEAR AFR WPR SEAR EUR WPR AMR AFR AFR WPR EUR EMR EMR WPR AMR WPR AMR AMR WPR EUR EUR EMR WPR EUR EUR EUR AFR AMR AMR AMR WPR 5.9 10.6 14.6 1.5 32.7 19.8 60.5 0.6 24.1 1.4 ... 4.4 4.3 236.4 ... ... 8.5 2.7 75.4 35.3 123.7 2.6 ... 56.4 60.3 12.1 11.4 22.4 257.4 ... 17.4 3.9 339.6 ... 7.2 12.5 12.8 44.9 217.2 173.6 43.7 1.4 113.6 18.7 121.6 875.8 14.2 ... ... ... ... Females 5.8 9.4 16.5 1.6 30.2 22.1 46.3 0.4 28.8 1.3 ... 5.1 3.4 231.7 ... ... 6.4 2.7 80.0 37.3 135.1 3.5 ... 54.4 64.5 12.8 9.9 22.2 246.2 ... 18.9 2.5 332.9 ... 6.2 11.0 10.2 42.8 166.3 163.5 39.3 0.5 97.2 19.6 112.4 925.7 13.5 ... ... ... ... Males 67.9% 44.9% 52.9% 33.0% 65.0% 60.1% 52.0% 38.2% 66.1% 35.2% ... 66.1% 60.2% 51.7% ... ... 67.4% 42.5% 53.9% 68.7% 58.7% 56.9% ... 52.1% 30.5% 31.2% 56.6% 73.5% 76.7% ... 28.2% 53.0% 52.1% ... 41.0% 76.5% 53.5% 46.1% 70.3% 45.8% 30.7% 75.9% 40.2% 52.2% 42.4% 51.9% 67.5% ... ... ... ... Females 64.0% 38.2% 21.9% 19.9% 59.5% 54.6% 48.1% 37.0% 64.4% 23.7% ... 57.0% 44.8% 42.7% ... ... 50.8% 25.6% 42.8% 61.8% 50.6% 49.0% ... 48.9% 21.0% 23.0% 50.0% 66.8% 74.6% ... 16.9% 45.4% 53.0% ... 37.7% 70.2% 45.6% 44.5% 57.3% 24.5% 16.8% 58.6% 19.9% 29.3% 22.8% 24.3% 62.2% ... ... ... ... NCD deaths under age 70 (% of all NCD deaths)

158

Annex 4.2: NCD mortality

Age-standardized death rate per 100 000 (Males) Chronic respiratory diseases 142.0 40.1 26.4 24.7 48.3 54.4 72.3 52.9 145.8 23.6 ... 39.9 56.5 42.5 ... ... 59.5 5.7 62.0 46.3 107.8 84.3 ... 171.6 30.1 27.7 41.4 49.1 40.1 ... 30.0 15.6 138.2 ... 27.4 155.7 35.1 28.4 97.1 35.6 32.9 10.6 33.3 40.3 31.6 36.6 30.6 ... ... ... ... Cardiovascular disease 236.6 368.1 448.2 131.5 349.4 296.4 324.9 279.0 334.9 184.0 ... 252.1 269.3 170.1 ... ... 723.3 405.8 347.2 224.8 324.9 279.6 ... 288.5 128.8 122.3 262.0 285.3 258.9 ... 139.2 275.8 256.4 ... 179.4 167.4 261.7 143.3 463.6 333.5 140.3 151.2 112.6 622.6 443.9 760.9 272.3 ... ... ... ...

Age-standardized death rate per 100 000 (Females) Chronic respiratory diseases 111.7 23.9 4.8 17.5 38.6 28.5 36.1 69.7 65.7 9.4 ... 26.2 23.2 27.6 ... ... 31.8 1.9 29.7 43.3 119.7 49.4 ... 135.6 18.0 21.4 29.1 40.1 34.0 ... 21.5 10.2 41.3 ... 19.6 70.2 15.5 22.5 34.8 11.3 14.5 12.5 11.7 11.7 10.4 7.1 21.5 ... ... ... ... Cardiovascular disease 256.4 277.8 241.6 88.2 354.6 366.7 268.8 208.0 447.6 124.8 ... 267.7 157.3 130.3 ... ... 483.2 329.7 314.0 203.6 311.1 318.3 ... 252.4 84.9 86.2 197.8 344.5 271.8 ... 87.2 209.8 293.6 ... 125.3 131.1 179.7 105.3 305.4 192.1 91.5 159.7 76.2 429.0 299.7 394.7 252.1 ... ... ... ...

All NCDs 698.5 630.7 848.2 388.6 694.8 665.4 618.9 523.8 852.6 434.8 ... 549.7 735.9 539.5 ... ... 1216.9 661.2 778.0 647.0 767.3 594.2 ... 719.9 424.2 355.9 630.6 653.0 712.8 ... 403.6 543.5 658.2 ... 424.0 815.5 568.4 409.7 899.2 667.6 456.3 394.7 415.0 1006.9 786.3 1155.6 641.4 ... ... ... ...

Cancers 103.9 109.2 221.1 153.7 151.0 91.1 103.8 79.8 78.5 141.7 ... 67.1 99.0 77.9 ... ... 244.1 190.7 123.1 85.4 147.4 81.3 ... 77.7 178.3 128.0 98.0 57.5 120.9 ... 145.5 72.3 84.6 ... 105.3 158.3 121.6 114.2 114.2 203.9 184.0 97.3 174.8 181.1 198.4 223.1 133.1 ... ... ... ...

Diabetes 34.1 37.9 5.5 7.0 25.0 37.8 23.1 12.0 50.3 11.3 ... 33.2 201.9 95.8 ... ... 8.9 11.6 106.2 40.2 32.2 45.3 ... 34.9 9.1 13.4 41.4 38.9 41.9 ... 9.2 90.0 35.7 ... 26.7 105.3 42.7 13.8 65.7 11.3 20.3 55.9 20.5 7.9 7.1 3.9 37.8 ... ... ... ...

All NCDs 621.1 479.3 411.4 262.2 606.6 645.9 509.4 451.0 879.1 306.7 ... 557.2 449.2 410.9 ... ... 773.2 491.3 651.1 553.3 662.5 572.0 ... 639.2 301.7 276.3 473.9 643.0 638.4 ... 281.8 405.4 681.3 ... 326.7 601.5 409.0 327.0 578.4 367.2 255.4 420.8 221.4 633.5 472.6 573.8 537.9 ... ... ... ...

Cancers 82.8 71.8 100.7 102.9 105.9 115.8 93.2 59.5 113.8 103.8 ... 67.5 72.1 68.7 ... ... 154.6 117.2 77.5 108.3 103.7 50.2 ... 75.3 124.2 100.8 90.2 56.0 97.0 ... 104.9 56.7 91.8 ... 81.9 139.3 95.5 108.9 85.4 113.8 88.2 76.2 74.8 91.8 102.2 105.7 118.1 ... ... ... ...

Diabetes 39.0 39.5 3.8 6.1 20.4 23.9 26.5 14.1 58.4 7.6 ... 44.9 144.1 86.0 ... ... 5.0 12.1 122.0 28.4 45.1 67.4 ... 30.5 6.6 8.3 47.7 44.0 51.4 ... 5.4 67.9 49.8 ... 28.2 102.5 49.4 11.9 60.7 7.8 15.3 78.7 12.4 7.6 5.6 4.7 31.8 ... ... ... ...

159

Global status report on NCDs 2014 … Indicates no data were available Total NCD deaths (`000s) Country name Region Males San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand the former Yugoslav Republic of Macedonia Timor–Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United Republic of Tanzania United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe EUR AFR EMR AFR EUR AFR AFR WPR EUR EUR WPR EMR AFR AFR EUR SEAR EMR AMR AFR EUR EUR EMR EUR SEAR EUR SEAR AFR WPR AMR EMR EUR EUR WPR AFR EUR EMR EUR AFR AMR AMR EUR WPR AMR WPR EMR AFR AFR ... ... 40.6 16.0 52.2 ... 12.5 9.7 23.3 8.1 1.0 13.7 130.9 17.6 188.2 60.3 53.8 0.9 1.5 38.7 26.9 36.1 13.9 198.7 9.6 1.5 9.5 ... 5.5 26.3 198.8 18.0 ... 50.4 283.8 4.6 243.7 64.3 1142.9 13.2 73.0 ... 51.9 203.3 34.6 16.3 19.5 Females ... ... 29.8 17.6 54.9 ... 14.0 8.2 22.5 8.2 0.8 13.0 133.1 15.7 177.2 43.5 46.9 0.8 2.5 43.3 28.9 25.8 16.1 155.7 9.1 1.5 9.8 ... 4.6 23.1 163.7 16.4 ... 45.5 330.6 1.8 253.7 58.7 1191.2 13.0 73.0 ... 44.1 175.7 29.1 16.9 22.7 Males ... ... 50.2% 65.3% 43.4% ... 80.4% 46.5% 48.4% 37.3% 59.8% 74.4% 62.1% 68.5% 26.9% 48.8% 68.5% 53.3% 59.2% 23.4% 26.6% 48.2% 57.7% 45.5% 41.1% 62.6% 74.3% ... 52.7% 46.4% 45.6% 73.0% ... 69.5% 45.4% 84.5% 29.1% 65.4% 37.2% 35.8% 56.8% ... 54.7% 54.3% 68.5% 65.0% 51.1% Females ... ... 40.0% 61.6% 23.7% ... 79.2% 35.0% 24.0% 17.5% 60.0% 68.8% 47.8% 63.3% 13.4% 35.8% 62.9% 44.1% 58.4% 14.7% 15.2% 44.8% 48.6% 38.7% 25.7% 56.6% 70.0% ... 41.1% 33.3% 33.8% 52.6% ... 64.0% 21.3% 73.3% 19.2% 58.3% 25.1% 22.1% 42.6% ... 46.1% 30.0% 66.1% 59.1% 45.3% NCD deaths under age 70 (% of all NCD deaths)

160

Annex 4.2: NCD mortality

Age-standardized death rate per 100 000 (Males) Chronic respiratory diseases ... ... 28.6 61.1 39.1 ... 69.2 19.5 22.5 18.1 104.8 37.9 84.9 63.2 42.4 74.0 56.0 14.9 100.6 17.3 18.3 30.6 44.8 87.7 28.6 73.6 48.0 ... 42.6 37.7 77.3 61.6 ... 42.4 31.9 33.7 37.2 32.1 43.1 53.3 37.3 ... 22.7 56.7 47.4 22.4 65.3 Cardiovascular disease ... ... 382.4 197.1 400.8 ... 386.9 137.4 394.5 174.2 314.6 226.2 354.2 259.4 121.4 345.1 231.5 169.1 248.2 162.8 122.0 455.0 490.9 215.8 448.3 336.6 295.1 ... 346.5 347.7 384.2 820.6 ... 276.7 707.7 315.6 140.6 214.7 169.5 197.3 656.7 ... 226.3 262.3 431.1 299.4 186.7

Age-standardized death rate per 100 000 (Females) Chronic respiratory diseases ... ... 20.5 32.7 18.8 ... 53.1 5.8 7.6 6.8 60.0 43.3 33.4 28.4 15.5 37.9 25.9 7.7 83.3 13.8 9.3 17.2 45.7 29.1 16.8 55.0 28.7 ... 18.1 25.9 38.8 42.4 ... 34.4 7.0 33.2 25.7 23.9 32.8 23.5 24.0 ... 18.6 27.7 51.4 24.8 44.9 Cardiovascular disease ... ... 287.5 198.2 318.9 ... 485.3 82.1 241.5 113.6 196.9 200.7 259.8 240.0 75.6 209.0 219.2 143.2 330.8 105.7 77.9 299.2 523.2 156.9 366.1 351.7 315.3 ... 220.7 271.2 256.0 618.2 ... 250.7 427.8 264.2 86.7 191.1 107.8 110.1 509.5 ... 152.1 145.0 327.1 245.8 202.7

All NCDs ... ... 622.4 599.8 775.5 ... 921.0 326.2 713.4 487.9 780.4 587.6 902.8 691.7 426.3 634.5 610.1 442.6 627.4 390.3 360.0 682.2 743.9 559.6 738.8 709.9 711.3 ... 879.3 582.2 726.3 1193.8 ... 728.2 1025.3 571.5 425.9 635.2 488.9 594.4 921.9 ... 476.9 604.3 703.7 620.4 624.1

Cancers ... ... 66.9 76.0 218.1 ... 93.6 127.2 196.8 208.1 90.7 108.5 143.0 121.1 169.3 68.8 96.0 108.7 101.1 124.9 131.1 125.4 103.0 127.8 189.5 185.4 109.0 ... 172.8 96.6 198.5 137.9 ... 150.0 173.1 103.6 153.9 104.4 143.6 211.5 86.2 ... 100.8 163.4 79.7 98.8 223.5

Diabetes ... ... 42.8 54.1 23.6 ... 54.2 3.9 7.8 4.2 93.3 31.2 98.5 39.7 9.3 59.7 35.6 47.5 43.3 10.6 8.1 10.3 16.9 23.5 24.5 22.3 40.9 ... 155.0 29.1 12.8 22.0 ... 46.1 3.2 35.1 5.0 49.3 16.3 13.9 22.7 ... 43.5 17.2 31.7 35.0 19.7

All NCDs ... ... 472.2 526.1 553.9 ... 1005.4 214.5 401.9 277.1 636.2 517.8 587.4 564.3 239.6 388.7 497.3 322.9 763.6 286.3 237.7 467.7 756.9 358.3 546.1 634.7 651.6 ... 570.6 442.8 430.8 881.4 ... 608.3 572.2 504.7 302.2 514.9 350.1 342.0 716.3 ... 352.3 314.9 556.2 558.2 578.9

Cancers ... ... 62.7 73.4 132.9 ... 77.6 86.0 100.7 110.2 116.3 127.9 89.6 108.8 80.8 61.4 76.2 64.8 75.7 100.5 83.9 99.0 80.0 82.6 110.1 122.3 93.9 ... 115.2 52.9 86.9 94.6 ... 122.3 86.2 94.1 112.5 90.9 104.2 115.9 69.7 ... 86.8 74.2 66.0 113.5 226.6

Diabetes ... ... 26.8 58.0 22.1 ... 83.6 3.6 5.6 3.1 108.2 27.6 91.0 35.6 7.0 38.8 33.0 32.7 98.2 6.1 5.0 9.6 21.1 27.9 27.6 33.9 44.9 ... 105.1 30.9 13.4 21.9 ... 40.2 3.1 39.4 3.6 49.5 10.9 10.6 22.8 ... 41.6 15.4 31.1 42.5 25.6

161

Global status report on NCDs 2014

4.3 Alcohol Comparable estimates, per capita consumption, heavy episodic drinking and prevalence of alcohol use disorders, (population aged 15+ years), 2010 and 2012 2010 Per capita consumption of pure alcohol (litres) Country name Region Crude adjusted estimates 2012 per capita consumption of pure alcohol (litres) Crude adjusted projected estimates Both sexes 0.7 6.8 0.6 11.8 9.0 4.7 9.4 5.3 11.9 8.4 2.4 6.1 1.5 0.2 7.4 17.8 10.7 8.2 2.1 0.5 6.2 6.8 7.5 8.9 1.0 11.2 6.8 9.0 5.8 5.7 8.6 10.1 3.7 4.5 10.3 8.8 [95% CI] [0.3–1.1] [4.7–8.8] [0.1–1.2] [8.6–14.9] [6.9–11.2] [2.8–6.6] [6.7–12.1] [3.5–7.1] [8.8–15.1] [5.8–11.1] [1.2–3.6] [3.9–8.3] [0.6–2.3] [0.1–0.3] [5.0–9.8] [14.2–21.4] [7.8–13.7] [6.5–9.9] [1.1–3.2] [0.2–0.7] [4.3–8.1] [5.6–8.0] [5.9–9.1] [6.6–11.3] [0.6–1.4] [8.6–13.8] [5.0–8.7] [6.5–11.5] [4.2–7.5] [4.3–7.1] [6.5–10.6] [7.4–12.8] [2.1–5.3] [3.0–6.0] [7.5–13.2] [7.0–10.7]

Males Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China EMR EUR AFR EUR AFR AMR AMR EUR WPR EUR EUR AMR EMR SEAR AMR EUR EUR AMR AFR SEAR AMR EUR AFR AMR WPR EUR AFR AFR AFR WPR AFR AMR AFR AFR AMR WPR 1.2 10.6 1.6 19.5 12.0 7.7 13.6 8.0 17.3 15.4 3.6 10.1 2.7 0.3 9.8 27.5 15.0 14.5 3.4 1.2 9.1 13.1 14.3 13.6 1.6 17.9 11.2 13.9 11.2 9.6 13.3 15.1 5.7 7.1 13.9 10.9

[95% CI] [0.8–1.6] [9.2–12.1] [1.4–1.8] [17.8–21.2] [10.7–13.4] [7.1–8.3] [12.4–14.8] [7.0–9.1] [15.6–19.1] [14.2–16.6] [3.0–4.2] [9.3–10.9] [2.5–2.9] [0.2–0.4] [9.0–10.6] [24.6–30.5] [13.7–16.3] [12.9–16.2] [2.8–4.0] [1.0–1.4] [7.7–10.4] [11.2–15.1] [12.1–16.4] [12.1–15.0] [1.4–1.8] [16.4–19.5] [9.5–12.9] [11.9–15.9] [9.3–13.1] [7.6–11.7] [11.5–15.2] [13.4–16.7] [4.6–6.8] [5.1–9.1] [12.3–15.5] [9.5–12.3]

Females 0.1 3.4 0.4 8.2 3.0 3.1 5.2 2.6 7.2 6.3 1.1 3.9 1.0 0.0 4.0 9.1 6.3 2.5 0.9 0.1 2.7 1.4 2.5 4.2 0.1 5.3 2.8 4.8 2.7 1.7 3.5 5.5 1.9 1.8 5.5 2.2

[95% CI] [0.1–0.2] [2.9–3.8] [0.4–0.5] [7.5–9.0] [2.7–3.4] [2.8–3.3] [4.8–5.7] [2.2–2.9] [6.5–7.9] [5.8–6.8] [0.9–1.3] [3.6–4.2] [0.9–1.1] [0.0–0.0] [3.6–4.3] [8.1–10.1] [5.7–6.8] [2.3–2.8] [0.7–1.0] [0.1–0.1] [2.3–3.1] [1.2–1.6] [2.1–2.9] [3.7–4.6] [0.1–0.1] [4.9–5.8] [2.3–3.2] [4.1–5.5] [2.3–3.2] [1.3–2.0] [3.0–3.9] [4.9–6.1] [1.6–2.3] [1.3–2.4] [4.9–6.1] [1.9–2.5]

Both sexes 0.7 7.0 1.0 13.8 7.5 5.4 9.3 5.3 12.2 10.3 2.3 6.9 2.1 0.2 6.8 17.5 11.0 8.5 2.1 0.7 5.9 7.1 8.4 8.7 0.9 11.4 6.8 9.3 6.9 5.5 8.4 10.2 3.8 4.4 9.6 6.7

[95% CI] [0.5–0.9] [6.0–7.9] [0.9–1.1] [12.6–15.0] [6.6–8.3] [4.9–5.8] [8.5–10.1] [4.6–6.0] [11.0–13.4] [9.9–11.5] [1.9–2.7] [6.3–7.4] [1.9–2.2] [0.1–0.2] [6.3–7.4] [15.6–19.4] [9.6–11.4] [7.6–9.4] [1.8–2.5] [0.6–0.8] [5.0–6.7] [6.0–8.1] [7.1–9.7] [7.8–9.7] [0.8–1.0] [10.4–12.4] [5.8–7.9] [8.0–10.6] [5.8–8.0] [4.3–6.6] [7.2–9.5] [9.1–11.3] [3.0–4.5] [3.2–5.7] [8.5–10.7] [5.8–7.5]

162

Annex 4.3: Alcohol

… Indicates no data were available

2010 Heavy episodic drinking, past 30 days (%) Age-standardized

2010 Alcohol use disorders, 12 month prevalence (%) Age-standardized

Males 0.1 11.7 0.7 7.5 7.5 11.3 24.1 38.3 17.5 53.5 19.9 9.5 0.1 0.1 24.3 47.6 49.6 4.3 35.4 1.2 7.5 12.4 11.6 20.0 0.9 28.0 29.6 6.7 8.8 2.4 17.8 26.7 3.2 1.6 9.7 13.9

[95% CI] [0.0–0.5] [8.3–15.0] [0.0–1.7] [4.7–10.3] [4.7–10.3] [7.9–14.6] [19.6–28.7] [33.2–43.4] [13.4–21.5] [48.1–58.8] [15.7–24.1] [6.4–12.6] [0.0–0.4] [0.0–0.3] [19.8–28.9] [42.3–52.9] [44.3–55.0] [2.2–6.5] [30.4–40.3] [0.0–2.4] [4.7–10.3] [8.9–15.9] [8.2–15.0] [15.8–24.3] [0.0–1.9] [23.2–32.8] [24.8–34.4] [4.0–9.3] [5.8–11.8] [0.7–4.0] [13.7–21.9] [22.0–31.3] [1.3–5.1] [0.3–3.0] [6.5–12.8] [10.2–17.6]

Females 0.0 1.0 0.1 0.7 0.6 1.5 0.8 2.2 2.7 23.6 1.2 0.9 0.0 0.0 3.8 7.2 17.6 0.1 9.8 0.0 0.4 0.7 1.2 4.5 0.1 9.6 8.7 0.1 2.0 0.2 6.8 7.6 0.2 0.1 0.1 0.7

[95% CI] [0.0–0.1] [0.0–2.1] [0.0–0.4] [0.0–1.6] [0.0–1.4] [0.2–2.8] [0.0–1.8] [0.6–3.8] [1.0–4.3] [19.2–28.0] [0.0–2.3] [0.0–1.8] [0.0–0.2] [0.0–0.0] [1.8–5.9] [4.5–10.0] [13.6–21.6] [0.0–0.4] [6.7–13.0] [0.0–0.2] [0.0–1.1] [0.0–1.7] [0.0–2.3] [2.3–6.7] [0.0–0.4] [6.5–12.7] [5.7–11.7] [0.0–0.4] [0.5–3.4] [0.0–0.6] [4.1–9.5] [4.8–10.4] [0.0–0.6] [0.0–0.6] [0.0–0.3] [0.0–1.6]

Both sexes 0.1 6.4 0.4 4.2 4.0 6.4 12.0 20.3 10.1 38.5 10.3 5.1 0.1 0.0 14.2 26.5 33.7 2.2 22.4 0.7 3.9 6.5 6.4 12.2 0.5 18.9 18.4 3.3 5.2 1.2 12.3 17.2 1.7 0.9 4.8 7.5

[95% CI] [0.0–0.3] [4.6–8.2] [0.0–0.9] [2.6–5.7] [2.5–5.4] [4.5–8.2] [9.6–14.5] [17.3–23.3] [7.8–12.4] [34.8–42.1] [8.0–12.5] [3.4–6.8] [0.0–0.3] [0.0–0.2] [11.6–16.9] [23.2–29.9] [30.1–37.2] [1.1–3.3] [19.3–25.6] [0.1–1.3] [2.5–5.4] [4.7–8.4] [4.6–8.3] [9.7–14.6] [0.0–1.1] [16.0–21.9] [15.5–21.3] [2.0–4.7] [3.6–6.9] [0.4–2.1] [9.8–14.8] [14.4–20.1] [0.7–2.6] [0.2–1.6] [3.2–6.5] [5.5–9.5]

Males 0.5 8.7 1.4 9.1 8.3 8.0 9.1 8.6 5.2 15.0 8.3 7.8 1.6 1.3 8.2 29.8 9.4 10.0 8.4 2.6 7.9 9.0 9.6 8.0 2.9 12.8 2.7 9.0 8.5 7.5 9.3 10.6 5.4 1.4 8.4 9.1

[95% CI] [0.0–1.3] [5.7–11.7] [0.1–2.7] [6–12.1] [5.3–11.2] [5.1–10.9] [6.0–12.2] [5.6–11.6] [2.8–7.6] [11.2–18.8] [5.4–11.3] [5–10.7] [0.3–3.0] [0.1–2.5] [5.3–11.2] [25.0–34.6] [6.3–12.5] [6.8–13.1] [5.5–11.4] [0.9–4.3] [5.0–10.7] [5.9–12.1] [6.5–12.8] [5.1–10.9] [1.1–4.7] [9.2–16.4] [1.0–4.5] [6.0–12.1] [5.6–11.5] [4.7–10.3] [6.2–12.4] [7.3–13.9] [3.0–7.8] [0.1–2.6] [5.5–11.4] [6.0–12.2]

Females 0.1 2.0 0.0 2.2 1.3 3.1 2.6 2.0 2.3 5.3 1.9 3.1 0.3 0.2 3.2 6.0 3.4 1.9 1.7 0.5 3.1 2.1 1.5 3.1 0.5 2.6 0.2 1.8 1.7 1.4 1.9 3.8 0.7 0.0 1.6 0.2

[95% CI] [0.0–0.5] [0.5–3.4] [0.0–0.2] [0.6–3.7] [0.1–2.6] [1.3–5.0] [0.9–4.4] [0.5–3.5] [0.7–3.9] [2.9–7.8] [0.4–3.3] [1.3–5.0] [0–0.8] [0.0–0.8] [1.3–5.1] [3.5–8.5] [1.5–5.3] [0.5–3.4] [0.3–3.1] [0.0–1.3] [1.2–4.9] [0.6–3.6] [0.2–2.8] [1.3–5.0] [0.0–1.3] [0.9–4.3] [0.0–0.7] [0.4–3.2] [0.3–3.1] [0.1–2.7] [0.4–3.3] [1.8–5.9] [0.0–1.6] [0.0–0.2] [0.2–2.9] [0.0–0.7]

Both sexes 0.3 5.3 0.7 5.7 4.7 5.6 5.8 5.4 3.7 10.2 5.0 5.4 1.1 0.8 5.8 17.5 6.4 5.9 5.0 1.7 5.4 5.5 5.6 5.5 1.7 7.7 1.4 5.4 5.1 4.3 5.6 7.2 3.0 0.7 5.0 4.8

[95% CI] [0.0–0.8] [3.6–7.0] [0.1–1.4] [3.9–7.4] [3.1–6.3] [3.8–7.3] [4.1–7.6] [3.7–7.1] [2.3–5.2] [7.9–12.5] [3.4–6.7] [3.7–7.1] [0.3–2.0] [0.1–1.5] [4.0–7.5] [14.6–20.4] [4.6–8.3] [4.1–7.7] [3.4–6.7] [0.7–2.6] [3.7–7.2] [3.8–7.3] [3.8–7.3] [3.8–7.3] [0.7–2.7] [5.7–9.7] [0.5–2.3] [3.7–7.1] [3.4–6.7] [2.7–5.8] [3.8–7.3] [5.3–9.2] [1.7–4.3] [0.1–1.3] [3.3–6.6] [3.2–6.4]

163

Global status report on NCDs 2014 … Indicates no data were available 2012 per capita consumption of pure alcohol (litres) Crude adjusted projected estimates Both sexes 6.2 0.2 4.2 9.4 5.0 5.8 13.0 5.1 8.8 14.0 3.8 4.3 9.9 1.3 6.3 6.6 7.5 0.3 3.2 5.0 1.0 10.1 4.2 3.0 11.7 12.3 11.3 3.5 8.1 11.5 4.9 9.2 10.3 3.7 0.8 3.3 8.1 5.9 3.8 12.4 [95% CI] [4.0–8.4] [0.1–0.6] [2.7–5.6] [7.5–11.2] [3.0–7.1] [4.4–7.2] [9.7–16.3] [3.8–6.4] [6.1–11.6] [10.6–17.4] [3.1–4.4] [2.8–5.8] [7.0–12.8] [0.8–1.9] [4.1–8.6] [4.3–8.9] [5.4–9.6] [0.2–0.5] [1.6–4.7] [3.4–6.7] [0.4–1.6] [7.4–12.8] [2.5–5.9] [2.3–3.7] [8.6–14.9] [9.1–15.5] [8.9–13.7] [2.2–4.8] [5.9–10.2] [8.4–14.5] [3.3–6.5] [6.4–12.0] [7.4–13.1] [2.9–4.4] [0.5–1.0] [2.0–4.6] [5.6–10.7] [4.1–7.8] [2.1–5.6] [9.4–15.4]

2010 Per capita consumption of pure alcohol (litres) Country name Region Crude adjusted estimates

Males Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea–Bissau Guyana Haiti Honduras Hungary AMR AFR AFR WPR AMR AFR EUR AMR EUR EUR SEAR AFR EUR EMR AMR AMR AMR EMR AMR AFR AFR EUR AFR WPR EUR EUR AFR AFR EUR EUR AFR EUR AMR AMR AFR AFR AMR AMR AMR EUR 9.1 0.4 6.2 10.5 7.5 9.8 17.7 8.8 12.5 18.6 7.4 5.8 16.1 2.4 10.2 9.8 11.1 0.7 5.0 10.1 1.8 16.2 6.2 5.5 17.5 17.8 17.3 5.5 12.6 16.8 7.8 14.6 17.9 7.5 1.4 6.4 11.7 10.1 5.7 20.4

[95% CI] [7.8–10.4] [0.3–0.4] [5.0–7.5] [9.7–11.4] [6.7–8.3] [8.4–11.3] [15.9–19.6] [7.8–9.8] [11.4–13.6] [17.0–20.1] [6.7–8.1] [4.9–6.7] [14.8–17.5] [2.2–2.6] [9.4–11.0] [8.9–10.6] [9.2–12.9] [0.6–0.9] [4.3–5.7] [9.2–11.0] [1.5–2.2] [14.9–17.5] [4.5–7.9] [4.7–6.3] [15.6–19.4] [16.5–19.0] [15.4–19.1] [4.8–6.3] [10.9–14.3] [15.6–18.0] [6.1–9.5] [13.0–16.2] [16.6–19.3] [6.2–8.7] [1.1–1.7] [5.4–7.4] [10.6–12.8] [9.3–11.0] [5.0–6.4] [18.3–22.4]

Females 3.5 0.1 1.6 2.1 3.2 1.9 7.1 1.6 5.7 7.8 0.4 1.5 6.9 0.3 4.1 4.0 3.4 0.0 1.7 2.9 0.3 5.3 2.2 0.5 7.3 7.1 4.6 1.4 3.4 7.0 1.9 6.2 7.3 0.5 0.1 1.7 4.7 2.9 2.3 7.1

[95% CI] [3.0–4.0] [0.1–0.1] [1.3–1.9] [1.9–2.2] [2.8–3.5] [1.6–2.1] [6.4–7.8] [1.4–1.7] [5.2–6.2] [7.1–8.4] [0.4–0.5] [1.3–1.7] [6.3–7.4] [0.3–0.3] [3.7–4.4] [3.6–4.3] [2.8–3.9] [0.0–0.0] [1.5–2.0] [2.6–3.1] [0.2–0.4] [4.9–5.7] [1.6–2.8] [0.4–0.5] [6.5–8.1] [6.6–7.6] [4.1–5.0] [1.2–1.6] [3.0–3.9] [6.5–7.5] [1.5–2.4] [5.5–6.8] [6.7–7.8] [0.5–0.6] [0.1–0.1] [1.4–1.9] [4.2–5.1] [2.7–3.2] [2.0–2.6] [6.4–7.8]

Both sexes 6.2 0.2 3.9 6.4 5.4 6.0 12.2 5.2 9.2 13.0 3.7 3.6 11.4 1.3 7.1 6.9 7.2 0.4 3.2 6.6 1.1 10.3 4.2 3.0 12.3 12.2 10.9 3.4 7.7 11.8 4.8 10.3 12.5 3.8 0.7 4.0 8.1 6.4 4.0 13.3

[95% CI] [5.3–7.1] [0.2–0.3] [3.1–4.7] [5.8–6.9] [4.8–6.0] [5.1–6.8] [10.9–13.4] [4.6–5.8] [8.4–10.0] [11.9–14.1] [3.4–4.1] [3.1–4.2] [10.5–12.4] [1.2–1.5] [6.5–7.6] [6.3–7.5] [6.0–8.4] [0.3–0.5] [2.8–3.7] [6.0–7.2] [0.8–1.3] [9.4–11.1] [3.0–5.3] [2.6–3.5] [10.9–13.6] [11.4–13.1] [9.7–12.1] [2.9–3.8] [6.6–8.7] [10.9–12.6] [3.8–5.8] [9.2–11.4] [11.6–13.5] [3.2–4.5] [0.6–0.9] [3.4–4.6] [7.4–8.9] [5.9–7.0] [3.5–4.5] [12.0–14.6]

164

Annex 4.3: Alcohol

2010 Heavy episodic drinking, past 30 days (%) Age-standardized

2010 Alcohol use disorders, 12 month prevalence (%) Age-standardized

Males 8.2 1.7 6.0 ... 12.2 4.9 22.3 11.3 42.4 54.5 8.8 5.7 41.9 0.2 41.3 24.0 7.0 0.1 16.3 8.2 1.0 41.4 1.2 16.7 53.6 45.4 8.9 1.3 19.1 21.3 4.3 48.2 7.6 13.3 3.3 7.5 9.9 9.4 8.1 44.4

[95% CI] [5.2–11.1] [0.3–3.0] [3.5–8.6] ... [8.7–15.7] [2.6–7.2] [17.9–26.7] [7.9–14.7] [37.2–47.5] [49.2–59.8] [5.7–11.8] [3.2–8.1] [36.9–47.0] [0.0–0.7] [36.3–46.4] [19.5–28.5] [4.3–9.7] [0.0–0.3] [12.4–20.2] [5.3–11.1] [0.0–2.1] [36.2–46.6] [0.0–2.3] [12.8–20.7] [48.3–58.9] [40.2–50.6] [5.8–11.9] [0.1–2.5] [15.0–23.3] [17.0–25.6] [2.2–6.5] [42.9–53.5] [4.8–10.5] [9.6–16.9] [1.4–5.2] [4.7–10.3] [6.7–13.0] [6.3–12.5] [5.2–11.0] [39.0–49.7]

Females 0.1 0.1 0.3 ... 1.5 0.3 1.5 1.3 7.1 18.1 0.1 0.2 15.8 0.0 9.7 5.3 0.3 0.0 2.9 0.9 0.0 9.1 0.0 2.9 17.9 14.4 1.0 0.1 0.6 5.0 0.5 18.8 0.7 2.8 0.6 0.7 1.1 0.9 0.1 7.6

[95% CI] [0.0–0.6] [0.0–0.4] [0.0–0.8] ... [0.2–2.8] [0.0–0.8] [0.2–2.8] [0.1–2.5] [4.3–9.8] [14.1–22.0] [0.0–0.3] [0.0–0.8] [11.9–19.6] [0.0–0.0] [6.6–12.8] [2.9–7.6] [0.0–1.0] [0.0–0.1] [1.2–4.7] [0.0–1.8] [0.0–0.1] [6.0–12.2] [0.0–0.1] [1.1–4.7] [13.9–22.0] [10.7–18.1] [0.0–2.1] [0.0–0.4] [0.0–1.4] [2.7–7.3] [0.0–1.2] [14.7–22.9] [0.0–1.6] [1.0–4.5] [0.0–1.5] [0.0–1.5] [0.0–2.1] [0.0–1.9] [0.0–0.5] [4.8–10.4]

Both sexes 4.0 0.9 3.1 ... 6.9 2.7 11.9 6.4 25.4 36.5 4.3 2.9 29.1 0.1 25.4 14.6 3.6 0.0 8.9 4.7 0.5 24.8 0.6 10.0 35.9 29.8 5.0 0.7 9.3 13.3 2.3 33.6 4.2 7.6 1.9 4.0 5.5 5.0 4.1 25.4

[95% CI] [2.5–5.5] [0.2–1.5] [1.8–4.4] ... [5.4–8.5] [1.5–3.9] [9.4–14.3] [4.5–8.2] [22.1–28.6] [32.9–40.2] [2.8–5.8] [1.6–4.2] [25.7–32.5] [0.0–0.3] [22.2–28.7] [11.9–17.3] [2.2–5.1] [0.0–0.2] [6.8–11.1] [3.1–6.3] [0.0–1.0] [21.5–28.0] [0.0–1.2] [7.7–12.2] [32.3–39.6] [26.4–33.3] [3.3–6.6] [0.1–1.3] [7.1–11.5] [10.7–15.8] [1.2–3.5] [30.0–37.1] [2.7–5.7] [5.6–9.6] [0.9–2.9] [2.5–5.5] [3.8–7.2] [3.4–6.7] [2.6–5.6] [22.1–28.7]

Males 8.4 1.4 3.0 7.6 8.4 12.2 9.0 8.1 8.9 8.7 4.9 7.1 8.6 1.1 8.1 8.0 7.9 0.4 7.8 8.6 3.2 19.3 3.6 7.5 12.1 9.4 9.1 1.7 7.7 9.7 5.7 8.6 7.8 7.8 1.4 1.7 8.1 8.2 7.8 32.2

[95% CI] [5.5–11.4] [0.1–2.6] [1.2–4.8] [4.8–10.5] [5.5–11.4] [8.7–15.7] [6.0–12.1] [5.2–11.0] [5.9–12.0] [5.7–11.7] [2.6–7.3] [4.4–9.9] [5.6–11.6] [0.0–2.2] [5.2–11.0] [5.1–10.9] [5.0–10.8] [0.0–1.1] [4.9–10.6] [5.6–11.6] [1.3–5.0] [15.1–23.5] [1.6–5.6] [4.7–10.4] [8.7–15.6] [6.3–12.5] [6.0–12.2] [0.3–3.1] [4.8–10.5] [6.6–12.9] [3.2–8.2] [5.6–11.6] [4.9–10.7] [4.9–10.6] [0.1–2.6] [0.3–3.1] [5.2–11.0] [5.3–11.2] [4.9–10.7] [27.3–37.1]

Females 3.2 0.0 0.4 1.4 2.8 3.3 2.2 3.2 2.8 1.5 0.9 0.8 3.4 0.2 3.2 3.1 3.1 0.0 3.1 1.6 0.3 3.7 0.6 1.4 3.2 2.8 1.8 0.1 0.9 2.4 0.8 2.8 3.1 3.1 0.0 0.1 3.2 3.1 3.1 6.8

[95% CI] [1.3–5.1] [0.0–0.2] [0.0–1.0] [0.2–2.7] [1.0–4.6] [1.4–5.2] [0.6–3.8] [1.3–5.1] [1.0–4.5] [0.2–2.7] [0.0–1.9] [0.0–1.8] [1.4–5.3] [0.0–0.6] [1.3–5.0] [1.3–5.0] [1.2–5.0] [0.0–0.2] [1.2–5.0] [0.2–2.9] [0–0.9] [1.7–5.7] [0.0–1.5] [0.1–2.7] [1.3–5.1] [1.0–4.5] [0.4–3.2] [0.0–0.4] [0.0–1.9] [0.8–4.1] [0.0–1.7] [1.0–4.6] [1.2–5.0] [1.2–4.9] [0.0–0.2] [0.0–0.4] [1.3–5.0] [1.3–5.0] [1.2–4.9] [4.1–9.5]

Both sexes 5.7 0.7 1.7 4.6 5.7 7.9 5.6 5.7 6.0 5.1 2.9 3.9 6.0 0.6 5.6 5.6 5.5 0.2 5.2 5.2 1.7 11.3 2.1 4.5 7.7 6.0 5.5 0.9 4.1 6.1 3.2 5.7 5.5 5.3 0.7 0.9 5.6 5.6 5.4 19.3

[95% CI] [4.0–7.5] [0.1–1.3] [0.7–2.6] [3.0–6.2] [3.9–7.4] [5.9–10.0] [3.9–7.4] [3.9–7.4] [4.2–7.7] [3.5–6.8] [1.6–4.2] [2.5–5.4] [4.2–7.8] [0.0–1.2] [3.9–7.3] [3.8–7.3] [3.8–7.2] [0.0–0.6] [3.5–6.9] [3.5–6.9] [0.7–2.7] [8.9–13.7] [1.0–3.2] [3.0–6.1] [5.7–9.7] [4.2–7.8] [3.7–7.2] [0.2–1.6] [2.6–5.6] [4.3–7.9] [1.9–4.5] [4.0–7.5] [3.7–7.2] [3.6–7.0] [0.1–1.3] [0.2–1.6] [3.9–7.4] [3.9–7.3] [3.7–7.1] [16.4–22.3]

165

Global status report on NCDs 2014 … Indicates no data were available 2012 per capita consumption of pure alcohol (litres) Crude adjusted projected estimates Both sexes 5.9 5.2 0.6 1.0 0.6 10.1 3.1 5.7 4.8 6.6 0.8 9.8 4.3 2.8 0.1 4.2 7.7 12.0 2.6 6.7 4.5 0.1 16.9 11.9 2.0 2.3 1.4 1.3 1.2 7.2 ... 0.1 3.7 7.2 3.1 ... 9.9 ... 0.9 2.0 [95% CI] [3.7–8.2] [4.4–6.0] [0.3–0.9] [0.4–1.7] [0.3–0.9] [7.2–13.0] [1.8–4.3] [3.5–7.9] [2.9–6.7] [4.3–8.9] [0.2–1.3] [7.1–12.5] [3.1–5.5] [2.1–3.5] [0.0–0.3] [2.6–5.8] [6.1–9.4] [9.1–15.0] [1.6–3.5] [5.0–8.5] [3.0–6.0] [0.1–0.2] [13.4–20.4] [8.7–15.1] [1.1–3.0] [1.6–3.0] [0.9–1.8] [0.9–1.7] [0.9–1.4] [4.8–9.7] ... [0.0–0.3] [2.4–5.0] [5.4–9.0] [2.4–3.8] ... [8.0–11.7] ... [0.6–1.2] [0.8–3.1]

2010 Per capita consumption of pure alcohol (litres) Country name Region Crude adjusted estimates

Males Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (Federated States of) Monaco Mongolia Montenegro Morocco Mozambique EUR SEAR SEAR EMR EMR EUR EUR EUR AMR WPR EMR EUR AFR WPR EMR EUR WPR EUR EMR AFR AFR EMR EUR EUR AFR AFR WPR SEAR AFR EUR WPR AFR AFR AMR WPR EUR WPR EUR EMR AFR 9.8 8.0 1.1 1.7 0.9 16.8 4.0 9.7 7.1 10.4 1.2 15.7 7.4 5.5 0.2 6.7 12.5 19.7 3.9 10.8 7.5 0.1 24.4 16.8 2.9 4.5 2.5 2.3 2.2 9.7 ... 0.2 5.9 12.4 6.0 ... 11.7 13.5 1.9 3.5

[95% CI] [9.0–10.6] [6.5–9.4] [0.8–1.4] [1.2–2.2] [0.7–1.1] [15.6–18.0] [4.2–4.9] [9.0–10.4] [6.1–8.0] [9.7–11.2] [1.0–1.3] [13.4–18.0] [5.8–8.9] [4.2–6.7] [0.1–0.2] [5.5–7.8] [11.2–13.7] [17.7–21.6] [3.5–4.4] [8.6–12.9] [6.4–8.6] [0.1–0.1] [21.9–26.9] [15.6–18.0] [2.3–3.4] [3.8–5.2] [1.9–3.1] [1.9–2.7] [1.8–2.6] [9.0–10.5] ... [0.1–0.3] [5.1–6.7] [10.9–13.9] [5.2–6.8] ... [10.2–13.3] [11.2–15.9] [1.5–2.2] [2.9–4.1]

Females 4.3 0.5 0.1 0.3 0.1 7.1 1.7 3.9 2.8 4.2 0.2 5.5 1.3 0.4 0.0 2.0 2.3 6.3 0.8 2.5 2.0 0.0 7.9 7.2 0.7 0.5 0.2 0.1 0.0 4.2 ... 0.0 1.4 2.6 0.5 ... 2.2 4.1 0.1 1.1

[95% CI] [4.0–4.7] [0.4–0.6] [0.1–0.1] [0.2–0.4] [0.1–0.1] [6.6–7.7] [.] [3.7–4.2] [2.4–3.1] [3.9–4.4] [0.2–0.3] [4.7–6.3] [1.0–1.5] [0.3–0.6] [0.0–0.0] [1.7–2.4] [2.1–2.5] [5.7–6.9] [0.7–0.9] [2.0–3.0] [1.7–2.3] [0.0–0.0] [7.1–8.7] [6.7–7.7] [0.6–0.8] [0.4–0.6] [0.1–0.2] [0.1–0.2] [0.0–0.1] [3.9–4.5] ... [0.0–0.0] [1.2–1.6] [2.3–3.0] [0.4–0.6] ... [1.9–2.5] [3.4–4.8] [0.1–0.1] [0.9–1.3]

Both sexes 7.1 4.3 0.6 1.0 0.5 11.9 2.8 6.7 4.9 7.2 0.7 10.3 4.3 3.0 0.1 4.3 7.3 12.3 2.4 6.5 4.7 0.1 15.4 11.9 1.8 2.5 1.3 1.2 1.1 7.0 ... 0.1 3.6 7.2 3.3 ... 6.9 8.7 0.9 2.3

[95% CI] [6.5–7.6] [3.5–5.1] [0.4–0.7] [0.7–1.3] [0.4–0.6] [11.0–12.8] [2.6–3.0] [6.2–7.2] [4.2–5.5] [6.7–7.7] [0.6–0.8] [8.8–11.8] [3.4–5.2] [2.3–3.7] [0.1–0.2] [3.6–5.0] [6.5–8.0] [11.1–13.5] [2.1–2.7] [5.2–7.8] [4.0–5.4] [0.0–0.1] [13.8–17.0] [11.0–12.7] [1.4–2.1] [2.1–2.9] [1.0–1.6] [1.0–1.4] [0.9–1.3] [6.4–7.5] ... [0.1–0.1] [3.2–4.1] [6.3–8.1] [2.8–3.8] ... [6.0–7.8] [7.2–10.2] [0.8–1.1] [1.9–2.6]

166

Annex 4.3: Alcohol

2010 Heavy episodic drinking, past 30 days (%) Age-standardized

2010 Alcohol use disorders, 12 month prevalence (%) Age-standardized

Males 34.3 3.2 4.6 0.0 0.0 53.8 12.6 8.8 11.8 30.0 0.0 14.7 2.8 4.4 0.5 14.5 23.5 31.0 0.1 6.5 18.9 1.2 50.4 38.3 15.5 15.6 0.6 0.7 0.2 40.1 ... 0.0 20.4 19.6 19.5 ... 40.2 13.8 0.0 2.0

[95% CI] [29.3–39.2] [1.3–5.0] [2.3–6.8] [0.0–0.2] [0.00–0.3] [48.5–59.1] [9.1–16.2] [5.7–11.8] [8.4–15.3] [25.1–34.8] [0.0–0.2] [10.9–18.5] [1.0–4.5] [2.2–6.6] [0.0–1.3] [10.8–18.3] [19.1–27.9] [26.1–36.0] [0.0–0.5] [3.8–9.1] [14.8–23.1] [0.1–2.4] [45.2–55.7] [33.1–43.4] [11.6–19.3] [11.8–19.4] [0.0–1.4] [0.0–1.6] [0.0–0.7] [35.0–45.2] ... [0.0–0.3] [16.2–24.7] [15.4–23.8] [15.3–23.7] ... [35.0–45.3] [10.1–17.4] [0.0–0.3] [0.5–3.4]

Females 11.0 0.0 0.2 0.0 0.0 19.3 2.4 0.6 1.4 6.6 0.0 1.3 0.0 0.3 0.1 1.1 5.2 12.9 0.0 0.6 4.7 0.4 24.3 9.0 2.4 1.1 0.0 0.0 0.0 12.3 ... 0.0 3.7 3.3 3.1 ... 13.6 1.1 0.0 0.0

[95% CI] [7.7–14.4] [0.0–0.2] [0.0–0.7] [0.0–0.0] [0.0–0.1] [15.2–23.5] [0.8–4.1] [0.0–1.4] [0.1–2.7] [3.9–9.2] [0.0–0.1] [0.1–2.6] [0.0–0.1] [0.0–0.8] [0.0–0.3] [0.0–2.3] [2.8–7.5] [9.3–16.5] [0.0–0.2] [0.0–1.4] [2.5–7.0] [0.0–1.2] [19.7–28.9] [6.0–12.1] [0.8–4.0] [0.0–2.3] [0.0–0.2] [0.0–0.2] [0.0–0.1] [8.9–15.8] ... [0.0–0.1] [1.7–5.7] [1.4–5.2] [1.2–4.9] ... [9.9–17.2] [0.0–2.2] [0.0–0.1] [0.0–0.1]

Both sexes 22.9 1.6 2.4 0.0 0.0 36.5 7.5 4.7 6.5 18.4 0.0 7.7 1.4 2.4 0.4 7.6 14.1 21.6 0.1 3.4 11.7 0.9 36.7 23.8 8.8 8.2 0.3 0.4 0.1 26.5 ... 0.0 12.0 10.9 11.4 ... 26.6 7.4 0.0 0.9

[95% CI] [19.7–26.1] [0.7–2.6] [1.2–3.6] [0.0–0.1] [0.0–0.1] [32.8–40.1] [5.5–9.5] [3.1–6.3] [4.6–8.4] [15.4–21.3] [0.0–0.1] [5.7–9.7] [0.5–2.3] [1.2–3.5] [0.0–0.8] [5.6–9.6] [11.4–16.7] [18.5–24.7] [0.0–0.3] [2.0–4.8] [9.3–14.2] [0.2–1.6] [33.1–40.4] [20.5–27.0] [6.7–11.0] [6.2–10.3] [0.0–0.7] [0.0–0.8] [0.0–0.3] [23.2–29.8] ... [0.0–0.1] [9.5–14.4] [8.6–13.3] [9.0–13.8] ... [23.2–29.9] [5.4–9.4] [0.0–0.1] [0.2–1.6]

Males 5.8 4.4 1.3 0.4 0.5 11.1 8.6 1.4 6.5 5.3 0.6 8.5 5.5 7.6 0.5 8.2 7.4 14.9 1.4 7.3 7.2 0.4 17.0 9.1 3.7 4.9 4.0 3.2 1.4 4.9 ... 0.5 7.7 5.1 7.3 ... 10.3 8.8 0.6 4.6

[95% CI] [3.3–8.3] [2.2–6.6] [0.1–2.5] [0.0–1.2] [0.0–1.3] [7.7–14.4] [5.6–11.6] [0.2–2.7] [3.9–9.1] [2.9–7.7] [0.0–1.4] [5.5–11.5] [3.1–8.0] [4.7–10.4] [0.0–1.2] [5.2–11.1] [4.6–10.2] [11.1–18.6] [0.1–2.7] [4.5–10.1] [4.4–9.9] [0.0–1.2] [13–21] [6.0–12.2] [1.7–5.7] [2.6–7.3] [1.9–6.1] [1.3–5.1] [0.1–2.7] [2.6–7.2] ... [0.0–1.3] [4.9–10.6] [2.8–7.5] [4.5–10.0] ... [7.1–13.6] [5.8–11.9] [0.0–1.5] [2.4–6.9]

Females 1.8 0.5 0.2 0.1 0.1 3.5 2.0 0.9 1.8 1.2 0.1 1.9 0.7 1.4 0.1 1.8 1.4 2.9 0.1 1.1 1.0 0.1 3.4 2.5 0.4 0.6 0.8 0.6 0.0 1.4 ... 0.1 1.1 0.5 1.4 ... 2.0 2.0 0.1 0.6

[95% CI] [0.4–3.2] [0.0–1.3] [0.0–0.8] [0.0–0.4] [0.0–0.5] [1.6–5.5] [0.5–3.5] [0.0–1.9] [0.4–3.3] [0.1–2.4] [0.0–0.5] [0.4–3.4] [0.0–1.7] [0.1–2.7] [0.0–0.4] [0.4–3.3] [0.1–2.7] [1.1–4.7] [0.0–0.5] [0.0–2.2] [0.0–2.1] [0.0–0.4] [1.5–5.3] [0.8–4.1] [0.0–1.1] [0.0–1.4] [0.0–1.7] [0.0–1.5] [0.0–0.2] [0.2–2.7] ... [0.0–0.4] [0.0–2.3] [0.0–1.2] [0.1–2.7] ... [0.5–3.5] [0.5–3.6] [0.0–0.5] [0.0–1.4]

Both sexes 3.8 2.5 0.8 0.3 0.3 7.3 5.3 1.2 4.1 3.3 0.4 5.1 3.1 4.5 0.3 4.9 4.3 8.6 0.8 4.0 4.1 0.3 9.9 5.8 2.0 2.7 2.3 1.9 0.7 3.2 ... 0.3 4.4 2.7 4.4 ... 6.1 5.4 0.4 2.5

[95% CI] [2.4–5.3] [1.3–3.7] [0.1–1.4] [0.0–0.7] [0.0–0.8] [5.3–9.3] [3.6–7.0] [0.3–2.0] [2.6–5.6] [1.9–4.6] [0.0–0.8] [3.4–6.7] [1.8–4.4] [2.9–6.1] [0.0–0.8] [3.3–6.6] [2.8–5.9] [6.5–10.8] [0.1–1.5] [2.5–5.5] [2.6–5.6] [0.0–0.7] [7.7–12.2] [4.0–7.6] [1.0–3.1] [1.5–4.0] [1.2–3.5] [0.9–2.9] [0.1–1.4] [1.8–4.5] ... [0.0–0.7] [2.9–6.0] [1.4–3.9] [2.8–5.9] ... [4.3–7.9] [3.7–7.1] [0.0–0.8] [1.3–3.7]

167

Global status report on NCDs 2014 … Indicates no data were available 2012 per capita consumption of pure alcohol (litres) Crude adjusted projected estimates Both sexes 0.7 12.2 3.6 2.2 9.6 10.6 4.7 0.3 9.5 7.8 7.2 1.0 0.0 ... 8.5 3.0 8.8 10.2 6.0 11.6 12.2 2.1 10.5 16.1 13.2 14.8 10.1 5.9 8.4 7.3 ... ... 6.4 0.2 0.5 12.3 3.3 8.9 3.6 12.5 [95% CI] [0.5–0.9] [9.4–15.1] [2.4–4.7] [1.7–2.7] [6.8–12.4] [7.7–13.5] [3.5–6.0] [0.0–0.6] [7.0–12.0] [6.1–9.5] [4.7–9.7] [0.3–1.6] [0.0–0.1] ... [5.9–11.1] [2.0–4.1] [6.2–11.5] [7.7–12.6] [4.5–7.5] [9.0–14.2] [9.0–15.4] [1.5–2.7] [8.5–12.4] [12.7–19.5] [10.3–16.0] [11.5–18.1] [7.5–12.7] [3.7–8.0] [5.9–11] [4.9–9.7] ... ... [4.6–8.2] [0.1–0.6] [0.2–0.8] [9.6–15.1] [2.0–4.6] [6.8–11.0] [2.3–4.9] [9.7–15.2]

2010 Per capita consumption of pure alcohol (litres) Country name Region Crude adjusted estimates

Males Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Korea Republic of Moldova Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia SEAR AFR WPR SEAR EUR WPR AMR AFR AFR WPR EUR EMR EMR WPR AMR WPR AMR AMR WPR EUR EUR EMR WPR EUR EUR EUR AFR AMR AMR AMR WPR EUR AFR EMR AFR EUR AFR AFR WPR EUR 1.4 16.7 5.9 4.4 14.0 15.7 8.7 0.5 14.9 13.3 10.8 1.2 0.1 13.2 11.2 5.1 12.4 12.4 9.2 19.8 18.7 1.8 21.0 25.9 22.6 23.9 15.1 11.8 15.1 9.2 6.6 ... 11.5 0.3 1.1 19.7 8.7 14.0 2.8 20.5

[95% CI] [1.0–1.8] [14.2–19.3] [4.5–7.3] [3.1–5.6] [13.0–15.0] [14.2–17.3] [7.5–9.8] [0.4–0.6] [13.6–16.2] [12.0–14.5] [9.8–11.8] [1.1–1.4] [0.1–0.1] [12.0–14.5] [10.3–12.2] [4.1–6.0] [11.1–13.7] [10.9–14.0] [8.3–10.1] [18.0–21.7] [16.9–20.5] [1.5–2.1] [18.6–23.3] [20.3–31.5] [19.7–25.6] [21.1–26.8] [13.0–17.2] [10.9–12.8] [14.1–16.1] [8.5–9.9] [5.7–7.4] ... [9.6–13.4] [0.3–0.4] [0.8–1.3] [17.3–22.0] [7.6–9.8] [12.3–15.6] [2.8–3.6] [18.6–22.5]

Females 0.0 5.4 1.1 0.2 6.0 6.3 1.5 0.1 5.1 2.6 4.7 0.4 0.0 2.6 4.7 1.0 5.2 3.8 1.7 5.8 7.6 0.4 3.9 8.9 6.8 7.8 5.0 4.7 5.9 3.9 0.6 ... 2.9 0.1 0.1 5.9 2.4 3.6 1.2 6.1

[95% CI] [0.0–0.1] [4.6–6.3] [0.9–1.4] [0.2–0.3] [5.5–6.4] [5.7–6.9] [1.3–1.6] [0.1–0.1] [4.6–5.5] [2.4–2.9] [4.2–5.1] [0.4–0.4] [0.0–0.0] [2.3–2.8] [4.3–5.1] [0.8–1.2] [4.6–5.7] [3.3–4.3] [1.6–1.9] [5.3–6.3] [6.8–8.3] [0.3–0.4] [3.5–4.3] [7.0–10.9] [5.9–7.6] [6.9–8.7] [4.3–5.7] [4.3–5.1] [5.5–6.3] [3.6–4.2] [0.5–0.6] ... [2.4–3.3] [0.1–0.1] [0.1–0.1] [5.2–6.6] [2.1–2.7] [3.2–4.0] [0.7–0.9] [5.5–6.7]

Both sexes 0.7 10.8 3.5 2.2 9.9 10.9 5.0 0.3 10.1 8.0 7.7 0.9 0.1 7.9 8.0 3.0 8.8 8.1 5.4 12.5 12.9 1.5 12.3 16.8 14.4 15.1 9.8 8.2 10.4 6.6 3.6 ... 7.1 0.2 0.6 12.6 5.6 8.7 2.0 13.0

[95% CI] [0.5–0.9] [9.1–12.5] [2.7–4.3] [1.6–2.8] [9.2–10.7] [9.8–12.0] [4.3–5.6] [0.2–0.4] [9.2–10.9] [7.3–8.8] [7.0–8.4] [0.8–1.0] [0.0–0.1] [7.2–8.7] [7.3–8.7] [2.5–3.6] [7.9–9.7] [7.1–9.1] [4.9–6.0] [11.3–13.7] [11.6–14.2] [1.3–1.8] [10.9–13.7] [13.2–20.5] [12.5–16.3] [13.3–16.9] [8.5–11.2] [7.6–8.8] [9.7–11.1] [6.1–7.1] [3.2–4.1] ... [5.9–8.2] [0.2–0.3] [0.5–0.7] [11.1–14.1] [4.9–6.3] [7.7–9.8] [1.7–2.2] [11.8–14.3]

168

Annex 4.3: Alcohol

2010 Heavy episodic drinking, past 30 days (%) Age-standardized

2010 Alcohol use disorders, 12 month prevalence (%) Age-standardized

Males 0.2 20.9 ... 0.8 11.5 7.8 23.3 0.3 12.0 ... 19.5 0.0 0.2 ... 11.2 15.9 43.0 22.1 3.1 10.3 30.0 0.0 12.0 49.1 14.5 29.6 30.0 ... 8.5 9.6 27.9 ... 9.3 0.0 0.5 14.0 37.2 13.1 8.1 41.4

[95% CI] [0.0–0.6] [16.6–25.2] ... [0.0–1.8] [8.1–14.9] [4.9–10.7] [18.8–27.8] [0.0–1.0] [8.5–15.5] ... [15.4–23.7] [0.0–0.3] [0.0–0.6] ... [7.8–14.5] [12.0–19.8] [37.9–48.1] [17.8–26.4] [1.2–4.9] [7.0–13.5] [25.1–34.9] [0.0–0.2] [8.5–15.5] [43.9–54.4] [10.7–18.2] [24.7–34.5] [25.2–34.8] ... [5.5–11.5] [6.5–12.8] [23.1–32.6] ... [6.2–12.4] [0.0–0.2] [0.0–1.2] [10.3–17.7] [32.2–42.2] [9.5–16.8] [5.2–11.0] [36.1–46.7]

Females 0.0 5.4 ... 0.0 1.1 0.9 1.6 0.0 1.9 ... 5.2 0.0 0.0 ... 0.2 1.2 17.3 2.2 0.2 0.6 9.4 0.0 0.1 16.5 1.2 9.9 8.8 ... 0.8 0.9 2.7 ... 1.8 0.0 0.0 1.1 5.9 4.6 0.3 11.7

[95% CI] [0.0–0.1] [3.0–7.8] ... [0.0–0.2] [0.0–2.2] [0.0–1.9] [0.2–2.9] [0.0–0.1] [0.4–3.4] ... [2.8–7.6] [0.0–0.1] [0.0–0.1] ... [0.0–0.8] [0.0–2.4] [13.3–21.4] [0.7–3.8] [0.0–0.7] [0.0–1.5] [6.3–12.5] [0.0–0.1] [0.0–0.4] [12.5–20.5] [0.0–2.4] [6.7–13.1] [5.8–11.7] ... [0.0–1.8] [0.0–1.9] [0.9–4.4] ... [0.4–3.2] [0.0–0.1] [0.0–0.1] [0.0–2.2] [3.5–8.4] [2.3–6.8] [0.0–1.0] [8.4–15.1]

Both sexes 0.1 12.8 ... 0.4 6.3 4.3 12.1 0.2 7.0 ... 12.6 0.0 0.1 ... 5.7 8.7 30.3 12.2 1.6 5.4 19.4 0.0 6.0 32.2 7.9 19.3 18.9 ... 4.6 5.3 15.8 ... 5.3 0.0 0.2 7.6 22.3 8.8 4.2 26.2

[95% CI] [0.0–0.3] [10.3–15.3] ... [0.0–0.9] [4.5–8.2] [2.8–5.9] [9.7–14.6] [0.0–0.5] [0.1–8.9] ... [10.1–15.1] [0.0–0.2] [0.0–0.3] ... [4.0–7.5] [6.5–10.8] [26.9–33.8] [9.8–14.7] [0.7–2.6] [3.7–7.1] [16.4–22.4] [0.0–0.2] [4.2–7.8] [28.7–35.8] [5.8–9.9] [16.3–22.3] [15.9–21.8] ... [3.0–6.2] [3.6–7.0] [13.0–18.5] ... [3.6–7.0] [0.0–0.1] [0.0–0.6] [5.6–9.6] [19.1–25.4] [6.6–10.9] [2.7–5.7] [22.9–29.6]

Males 2.5 8.5 7.6 2.5 1.8 4.7 7.9 1.4 3.7 7.6 18.5 0.5 0.5 7.6 8.0 7.4 8.1 12.0 7.4 14.6 9.9 0.3 10.2 8.8 3.9 30.8 9.4 8.0 7.8 8.0 7.6 ... 8.7 0.4 1.4 8.9 9.4 4.7 1.4 19.1

[95% CI] [0.9–4.2] [5.5–11.5] [4.7–10.4] [0.8–4.1] [0.4–3.2] [2.4–6.9] [5.0–10.7] [0.1–2.6] [1.7–5.7] [4.8–10.5] [14.4–22.6] [0.0–1.2] [0.0–1.3] [4.7–10.4] [5.1–10.9] [4.6–10.2] [5.2–11.1] [8.5–15.4] [4.6–10.2] [10.9–18.4] [6.7–13.1] [0.0–0.9] [6.9–13.4] [5.8–11.8] [1.8–5.9] [25.9–35.6] [6.3–12.6] [5.1–10.8] [4.9–10.7] [5.1–10.9] [4.7–10.4] ... [5.7–11.7] [0.0–1.1] [0.1–2.7] [5.9–11.9] [6.3–12.5] [2.4–7.0] [0.1–2.6] [15.0–23.3]

Females 0.5 1.7 1.4 0.5 0.8 2.1 3.1 0.0 0.4 1.4 6.0 0.1 0.1 1.4 3.1 1.4 3.1 3.3 1.4 2.9 3.0 0.1 2.3 2.0 1.2 6.7 1.9 3.1 3.1 3.1 1.4 ... 1.6 0.1 0.0 2.1 1.9 0.5 0.4 2.2

[95% CI] [0.0–1.2] [0.3–3.1] [0.1–2.7] [0.0–1.2] [0.0–1.8] [0.6–3.7] [1.2–4.9] [0.0–0.2] [0.0–1.1] [0.2–2.7] [3.5–8.6] [0.0–0.5] [0.0–0.5] [0.1–2.7] [1.3–5.0] [0.1–2.6] [1.3–5.0] [1.4–5.2] [0.1–2.6] [1.1–4.6] [1.2–4.8] [0.0–0.3] [0.7–3.9] [0.5–3.5] [0.1–2.4] [4.1–9.4] [0.5–3.4] [1.3–5.0] [1.3–5.0] [1.3–5.0] [0.2–2.7] ... [0.2–2.9] [0.0–0.4] [0.0–0.2] [0.5–3.6] [0.4–3.4] [0.0–1.2] [0.0–1.1] [0.6–3.8]

Both sexes 1.5 4.9 4.5 1.4 1.3 3.4 5.4 0.7 2.1 4.6 12.4 0.3 0.3 4.5 5.6 4.4 5.7 7.6 4.4 8.7 6.4 0.2 6.3 5.3 2.6 18.2 5.5 5.5 5.4 5.6 4.6 ... 5.0 0.3 0.7 5.5 5.8 2.6 0.9 10.6

[95% CI] [0.6–2.4] [3.3–6.5] [2.9–6.1] [0.5–2.3] [0.4–2.2] [2.0–4.7] [3.7–7.1] [0.1–1.4] [1.0–3.1] [3.0–6.2] [9.9–14.9] [0.0–0.8] [0.0–0.7] [2.9–6.1] [3.9–7.4] [2.9–6.0] [3.9–7.4] [5.6–9.6] [2.8–5.9] [6.6–10.8] [4.6–8.3] [0.0–0.6] [4.4–8.1] [3.6–7.0] [1.4–3.8] [15.3–21.1] [3.8–7.2] [3.8–7.2] [3.7–7.1] [3.9–7.4] [3.0–6.2] ... [3.3–6.6] [0.0–0.7] [0.1–1.3] [3.7–7.2] [4.0–7.6] [1.4–3.8] [0.2–1.6] [8.3–13]

169

Global status report on NCDs 2014 … Indicates no data were available 2012 per capita consumption of pure alcohol (litres) Crude adjusted projected estimates Both sexes 11.1 2.0 0.5 11.0 ... 9.7 4.0 2.8 7.0 5.6 9.7 10.8 1.2 2.7 6.5 7.4 0.6 2.2 1.6 6.7 1.4 2.5 4.4 1.5 9.5 14.0 4.7 11.4 7.7 9.1 7.2 5.9 1.2 7.6 7.2 0.3 4.3 4.9 [95% CI] [8.0–14.2] [1.4–2.5] [0.2–0.8] [8.7–13.2] ... [6.9–12.6] [3.4–4.5] [2.0–3.6] [4.7–9.4] [4.6–6.7] [6.8–12.5] [7.8–13.7] [0.8–1.5] [1.4–4.0] [5.6–7.4] [5.2–9.5] [0.3–0.9] [1.1–3.2] [1.1–2.1] [4.4–9.0] [1.3–1.6] [1.8–3.2] [3.2–5.6] [0.7–2.2] [6.9–12.1] [10.8–17.2] [3.9–5.5] [8.3–14.4] [5.4–10.0] [6.5–11.7] [4.8–9.5] [4.5–7.4] [0.8–1.7] [5.2–10.1] [6.7–7.7] [0.0–0.5] [2.9–5.7] [4.1–5.8]

2010 Per capita consumption of pure alcohol (litres) Country name Region Crude adjusted estimates

Males Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand the former Yugoslav Republic of Macedonia Timor–Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United Republic of Tanzania United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe EUR WPR EMR AFR AFR EUR SEAR EMR AMR AFR EUR EUR EMR EUR SEAR EUR SEAR AFR WPR AMR EMR EUR EUR WPR AFR EUR EMR EUR AFR AMR AMR EUR WPR AMR WPR EMR AFR AFR 16.3 3.1 0.9 18.4 ... 15.9 7.3 4.8 9.4 10.6 12.9 15.2 2.3 4.3 13.8 10.2 1.0 3.8 3.0 9.7 3.0 4.4 7.6 2.5 14.4 22.0 5.5 16.5 11.4 13.6 11.3 7.9 2.5 12.7 12.1 0.4 6.5 10.8

[95% CI] [15.0–17.7] [2.7–3.5] [0.6–1.2] [16.1–20.8] ... [14.5–17.3] [6.1–8.5] [4.1–5.5] [8.5–10.4] [9.5–11.7] [11.4–14.4] [14.1–16.3] [2.0–2.5] [3.1–5.5] [12.6–14.9] [8.5–11.9] [0.7–1.3] [3.1–4.4] [2.6–3.4] [9.0–10.4] [2.7–3.3] [3.7–5.2] [6.1–9.0] [2.1–2.8] [13.0–15.9] [18.7–25.4] [4.7–6.3] [15.0–17.9] [10.0–12.9] [12.6–14.7] [10.2–12.3] [6.5–9.2] [2.1–2.9] [11.4–13.9] [10.1–16.4] [0.3–0.6] [5.5–7.5] [9.7–12.0]

Females 7.0 0.3 0.1 4.2 ... 6.7 0.3 0.6 3.9 1.1 5.5 6.4 0.1 1.4 0.8 3.2 0.1 0.9 0.2 3.9 0.0 0.5 1.3 0.5 5.2 7.2 0.8 6.9 4.0 4.9 4.2 1.3 0.2 5.2 0.2 0.1 1.6 0.8

[95% CI] [6.4–7.6] [0.2–0.3] [0.1–0.1] [3.7–4.7] ... [6.1–7.3] [0.2–0.3] [0.5–0.6] [3.5–4.2] [1.0–1.2] [4.9–6.2] [5.9–6.9] [0.1–0.1] [1.0–1.7] [0.7–0.9] [2.7–3.8] [0.1–0.1] [0.8–1.1] [0.2–0.3] [3.6–4.2] [0.0–0.0] [0.4–0.5] [1.0–1.5] [0.4–0.6] [4.6–5.7] [6.1–8.3] [0.7–0.9] [6.3–7.5] [3.5–4.6] [4.5–5.3] [3.8–4.6] [1.1–1.6] [0.2–0.2] [4.7–5.7] [0.2–0.3] [0.0–0.1] [1.4–1.9] [0.7–0.9]

Both sexes 11.6 1.7 0.5 11.0 ... 11.2 3.7 2.7 6.6 5.7 9.2 10.7 1.2 2.8 7.1 6.7 0.6 2.3 1.6 6.7 1.5 2.0 4.3 1.5 9.8 13.9 4.3 11.6 7.7 9.2 7.6 4.6 1.4 8.9 6.6 0.3 4.0 5.7

[95% CI] [10.6–12.6] [1.5–1.9] [0.3–0.7] [9.6–12.4] ... [10.2–12.2] [3.1–4.3] [2.3–3.1] [6.0–7.3] [5.1–6.3] [8.1–10.2] [9.9–11.5] [1.1–1.4] [2.0–3.6] [6.5–7.7] [5.6–7.8] [0.4–0.7] [1.9–2.7] [1.4–1.8] [6.2–7.2] [1.3–1.6] [2.0–2.8] [3.5–5.1] [1.3–1.7] [8.8–10.8] [11.8–16.0] [3.6–4.9] [10.6–12.6] [6.7–8.7] [8.5–9.8] [6.8–8.3] [3.7–5.4] [1.1–1.6] [8.1–9.8] [5.0–8.1] [0.2–0.3] [3.4–4.7] [5.1–6.3]

170

Annex 4.3: Alcohol

2010 Heavy episodic drinking, past 30 days (%) Age-standardized

2010 Alcohol use disorders, 12 month prevalence (%) Age-standardized

Males 14.0 24.9 0.2 17.5 ... 20.3 0.8 0.6 8.2 10.8 36.3 28.4 0.1 1.9 2.3 12.3 0.1 36.1 11.0 30.7 0.1 0.3 23.5 ... 7.6 35.6 0.2 37.2 22.3 24.7 14.8 20.4 10.5 37.8 2.4 0.0 5.0 19.7

[95% CI] [10.3–17.7] [20.4–29.4] [0.0–0.7] [13.4–21.5] ... [16.0–24.6] [0.0–1.8] [0.0–1.4] [5.3–11.2] [7.5–14.2] [31.2–41.3] [23.6–33.1] [0.0–0.4] [0.4–3.3] [0.7–3.8] [8.8–15.8] [0.0–0.5] [31.1–41.1] [7.7–14.3] [25.9–35.6] [0.0–0.3] [0.0–1.0] [19.0–28.0] ... [4.8–10.4] [30.5–40.7] [0.0–0.7] [32.1–42.4] [17.9–26.6] [20.2–29.3] [11.0–18.6] [16.1–24.7] [7.3–13.8] [32.7–42.9] [0.8–4.1] [0.0–0.2] [2.7–7.4] [15.4–23.9]

Females 1.2 3.5 0.0 2.9 ... 5.9 0.0 0.0 0.8 1.9 11.8 9.7 0.0 0.1 0.1 0.7 0.0 13.8 1.5 6.7 0.0 0.0 0.4 ... 0.1 11.8 0.0 16.8 6.1 7.5 4.6 0.4 2.4 6.5 0.2 0.0 0.0 4.7

[95% CI] [0.0–2.4] [1.5–5.5] [0.0–0.0] [1.1–4.7] ... [3.4–8.4] [0.0–0.2] [0.0–0.1] [0.0–1.8] [0.4–3.3] [8.4–15.3] [6.5–12.8] [0.0–0.1] [0.0–0.3] [0.0–0.3] [0.0–1.6] [0.0–0.0] [10.2–17.5] [0.2–2.8] [4.0–9.3] [0–0.1] [0–0.2] [0.0–1.0] ... [0.0–0.3] [8.3–15.2] [0.0–0.1] [12.8–20.7] [3.6–8.6] [4.7–10.3] [2.3–6.8] [0.0–1.0] [0.8–4.0] [3.9–9.1] [0.0–0.6] [0.0–0.1] [0.0–0.2] [2.4–7.0]

Both sexes 7.8 14.2 0.1 9.8 ... 13.2 0.4 0.3 4.6 6.2 24.3 19.1 0.0 1.0 1.1 6.6 0.1 24.4 6.2 18.7 0.0 0.2 11.6 ... 3.8 23.2 0.2 27.1 14.1 16.2 9.5 10.2 6.5 22.1 1.3 0.0 2.5 12.0

[95% CI] [5.8–9.9] [11.6–16.8] [0.0–0.4] [7.6–12.1] ... [10.6–15.7] [0.0–0.9] [0.0–0.7] [3.0–6.1] [4.4–8.0] [21.1–27.6] [16.2–22.1] [0.0–0.2] [0.2–1.7] [0.3–1.9] [4.7–8.4] [0.0–0.3] [21.2–27.7] [4.4–8.0] [15.8–21.7] [0.0–0.2] [0.0–0.5] [9.2–14.0] ... [2.4–5.3] [20.0–26.4] [0.0–0.5] [23.7–30.4] [11.5–16.7] [13.4–19.0] [7.3–11.7] [7.9–12.5] [4.6–8.3] [19.0–25.3] [0.4–2.1] [0.0–0.1] [1.3–3.7] [9.5–14.5]

Males 20.5 7.5 0.5 9.6 ... 2.4 5.5 1.7 8.0 9.5 13.7 14.3 0.8 1.3 9.0 8.7 2.4 11.8 7.6 8.0 0.9 4.4 8.1 7.6 9.8 9.5 0.6 17.5 9.0 11.0 8.2 8.2 7.5 8.0 8.3 0.5 7.7 8.8

[95% CI] [16.2–24.8] [4.7–10.3] [0.0–1.3] [6.5–12.8] ... [0.8–4.0] [3.1–7.9] [0.3–3.1] [5.1–10.9] [6.3–12.6] [10–17.3] [10.6–18.1] [0.0–1.8] [0.1–2.5] [5.9–12.1] [5.7–11.8] [0.7–4.0] [8.4–15.3] [4.8–10.5] [5.1–10.9] [0.0–1.9] [2.2–6.6] [5.2–11.1] [4.8–10.5] [6.6–13.0] [6.4–12.7] [0.0–1.5] [13.4–21.5] [6.0–12.1] [7.7–14.4] [5.2–11.1] [5.2–11.1] [4.7–10.3] [5.1–10.9] [5.4–11.3] [0.0–1.3] [4.9–10.6] [5.8–11.9]

Females 4.3 1.4 0.1 1.5 ... 0.4 0.6 0.3 3.1 1.9 6.0 2.9 0.1 0.2 1.0 2.0 0.5 3.2 1.5 3.2 0.2 0.9 1.8 1.4 1.5 1.3 0.1 6.7 1.8 4.5 3.2 1.8 1.4 3.1 0.9 0.1 1.0 1.6

[95% CI] [2.1–6.4] [0.1–2.6] [0.0–0.5] [0.2–2.8] ... [0.0–1.1] [0.0–1.5] [0.0–0.8] [1.3–5.0] [0.4–3.4] [3.5–8.5] [1.1–4.8] [0.0–0.4] [0.0–0.8] [0.0–2.1] [0.5–3.5] [0.0–1.2] [1.3–5.1] [0.2–2.7] [1.3–5.0] [0.0–0.6] [0.0–2.0] [0.4–3.2] [0.2–2.7] [0.2–2.8] [0.1–2.5] [0.0–0.5] [4.0–9.4] [0.4–3.2] [2.3–6.8] [1.3–5.1] [0.4–3.3] [0.1–2.7] [1.3–5.0] [0.0–1.9] [0.0–0.5] [0.0–2.0] [0.3–3.0]

Both sexes 12.6 4.4 0.3 5.4 ... 1.4 3.0 1.0 5.6 5.5 9.9 8.7 0.4 0.8 4.9 5.4 1.4 7.4 4.5 5.6 0.5 2.6 4.9 4.6 5.6 5.2 0.5 12.1 5.4 7.8 5.7 5.0 4.4 5.6 4.6 0.3 4.4 5.1

[95% CI] [10.1–15.1] [2.9–6.0] [0.0–0.7] [3.7–7.1] ... [0.5–2.3] [1.7–4.3] [0.2–1.7] [3.8–7.3] [3.8–7.2] [7.6–12.1] [6.5–10.8] [0.0–0.9] [0.1–1.4] [3.3–6.6] [3.7–7.1] [0.5–2.3] [5.4–9.3] [2.9–6.1] [3.8–7.3] [0.0–1.0] [1.4–3.9] [3.3–6.5] [3.0–6.2] [3.9–7.4] [3.6–6.9] [0.0–1.0] [9.6–14.6] [3.7–7.1] [5.7–9.8] [3.9–7.4] [3.3–6.6] [2.9–6.0] [3.8–7.3] [3.0–6.1] [0.0–0.7] [2.8–5.9] [3.4–6.8]

171

Global status report on NCDs 2014

4.4a Insufficient physical activity Comparable estimates of prevalence of insufficient physical activity (adults 18+ years), 2010 Prevalence of insuﬃcient physical activity Crude adjusted estimates Males Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus EMR EUR AFR EUR AFR AMR AMR EUR WPR EUR EUR AMR EMR SEAR AMR EUR EUR AMR AFR SEAR AMR EUR AFR AMR WPR EUR AFR AFR AFR WPR AFR AMR AFR AFR AMR WPR AMR AFR AFR WPR AMR AFR EUR AMR EUR ... ... 25.8 27.2 ... ... 35.7 ... 21.5 21.1 ... 28.5 ... 9.2 30.0 ... 31.5 ... 4.3 4.8 ... 17.0 18.0 24.9 ... 19.0 13.5 ... 11.7 8.7 20.9 22.2 8.9 19.2 17.6 22.2 53.4 6.7 18.6 63.3 ... 16.0 16.8 ... 29.3 [95% CI] ... ... [20.4–31.7] [8.9–65.3] ... ... [13.2–76] ... [6.4–57.5] [6–56.3] ... [19.9–38.2] ... [8.4–10.4] [23.7–36.7] ... [11.1–70.6] ... [2.7–6.3] [3.4–6.5] ... [4.6–47.8] [8.9–30.2] [7.8–63.6] ... [5.1–54.6] [10.4–17.1] ... [6–20] [6.9–10.9] [5.1–46.7] [6.5–57.9] [1.5–19.9] [5.3–54.5] [13.8–21.9] [18.9–25.8] [45.6–61.1] [4.8–9] [5.3–53.6] [55.5–70.6] ... [4.3–48.5] [4.5–48] ... [9.6–68.6] Females ... ... 39.4 34.7 ... ... 44.1 ... 29.9 31.3 ... 56.5 ... 41.3 47.2 ... 42.9 ... 6.6 10.9 ... 24.0 31.0 29.4 ... 26.7 19.1 ... 25.0 10.6 37.7 29.4 12.0 24.8 25.5 25.4 72.9 18.4 26.1 67.7 ... 25.1 22.5 ... 41.5 [95% CI] ... ... [33.9–45.1] [10.2–69.8] ... ... [15.6–79.3] ... [8.3–65.1] [8.7–66.5] ... [47.4–65.4] ... [39.8–43.1] [42–52.4] ... [15.1–77.6] ... [4.3–9.5] [8.9–13.4] ... [6.5–54.3] [19.6–44.3] [8.3–65.1] ... [6.8–60.6] [15.5–23.1] ... [11.6–44] [9.3–11.9] [10–64.9] [7.9–63.2] [1.9–23.6] [6.3–59.1] [21.3–30.1] [22.2–29] [65.7–79.3] [16.9–19.9] [7.1–60.1] [61.8–73.2] ... [6.5–60.9] [5.6–51.3] ... [13.6–77.3] Both sexes ... ... 32.5 30.9 ... ... 40.1 ... 25.8 26.4 ... 43.0 ... 25.1 38.7 ... 37.4 ... 5.4 7.5 ... 20.6 24.5 27.2 ... 23.0 16.4 ... 18.5 9.7 29.3 25.9 10.5 22.0 21.6 23.8 63.5 12.5 22.4 65.5 ... 20.4 19.8 ... 35.3 [95% CI] ... ... [28.6–36.6] [15.6–72.6] ... ... [13.9–77] ... [7.1–60.8] [7–61] ... [36.5–49.6] ... [24.2–26.1] [34.7–42.8] ... [12.6–73.6] ... [4–7.1] [6.3–9] ... [5.7–51.8] [16.9–33.3] [7.8–63.3] ... [5.7–56.7] [14–19] ... [12.3–26.2] [8.7–10.8] [7.4–57.3] [6.9–59.6] [1.6–20.9] [5.5–55.6] [18.7–24.7] [21.5–26.3] [58.2–68.6] [11.4–13.7] [5.9–56] [60.9–69.9] ... [5.2–54.1] [4.9–48.3] ... [11–72.5]

Country name

Region

172

Annex 4.4a: Insufficient physical activity

… Indicates no data were available Prevalence of insuﬃcient physical activity Age-standardized Males ... ... 27.7 22.4 ... ... 35.8 ... 20.1 19.2 ... 29.6 ... 10.2 29.3 ... 28.3 ... 5.7 5.7 ... 15.8 21.7 25.9 ... 18.2 15.9 ... 13.5 9.7 22.8 20.3 10.8 21.7 17.8 22.5 54.3 8.5 21.2 62.7 ... 18.0 15.0 ... 28.9 [95% CI] ... ... [22.3–33.6] [6.9–60.3] ... ... [13.2–76.1] ... [5.9–55.8] [5.4–53.4] ... [21–39.3] ... [9.4–11.4] [23–36] ... [9.6–67.6] ... [4.2–7.8] [4.3–7.4] ... [4.3–45.9] [12.6–33.9] [8.2–64.6] ... [4.9–53.5] [12.8–19.5] ... [7.8–21.8] [7.9–11.9] [5.9–49.8] [5.9–55.6] [2–23.9] [6.3–58.1] [14–22.1] [19.2–26.1] [46.6–62] [6.6–10.8] [6.1–56.8] [54.9–70] ... [4.9–51.1] [3.9–45.1] ... [9.4–68.3] Females ... ... 41.2 29.7 ... ... 42.7 ... 27.6 28.5 ... 56.3 ... 43.4 45.9 ... 38.2 ... 8.1 11.8 ... 20.4 32.6 29.7 ... 23.8 20.9 ... 25.7 10.9 38.7 26.2 13.3 27.4 24.9 25.6 72.9 20.0 29.6 67.3 ... 27.1 17.4 ... 40.4 [95% CI] Both sexes [95% CI] ... ... [35.7–46.9] [8.3–66.1] ... ... [14.7–78.5] ... [7.5–63.2] [7.8–63.6] ... [47.3–65.2] ... [41.9–45.3] [40.7–51.1] ... [12.4–74.5] ... [5.9–11] [9.7–14.2] ... [5.2–49.9] [21.3–46] [8.4–65.4] ... [6–57] [17.4–25] ... [12.3–44.6] [9.7–12.3] [11–66.2] [6.9–60.4] [2.2–26.3] [7.2–61.9] [20.7–29.5] [22.3–29.1] [65.8–79.3] [18.6–21.5] [8.3–63.7] [61.4–72.8] ... [7.1–62.2] [4.1–44.2] ... [13.1–76.6] ... ... 34.4 26.1 ... ... 39.2 ... 23.8 23.8 ... 43.0 ... 26.8 37.6 ... 33.2 ... 6.9 8.7 ... 18.1 27.2 27.8 ... 21.0 18.4 ... 19.6 10.3 30.7 23.2 12.0 24.6 21.3 24.1 63.6 14.2 25.4 65.0 ... 22.6 16.2 ... 34.7 ... ... [30.5–38.5] [11.6–66.5] ... ... [13.5–76.6] ... [6.4–58.9] [6.3–58.1] ... [36.5–49.6] ... [25.9–27.8] [33.6–41.7] ... [10.6] ... [5.6–8.6] [7.5–10.2] ... [4.8–48.5] [19.6–36] [8–63.9] ... [5.2–54.3] [16.1–21.1] ... [13.5–27.4] [9.3–11.4] [8.3–59] [6.1–57] [2–24.2] [6.3–58.8] [18.4–24.4] [21.7–26.5] [58.3–68.7] [13.1–15.4] [6.8–59.4] [60.4–69.4] ... [6–56.3] [3.8–43] ... [10.7–71.9] Latest year with national data

Latest year with data

Country name

2003 2004

2004

2013 2003 2005 2011 2009 2007 2008 2008 2014 2003 2007 2003 2005 2013 2007 2010 2003 2003 2010 2003 2009 2008 2010 2011 2003 2003 2003 2005 2011

2013 2003 2005 2011 2009 2007 2008 2008 2014 2003 2007 2003 2005 2013 2007 2010 2003 2003 2009

2011 2003 2003 2005 2011

Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus

173

Global status report on NCDs 2014 … Indicates no data were available Prevalence of insuﬃcient physical activity Crude adjusted estimates Males Czech Republic Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea–Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon EUR SEAR AFR EUR EMR AMR AMR AMR EMR AMR AFR AFR EUR AFR WPR EUR EUR AFR AFR EUR EUR AFR EUR AMR AMR AFR AFR AMR AMR AMR EUR EUR SEAR SEAR EMR EMR EUR EUR EUR AMR WPR EMR EUR AFR WPR EMR EUR WPR EUR EMR 24.1 ... 21.8 24.3 ... 17.9 30.5 18.9 23.4 ... ... 4.2 12.0 12.6 9.5 24.2 21.2 15.5 14.2 21.1 20.1 11.9 12.4 22.9 10.5 5.4 ... ... ... ... 18.5 ... 9.2 24.4 22.3 49.6 30.6 ... 30.0 23.7 35.1 12.7 18.8 14.9 31.9 48.3 9.1 3.1 19.3 43.7 [95% CI] [17.4–32] ... [14.4–30.6] [7.2–62] ... [14.5–22.2] [10.5–70.9] [5.3–54.3] [16.7–31.3] ... ... [3–5.6] [3–35.4] [3.1–40.7] [7.1–12.4] [7.2–61.1] [16.2–26.9] [2.5–27.6] [8.4–21.9] [17.4–25.1] [5.5–56.2] [8.8–15.5] [3.2–34.6] [16.4–30.6] [2.5–35.5] [1–13.5] ... ... ... ... [5.2–52.1] ... [7.3–11.2] [17.5–32.4] [20.7–24] [44–55.3] [10–70.7] ... [9.6–69.7] [7.3–62.4] [13.7–75.2] [10.9–14.7] [5.4–54.3] [3.9–46.1] [23–41.6] [44.1–52.5] [6.4–12.5] [2.1–4.5] [5.3–54.4] [35.6–52.2] Females 28.2 ... 28.1 28.9 ... 34.6 39.4 29.9 38.6 ... ... 13.5 17.9 21.5 22.0 28.1 31.2 33.5 22.9 23.7 26.5 17.0 18.2 37.4 14.1 11.0 ... ... ... ... 23.0 ... 15.1 21.1 41.6 43.1 41.2 ... 41.3 32.2 42.0 11.4 21.0 18.9 46.9 62.8 15.3 14.6 27.3 34.2 [95% CI] [20.3–37.3] ... [20.8–36.3] [7.7–63.7] ... [30.5–39] [13.1–76.1] [8.4–65.7] [32.9–44.5] ... ... [10.5–16.9] [4.1–41.2] [5.3–53.3] [18.3–26.1] [7.3–62.9] [25.5–37.5] [6–50.9] [15.6–31.7] [21.8–25.7] [6.7–60.6] [13.5–21] [4.1–46.6] [32.2–42.9] [3–40] [1.8–23.2] ... ... ... ... [5.7–53.3] ... [13.4–17] [14.8–28.9] [39.4–43.9] [37.6–48.6] [13.7–76.8] ... [13.4–76.8] [9.2–68.3] [14.7–77.6] [9.6–13.4] [5.1–52.7] [4.4–49.4] [37.5–56.5] [60.2–65.4] [13.3–17.6] [10.9–19.1] [7–62.7] [26.4–42.7] Both sexes 26.2 ... 25.0 26.6 ... 26.2 35.0 24.5 31.0 ... ... 9.0 15.2 17.1 15.7 26.2 26.4 24.5 18.7 22.5 23.4 14.6 15.4 30.2 12.4 8.2 ... ... ... ... 20.9 ... 12.1 22.8 31.9 46.3 36.0 ... 35.9 28.1 38.7 12.1 20.0 16.9 39.6 53.6 12.3 9.0 23.8 39.1 [95% CI] [21–32.1] ... [19.7–30.9] [7.1–61.7] ... [23.4–29.3] [11.1–72.6] [6.5–59.4] [26.7–35.7] ... ... [7.5–10.6] [3.5–39.2] [4.2–47] [13.4–18.1] [6.9–60.9] [22.6–30.6] [4.2–41.4] [13.9–24.3] [20.8–24.3] [5.8–57.3] [12.2–17.2] [3.5–41.3] [26.1–34.6] [2.6–37.2] [1.3–17.6] ... ... ... ... [5.2–51.7] ... [10.8–13.4] [18–28.1] [30.5–33.3] [42.4–50.3] [11.3–73] ... [10.9–72.5] [7.9–64.7] [13.6–75.8] [10.8–13.5] [5–52.4] [3.9–46.5] [33–46.4] [51.4–55.8] [10.7–14.1] [7.4–10.8] [5.9–58.3] [33.5–45]

Country name

Region

174

Annex 4.4a: Insufficient physical activity

Prevalence of insuﬃcient physical activity Age-standardized Males 22.7 ... 23.1 22.4 ... 13.3 31.5 19.6 25.1 ... ... 5.7 11.2 14.0 10.7 21.7 19.1 17.7 16.9 20.2 18.7 13.1 10.1 23.9 11.5 7.1 ... ... ... ... 17.2 ... 10.8 25.5 24.1 52.8 30.0 ... 28.2 23.9 31.1 15.6 20.2 17.3 33.9 49.2 10.4 4.7 18.3 43.9 [95% CI] [16–30.6] ... [15.8–32] [6.5–59.7] ... [9.9–17.6] [10.9–71.8] [5.5–55.1] [18.5–33.1] ... ... [4.5–7.1] [2.8–34.5] [3.6–42.9] [8.3–13.6] [6.3–57.8] [14.1–24.8] [2.9–31.3] [11.1–24.5] [16.6–24.3] [5.1–54.2] [10.1–16.7] [2.6–28.9] [17.3–31.6] [2.8–37.3] [1.4–17.2] ... ... ... ... [4.8–50.1] ... [9–12.9] [18.6–33.5] [22.5–25.8] [47.2–58.5] [9.8–70.1] ... [8.9–68.1] [7.4–62.6] [11.3–70.8] [13.8–17.6] [5.9–55.9] [4.7–49.9] [25.1–43.7] [45.1–53.4] [7.7–13.8] [3.6–6] [5–52.9] [35.7–52.3] Females 24.8 ... 29.0 26.2 ... 30.2 40.3 30.8 39.4 ... ... 15.6 12.6 23.9 23.2 25.3 28.5 34.4 26.1 21.0 23.5 18.0 15.7 37.2 15.0 12.7 ... ... ... ... 19.0 ... 16.1 22.0 42.9 45.8 40.1 ... 38.1 31.8 36.5 15.6 21.0 21.1 48.2 63.9 16.1 16.0 25.6 33.8 [95% CI] Both sexes [95% CI] [16.9–33.9] ... [21.7–37.3] [6.9–60.7] ... [26–34.6] [13.5–76.7] [8.7–66.6] [33.8–45.4] ... ... [12.6–19.1] [2.7–33.3] [6.2–56.2] [19.5–27.3] [6.5–59.7] [22.8–34.8] [6.3–52.4] [18.8–34.9] [19.1–23.1] [5.9–56.8] [14.5–22] [3.4–42.1] [31.9–42.7] [3.2–41.5] [2.3–26.3] ... ... ... ... [4.5–48.8] ... [14.3–17.9] [15.7–29.7] [40.6–45.1] [40.4–51.4] [13.2–76] ... [12–74.5] [9.1–68.2] [11.8–73.4] [13.7–17.6] [5.1–52.7] [5–52.1] [38.9–57.8] [61.2–66.5] [14.1–18.4] [12.2–20.5] [6.5–60.9] [25.9–42.3] 23.8 ... 26.0 24.3 ... 21.8 35.9 25.2 32.3 ... ... 10.7 11.9 18.9 17.0 23.5 23.8 26.0 21.5 20.6 21.1 15.6 12.9 30.5 13.3 9.9 ... ... ... ... 18.1 ... 13.4 23.7 33.5 49.3 35.1 ... 33.2 27.9 33.8 15.6 20.6 19.2 41.1 56.6 13.3 10.3 22.0 38.8 [18.5–29.6] ... [20.7–32] [6.4–58.9] ... [18.9–24.8] [11.6–73.3] [6.8–60.4] [28–36.9] ... ... [9.2–12.2] [2.7–35.1] [4.9–50.1] [14.7–19.4] [6.1–57.6] [19.9–28] [4.5–43.4] [16.7–27.1] [18.9–22.4] [5.2–54.4] [13.2–18.2] [2.9–36.5] [26.4–34.9] [2.8–38.8] [1.7–20.9] ... ... ... ... [4.4–48.5] ... [12.2–14.8] [19–29.1] [32.1–34.9] [45.4–53.2] [10.9–72.3] ... [9.9–70.4] [7.9–64.7] [11.1–71.6] [14.3–17] [5.2–53.2] [4.5–49.7] [34.5–47.9] [54.3–58.8] [11.7–15] [8.7–12.1] [5.5–56.6] [33.1–44.7]

Latest year with data 2003 2005 2005 2007 2003 2003 2011

Latest year with national data

Country name

2005 2007 2003 2003 2011

2010 2003 2003 2011 2005 2008 2009 2010 2010 2005 2009 2005 2011 2003 2009

2010 2003 2003 2011 2005 2008 2010 2010 2005 2009 2005 2011 2003

2003 2008 2006 2011 2006 2005 2005 2007 2003 2007 2003 2004 2004 2006 2013 2013 2005 2008

2003

2011 2006 2005 2005 2007 2007 2003 2004 2004 2006 2013 2013 2005 2008

Czech Republic Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea–Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon

175

Global status report on NCDs 2014 … Indicates no data were available Prevalence of insuﬃcient physical activity Crude adjusted estimates Males Lesotho Liberia Libya Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (Federated States of) Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Korea Republic of Moldova Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia AFR AFR EMR EUR EUR AFR AFR WPR SEAR AFR EUR WPR AFR AFR AMR WPR EUR WPR EUR EMR AFR SEAR AFR WPR SEAR EUR WPR AMR AFR AFR WPR EUR EMR EMR WPR AMR WPR AMR AMR WPR EUR EUR EMR WPR EUR EUR EUR AFR AMR AMR 5.8 22.4 31.0 16.6 28.2 11.7 4.3 45.6 24.2 16.2 40.3 41.2 35.3 22.7 18.9 32.0 ... 17.5 ... ... 4.3 7.2 23.9 40.5 3.9 16.0 36.8 ... 21.2 17.7 8.1 25.0 ... 18.5 ... ... 9.2 20.8 ... 11.5 14.4 33.5 29.9 29.4 12.8 19.1 10.1 10.0 28.0 27.8 [95% CI] [3.8–8.9] [16.7–29] [27–35.1] [9.3–26.5] [9–66.8] [8.4–15.8] [3–6.1] [38–53.4] [5.3–48.4] [4.3–49.2] [15–79.6] [34.1–48.8] [12.8–76.4] [6.9–60.2] [11.8–27.8] [27.5–36.8] ... [13.8–21.7] ... ... [2.2–7.9] [5.1–9.8] [7.4–63.2] [37.2–44.1] [2.7–5.7] [4.2–46.3] [33.9–39.8] ... [15.7–27.5] [7.9–64.3] [6.2–10.8] [7.9–62.5] ... [5.3–54] ... ... [6.6–12.3] [6.1–57.9] ... [2.9–38.9] [3.6–44.1] [11.6–72.7] [25.3–34.8] [9.6–69.7] [10.3–15.6] [5.2–55.3] [6.6–14.7] [8.2–12] [19.5–38.5] [22.8–33.1] Females 6.3 29.3 42.3 23.1 31.7 20.1 8.0 57.2 36.3 26.0 49.9 53.9 49.7 27.9 31.2 41.4 ... 21.7 ... ... 5.2 10.7 34.8 47.9 2.8 19.7 44.4 ... 24.8 21.9 6.1 32.5 ... 29.7 ... ... 14.8 25.9 ... 17.3 26.0 40.8 46.9 39.7 13.2 33.3 12.0 17.0 46.6 54.5 [95% CI] [4.9–8] [24.1–34.9] [36.8–47.9] [13.9–34.7] [8.8–68.1] [15.5–25.4] [6.9–9.4] [50–64.3] [8.1–60.7] [7–60.5] [18.6–83.2] [46.8–61.1] [19.2–84] [7.7–62.6] [23.1–39.9] [37.3–45.6] ... [17.4–26.6] ... ... [3–8.7] [8.4–13.5] [10.7–72.2] [44.4–51.4] [2.4–3.2] [4.5–48.9] [41–47.9] ... [18.1–32.6] [7.8–65.3] [3.9–8.9] [9.4–67.4] ... [8.4–66.4] ... ... [12.8–17.2] [6.9–61.1] ... [4–47.1] [6.7–59.7] [13–76.6] [41.8–52] [13–75.9] [11.7–14.8] [9.5–69.5] [8–16.9] [15.2–18.9] [37.5–56.3] [40.3–68.3] Both sexes 6.1 25.9 36.6 20.2 30.0 16.0 6.2 51.6 30.3 21.2 45.2 47.6 42.5 25.4 25.4 36.6 ... 19.6 ... ... 4.8 9.0 29.7 44.2 3.3 17.9 40.7 ... 23.0 19.8 7.1 28.8 ... 24.0 ... ... 12.0 23.3 ... 14.4 20.5 37.3 33.3 34.7 13.0 26.5 11.1 13.6 37.3 41.5 [95% CI] [4.9–7.5] [22–30] [33.3–39.9] [14.1–27.4] [8.5–66.5] [13.1–19.2] [5.3–7.2] [46.3–56.8] [6.2–53.8] [5.5–54.6] [16–80.7] [42.5–52.8] [15–79.7] [7–60.3] [19.9–31.5] [33.6–39.7] ... [16.8–22.8] ... ... [3.1–7.1] [7.4–10.9] [8.7–67.3] [41.8–46.7] [2.9–3.8] [4.1–46.4] [38.5–43] ... [18.8–27.8] [7.5–63.9] [5.6–9] [8.1–63.7] ... [6.5–60] ... ... [10.4–13.8] [6.2–58.3] ... [3.3–42.2] [5.1–52.7] [11.7–73.9] [29.8–36.8] [10.7–71.9] [11.7–14.4] [7–62.6] [8.4–14.4] [12.4–15] [30.8–44.4] [36.5–46.8]

Country name

Region

176

Annex 4.4a: Insufficient physical activity

Prevalence of insuﬃcient physical activity Age-standardized Males 7.5 24.5 32.8 16.1 26.6 13.7 5.6 46.7 25.8 18.2 38.6 38.0 38.0 23.1 20.3 31.1 ... 19.6 ... ... 5.5 8.3 26.4 36.4 4.5 14.0 35.8 ... 23.3 20.6 6.7 22.9 ... 20.2 ... ... 11.8 22.1 ... 13.1 13.6 31.4 33.4 28.9 12.9 18.9 10.2 12.0 22.7 27.9 [95% CI] [5.4–10.5] [18.7–31] [28.9–37] [8.8–26] [8.4–65.2] [10.4–17.8] [4.3–7.4] [39.1–54.4] [5.9–51.1] [5.1–52] [14.2–78.6] [30.8–45.6] [14.2–78.2] [7–60.4] [13.1–29.1] [26.6–35.9] ... [15.8–23.8] ... ... [3.3–9] [6.2–10.9] [8.4–65.8] [33–39.9] [3.3–6.3] [3.6–42.2] [32.9–38.8] ... [17.8–29.5] [9.3–67.4] [4.8–9.4] [7–59.9] ... [5.9–56.3] ... ... [9.3–15] [6.6–59.4] ... [3.4–41.3] [3.4–42.5] [10.7–70.8] [28.9–38.3] [9.5–69.2] [10.4–15.8] [5.1–55] [6.8–14.8] [10.3–14] [14.2–33.2] [23–33.2] Females 7.0 30.6 43.3 20.6 30.4 22.2 9.4 58.0 35.5 29.1 47.2 51.1 52.1 27.3 31.8 40.9 ... 23.2 ... ... 6.2 11.6 37.1 45.0 3.7 17.0 43.7 ... 27.0 24.0 4.6 28.8 ... 31.7 ... ... 17.5 27.0 ... 18.6 23.8 38.5 49.7 37.9 11.7 31.8 8.8 18.6 42.0 54.5 [95% CI] Both sexes [95% CI] [5.6–8.7] [25.5–36.2] [37.8–48.9] [11.4–32.2] [8.4–66.9] [17.6–27.5] [8.2–10.7] [50.7–65] [8.1–60.2] [8.3–64] [17.1–81.8] [43.9–58.3] [20.8–85.1] [7.5–61.9] [23.7–40.5] [36.8–45.1] ... [18.8–28.1] ... ... [4–9.7] [9.2–14.3] [11.7–73.8] [41.5–48.5] [3.3–4.2] [3.8–44.3] [40.3–47.2] ... [20.3–34.7] [8.4–66.7] [2.4–7.3] [8–64.5] ... [9.2–68] ... ... [15.4–19.8] [7.2–62.2] ... [4.3–48.7] [6–57] [12.1–75.1] [44.6–54.8] [12.1–74.5] [10.2–13.3] [9–68.2] [4.8–13.8] [16.8–20.5] [32.9–51.7] [40.2–68.2] 7.2 27.5 38.0 18.4 28.5 17.9 7.5 52.3 30.7 23.7 42.9 44.5 45.1 25.2 26.0 36.0 ... 21.4 ... ... 5.8 9.9 31.8 40.7 4.1 15.5 39.8 ... 25.1 22.3 5.6 25.8 ... 26.0 ... ... 14.7 24.6 ... 15.8 18.7 34.9 41.6 33.4 12.3 25.3 9.5 15.3 32.4 41.2 [6–8.6] [23.7–31.7] [34.8–41.4] [12.3–25.6] [8–65] [15.1–21.2] [6.6–8.5] [47.1–57.6] [6.5–54.6] [6.7–58.2] [14.9–79.4] [39.4–49.7] [16.5–81.1] [7–60] [20.5–32.1] [33–39.1] ... [18.5–24.5] ... ... [4.2–8.1] [8.3–11.8] [9.7–69.5] [38.2–43.2] [3.7–4.6] [3.5–42.1] [37.5–42] ... [20.8–29.9] [8.5–66.3] [4.1–7.5] [7–61] ... [7.2–62] ... ... [13–16.4] [6.6–59.6] ... [3.6–44.2] [4.7–50.4] [10.8–72] [38.1–45.1] [10.2–71] [11–13.7] [6.8–61.7] [6.8–12.8] [14–16.7] [25.9–39.4] [36.1–46.4]

Latest year with data 2012 2011 2009 2010 2005 2005 2009 2005 2011 2003 2005 2002 2003 2003 2008 2008 2013

Latest year with national data 2012 2011 2009 2010 2005 2009 2005 2003 2005 2002 2003 2003 2008 2008 2013

Country name

2005 2009 2003 2004 2013 2005 2012 2007 2011 2011 2003 2003

2005 2009 2003 2004 2013 2005 2012

2011 2003 2003

2007 2003 2003 2005 2005 2012 2012 2013 2005 2008 2012 2007 2012

2003 2003 2005 2005 2012 2012 2013 2005 2008 2012 2012

Lesotho Liberia Libya Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (Federated States of) Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Korea Republic of Moldova Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia

177

Global status report on NCDs 2014 … Indicates no data were available Prevalence of insuﬃcient physical activity Crude adjusted estimates Males Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand the former Yugoslav Republic of Macedonia Timor–Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United Republic of Tanzania United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe AMR WPR EUR AFR EMR AFR EUR AFR AFR WPR EUR EUR WPR EMR AFR AFR EUR SEAR EMR AMR AFR EUR EUR EMR EUR SEAR EUR SEAR AFR WPR AMR EMR EUR EUR WPR AFR EUR EMR EUR AFR AMR AMR EUR WPR AMR WPR EMR AFR AFR ... 9.8 ... 8.1 52.1 18.0 35.3 18.2 8.0 31.6 16.8 18.8 29.0 ... 40.5 ... 29.2 16.9 ... ... 29.4 26.2 ... ... ... 12.8 ... ... 7.6 12.8 29.9 18.6 27.1 ... ... ... 12.2 27.0 35.4 4.6 27.6 27.4 11.8 6.0 ... 21.0 ... 14.7 15.3 [95% CI] ... [7.3–12.8] ... [4.8–12.8] [46.9–57.3] [5.1–52.9] [13.2–74.9] [14.7–22.2] [5.1–11.8] [28.5–34.9] [4.6–49.2] [5.3–52.8] [22.6–36] ... [34.7–46.6] ... [9.8–69.1] [14.6–19.4] ... ... [9.9–70.4] [8–64.8] ... ... ... [11.2–14.5] ... ... [5.8–9.7] [10.3–15.7] [25.9–34.1] [5.4–52.9] [8.8–67.1] ... ... ... [3–38] [8.8–68.5] [33.5–37.3] [3.4–5.9] [24.3–31] [19.6–36.6] [8.9–15.3] [4.9–7.4] ... [11.2–34.5] ... [3.9–46.4] [4.1–45.5] Females ... 21.2 ... 18.3 67.7 25.8 47.1 23.0 15.0 35.7 21.4 29.2 39.0 ... 53.1 ... 37.4 30.2 ... ... 38.6 35.8 ... ... ... 16.4 ... ... 9.8 29.9 53.1 26.6 37.1 ... ... ... 16.2 39.4 44.3 6.4 42.1 40.3 24.1 8.1 ... 26.0 ... 20.6 23.8 [95% CI] ... [17.8–25] ... [16.1–20.8] [62.1–73] [6.9–60.5] [17.9–81.1] [20.2–26] [9.4–22.3] [32.1–39.5] [5.1–51.3] [7.9–62.8] [32.1–46.3] ... [47.2–59.1] ... [11.6–73] [27–33.6] ... ... [12.5–76] [10.6–71.6] ... ... ... [14.5–18.5] ... ... [7.6–12.4] [26.5–33.6] [49.1–57.1] [7.4–61.3] [11.8–73.5] ... ... ... [3.5–39.8] [12.9–77.4] [42.2–46.5] [4.8–8.3] [38.3–46] [32.9–48.1] [20.9–27.5] [6.7–9.7] ... [15.7–39] ... [5.1–52.9] [6.1–57.1] Both sexes ... 15.3 ... 13.4 58.5 22.1 41.4 20.6 11.6 33.7 19.2 24.1 34.0 ... 47.1 ... 33.4 23.7 ... ... 34.2 31.1 ... ... ... 14.6 ... ... 8.7 21.6 41.7 22.6 32.3 ... ... ... 14.4 30.2 40.0 5.5 35.0 34.2 18.1 7.1 ... 23.6 ... 17.7 19.7 [95% CI] ... [13.2–17.8] ... [11.6–15.4] [54.6–62.2] [6–56.3] [14.7–77.4] [18.4–22.9] [8.7–15] [31.3–36.1] [5.4–51.6] [5.8–55.6] [29.2–39] ... [42.9–51.3] ... [10.3–70.3] [21.8–25.8] ... ... [10.7–72.6] [8.9–67.5] ... ... ... [13.4–16] ... ... [7.3–10.4] [19.4–23.9] [38.8–44.7] [6.1–56.4] [9.9–69.5] ... ... ... [3.2–38.2] [9.6–70.9] [38.6–41.4] [4.6–6.5] [32.5–37.6] [28.7–40.1] [15.9–20.5] [6.2–8.1] ... [16.2–32.5] ... [4.3–48.7] [4.9–51]

Country name

Region

178

Annex 4.4a: Insufficient physical activity

Prevalence of insuﬃcient physical activity Age-standardized Males ... 10.9 ... 10.3 53.2 21.0 33.5 19.3 10.5 30.9 16.6 17.4 30.2 ... 42.2 ... 27.2 17.3 ... ... 32.8 24.4 ... ... ... 12.9 ... ... 9.9 13.3 30.1 19.7 28.1 ... ... ... 11.6 32.2 32.3 6.1 25.4 26.2 13.6 7.4 ... 22.1 ... 17.3 18.7 [95% CI] ... [8.4–14] ... [7–15] [48–58.4] [6.1–56.8] [12.3–73.6] [15.8–23.3] [7.6–14.3] [27.8–34.2] [4.6–48.7] [4.9–50.6] [23.8–37.3] ... [36.4–48.3] ... [8.9–67.3] [15–19.8] ... ... [11.4–73.2] [7.3–62.8] ... ... ... [11.3–14.7] ... ... [8.1–12] [10.8–16.2] [26.2–34.4] [5.9–54.3] [9.2–68] ... ... ... [2.9–36.9] [11.3–72.9] [30.4–34.2] [5–7.4] [22.2–28.8] [18.4–35.4] [10.7–17.1] [6.3–8.7] ... [12.3–35.6] ... [4.8–50.4] [5.3–51.6] Females ... 21.5 ... 20.9 68.7 29.0 43.8 22.3 17.9 35.3 19.1 25.1 39.9 ... 51.6 ... 33.7 30.3 ... ... 40.8 33.0 ... ... ... 16.7 ... ... 11.0 30.0 52.9 27.3 37.5 ... ... ... 12.7 44.6 42.4 7.6 39.3 37.3 24.9 9.4 ... 25.8 ... 23.7 26.1 [95% CI] Both sexes [95% CI] ... [18.1–25.3] ... [18.7–23.4] [63.1–74] [8–63.6] [15.7–79.3] [19.5–25.3] [12.3–25.2] [31.7–39.1] [4.5–48.7] [6.5–59.2] [33–47.2] ... [45.7–57.5] ... [10–70.4] [27.1–33.7] ... ... [13.4–77.1] [9.6–69.2] ... ... ... [14.7–18.8] ... ... [8.8–13.6] [26.5–33.6] [48.9–56.9] [7.7–62] [12–73.8] ... ... ... [2.7–35.1] [15.7–80.4] [40.3–44.6] [6.1–9.6] [35.5–43.3] [29.9–45.1] [21.7–28.3] [8–10.9] ... [15.5–38.8] ... [6.1–56.6] [6.8–59.6] ... 16.2 ... 15.6 61.0 25.0 38.7 20.8 14.2 33.1 17.8 21.3 35.1 ... 46.9 ... 30.5 23.8 ... ... 36.8 28.7 ... ... ... 14.8 ... ... 10.4 21.6 41.5 23.5 32.8 ... ... ... 12.2 38.4 37.3 6.9 32.4 31.7 19.2 8.4 ... 23.9 ... 20.5 22.4 ... [14.1–18.6] ... [13.8–17.6] [57.1–64.7] [7.2–60.2] [13.2–75.8] [18.6–23.1] [11.3–17.7] [30.7–35.5] [4.9–49.7] [5.1–53.2] [30.3–40.1] ... [42.7–51.1] ... [9.1–68] [21.8–25.9] ... ... [11.8–74.4] [8.1–65.2] ... ... ... [13.5–16.1] ... ... [9–12] [19.4–24] [38.6–44.5] [6.5–57.4] [10.3–70.1] ... ... ... [2.7–35.1] [11.9–74.6] [35.9–38.8] [5.9–7.9] [29.8–35] [26.2–37.6] [17–21.6] [7.5–9.4] ... [16.6–32.9] ... [5.2–52.6] [5.8–54.9]

Latest year with data

Latest year with national data

Country name

2013 2009 2005 2003 2006 2013 2009 2013 2003 2003 2005 2009 2011 2006

2013 2009 2005 2003 2006 2013 2009 2013 2003 2003

2009 2011 2006

2003 2005

2008

2011 2011 2011 2003 2003

2003 2003 2012 2011 2011 2006 2014 2011 2009 2003 2003

Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand the former Yugoslav Republic of Macedonia Timor–Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United Republic of Tanzania United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe

179

Global status report on NCDs 2014

4.4b Insufficient physical activity Comparable estimates of prevalence of insufficient physical activity (adolescents 11-17 years), 2010 Prevalence of insuﬃcient physical activity Country name Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Region Boys EMR EUR AFR EUR AFR AMR AMR EUR WPR EUR EUR AMR EMR SEAR AMR EUR EUR AMR AFR SEAR AMR EUR AFR AMR WPR EUR AFR AFR AFR WPR AFR AMR AFR AFR AMR WPR AMR AFR AFR WPR AMR AFR EUR AMR EUR ... ... 75.9 ... ... 72.4 78.0 73.0 78.0 65.6 ... 81.0 ... ... 75.3 ... 77.5 75.1 72.8 ... 83.2 ... 87.3 82.0 80.6 68.3 ... ... ... 91.6 ... 73.0 ... ... 79.6 79.4 83.4 ... ... 76.4 75.3 72.6 ... ... 72.9 [95% CI] ... ... [73.1–78.6] ... ... [65.3–78.7] [75.0–80.8] [68.7–76.9] [76.2–79.7] [62.3–68.8] ... [74.7–86.3] ... ... [71.1–79.3] ... [75.3–79.7] [72.6–77.6] [70.1–75.4] ... [80.8–85.4] ... [84.5–89.8] [81.3–82.6] [78.3–82.7] [65.1–71.4] ... ... ... [89.7–93.3] ... [71.3–74.7] ... ... [72.4–85.6] [72.4–88.7] [77.7–91.3] ... ... [72.5–80.0] [73.3–77.3] [69.8–75.3] ... ... [69.5–76.0] Girls ... ... 92.4 ... ... 83.3 87.7 79.8 91.5 84.9 ... 87.9 ... ... 86.7 ... 87.5 82.2 76.8 ... 88.8 ... 88.7 91.4 94.6 79.9 ... ... ... 94.8 ... 81.4 ... ... 90.6 87.9 86.7 ... ... 84.6 88.1 85.4 ... ... 80.6 [95% CI] ... ... [91.0–93.7] ... ... [77.8–87.9] [86.0–89.2] [76.3–83.1] [90.2–92.6] [82.5–87.1] ... [85.1–90.4] ... ... [83.6–89.5] ... [85.7–89.1] [79.8–84.4] [72.3–80.8] ... [86.4–90.8] ... [87.2–90.1] [90.9–91.9] [93.1–95.8] [77.1–82.4] ... ... ... [92.4–96.6] ... [79.9–82.8] ... ... [85.1–94.5] [81.6–92.9] [81.5–92.9] ... ... [81.6–87.3] [85.5–90.3] [83.3–87.4] ... ... [77.8–83.2] Both sexes ... ... 84.6 ... ... 78.3 83.1 76.6 83.9 75.4 ... 84.8 ... ... 81.8 ... 82.5 78.9 74.1 ... 85.9 ... 88.1 86.7 88.1 74.1 ... ... ... 93.4 ... 77.3 ... ... 85.2 83.8 85.2 ... ... 80.8 81.9 79.3 ... ... 76.9 [95% CI] ... ... [83.1–85.9] ... ... [73.9–82.2] [81.6–84.6] [73.9–79.1] [82.8–85.0] [73.4–77.4] ... [82.1–87.2] ... ... [79.2–84.2] ... [81.1–83.9] [77.1–80.5] [71.9–76.3] ... [84.3–87.5] ... [86.7–89.3] [86.3–87.1] [86.7–89.3] [72.0–76.2] ... ... ... [92.0–94.6] ... [76.2–78.4] ... ... [80.8–88.8] [77.3–91.1] [80.1–92.3] ... ... [78.4–83.0] [80.4–83.4] [77.5–80.9] ... ... [74.7–78.9] Latest year with data ... ... 2011 ... ... 2009 2012 2010 2009 2010 ... 2013 ... ... 2011 ... 2010 2011 2009 ... 2012 ... 2005 2012 2014 2005 ... ... ... 2013 ... 2010 ... ... 2013 2003 2007 ... ... 2011 2009 2010 ... ... 2010 Latest year with national data ... ... 2011 ... ... 2009 2012 2010 2009 2010 ... 2013 ... ... 2011 ... 2010 2011 2009 ... 2012 ... 2005 2012 2014 2005 ... ... ... 2013 ... 2010 ... ... 2013 ... ... ... ... 2011 2009 2010 ... ... 2010

180

Annex 4.4b: Insufficient physical activity … Indicates no data were available Prevalence of insuﬃcient physical activity Country name Czech Republic Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea–Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Region Boys EUR SEAR AFR EUR EMR AMR AMR AMR EMR AMR AFR AFR EUR AFR WPR EUR EUR AFR AFR EUR EUR AFR EUR AMR AMR AFR AFR AMR AMR AMR EUR EUR SEAR SEAR EMR EMR EUR EUR EUR AMR WPR EMR EUR AFR WPR EMR EUR WPR EUR EMR ... ... ... 87.1 81.3 82.9 ... 85.9 80.6 83.7 ... ... 82.7 ... 84.2 68.2 84.4 ... ... ... 77.9 87.5 81.9 82.6 80.9 ... ... 81.9 ... 80.3 74.4 79.4 69.6 84.3 ... 80.3 64.6 77.8 91.0 ... ... 82.3 ... 85.7 78.0 77.0 ... ... 77.0 69.4 [95% CI] ... ... ... [84.3–89.5] [78.0–84.3] [78.5–86.7] ... [80.8–92.8] [71.4–87.9] [80.5–86.5] ... ... [79.7–85.4] ... [82.2–86.0] [65.3–70.9] [82.1–86.5] ... ... ... [75.0–80.7] [84.8–89.9] [79.2–84.5] [78.6–86.1] [78.0–83.6] ... ... [77.0–86.1] ... [77.8–82.7] [71.2–77.5] [77.5–81.1] [66.5–72.7] [81.5–86.8] ... [77.8–82.6] [61.4–67.8] [74.7–80.6] [88.9–92.9] ... ... [78.5–85.6] ... [83.5–87.7] [74.0–81.6] [72.4–81.2] ... ... [73.7–80.0] [64.9–73.6] Girls ... ... ... 89.4 89.1 84.7 ... 93.4 92.9 90.1 ... ... 89.0 ... 89.4 85.3 91.7 ... ... ... 88.1 88.3 89.7 86.7 88.0 ... ... 86.5 ... 87.3 86.5 88.3 71.6 83.1 ... 91.4 79.6 89.5 92.6 ... ... 88.9 ... 88.9 85.5 92.9 ... ... 82.3 83.2 [95% CI] ... ... ... [87.0–91.4] [86.8–91.2] [81.9–87.2] ... [89.3–96.3] [88.9–95.8] [87.3–92.4] ... ... [86.7–91.1] ... [87.3–91.2] [83.2–87.2] [90.0–93.2] ... ... ... [85.9–90.1] [84.3–91.6] [87.5–91.5] [83.9–89.2] [84.1–91.2] ... ... [83.6–89.1] ... [84.4–89.9] [84.1–88.6] [86.8–89.7] [67.4–75.5] [79.0–86.7] ... [87.4–94.4] [76.7–82.3] [87.6–91.2] [90.6–94.2] ... ... [86.5–91.0] ... [86.4–91.1] [83.0–87.8] [90.9–94.5] ... ... [79.5–84.8] [81.0–85.1] Both sexes ... ... ... 88.3 84.6 83.9 ... 89.8 87.3 86.6 ... ... 86.0 ... 86.6 77.0 88.1 ... ... ... 83.1 87.9 85.9 84.9 84.8 ... ... 84.5 ... 83.9 80.8 83.8 70.5 83.7 ... 85.1 71.6 84.6 91.8 ... ... 85.2 ... 87.4 82.2 84.9 ... ... 79.7 76.7 [95% CI] ... ... ... [86.5–89.9] [82.6–86.5] [81.6–86.0] ... [85.5–94.7] [83.2–90.7] [84.5–88.4] ... ... [84.1–87.7] ... [85.3–88.0] [75.3–78.7] [86.6–89.4] ... ... ... [81.3–84.9] [85.7–89.9] [84.2–87.5] [82.6–87.0] [82.5–86.9] ... ... [81.9–86.8] ... [82.1–85.7] [78.9–82.6] [82.6–84.9] [68.0–72.9] [81.4–85.7] ... [83.1–87.0] [69.4–73.8] [82.9–86.2] [90.4–93.0] ... ... [83.1–87.1] ... [85.8–88.9] [80.1–84.2] [82.8–86.9] ... ... [77.6–81.7] [74.6–78.6] Latest year with data ... ... ... 2010 2007 2009 ... 2007 2011 2013 ... ... 2010 ... 2010 2010 2010 ... ... ... 2010 2012 2010 2008 2009 ... ... 2010 ... 2012 2010 2010 2007 2007 ... 2012 2010 2005 2010 ... ... 2007 ... 2003 2011 2011 ... ... 2010 2011 Latest year with national data ... ... ... 2010 2007 2009 ... ... 2011 2013 ... ... 2010 ... 2010 2010 2010 ... ... ... 2010 2012 2010 2008 2009 ... ... 2010 ... 2012 2010 2010 2007 2007 ... 2012 2010 2005 2010 ... ... 2007 ... 2003 2011 2011 ... ... 2010 2011

181

Global status report on NCDs 2014 … Indicates no data were available Prevalence of insuﬃcient physical activity Country name Lesotho Liberia Libya Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (Federated States of) Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Korea Republic of Moldova Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Region Boys AFR AFR EMR EUR EUR AFR AFR WPR SEAR AFR EUR WPR AFR AFR AMR WPR EUR WPR EUR EMR AFR SEAR AFR WPR SEAR EUR WPR AMR AFR AFR WPR EUR EMR EMR WPR AMR WPR AMR AMR WPR EUR EUR EMR WPR EUR EUR EUR AFR AMR AMR ... ... 78.2 80.6 73.4 ... ... 80.1 76.7 ... 78.2 ... 83.1 74.2 ... ... ... 69.4 ... 84.2 ... 81.1 85.0 83.0 ... 77.8 ... ... ... ... 89.3 78.9 77.9 87.3 74.1 ... ... ... 83.8 89.6 74.7 81.5 88.3 91.9 ... 73.2 84.1 ... 78.0 83.8 [95% CI] ... ... [74.0–82.0] [78.0–83.1] [70.0–76.7] ... ... [78.7–81.5] [73.2–79.9] ... [72.4–83.2] ... [77.4–87.8] [70.1–77.9] ... ... ... [67.3–71.5] ... [82.3–85.9] ... [78.2–83.7] [81.9–87.8] [67.5–92.7] ... [74.7–80.7] ... ... ... ... [71.8–97.7] [75.8–81.7] [72.9–82.4] [80.6–92.4] [62.6–83.8] ... ... ... [81.4–86.1] [85.8–92.7] [71.3–77.8] [78.3–84.4] [83.8–91.8] [91.5–92.4] ... [70.2–76.0] [81.6–86.5] ... [74.4–81.3] [80.0–87.1] Girls ... ... 88.2 86.4 81.8 ... ... 91.5 82.6 ... 84.5 ... 92.3 86.8 ... ... ... 79.4 ... 89.4 ... 86.4 86.8 90.8 ... 84.3 ... ... ... ... 88.6 91.2 90.2 91.1 78.2 ... ... ... 85.9 91.7 84.2 91.2 91.6 97.8 ... 88.1 90.7 ... 85.5 85.5 [95% CI] ... ... [86.2–90.0] [84.0–88.5] [78.8–84.5] ... ... [90.6–92.4] [79.2–85.7] ... [79.5–88.7] ... [90.1–94.2] [83.8–89.4] ... ... ... [77.4–81.3] ... [86.3–92.0] ... [83.2–89.2] [84.2–89.0] [83.6–95.4] ... [81.7–86.6] ... ... ... ... [66.5–99.8] [89.1–93.1] [87.4–92.5] [75.4–98.5] [68.0–86.6] ... ... ... [84.0–87.7] [89.0–94.0] [81.5–86.7] [89.1–93.1] [87.0–94.9] [97.5–98.0] ... [85.9–90.0] [88.7–92.5] ... [83.1–87.6] [82.2–88.3] Both sexes ... ... 84.0 83.4 77.6 ... ... 85.8 80.0 ... 81.4 ... 88.0 81.1 ... ... ... 74.7 ... 86.6 ... 83.8 86.0 88.6 ... 81.1 ... ... ... ... 89.0 85.0 84.7 88.2 76.3 ... ... ... 84.9 90.8 79.6 86.7 90.1 94.8 ... 80.7 87.5 ... 82.2 84.8 [95% CI] ... ... [82.0–85.8] [81.7–85.1] [75.4–79.7] ... ... [85.0–86.6] [77.6–82.2] ... [77.7–84.7] ... [85.7–90.1] [78.6–83.4] ... ... ... [73.3–76.1] ... [85.1–88.1] ... [81.7–85.7] [84.1–87.8] [82.0–93.4] ... [79.1–83.0] ... ... ... ... [77.0–95.8] [83.2–86.8] [82.0–87.0] [82.4–92.6] [69.0–82.8] ... ... ... [83.4–86.3] [88.7–92.7] [77.5–81.6] [84.8–88.4] [87.1–92.6] [94.6–95.1] ... [78.9–82.5] [85.9–88.9] ... [80.2–84.1] [82.4–87.0] Latest year with data ... ... 2007 2010 2010 ... ... 2012 2009 ... 2005 ... 2010 2011 ... ... ... 2013 ... 2010 ... 2007 2014 2011 ... 2010 ... ... ... ... 2010 2010 2010 2009 2011 ... ... ... 2010 2011 2010 2010 2011 2013 ... 2010 2010 ... 2011 2007 Latest year with national data ... ... 2007 2010 2010 ... ... 2012 2009 ... 2005 ... 2010 2011 ... ... ... 2013 ... 2010 ... 2007 2014 2011 ... 2010 ... ... ... ... 2010 2010 2010 2009 2011 ... ... ... 2010 2011 2010 2010 2011 2013 ... 2010 2010 ... 2011 2007

182

Annex 4.4b: Insufficient physical activity … Indicates no data were available Prevalence of insuﬃcient physical activity Country name Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand the former Yugoslav Republic of Macedonia Timor–Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United Republic of Tanzania United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe Region Boys AMR WPR EUR AFR EMR AFR EUR AFR AFR WPR EUR EUR WPR EMR AFR AFR EUR SEAR EMR AMR AFR EUR EUR EMR EUR SEAR EUR SEAR AFR WPR AMR EMR EUR EUR WPR AFR EUR EMR EUR AFR AMR AMR EUR WPR AMR WPR EMR AFR AFR 84.4 89.3 ... ... ... 85.6 ... 76.6 ... 87.9 72.9 74.7 81.6 ... ... ... 69.7 82.6 91.2 77.9 ... 83.3 84.8 85.5 ... 78.3 70.9 ... ... 88.6 78.2 74.1 77.1 ... 86.6 84.7 70.4 77.5 72.7 75.5 63.1 76.6 ... 88.3 87.1 82.1 82.5 91.5 85.5 [95% CI] [81.0–87.5] [86.2–91.9] ... ... ... [79.0–90.8] ... [70.3–82.2] ... [85.2–90.3] [69.9–75.8] [71.8–77.4] [76.9–85.8] ... ... ... [66.5–72.8] [79.2–85.6] [86.7–94.6] [73.7–81.8] ... [81.0–85.4] [82.6–86.8] [81.6–88.9] ... [76.0–80.4] [67.4–74.3] ... ... [85.9–90.9] [73.6–82.3] [71.3–76.7] [74.2–79.7] ... [79.9–91.7] [81.7–87.4] [67.5–73.3] [72.6–82.0] [71.0–74.4] [66.6–85.9] [61.1–65.0] [73.9–79.1] ... [81.8–93.0] [82.6–93.6] [79.8–84.3] [77.7–86.6] [88.8–93.8] [83.0–87.6] Girls 88.6 86.7 ... ... ... 93.6 ... 86.8 ... 91.9 81.6 85.0 85.0 ... ... ... 84.3 88.4 92.3 83.9 ... 88.9 91.2 92.3 ... 90.2 83.3 ... ... 84.2 85.1 88.2 86.9 ... 89.9 86.6 83.4 86.0 84.9 84.9 82.2 90.8 ... 89.9 95.5 90.8 87.7 88.8 88.6 [95% CI] [85.2–91.5] [84.1–89.1] ... ... ... [90.9–95.7] ... [82.0–90.8] ... [89.7–93.9] [79.1–83.9] [82.7–87.2] [81.0–88.4] ... ... ... [81.8–86.5] [86.4–90.1] [89.7–94.4] [81.7–85.9] ... [87.0–90.6] [89.4–92.7] [90.3–94.0] ... [88.1–92.1] [80.4–86.0] ... ... [81.2–86.9] [81.2–88.5] [86.1–90.1] [84.7–88.8] ... [84.3–94.0] [84.3–88.7] [81.2–85.6] [81.7–89.6] [83.5–86.1] [76.6–90.7] [80.6–83.7] [89.2–92.2] ... [85.7–93.2] [92.7–97.8] [89.0–92.3] [83.3–91.3] [86.2–91.1] [86.8–90.3] Both sexes 86.6 87.8 ... ... ... 89.2 ... 82.1 ... 89.9 77.4 79.8 83.2 ... ... ... 77.2 85.9 91.9 80.9 ... 86.1 88.0 89.6 ... 84.4 77.1 ... ... 86.1 81.5 81.4 82.2 ... 88.3 85.6 77.2 82.6 79.0 80.4 72.6 84.2 ... 89.2 91.8 86.7 84.3 90.1 87.2 [95% CI] [84.3–88.7] [85.8–89.5] ... ... ... [86.4–91.7] ... [78.3–85.5] ... [88.2–91.5] [75.4–79.2] [77.9–81.5] [80.3–85.9] ... ... ... [75.2–79.1] [84.1–87.5] [89.7–93.7] [78.9–82.8] ... [84.7–87.5] [86.6–89.2] [87.8–91.3] ... [82.8–85.8] [74.8–79.3] ... ... [84.2–87.9] [78.5–84.2] [79.6–83.0] [80.5–83.8] ... [84.2–91.6] [83.8–87.3] [75.4–79.0] [79.4–85.4] [77.9–80.0] [72.2–88.8] [71.4–73.9] [82.7–85.6] ... [85.7–92.0] [88.2–95.9] [85.3–88.0] [81.0–87.2] [88.3–91.8] [85.8–88.6] Latest year with data 2007 2011 ... ... ... 2005 ... 2007 ... 2012 2010 2010 2011 ... ... ... 2010 2008 2012 2009 ... 2010 2010 2010 ... 2008 2010 ... ... 2010 2011 2008 2010 ... 2012 2003 2010 2010 2010 2006 2013 2012 ... 2011 2003 2013 2008 2004 2003 Latest year with national data 2007 2011 ... ... ... 2005 ... 2007 ... 2012 2010 2010 2011 ... ... ... 2010 2008 2012 2009 ... 2010 2010 2010 ... 2008 2010 ... ... 2010 2011 2008 2010 ... 2012 2003 2010 2010 2010 ... 2013 2012 ... 2011 ... 2013 2008 2004 ...

183

Global status report on NCDs 2014

4.5 Tobacco Comparable estimates of prevalence of current tobacco smoking (population aged 15+ years), 2010 Current tobacco smoking Crude adjusted estimates Males Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic EMR EUR AFR EUR AFR AMR AMR EUR WPR EUR EUR AMR EMR SEAR AMR EUR EUR AMR AFR SEAR AMR EUR AFR AMR WPR EUR AFR AFR AFR WPR AFR AMR AFR AFR AMR WPR AMR AFR AFR WPR AMR AFR EUR AMR EUR EUR ... 51.6 ... 37.5 ... ... 33.3 ... 19.2 ... ... ... 33.4 46.3 13.4 51.9 28.7 ... ... ... 38.6 49.7 ... 22.1 28.4 45.2 31.7 ... ... 41.3 25.5 20.6 ... ... 41.7 50.8 ... ... ... ... 21.0 ... 37.4 ... ... 36.4 [95% CI] ... [ 40.8 - 61.5] ... [ 28.1 - 48.1] ... ... [ 27.6 - 40.1] ... [ 16.1 - 22.9] ... ... ... [ 25.5 - 40.9] [ 37.8 - 54.9] [ 8.8 - 18.4] [ 42.5 - 62.3] [ 20.4 - 38.4] ... ... ... [ 21.1 - 58.7] [ 37.8 - 62.0] ... [ 17.7 - 26.7] [ 14.6 - 47.9] [ 36.4 - 53.7] [ 22.1 - 41.8] ... ... [ 30.8 - 52.3] [ 16.4 - 36.5] [ 17.1 - 24.1] ... ... [ 30.9 - 52.4] [ 40.8 - 60.1] ... ... ... ... [ 12.4 - 28.9] ... [ 30.3 - 45.9] ... ... [ 30.3 - 43.0] Females ... 9.3 ... 25.1 ... ... 21.6 ... 15.1 ... ... ... 6.4 1.4 1.1 10.0 21.3 ... ... ... 19.9 31.0 ... 13.4 3.2 26.4 5.0 ... ... 3.6 0.9 15.3 ... ... 36.1 2.3 ... ... ... ... 9.7 ... 26.1 ... ... 26.1 [95% CI] ... [ 6.6 - 11.9] ... [ 18.6 - 33.0] ... ... [ 17.6 - 25.4] ... [ 12.4 - 17.6] ... ... ... [ 4.1 - 8.8] [ 1.0 - 1.9] [ 0.6 - 1.8] [ 8.1 - 12.0] [ 14.0 - 29.5] ... ... ... [ 12.2 - 29.5] [ 23.1 - 39.3] ... [ 10.9 - 16.1] [ 1.4 - 5.3] [ 20.6 - 32.3] [ 2.7 - 7.6] ... ... [ 2.9 - 4.4] [ 0.3 - 1.6] [ 13.0 - 17.7] ... ... [ 26.2 - 45.0] [ 1.9 - 2.8] ... ... ... ... [ 5.3 - 15.2] ... [ 20.3 - 31.5] ... ... [ 21.2 - 30.4] Both sexes ... 30.6 ... 31.3 ... ... 27.6 ... 17.2 ... ... ... 15.8 23.6 7.3 32.8 25.1 ... ... ... 29.4 40.7 ... 17.8 15.7 36.1 18.7 ... ... 23.4 13.3 18.0 ... ... 39.0 25.9 ... ... ... ... 15.3 ... 32.0 ... ... 31.4 [95% CI] ... [ 23.8 - 36.8] ... [ 23.3 - 40.6] ... ... [ 22.8 - 33.0] ... [ 14.3 - 20.3] ... ... ... [ 11.5 - 19.9] [ 19.2 - 28.0] [ 4.7 - 10.2] [ 26.8 - 39.3] [ 17.3 - 34.1] ... ... ... [ 16.7 - 44.3] [ 30.7 - 51.0] ... [ 14.4 - 21.5] [ 7.9 - 26.4] [ 28.8 - 43.4] [ 12.7 - 25.2] ... ... [ 17.5 - 29.5] [ 8.4 - 19.2] [ 15.1 - 21.0] ... ... [ 28.6 - 48.8] [ 20.8 - 30.7] ... ... ... ... [ 8.8 - 22.0] ... [ 25.5 - 39.1] ... ... [ 25.9 - 36.9]

Country name

Region

184

Annex 4.5: Tobacco

… Indicates no data were available Current tobacco smoking Age-standardized Males ... 51.9 ... 39.0 ... ... 33.5 ... 19.6 ... ... ... 32.9 47.1 13.5 51.6 29.8 ... ... ... 38.1 50.2 ... 22.2 28.5 47.3 31.6 ... ... 46.7 27.4 21.1 ... ... 41.7 49.9 ... ... ... ... 21.1 ... 39.2 ... ... 37.5 [95% CI] ... [ 42.1 - 62.5] ... [ 29.3 - 50.4] ... ... [ 27.7 - 40.3] ... [ 16.4 - 23.4] ... ... ... [ 24.9 - 39.8] [ 38.6 - 55.6] [ 8.7 - 18.5] [ 42.4 - 61.9] [ 20.7 - 39.8] ... ... ... [ 21.0 - 56.7] [ 37.9 - 62.3] ... [ 17.9 - 26.8] [ 14.6 - 47.5] [ 38.3 - 56.7] [ 22.0 - 41.1] ... ... [ 34.6 - 58.2] [ 17.1 - 37.8] [ 17.5 - 24.6] ... ... [ 30.8 - 52.3] [ 40.1 - 58.9] ... ... ... ... [ 12.7 - 29.2] ... [ 31.8 - 48.4] ... ... [ 30.8 - 43.9] Females ... 9.1 ... 28.6 ... ... 22.6 ... 15.8 ... ... ... 7.2 1.6 1.2 11.4 22.8 ... ... ... 19.7 31.9 ... 13.3 3.3 32.2 5.5 ... ... 4.0 0.9 16.0 ... ... 36.9 2.2 ... ... ... ... 9.7 ... 30.3 ... ... 28.8 [95% CI] ... [ 6.6 - 11.7] ... [ 20.0 - 36.8] ... ... [ 18.4 - 26.6] ... [ 13.0 - 18.5] ... ... ... [ 4.8 - 10.0] [ 1.2 - 2.1] [ 0.6 - 1.8] [ 9.3 - 13.7] [ 14.9 - 31.7] ... ... ... [ 12.6 - 29.8] [ 24.2 - 40.7] ... [ 10.8 - 16.0] [ 1.5 - 5.5] [ 25.0 - 40.2] [ 3.0 - 8.2] ... ... [ 3.2 - 4.8] [ 0.3 - 1.7] [ 13.6 - 18.4] ... ... [ 27.1 - 46.5] [ 1.8 - 2.7] ... ... ... ... [ 5.6 - 15.6] ... [ 23.5 - 36.6] ... ... [ 23.6 - 33.9] Both sexes ... 30.6 ... 33.8 ... ... 28.2 ... 17.7 ... ... ... 16.2 24.0 7.4 33.3 26.4 ... ... ... 29.1 41.3 ... 17.9 15.8 40.0 19.0 ... ... 26.4 14.2 18.6 ... ... 39.3 25.4 ... ... ... ... 15.3 ... 35.0 ... ... 33.3 [95% CI] ... [ 24.4 - 37.2] ... [ 24.6 - 43.6] ... ... [ 23.2 - 33.7] ... [ 14.7 - 21.0] ... ... ... [ 11.8 - 20.4] [ 19.6 - 28.5] [ 4.7 - 10.3] [ 27.3 - 39.9] [ 17.9 - 35.9] ... ... ... [ 16.9 - 43.5] [ 31.3 - 51.9] ... [ 14.4 - 21.6] [ 8.0 - 26.3] [ 31.9 - 48.7] [ 12.8 - 25.2] ... ... [ 19.7 - 32.8] [ 8.8 - 19.9] [ 15.5 - 21.6] ... ... [ 29.0 - 49.5] [ 20.4 - 30.1] ... ... ... ... [ 9.1 - 22.3] ... [ 27.9 - 42.8] ... ... [ 27.3 - 39.0] Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic

Country name

185

Global status report on NCDs 2014 … Indicates no data were available Current tobacco smoking Crude adjusted estimates Males Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea–Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland* Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho * Cigarette smoking only SEAR AFR EUR EMR AMR AMR AMR EMR AMR AFR AFR EUR AFR WPR EUR EUR AFR AFR EUR EUR AFR EUR AMR AMR AFR AFR AMR AMR AMR EUR EUR SEAR SEAR EMR EMR EUR EUR EUR AMR WPR EMR EUR AFR WPR EMR EUR WPR EUR EMR AFR ... ... 24.4 ... ... 18.5 15.8 41.2 ... ... ... 44.3 7.9 ... 25.0 32.1 ... ... 57.0 32.6 ... 56.5 ... ... ... ... ... 19.2 40.2 34.8 20.5 24.0 67.7 ... ... 24.8 40.7 28.8 29.7 ... ... 47.4 24.8 ... ... 48.2 ... 49.7 41.9 46.7 [95% CI] ... ... [ 19.9 - 29.3] ... ... [ 13.8 - 23.7] [ 11.0 - 21.4] [ 32.7 - 49.8] ... ... ... [ 36.6 - 53.2] [ 5.7 - 10.1] ... [ 21.1 - 29.0] [ 23.2 - 40.5] ... ... [ 45.9 - 70.0] [ 27.3 - 38.3] ... [ 41.2 - 72.1] ... ... ... ... ... [ 12.5 - 26.3] [ 28.5 - 54.4] [ 27.9 - 42.4] [ 14.1 - 27.1] [ 19.0 - 28.7] [ 54.0 - 80.4] ... ... [ 19.3 - 30.4] [ 31.6 - 52.6] [ 24.3 - 33.6] [ 17.3 - 42.3] ... ... [ 38.0 - 56.4] [ 18.3 - 31.6] ... ... [ 38.8 - 58.0] ... [ 40.1 - 58.8] [ 31.9 - 52.6] [ 34.0 - 60.9] Females ... ... 21.2 ... ... 10.7 3.7 0.5 ... ... ... 22.6 0.5 ... 17.7 23.3 ... ... 5.6 25.5 ... 34.7 ... ... ... ... ... 2.9 2.5 25.0 18.1 2.5 3.8 ... ... 23.3 20.3 18.2 6.8 ... ... 10.1 2.2 ... ... 4.0 ... 20.9 28.1 0.5 [95% CI] ... ... [ 17.3 - 25.8] ... ... [ 7.7 - 13.7] [ 2.2 - 5.9] [ 0.3 - 0.6] ... ... ... [ 19.0 - 27.1] [ 0.3 - 0.8] ... [ 14.8 - 21.1] [ 18.3 - 29.6] ... ... [ 4.3 - 6.9] [ 21.6 - 30.3] ... [ 19.9 - 49.7] ... ... ... ... ... [ 1.7 - 4.3] [ 1.5 - 3.8] [ 19.6 - 30.2] [ 12.9 - 22.8] [ 2.0 - 3.1] [ 3.0 - 4.6] ... ... [ 18.5 - 29.0] [ 15.0 - 26.5] [ 15.1 - 21.1] [ 4.0 - 10.2] ... ... [ 7.6 - 12.5] [ 1.5 - 3.1] ... ... [ 2.8 - 5.3] ... [ 17.3 - 25.7] [ 20.8 - 35.3] [ 0.2 - 0.8] Both sexes ... ... 22.8 ... ... 14.6 9.8 20.9 ... ... ... 34.5 4.2 ... 21.5 27.9 ... ... 33.4 29.1 ... 45.8 ... ... ... ... ... 11.3 21.6 30.2 19.3 12.9 35.9 ... ... 24.1 30.8 23.7 18.5 ... ... 29.8 13.6 ... ... 26.7 ... 36.8 34.8 24.4 [95% CI] ... ... [ 18.6 - 27.6] ... ... [ 10.8 - 18.7] [ 6.6 - 13.7] [ 16.6 - 25.3] ... ... ... [ 28.6 - 41.3] [ 3.0 - 5.5] ... [ 18.0 - 25.1] [ 20.9 - 35.3] ... ... [ 26.8 - 41.1] [ 24.5 - 34.4] ... [ 30.8 - 61.1] ... ... ... ... ... [ 7.2 - 15.6] [ 15.2 - 29.4] [ 24.0 - 36.7] [ 13.5 - 24.9] [ 10.2 - 15.5] [ 28.6 - 42.6] ... ... [ 18.9 - 29.7] [ 23.5 - 39.9] [ 19.9 - 27.6] [ 10.8 - 26.7] ... ... [ 23.7 - 35.7] [ 10.0 - 17.5] ... ... [ 21.3 - 32.4] ... [ 29.9 - 44.0] [ 26.2 - 43.7] [ 17.6 - 31.9]

Country name

Region

186

Annex 4.5: Tobacco

Current tobacco smoking Age-standardized Males ... ... 24.0 ... ... 19.8 16.1 42.4 ... ... ... 45.0 8.8 ... 26.2 33.9 ... ... 58.3 35.3 ... 56.5 ... ... ... ... ... 20.4 40.4 36.2 20.7 25.0 68.1 ... ... 25.2 41.0 29.5 30.0 ... ... 47.3 26.0 ... ... 49.5 ... 50.2 42.0 47.7 [95% CI] ... ... [ 19.7 - 29.2] ... ... [ 14.9 - 25.4] [ 11.2 - 21.7] [ 33.6 - 51.0] ... ... ... [ 36.4 - 53.1] [ 6.6 - 11.3] ... [ 22.2 - 30.6] [ 24.6 - 42.7] ... ... [ 47.0 - 72.0] [ 29.3 - 41.5] ... [ 42.2 - 74.6] ... ... ... ... ... [ 14.0 - 28.4] [ 27.5 - 53.5] [ 28.3 - 43.5] [ 14.2 - 27.4] [ 20.2 - 30.3] [ 55.0 - 81.7] ... ... [ 19.5 - 31.1] [ 30.5 - 51.7] [ 25.0 - 34.5] [ 17.6 - 43.0] ... ... [ 37.7 - 55.9] [ 19.6 - 33.2] ... ... [ 40.0 - 58.9] ... [ 40.4 - 59.0] [ 32.0 - 52.8] [ 35.3 - 63.2] Females ... ... 21.1 ... ... 11.4 3.8 0.5 ... ... ... 25.9 0.5 ... 20.6 26.9 ... ... 5.9 30.4 ... 36.6 ... ... ... ... ... 3.0 2.6 28.6 18.5 3.0 4.3 ... ... 23.9 20.5 19.9 6.8 ... ... 10.1 2.5 ... ... 3.9 ... 24.2 29.0 0.5 [95% CI] ... ... [ 17.3 - 25.8] ... ... [ 8.3 - 14.7] [ 2.0 - 5.7] [ 0.3 - 0.6] ... ... ... [ 21.7 - 30.8] [ 0.3 - 0.8] ... [ 16.9 - 24.3] [ 20.9 - 34.4] ... ... [ 4.5 - 7.4] [ 25.7 - 36.3] ... [ 23.1 - 55.0] ... ... ... ... ... [ 1.7 - 4.4] [ 1.5 - 3.9] [ 22.3 - 34.8] [ 13.7 - 24.1] [ 2.3 - 3.6] [ 3.4 - 5.2] ... ... [ 18.6 - 29.6] [ 15.3 - 27.0] [ 16.8 - 23.4] [ 4.0 - 10.2] ... ... [ 7.8 - 12.7] [ 1.7 - 3.4] ... ... [ 2.8 - 5.2] ... [ 19.4 - 29.2] [ 21.4 - 36.3] [ 0.2 - 0.8] Both sexes ... ... 22.6 ... ... 15.6 10.0 21.5 ... ... ... 36.3 4.7 ... 23.5 30.6 ... ... 34.3 32.9 ... 46.8 ... ... ... ... ... 12.0 21.7 32.6 19.6 13.7 36.3 ... ... 24.5 31.0 24.9 18.7 ... ... 29.7 14.3 ... ... 27.4 ... 38.6 35.3 24.9 [95% CI] ... ... [ 18.5 - 27.5] ... ... [ 11.6 - 20.1] [ 6.7 - 13.8] [ 17.0 - 25.9] ... ... ... [ 29.7 - 43.0] [ 3.5 - 6.1] ... [ 19.6 - 27.5] [ 22.8 - 38.7] ... ... [ 27.5 - 42.3] [ 27.6 - 39.0] ... [ 32.9 - 65.0] ... ... ... ... ... [ 8.0 - 16.7] [ 14.7 - 29.0] [ 25.5 - 39.5] [ 14.0 - 25.7] [ 11.0 - 16.6] [ 29.2 - 43.6] ... ... [ 19.1 - 30.4] [ 23.1 - 39.7] [ 21.1 - 29.2] [ 11.0 - 27.1] ... ... [ 23.6 - 35.5] [ 10.7 - 18.4] ... ... [ 21.9 - 32.8] ... [ 31.0 - 45.7] [ 26.5 - 44.3] [ 18.3 - 33.0]

Country name

Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea–Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland* Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho

187

Global status report on NCDs 2014 … Indicates no data were available Current tobacco smoking Crude adjusted estimates Males Liberia Libya Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (Federated States of) Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Korea Republic of Moldova Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines AFR EMR EUR EUR AFR AFR WPR SEAR AFR EUR WPR AFR AFR AMR WPR EUR WPR EUR EMR AFR SEAR AFR WPR SEAR EUR WPR AMR AFR AFR WPR EUR EMR EMR WPR AMR WPR AMR AMR WPR EUR EUR EMR WPR EUR EUR EUR AFR AMR AMR AMR ... ... 41.7 ... ... 23.5 48.1 40.7 30.6 31.5 ... 36.7 42.6 26.1 ... ... 49.8 ... ... 32.5 40.0 32.8 ... ... 30.9 20.0 ... 14.9 ... 23.2 28.1 17.5 37.5 41.4 14.4 ... 32.1 ... 48.2 36.2 30.3 ... ... 43.3 41.3 61.1 20.6 ... ... ... [95% CI] ... ... [ 33.0 - 50.6] ... ... [ 18.8 - 28.9] [ 35.0 - 60.0] [ 30.3 - 51.8] [ 22.5 - 39.5] [ 25.0 - 39.2] ... [ 27.5 - 47.3] [ 33.9 - 52.2] [ 21.3 - 30.4] ... ... [ 40.7 - 60.0] ... ... [ 21.4 - 44.4] [ 30.9 - 51.2] [ 22.5 - 42.1] ... ... [ 24.8 - 36.6] [ 16.8 - 23.4] ... [ 10.7 - 18.6] ... [ 15.8 - 31.8] [ 23.8 - 33.0] [ 11.1 - 23.7] [ 27.6 - 47.4] [ 14.1 - 75.8] [ 11.2 - 17.7] ... [ 23.9 - 41.9] ... [ 39.5 - 57.3] [ 30.4 - 43.8] [ 23.8 - 37.3] ... ... [ 35.2 - 52.2] [ 33.1 - 49.0] [ 51.3 - 74.0] [ 15.6 - 26.1] ... ... ... Females ... ... 18.8 ... ... 6.2 1.8 4.6 3.2 20.3 ... 4.5 3.6 8.6 ... ... 6.2 ... ... 6.0 8.7 10.9 ... ... 26.5 18.2 ... 0.2 ... 12.7 26.9 1.0 3.6 13.2 3.2 ... 9.7 6.8 8.4 25.8 12.3 ... ... 5.0 22.5 19.1 5.1 ... ... ... [95% CI] ... ... [ 15.0 - 23.0] ... ... [ 3.9 - 9.0] [ 1.3 - 2.4] [ 3.1 - 6.3] [ 1.7 - 4.9] [ 15.8 - 25.1] ... [ 2.9 - 5.9] [ 2.8 - 4.5] [ 7.0 - 10.0] ... ... [ 4.9 - 7.8] ... ... [ 2.7 - 9.7] [ 5.5 - 12.9] [ 7.8 - 13.7] ... ... [ 21.8 - 31.0] [ 15.2 - 21.1] ... [ 0.1 - 0.4] ... [ 8.4 - 17.4] [ 21.9 - 31.2] [ 0.4 - 1.7] [ 2.7 - 4.8] [ 6.1 - 22.9] [ 2.5 - 4.0] ... [ 7.1 - 13.0] [ 5.2 - 8.5] [ 6.8 - 9.9] [ 21.2 - 31.6] [ 8.9 - 15.9] ... ... [ 3.8 - 6.0] [ 18.5 - 26.9] [ 15.7 - 23.1] [ 2.9 - 7.3] ... ... ... Both sexes ... ... 31.3 ... ... 14.9 25.6 22.6 16.9 25.9 ... 20.6 23.4 17.8 ... ... 28.3 ... ... 19.9 25.0 22.4 ... ... 28.7 19.1 ... 7.6 ... 18.0 27.5 7.3 20.2 27.3 8.8 ... 20.8 ... 28.5 31.2 21.7 ... ... 25.4 32.3 42.1 13.2 ... ... ... [95% CI] ... ... [ 24.9 - 38.1] ... ... [ 11.4 - 19.0] [ 18.6 - 32.0] [ 16.7 - 29.1] [ 12.1 - 22.2] [ 20.4 - 32.2] ... [ 15.2 - 26.6] [ 18.6 - 28.7] [ 14.6 - 20.8] ... ... [ 23.1 - 34.3] ... ... [ 12.5 - 27.9] [ 18.7 - 32.9] [ 15.5 - 28.6] ... ... [ 23.3 - 33.9] [ 16.0 - 22.3] ... [ 5.4 - 9.6] ... [ 12.1 - 24.6] [ 22.9 - 32.1] [ 4.5 - 10.2] [ 14.9 - 25.7] [ 10.1 - 49.4] [ 6.8 - 10.8] ... [ 15.4 - 27.4] ... [ 23.3 - 33.8] [ 26.0 - 38.0] [ 16.7 - 27.0] ... ... [ 20.5 - 30.6] [ 26.1 - 38.3] [ 35.2 - 50.9] [ 9.5 - 17.1] ... ... ...

Country name

Region

188

Annex 4.5: Tobacco

Current tobacco smoking Age-standardized Males ... ... 42.1 ... ... 27.6 47.4 40.2 29.4 32.4 ... 34.0 42.5 25.7 ... ... 50.7 ... ... 34.3 40.6 34.5 ... ... 31.1 21.0 ... 14.6 ... 23.2 28.3 17.2 39.7 41.2 14.4 ... 32.7 ... 48.1 36.1 32.5 ... ... 43.6 41.9 61.0 23.7 ... ... ... [95% CI] ... ... [ 33.3 - 51.2] ... ... [ 21.7 - 33.9] [ 35.7 - 59.9] [ 30.0 - 50.9] [ 21.9 - 37.1] [ 25.3 - 40.4] ... [ 25.4 - 43.3] [ 33.8 - 52.1] [ 21.1 - 30.0] ... ... [ 41.6 - 60.9] ... ... [ 22.8 - 47.2] [ 31.1 - 52.0] [ 23.9 - 44.0] ... ... [ 25.3 - 37.3] [ 17.6 - 24.5] ... [ 10.6 - 18.2] ... [ 16.2 - 31.6] [ 23.9 - 33.3] [ 11.2 - 23.2] [ 29.9 - 50.7] [ 15.8 - 77.3] [ 11.2 - 17.5] ... [ 24.4 - 42.1] ... [ 39.5 - 56.7] [ 30.0 - 43.4] [ 24.9 - 40.1] ... ... [ 35.5 - 52.6] [ 33.3 - 49.5] [ 51.3 - 74.3] [ 17.6 - 30.0] ... ... ... Females ... ... 21.5 ... ... 7.3 1.9 5.1 3.4 22.5 ... 4.2 3.7 8.5 ... ... 6.5 ... ... 6.3 9.1 12.2 ... ... 27.9 19.4 ... 0.2 ... 12.8 27.9 1.1 4.1 13.2 3.2 ... 10.1 6.9 9.5 27.8 14.3 ... ... 5.4 24.5 22.1 5.8 ... ... ... [95% CI] ... ... [ 17.3 - 26.2] ... ... [ 4.8 - 10.5] [ 1.3 - 2.6] [ 3.4 - 6.9] [ 1.8 - 5.0] [ 17.1 - 27.8] ... [ 2.8 - 5.5] [ 2.8 - 4.6] [ 6.9 - 9.9] ... ... [ 5.2 - 8.3] ... ... [ 2.8 - 10.1] [ 5.8 - 13.5] [ 8.9 - 15.5] ... ... [ 23.1 - 33.0] [ 16.3 - 22.6] ... [ 0.1 - 0.4] ... [ 8.7 - 17.5] [ 23.0 - 32.4] [ 0.5 - 1.8] [ 2.9 - 5.3] [ 6.2 - 22.7] [ 2.5 - 4.0] ... [ 7.2 - 13.2] [ 5.3 - 8.8] [ 7.7 - 11.2] [ 22.6 - 33.8] [ 10.0 - 18.6] ... ... [ 4.2 - 6.5] [ 19.8 - 28.8] [ 17.9 - 26.7] [ 3.7 - 8.5] ... ... ... Both sexes ... ... 32.8 ... ... 17.5 25.3 22.6 16.4 27.5 ... 19.1 23.4 17.6 ... ... 28.9 ... ... 21.0 25.5 23.9 ... ... 29.5 20.2 ... 7.5 ... 18.0 28.1 7.3 21.5 27.2 8.8 ... 21.3 ... 29.0 32.1 23.8 ... ... 25.7 33.5 43.3 15.1 ... ... ... [95% CI] ... ... [ 26.1 - 39.9] ... ... [ 13.4 - 22.3] [ 19.0 - 32.1] [ 16.7 - 28.9] [ 11.9 - 21.1] [ 21.2 - 34.2] ... [ 14.1 - 24.4] [ 18.5 - 28.7] [ 14.4 - 20.5] ... ... [ 23.7 - 35.0] ... ... [ 13.3 - 29.5] [ 19.0 - 33.6] [ 16.8 - 30.5] ... ... [ 24.2 - 35.2] [ 17.0 - 23.6] ... [ 5.4 - 9.4] ... [ 12.5 - 24.5] [ 23.4 - 32.8] [ 4.6 - 10.0] [ 16.1 - 27.5] [ 11.0 - 50.0] [ 6.8 - 10.7] ... [ 15.8 - 27.6] ... [ 23.8 - 34.2] [ 26.5 - 38.8] [ 17.8 - 29.8] ... ... [ 20.8 - 31.1] [ 26.8 - 39.5] [ 36.2 - 52.7] [ 11.0 - 19.7] ... ... ...

Country name

Liberia Libya Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (Federated States of) Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Korea Republic of Moldova Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines

189

Global status report on NCDs 2014 … Indicates no data were available Current tobacco smoking Crude adjusted estimates Males Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand the former Yugoslav Republic of Macedonia Timor–Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom* United Republic of Tanzania United States of America* Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe * Cigarette smoking only WPR EUR AFR EMR AFR EUR AFR AFR WPR EUR EUR WPR EMR AFR AFR EUR SEAR EMR AMR AFR EUR EUR EMR EUR SEAR EUR SEAR AFR WPR AMR EMR EUR EUR WPR AFR EUR EMR EUR AFR AMR AMR EUR WPR AMR WPR EMR AFR AFR 47.4 ... 10.3 ... ... ... 43.8 49.4 27.4 39.1 23.5 ... ... ... ... 34.3 29.2 ... 57.2 16.4 23.7 30.4 ... ... ... ... ... ... 48.3 ... ... 46.1 ... ... 18.2 52.3 ... 22.3 29.3 21.5 31.7 25.0 ... ... 48.5 ... 24.9 ... [95% CI] [ 34.4 - 59.8] ... [ 6.4 - 14.3] ... ... ... [ 31.8 - 57.0] [ 37.4 - 62.0] [ 21.8 - 33.2] [ 26.9 - 52.0] [ 19.4 - 29.0] ... ... ... ... [ 28.3 - 40.8] [ 22.0 - 36.7] ... [ 28.4 - 94.5] [ 12.3 - 21.0] [ 19.5 - 27.7] [ 25.6 - 35.7] ... ... ... ... ... ... [ 38.5 - 60.4] ... ... [ 38.6 - 56.0] ... ... [ 12.4 - 24.2] [ 43.7 - 61.8] ... [ 18.3 - 26.3] [ 22.3 - 38.2] [ 18.2 - 25.4] [ 25.7 - 38.0] [ 16.8 - 33.6] ... ... [ 39.8 - 58.7] ... [ 18.4 - 32.2] ... Females 20.9 ... 1.8 ... ... ... 8.9 14.6 4.5 17.9 17.0 ... ... ... ... 24.6 0.7 ... 11.9 2.3 23.3 22.3 ... ... ... ... ... ... 13.6 ... ... 14.7 ... ... 2.8 11.6 ... 19.8 3.7 16.6 21.9 1.4 ... ... 1.3 ... 4.0 ... [95% CI] [ 15.4 - 27.3] ... [ 0.9 - 2.7] ... ... ... [ 5.9 - 12.1] [ 8.8 - 21.4] [ 3.5 - 5.5] [ 10.2 - 25.5] [ 13.7 - 20.8] ... ... ... ... [ 19.4 - 29.0] [ 0.4 - 0.9] ... [ 5.5 - 19.9] [ 1.5 - 3.3] [ 19.3 - 27.7] [ 18.8 - 26.5] ... ... ... ... ... ... [ 10.0 - 16.7] ... ... [ 12.3 - 17.4] ... ... [ 2.0 - 3.7] [ 9.6 - 13.6] ... [ 16.5 - 23.5] [ 2.1 - 5.6] [ 13.6 - 19.4] [ 17.6 - 26.2] [ 0.8 - 2.0] ... ... [ 1.1 - 1.6] ... [ 2.3 - 5.6] ... Both sexes 33.8 ... 6.1 ... ... ... 26.0 32.2 16.2 28.9 20.3 ... ... ... ... 29.5 15.4 ... 34.6 9.6 23.5 26.5 ... ... ... ... ... ... 31.3 ... ... 30.9 ... ... 10.5 33.8 ... 21.1 16.6 19.1 27.1 13.3 ... ... 25.6 ... 14.5 ... [95% CI] [ 24.6 - 43.1] ... [ 3.8 - 8.7] ... ... ... [ 18.6 - 34.1] [ 23.3 - 41.9] [ 12.9 - 19.6] [ 18.9 - 39.2] [ 16.6 - 24.9] ... ... ... ... [ 24.0 - 35.0] [ 11.5 - 19.3] ... [ 17.0 - 57.3] [ 7.1 - 12.4] [ 19.4 - 27.7] [ 22.3 - 31.2] ... ... ... ... ... ... [ 24.6 - 39.0] ... ... [ 25.8 - 37.3] ... ... [ 7.2 - 14.0] [ 28.2 - 40.0] ... [ 17.4 - 24.9] [ 12.3 - 22.0] [ 15.9 - 22.5] [ 21.8 - 32.4] [ 8.9 - 18.0] ... ... [ 21.0 - 31.0] ... [ 10.4 - 19.0] ...

Country name

Region

190

Annex 4.5: Tobacco

Current tobacco smoking Age-standardized Males 48.2 ... 11.4 ... ... ... 43.9 51.6 27.2 39.6 24.6 ... ... ... ... 35.4 29.1 ... 57.2 17.5 23.7 31.9 ... ... ... ... ... ... 48.7 ... ... 45.2 ... ... 19.9 52.5 ... 23.4 30.9 21.9 32.5 26.1 ... ... 48.8 ... 27.5 ... [95% CI] [ 36.1 - 61.3] ... [ 7.4 - 15.5] ... ... ... [ 31.8 - 57.1] [ 39.2 - 64.0] [ 21.8 - 33.0] [ 27.6 - 53.4] [ 20.0 - 30.4] ... ... ... ... [ 29.3 - 42.4] [ 21.8 - 36.4] ... [ 34.0 - 100.0] [ 13.3 - 22.1] [ 19.5 - 27.7] [ 26.8 - 37.4] ... ... ... ... ... ... [ 38.4 - 59.9] ... ... [ 37.3 - 54.3] ... ... [ 13.8 - 26.0] [ 43.9 - 62.4] ... [ 19.4 - 27.7] [ 23.2 - 39.4] [ 18.4 - 25.8] [ 26.4 - 39.1] [ 17.9 - 35.2] ... ... [ 39.1 - 58.0] ... [ 20.4 - 35.0] ... Females 21.2 ... 1.8 ... ... ... 8.9 14.6 5.0 18.7 19.3 ... ... ... ... 28.7 0.7 ... 11.9 2.5 24.5 24.6 ... ... ... ... ... ... 13.5 ... ... 14.5 ... ... 3.4 14.4 ... 21.3 4.1 17.3 24.1 1.4 ... ... 1.4 ... 4.9 ... [95% CI] [ 15.5 - 27.6] ... [ 1.0 - 2.8] ... ... ... [ 5.9 - 12.1] [ 9.2 - 21.3] [ 3.9 - 6.2] [ 10.8 - 27.6] [ 15.6 - 24.1] ... ... ... ... [ 22.6 - 33.9] [ 0.5 - 0.9] ... [ 5.5 - 20.0] [ 1.7 - 3.6] [ 20.3 - 29.2] [ 20.6 - 28.9] ... ... ... ... ... ... [ 10.0 - 16.6] ... ... [ 11.9 - 16.9] ... ... [ 2.4 - 4.5] [ 11.9 - 17.0] ... [ 18.0 - 25.6] [ 2.2 - 5.9] [ 14.3 - 20.4] [ 19.1 - 28.8] [ 0.8 - 2.1] ... ... [ 1.1 - 1.7] ... [ 3.2 - 6.9] ... Both sexes 34.3 ... 6.8 ... ... ... 26.1 33.3 16.3 29.5 22.0 ... ... ... ... 32.1 15.3 ... 34.6 10.3 24.1 28.3 ... ... ... ... ... ... 31.5 ... ... 30.3 ... ... 11.6 35.2 ... 22.3 17.6 19.7 28.5 13.9 ... ... 25.8 ... 16.3 ... [95% CI] [ 25.5 - 44.0] ... [ 4.3 - 9.3] ... ... ... [ 18.6 - 34.2] [ 24.4 - 42.9] [ 13.1 - 19.9] [ 19.5 - 41.0] [ 17.8 - 27.3] ... ... ... ... [ 26.0 - 38.2] [ 11.4 - 19.2] ... [ 19.8 - 60.2] [ 7.7 - 13.1] [ 19.9 - 28.4] [ 23.7 - 33.2] ... ... ... ... ... ... [ 24.5 - 38.7] ... ... [ 25.0 - 36.2] ... ... [ 8.1 - 15.3] [ 29.4 - 41.8] ... [ 18.7 - 26.7] [ 12.8 - 22.8] [ 16.4 - 23.1] [ 23.0 - 34.2] [ 9.5 - 18.9] ... ... [ 20.7 - 30.6] ... [ 11.8 - 21.0] ...

Country name

Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand the former Yugoslav Republic of Macedonia Timor–Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom* United Republic of Tanzania United States of America* Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe

191

Global status report on NCDs 2014

4.5 Tobacco (continued) Comparable estimates of prevalence of current tobacco smoking (population aged 15+ years), 2012 Current tobacco smoking Crude adjusted estimates Males Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic EMR EUR AFR EUR AFR AMR AMR EUR WPR EUR EUR AMR EMR SEAR AMR EUR EUR AMR AFR SEAR AMR EUR AFR AMR WPR EUR AFR AFR AFR WPR AFR AMR AFR AFR AMR WPR AMR AFR AFR WPR AMR AFR EUR AMR EUR EUR ... 50.7 ... 36.5 ... ... 31.4 ... 17.9 ... ... ... 37.1 44.2 13.4 49.7 28.4 ... ... ... 36.3 48.2 ... 20.9 28.4 43.2 33.6 ... ... 41.1 30.4 19.2 ... ... 40.0 50.1 ... ... ... ... 19.9 ... 37.0 ... ... 35.2 [95% CI] ... [40.1–62.1] ... [27.1–47.9] ... ... [25.7–37.2] ... [14.5–21.1] ... ... ... [28.5–47.2] [36.0–53.7] [8.6–18.4] [41.0–59.7] [19.3–37.0] ... ... ... [19.7–56.3] [35.0–60.5] ... [16.4–25.5] [12.1–47.7] [34.8–52.1] [23.1–44.9] ... ... [30.7–53.2] [18.7–43.6] [16.1–22.2] ... ... [28.7–50.5] [41.6–62.0] ... ... ... ... [11.8–27.9] ... [29.0–46.1] ... ... [29.0–43.1] Females ... 9.0 ... 24.4 ... ... 20.0 ... 13.9 ... ... ... 7.1 1.1 1.1 9.8 21.2 ... ... ... 18.8 30.2 ... 12.6 3.0 25.2 4.6 ... ... 3.3 0.9 13.9 ... ... 34.5 2.3 ... ... ... ... 9.1 ... 26.0 ... ... 25.6 [95% CI] ... [6.4–11.9] ... [17.6–32.2] ... ... [15.9–23.6] ... [11.5–16.7] ... ... ... [4.6–9.9] [0.8–1.5] [0.5–1.7] [7.6–11.6] [13.4–28.8] ... ... ... [11.1–28.2] [23.1–39.9] ... [10.1–15.5] [1.3–5.2] [20.0–32.4] [2.4–7.2] ... ... [2.6–4.0] [0.3–1.7] [11.6–16.2] ... ... [25.6–43.8] [1.7–2.7] ... ... ... ... [4.9–14.3] ... [20.3–32.2] ... ... [20.4–30.5] Both sexes ... 29.7 ... 30.4 ... ... 25.5 ... 15.9 ... ... ... 26.6 22.8 7.2 28.0 24.7 ... ... ... 27.5 38.9 ... 16.6 15.8 33.9 18.7 ... ... 21.3 15.6 16.5 ... ... 37.2 26.8 ... ... ... ... 14.6 ... 31.3 ... ... 30.2 [95% CI] ... [23.1–36.8] ... [22.4–40.1] ... ... [20.7–30.2] ... [13.0–18.9] ... ... ... [20.2–34.2] [18.6–27.8] [4.5–10.0] [22.8–33.5] [16.2–32.8] ... ... ... [15.3–42.1] [28.8–49.9] ... [13.2–20.4] [6.7–26.6] [27.1–41.9] [12.4–25.5] ... ... [16.0–27.5] [9.4–22.5] [13.8–19.2] ... ... [27.1–47.1] [22.2–33.2] ... ... ... ... [8.4–21.2] ... [24.4–38.8] ... ... [24.6–36.6]

Country name

Region

192

Annex 4.5: Tobacco (continued)

… Indicates no data were available Current tobacco smoking Age-standardized Males ... 50.9 ... 38.0 ... ... 31.6 ... 18.3 ... ... ... 36.6 44.7 13.6 49.3 29.5 ... ... ... 35.9 48.7 ... 20.9 28.4 45.3 33.6 ... ... 46.0 32.6 19.7 ... ... 40.2 48.9 ... ... ... ... 19.9 ... 38.9 ... ... 36.4 [95% CI] ... [40.2–61.8] ... [27.8–49.6] ... ... [25.9–37.4] ... [14.5–21.3] ... ... ... [27.5–46.1] [35.4–53.0] [8.9–19.2] [40.6–59.1] [21.2–40.0] ... ... ... [20.1–55.6] [36.0–62.2] ... [16.4–25.4] [12.2–47.5] [36.3–54.6] [24.0–44.9] ... ... [33.8–58.5] [20.4–46.3] [16.5–22.8] ... ... [28.7–50.7] [40.2–60.3] ... ... ... ... [11.6–27.7] ... [30.2–48.2] ... ... [29.5–44.1] Females ... 8.7 ... 28.2 ... ... 21.0 ... 14.7 ... ... ... 7.9 1.3 1.1 11.2 22.8 ... ... ... 18.7 31.2 ... 12.5 3.1 31.0 5.1 ... ... 3.6 0.9 14.6 ... ... 35.4 2.1 ... ... ... ... 9.0 ... 30.5 ... ... 28.3 [95% CI] ... [6.4–11.6] ... [20.0–36.8] ... ... [16.7–24.8] ... [12.2–17.6] ... ... ... [5.0–10.8] [0.9–1.7] [0.5–1.7] [9.1–13.7] [14.4–31.0] ... ... ... [10.9–27.8] [23.6–41.1] ... [10.0–15.4] [1.3–5.2] [23.7–40.0] [2.6–7.8] ... ... [2.8–4.4] [0.3–1.7] [12.2–17.0] ... ... [26.4–45.2] [1.6–2.6] ... ... ... ... [5.0–14.4] ... [23.4–37.3] ... ... [22.6–33.7] Both sexes ... 29.6 ... 33.1 ... ... 26.1 ... 16.5 ... ... ... 26.6 23.2 7.3 28.6 26.1 ... ... ... 27.2 39.7 ... 16.6 15.9 37.9 18.9 ... ... 23.8 16.6 17.1 ... ... 37.7 26.1 ... ... ... ... 14.6 ... 34.5 ... ... 32.3 [95% CI] ... [23.2–36.5] ... [23.9–43.2] ... ... [21.2–30.9] ... [13.3–19.4] ... ... ... [19.7–33.8] [18.3–27.6] [4.7–10.4] [23.4–34.4] [17.7–35.4] ... ... ... [15.4–41.5] [29.6–51.3] ... [13.1–20.3] [6.8–26.5] [29.8–47.0] [13.0–25.9] ... ... [17.6–30.2] [10.3–23.9] [14.3–19.9] ... ... [27.5–47.9] [21.5–32.2] ... ... ... ... [8.4–21.1] ... [26.6–42.5] ... ... [26.0–38.8] Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic

Country name

193

Global status report on NCDs 2014 … Indicates no data were available Current tobacco smoking Crude adjusted estimates Males Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea–Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland* Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho * Cigarette smoking only SEAR AFR EUR EMR AMR AMR AMR EMR AMR AFR AFR EUR AFR WPR EUR EUR AFR AFR EUR EUR AFR EUR AMR AMR AFR AFR AMR AMR AMR EUR EUR SEAR SEAR EMR EMR EUR EUR EUR AMR WPR EMR EUR AFR WPR EMR EUR WPR EUR EMR AFR ... ... 22.2 ... ... 18.4 14.9 42.2 ... ... ... 42.7 7.8 ... 23.7 31.7 ... ... 55.6 32.1 ... 54.8 ... ... ... ... ... 19.6 37.8 33.0 19.1 22.7 69.7 ... ... 23.3 39.9 27.8 30.4 ... ... 45.7 24.3 ... ... 48.0 ... 48.6 43.8 48.9 [95% CI] ... ... [17.5–27.2] ... ... [13.4–23.8] [10.1–20.9] [34.4–51.4] ... ... ... [35.1–51.6] [5.5–10.1] ... [20.0–28.1] [23.4–40.4] ... ... [44.8–70.2] [25.6–37.0] ... [39.8–70.6] ... ... ... ... ... [13.1–27.7] [27.0–49.5] [25.6–41.7] [12.7–25.2] [17.6–27.6] [57.0–86.3] ... ... [17.9–29.1] [28.1–51.0] [23.0–32.3] [17.2–46.5] ... ... [35.9–56.0] [17.8–31.4] ... ... [38.8–58.9] ... [39.0–59.2] [34.3–56.0] [34.6–63.0] Females ... ... 19.4 ... ... 10.3 3.5 0.5 ... ... ... 22.2 0.5 ... 16.9 23.5 ... ... 5.4 25.7 ... 33.7 ... ... ... ... ... 2.7 2.3 24.0 17.0 2.1 3.6 ... ... 22.0 20.0 17.9 6.5 ... ... 9.8 2.1 ... ... 3.8 ... 20.6 29.9 0.5 [95% CI] ... ... [15.8–24.2] ... ... [7.1–13.4] [2.0–5.4] [0.3–0.6] ... ... ... [18.4–26.6] [0.3–0.8] ... [14.2–19.9] [17.5–29.3] ... ... [4.1–6.8] [21.2–30.9] ... [21.0–50.2] ... ... ... ... ... [1.6–4.1] [1.4–3.5] [18.7–29.7] [12.7–21.8] [1.7–2.6] [2.9–4.5] ... ... [16.7–27.5] [14.3–26.3] [14.9–21.0] [3.6–10.0] ... ... [7.3–12.5] [1.4–2.9] ... ... [2.7–5.2] ... [16.4–25.1] [22.6–38.9] [0.2–0.8] Both sexes ... ... 20.8 ... ... 14.3 9.2 21.3 ... ... ... 31.5 4.1 ... 20.2 27.4 ... ... 28.4 28.8 ... 44.1 ... ... ... ... ... 10.9 19.9 28.2 18.0 12.7 36.5 ... ... 22.7 29.7 22.7 18.1 ... ... 26.7 13.1 ... ... 25.3 ... 33.1 37.0 24.0 [95% CI] ... ... [16.6–25.7] ... ... [10.2–18.6] [6.0–13.1] [17.3–25.9] ... ... ... [26.0–37.9] [2.9–5.4] ... [17.0–23.9] [20.3–34.6] ... ... [22.8–35.8] [23.4–33.9] ... [30.2–60.2] ... ... ... ... ... [7.2–15.6] [14.1–26.3] [22.0–35.3] [12.7–23.5] [9.8–15.4] [29.9–45.3] ... ... [17.3–28.3] [21.0–38.3] [18.8–26.5] [10.2–27.8] ... ... [20.8–33.0] [9.5–17.0] ... ... [20.2–31.3] ... [26.5–40.4] [28.6–47.6] [16.9–31.0]

Country name

Region

194

Annex 4.5: Tobacco (continued)

Current tobacco smoking Age-standardized Males ... ... 22.0 ... ... 19.5 15.2 43.2 ... ... ... 43.4 8.6 ... 25.0 33.6 ... ... 57.1 35.1 ... 54.8 ... ... ... ... ... 20.8 37.9 34.4 19.3 23.6 70.0 ... ... 23.8 40.2 28.7 30.7 ... ... 45.4 25.4 ... ... 49.1 ... 49.1 43.9 50.0 [95% CI] ... ... [17.3–27.0] ... ... [14.2–25.3] [10.3–21.0] [35.2–52.3] ... ... ... [35.9–52.7] [6.1–11.1] ... [21.0–29.8] [24.8–42.6] ... ... [45.1–71.5] [28.1–40.8] ... [40.2–71.6] ... ... ... ... ... [13.4–28.9] [26.7–50.0] [26.0–42.8] [13.7–26.5] [18.3–28.5] [56.5–85.8] ... ... [18.4–29.9] [28.4–51.6] [24.2–33.9] [18.8–48.5] ... ... [35.5–55.2] [18.6–32.4] ... ... [40.1–60.3] ... [39.7–60.1] [34.9–56.6] [35.6–65.1] Females ... ... 19.4 ... ... 10.9 3.6 0.5 ... ... ... 25.6 0.5 ... 19.9 27.4 ... ... 5.8 30.9 ... 35.7 ... ... ... ... ... 2.8 2.4 27.6 17.4 2.5 4.0 ... ... 22.6 20.2 19.8 6.6 ... ... 9.8 2.4 ... ... 3.8 ... 24.1 30.9 0.5 [95% CI] ... ... [15.7–23.9] ... ... [7.5–14.3] [2.0–5.5] [0.3–0.6] ... ... ... [21.2–30.6] [0.3–0.8] ... [16.5–23.2] [21.1–34.9] ... ... [4.4–7.2] [24.8–36.5] ... [20.3–51.9] ... ... ... ... ... [1.7–4.3] [1.4–3.6] [21.3–34.2] [12.9–22.4] [1.9–3.0] [3.3–5.0] ... ... [17.0–28.3] [14.0–26.3] [16.4–23.2] [3.6–10.0] ... ... [7.3–12.5] [1.6–3.3] ... ... [2.6–5.1] ... [19.5–29.7] [23.7–40.2] [0.2–0.8] Both sexes ... ... 20.7 ... ... 15.2 9.3 21.8 ... ... ... 33.6 4.5 ... 22.4 30.3 ... ... 29.3 32.9 ... 45.1 ... ... ... ... ... 11.6 19.9 30.8 18.3 13.3 36.9 ... ... 23.2 30.0 24.0 18.3 ... ... 26.6 13.8 ... ... 25.8 ... 35.3 37.6 24.5 [95% CI] ... ... [16.5–25.4] ... ... [10.8–19.7] [6.2–13.2] [17.7–26.4] ... ... ... [27.9–40.6] [3.2–5.9] ... [18.7–26.4] [22.8–38.6] ... ... [23.1–36.7] [26.4–38.6] ... [30.0–61.6] ... ... ... ... ... [7.4–16.2] [13.9–26.6] [23.5–38.2] [13.3–24.5] [10.3–16.1] [29.8–45.3] ... ... [17.7–29.1] [21.0–38.6] [20.1–28.4] [11.0–28.7] ... ... [20.6–32.6] [10.0–17.8] ... ... [20.8–31.9] ... [28.5–43.3] [29.4–48.6] [17.4–32.1]

Country name

195

Global status report on NCDs 2014 … Indicates no data were available Current tobacco smoking Crude adjusted estimates Males Liberia Libya Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (Federated States of) Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Korea Republic of Moldova Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines AFR EMR EUR EUR AFR AFR WPR SEAR AFR EUR WPR AFR AFR AMR WPR EUR WPR EUR EMR AFR SEAR AFR WPR SEAR EUR WPR AMR AFR AFR WPR EUR EMR EMR WPR AMR WPR AMR AMR WPR EUR EUR EMR WPR EUR EUR EUR AFR AMR AMR AMR ... ... 39.7 ... ... 22.8 47.0 39.3 32.8 30.3 ... 39.2 41.9 24.4 ... ... 49.1 ... ... 31.4 38.4 33.6 ... ... 30.0 18.8 ... 16.1 ... 22.2 26.2 18.5 38.0 39.9 13.2 ... 30.4 ... 46.4 34.3 29.2 ... ... 43.6 39.3 59.5 20.0 ... ... ... [95% CI] ... ... [31.8–49.1] ... ... [17.3–28.0] [34.4–61.1] [29.8–51.5] [23.9–42.4] [23.3–38.6] ... [26.8–51.0] [33.6–53.2] [20.1–29.6] ... ... [40.8–60.6] ... ... [21.3–43.5] [27.5–49.1] [23.1–44.7] ... ... [23.6–36.3] [15.8–22.5] ... [12.1–20.5] ... [15.4–31.1] [22.1–31.1] [11.1–25.9] [27.6–47.9] [13.9–75.3] [10.4–16.5] ... [20.5–39.0] ... [36.7–55.3] [28.2–41.5] [23.0–36.2] ... ... [34.4–52.4] [30.9–46.6] [48.3–70.7] [14.5–25.7] ... ... ... Females ... ... 18.8 ... ... 5.9 1.7 3.9 3.0 19.7 ... 4.2 3.4 7.9 ... ... 6.1 ... ... 5.8 8.0 10.5 ... ... 26.2 16.8 ... 0.2 ... 12.4 25.2 1.0 3.2 12.9 3.0 ... 9.0 6.4 8.0 24.5 11.9 ... ... 4.9 22.0 18.9 5.0 ... ... ... [95% CI] ... ... [14.4–23.2] ... ... [3.7–8.6] [1.1–2.3] [2.7–5.4] [1.5–4.6] [14.3–24.7] ... [2.6–5.6] [2.4–4.2] [6.2–9.4] ... ... [4.7–7.5] ... ... [2.7–9.6] [4.6–11.8] [7.7–13.8] ... ... [21.3–31.4] [14.1–19.7] ... [0.1–0.3] ... [8.3–17.1] [20.7–29.7] [0.4–1.8] [2.2–4.3] [5.7–22.1] [2.3–3.7] ... [6.5–12.2] [5.0–8.0] [6.6–9.7] [19.8–29.2] [8.8–16.0] ... ... [3.9–6.1] [17.7–27.1] [15.6–23.3] [3.0–7.1] ... ... ... Both sexes ... ... 28.3 ... ... 14.3 23.6 21.6 17.9 24.9 ... 21.7 22.3 15.7 ... ... 27.2 ... ... 18.0 22.6 21.5 ... ... 28.1 17.8 ... 8.1 ... 17.3 25.7 12.5 21.0 26.4 8.1 ... 19.8 ... 27.0 29.2 20.2 ... ... 23.0 30.4 37.2 12.2 ... ... ... [95% CI] ... ... [22.3–34.9] ... ... [10.5–18.2] [17.2–30.7] [16.2–28.5] [12.7–23.4] [18.8–31.6] ... [14.7–28.3] [17.7–28.3] [12.8–19.0] ... ... [22.4–33.6] ... ... [11.6–25.8] [15.6–29.7] [15.0–28.5] ... ... [22.5–33.8] [14.9–21.1] ... [6.0–10.4] ... [11.8–24.1] [21.4–30.4] [7.4–17.6] [15.2–26.6] [9.8–48.7] [6.3–10.1] ... [13.5–25.7] ... [21.5–32.3] [23.9–35.1] [15.6–25.6] ... ... [18.1–27.7] [24.1–36.5] [30.4–44.7] [8.5–16.0] ... ... ...

Country name

Region

196

Annex 4.5: Tobacco (continued)

Current tobacco smoking Age-standardized Males ... ... 40.3 ... ... 26.7 46.4 38.8 31.5 31.2 ... 36.4 41.9 24.1 ... ... 49.7 ... ... 33.1 38.9 35.3 ... ... 30.4 19.7 ... 15.8 ... 22.2 26.5 18.3 40.2 39.7 13.1 ... 30.9 ... 46.3 34.2 31.6 ... ... 43.8 39.9 59.3 23.0 ... ... ... [95% CI] ... ... [32.5–50.1] ... ... [20.5–32.9] [34.2–59.9] [29.4–50.3] [23.6–40.4] [23.8–40.0] ... [25.2–46.8] [33.2–52.8] [19.4–28.8] ... ... [40.4–60.4] ... ... [21.8–45.6] [27.7–49.4] [24.4–46.2] ... ... [24.0–36.9] [16.3–23.4] ... [11.8–20.0] ... [15.0–30.5] [22.3–31.3] [11.2–25.2] [29.1–50.4] [14.1–74.4] [10.4–16.4] ... [22.3–40.7] ... [37.2–55.5] [28.2–41.7] [24.7–39.2] ... ... [34.6–52.6] [31.5–47.7] [48.2–70.4] [16.9–29.8] ... ... ... Females ... ... 21.7 ... ... 7.0 1.8 4.2 3.2 22.0 ... 3.9 3.5 7.8 ... ... 6.3 ... ... 6.1 8.3 11.8 ... ... 27.7 18.1 ... 0.2 ... 12.4 26.2 1.1 3.5 12.8 3.0 ... 9.4 6.5 8.9 26.5 14.0 ... ... 5.3 24.0 22.0 5.6 ... ... ... [95% CI] ... ... [16.9–27.0] ... ... [4.3–10.0] [1.2–2.4] [2.9–5.7] [1.7–4.8] [16.4–28.2] ... [2.5–5.3] [2.5–4.4] [6.1–9.3] ... ... [5.0–8.0] ... ... [2.8–10.1] [4.7–12.1] [8.7–15.6] ... ... [22.4–33.0] [15.2–21.2] ... [0.1–0.4] ... [8.2–16.9] [22.1–31.5] [0.5–1.9] [2.3–4.6] [5.5–21.6] [2.3–3.8] ... [6.6–12.4] [4.9–8.0] [7.3–10.8] [21.3–31.7] [9.7–18.3] ... ... [4.3–6.7] [19.2–29.6] [17.8–27.0] [3.5–7.9] ... ... ... Both sexes ... ... 30.1 ... ... 16.8 23.3 21.5 17.3 26.6 ... 20.2 22.3 15.5 ... ... 27.6 ... ... 19.0 23.0 23.0 ... ... 29.0 18.9 ... 7.9 ... 17.3 26.4 12.4 22.2 26.3 8.1 ... 20.2 ... 27.4 30.1 22.4 ... ... 23.3 31.7 38.8 14.0 ... ... ... [95% CI] ... ... [24.0–37.4] ... ... [12.4–21.4] [17.1–30.2] [16.1–28.0] [12.6–22.5] [20.1–34.1] ... [13.9–26.0] [17.6–28.1] [12.4–18.5] ... ... [22.4–33.8] ... ... [11.9–27.0] [15.7–30.0] [16.2–30.1] ... ... [23.2–34.9] [15.7–22.3] ... [5.9–10.1] ... [11.6–23.7] [22.2–31.4] [7.5–17.2] [16.0–28.0] [9.8–48.0] [6.4–10.1] ... [14.5–26.6] ... [22.1–32.9] [24.6–36.4] [16.9–28.3] ... ... [18.4–28.1] [25.1–38.3] [31.6–46.7] [9.9–18.4] ... ... ...

Country name

197

Global status report on NCDs 2014 … Indicates no data were available Current tobacco smoking Crude adjusted estimates Males Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand the former Yugoslav Republic of Macedonia Timor–Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom* United Republic of Tanzania United States of America* Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe * Cigarette smoking only WPR EUR AFR EMR AFR EUR AFR AFR WPR EUR EUR WPR EMR AFR AFR EUR SEAR EMR AMR AFR EUR EUR EMR EUR SEAR EUR SEAR AFR WPR AMR EMR EUR EUR WPR AFR EUR EMR EUR AFR AMR AMR EUR WPR AMR WPR EMR AFR AFR 44.9 ... 12.1 ... ... ... 43.5 52.4 27.3 37.9 22.5 ... ... ... ... 32.6 29.0 ... 54.4 16.8 22.1 30.5 ... ... ... ... ... ... 46.7 ... ... 44.1 ... ... 17.2 50.8 ... 21.0 28.4 20.5 29.4 24.2 ... ... 48.6 ... 24.4 ... [95% CI] [33.9–58.3] ... [8.3–17.4] ... ... ... [32.3–57.2] [40.5–66.3] [22.3–34.4] [25.6–53.0] [17.9–27.3] ... ... ... ... [26.9–38.7] [21.6–38.3] ... [27.8–91.7] [12.3–21.6] [18.4–26.1] [25.0–35.4] ... ... ... ... ... ... [36.1–58.2] ... ... [35.5–51.7] ... ... [12.0–23.2] [40.9–59.8] ... [17.0–24.6] [20.7–36.5] [17.1–24.0] [23.0–35.1] [15.5–32.1] ... ... [39.6–59.0] ... [17.8–31.7] ... Females 20.4 ... 1.8 ... ... ... 8.6 13.6 4.3 17.5 16.5 ... ... ... ... 23.9 0.6 ... 11.1 2.2 21.7 22.7 ... ... ... ... ... ... 13.3 ... ... 14.0 ... ... 2.6 11.2 ... 18.8 3.6 15.7 20.2 1.3 ... ... 1.3 ... 3.9 ... [95% CI] [15.0–26.3] ... [1.1–2.9] ... ... ... [5.8–11.9] [8.1–19.9] [3.2–5.3] [10.1–26.0] [13.2–20.0] ... ... ... ... [19.9–29.0] [0.3–0.8] ... [5.1–18.8] [1.4–3.1] [17.7–25.8] [18.3–26.3] ... ... ... ... ... ... [9.8–16.8] ... ... [11.3–16.8] ... ... [1.9–3.6] [9.2–13.3] ... [15.4–22.5] [2.0–5.5] [12.8–18.3] [16.2–24.7] [0.8–2.0] ... ... [1.0–1.6] ... [2.4–5.7] ... Both sexes 33.0 ... 6.8 ... ... ... 26.4 32.8 15.6 27.3 19.5 ... ... ... ... 28.2 14.3 ... 32.7 9.3 21.9 26.5 ... ... ... ... ... ... 29.6 ... ... 28.5 ... ... 9.9 29.1 ... 19.9 15.9 18.0 24.6 12.6 ... ... 24.3 ... 14.1 ... [95% CI] [24.7–42.7] ... [4.6–10.0] ... ... ... [19.3–35.0] [24.1–42.8] [12.6–19.6] [17.6–39.0] [15.5–23.6] ... ... ... ... [23.3–33.7] [10.6–18.9] ... [16.3–55.0] [6.7–12.1] [18.1–25.9] [21.6–30.7] ... ... ... ... ... ... [22.7–37.1] ... ... [23.0–33.7] ... ... [6.9–13.4] [23.5–34.3] ... [16.2–23.5] [11.3–20.9] [14.9–21.1] [19.4–29.6] [8.0–16.8] ... ... [19.8–29.5] ... [10.0–18.6] ...

Country name

Region

198

Annex 4.5: Tobacco (continued)

Current tobacco smoking Age-standardized Males 45.6 ... 13.5 ... ... ... 43.6 54.6 27.2 38.6 23.7 ... ... ... ... 33.8 28.7 ... 54.5 18.0 22.1 32.0 ... ... ... ... ... ... 47.1 ... ... 43.2 ... ... 18.8 50.9 ... 22.1 29.8 21.0 30.1 25.2 ... ... 48.4 ... 26.8 ... [95% CI] [34.2–58.9] ... [8.9–18.4] ... ... ... [32.3–57.4] [42.4–69.4] [22.2–34.4] [24.3–52.6] [19.0–29.2] ... ... ... ... [27.9–40.0] [21.4–37.9] ... [27.7–91.9] [13.4–22.8] [18.4–26.1] [26.2–37.0] ... ... ... ... ... ... [35.4–57.4] ... ... [34.9–50.6] ... ... [13.3–24.8] [41.0–60.1] ... [18.0–25.9] [22.0–38.1] [17.2–24.4] [24.3–36.7] [16.5–33.7] ... ... [39.4–58.4] ... [19.2–34.1] ... Females 20.6 ... 1.9 ... ... ... 8.6 13.5 4.8 18.4 18.9 ... ... ... ... 28.3 0.5 ... 11.1 2.4 22.9 25.1 ... ... ... ... ... ... 13.2 ... ... 13.8 ... ... 3.2 14.1 ... 20.2 4.0 16.4 22.2 1.4 ... ... 1.3 ... 4.8 ... [95% CI] [15.1–26.6] ... [1.0–2.9] ... ... ... [5.7–12.0] [8.2–19.7] [3.6–6.0] [9.8–26.6] [14.8–23.1] ... ... ... ... [22.7–33.8] [0.3–0.8] ... [4.7–18.4] [1.5–3.4] [18.7–27.2] [20.1–29.1] ... ... ... ... ... ... [9.9–16.7] ... ... [11.3–16.6] ... ... [2.3–4.3] [11.4–16.6] ... [16.4–24.0] [2.2–5.8] [13.7–19.3] [17.8–27.3] [0.8–2.0] ... ... [1.1–1.7] ... [3.0–6.9] ... Both sexes 33.5 ... 7.5 ... ... ... 26.4 33.9 15.8 28.1 21.3 ... ... ... ... 31.0 14.1 ... 32.7 10.0 22.5 28.5 ... ... ... ... ... ... 29.8 ... ... 28.1 ... ... 11.0 30.8 ... 21.1 16.8 18.6 26.0 13.1 ... ... 24.2 ... 15.8 ... [95% CI] [24.9–43.2] ... [4.8–10.5] ... ... ... [19.3–35.1] [25.1–44.3] [12.7–19.9] [16.8–39.1] [16.9–26.1] ... ... ... ... [25.2–36.9] [10.5–18.7] ... [16.2–54.9] [7.3–12.8] [18.6–26.7] [23.1–33.0] ... ... ... ... ... ... [22.4–36.7] ... ... [22.7–33.1] ... ... [7.8–14.5] [24.8–36.3] ... [17.2–24.9] [12.0–21.9] [15.4–21.8] [20.9–31.7] [8.5–17.6] ... ... [19.7–29.2] ... [11.1–20.5] ...

Country name

199

Global status report on NCDs 2014

4.6 Body mass index Comparable estimates of mean body mass index (adults 18+ years), 2010 and 2014 2010 Mean BMI Country name Region Males Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic EMR EUR AFR EUR AFR AMR AMR EUR WPR EUR EUR AMR EMR SEAR AMR EUR EUR AMR AFR SEAR AMR EUR AFR AMR WPR EUR AFR AFR AFR WPR AFR AMR AFR AFR AMR WPR AMR AFR AFR WPR AMR AFR EUR AMR EUR EUR 21.1 26.3 25.1 27.5 23.1 26.8 27.4 25.5 27.3 26.2 25.9 27.5 27.5 20.5 26.8 26.6 26.1 27.1 22.4 23.0 24.2 26.2 22.5 25.5 25.5 26.4 21.9 20.4 23.6 21.5 23.6 27.4 21.5 21.9 27.2 23.6 25.0 22.9 22.2 31.7 26.4 23.0 26.2 25.1 27.4 27.6 [95% CI] [18.8–23.5] [25.5–27] [23.7–26.6] [25.2–29.9] [20.7–25.6] [24.5–29.2] [26.3–28.4] [24.5–26.6] [26.9–27.7] [24.6–27.9] [25–26.8] [25.2–29.8] [26.5–28.6] [19.8–21.1] [25.4–28.2] [24.2–29] [25.2–27] [26.1–28.2] [21.6–23.2] [22.3–23.8] [23–25.5] [25.2–27.3] [21.6–23.4] [25–25.9] [23.2–27.9] [25.5–27.4] [21.1–22.6] [18–22.7] [22.7–24.5] [20.7–22.3] [22.4–24.8] [26.9–27.9] [20.1–22.9] [20.5–23.3] [26.6–27.8] [23.2–24] [24.4–25.5] [22.1–23.7] [20.7–23.7] [30.6–32.8] [25.7–27.1] [22.2–23.8] [24.9–27.5] [24–26.2] [26.3–28.6] [26.9–28.3] Females 21.2 25.6 26.7 27.1 24.1 28.9 27.1 27.1 26.6 24.3 27.6 29.2 28.3 20.7 29.5 26.2 24.8 29.8 23.8 23.7 26.8 25.7 26.2 25.7 26.5 25.2 21.8 21.0 25.0 21.6 24.7 26.6 22.8 22.2 27.7 23.3 26.2 24.6 23.7 32.4 26.7 23.8 24.5 26.3 26.2 26.1 [95% CI] [18.3–24.4] [24.7–26.4] [24.9–28.5] [24.2–30] [21.1–27.1] [25.9–31.8] [26.2–28.1] [26.1–28.2] [26.2–27] [22.2–26.4] [26.5–28.6] [26.3–32.2] [27.1–29.6] [20.1–21.2] [27.8–31.1] [23.1–29.1] [23.4–26] [28.6–30.9] [23.2–24.3] [22.8–24.6] [26–27.7] [24.5–26.9] [25.2–27.2] [25.2–26.2] [23.5–29.5] [24.1–26.4] [21.2–22.3] [20–22] [24–26.1] [21–22.2] [24.1–25.3] [26–27.1] [21.5–24] [21.2–23.1] [27–28.4] [22.8–23.7] [25.6–26.8] [23.9–25.3] [22.9–24.5] [31.2–33.5] [25.9–27.5] [23.1–24.4] [23–26.1] [25.1–27.5] [25–27.5] [25.3–26.9] Both sexes 21.2 25.9 25.9 27.3 23.6 27.9 27.2 26.3 26.9 25.3 26.7 28.4 27.8 20.6 28.2 26.4 25.4 28.4 23.1 23.3 25.5 26.0 24.4 25.6 26.0 25.8 21.8 20.7 24.3 21.5 24.2 27.0 22.2 22.0 27.5 23.4 25.6 23.8 23.0 32.0 26.5 23.4 25.3 25.7 26.8 26.8 [95% CI] [19.3–23.1] [25.3–26.5] [24.8–27] [25.5–29.3] [21.8–25.6] [26–29.7] [26.5–28] [25.5–27.1] [26.7–27.2] [24–26.6] [26.1–27.4] [26.4–30.2] [27–28.7] [20.2–21] [27–29.2] [24.5–28.4] [24.6–26.2] [27.7–29.1] [22.6–23.6] [22.8–23.9] [24.7–26.3] [25.2–26.8] [23.7–25] [25.3–25.9] [24.2–28] [25.1–26.6] [21.4–22.2] [19.5–21.9] [23.6–25.1] [21–22] [23.5–24.9] [26.6–27.3] [21.3–23.1] [21.2–22.8] [27–27.9] [23.1–23.7] [25.2–26] [23.2–24.3] [22.1–23.8] [31.2–32.9] [26–27.1] [22.8–23.9] [24.4–26.3] [24.9–26.4] [25.9–27.7] [26.3–27.3]

200

Annex 4.6: Body mass index

… Indicates no data were available

2014 Mean BMI Country name Males 21.5 26.6 25.5 27.8 23.5 27.3 27.8 25.9 27.6 26.5 26.6 28.0 28.0 20.7 27.4 27.1 26.2 27.5 22.6 23.4 24.6 26.5 22.9 25.9 25.8 26.7 22.1 20.4 23.9 21.9 23.8 27.6 21.6 22.1 27.6 24.2 25.4 23.0 22.5 32.1 26.7 23.2 26.5 25.6 27.6 27.8 [95% CI] [19–23.9] [25.6–27.5] [23.9–27.1] [25.4–30.3] [21–26.1] [24.9–29.8] [26.5–29.1] [24.7–27.3] [27–28.1] [24.6–28.3] [25.4–27.8] [25.6–30.4] [26.6–29.3] [19.9–21.6] [25.7–29] [24.6–29.5] [25.1–27.4] [26.2–28.8] [21.6–23.6] [22.7–24.2] [23.2–26] [25.2–27.8] [21.8–24] [25.2–26.6] [23.3–28.3] [25.5–28] [21.3–22.9] [17.9–22.9] [22.8–25] [20.9–22.8] [22.4–25.2] [26.8–28.3] [20.1–23.2] [20.6–23.7] [26.7–28.5] [23.5–24.9] [24.6–26.1] [22.2–23.9] [20.8–24.1] [30.8–33.4] [25.9–27.5] [22.1–24.2] [24.9–28.1] [24.2–27] [26.3–29] [26.9–28.8] Females 21.8 25.6 27.0 27.1 24.6 29.5 27.5 27.4 26.8 24.4 28.1 29.6 28.6 21.2 30.0 26.2 24.7 30.2 24.3 24.2 27.3 25.7 26.6 26.0 26.6 25.3 22.0 21.3 25.4 22.0 25.1 26.8 23.2 22.5 28.0 23.6 26.5 25.1 24.1 32.6 27.1 24.1 24.6 26.7 26.3 26.0 [95% CI] [18.6–25] [24.6–26.7] [25.1–28.9] [24.1–30.2] [21.5–27.8] [26.3–32.5] [26.3–28.8] [26.1–28.8] [26.2–27.4] [22–26.7] [26.8–29.5] [26.6–32.7] [27.1–30.3] [20.4–22] [27.9–32] [23.1–29.4] [23.1–26.2] [28.9–31.6] [23.5–25] [23.4–25.1] [26.1–28.5] [24.2–27.3] [25.4–27.8] [25.3–26.8] [23.4–29.7] [23.9–26.7] [21.3–22.7] [20.2–22.5] [24.2–26.6] [21.2–22.8] [24.3–25.8] [25.9–27.6] [21.7–24.8] [21.3–23.7] [27–28.9] [22.9–24.4] [25.6–27.3] [24.4–26] [23.2–25.1] [31.2–34] [26.2–27.9] [23.2–24.9] [22.7–26.4] [25.2–28.2] [24.8–27.9] [24.9–27.1] Both sexes 21.6 26.1 26.2 27.5 24.1 28.4 27.7 26.7 27.2 25.4 27.4 28.8 28.2 21.0 28.7 26.6 25.5 28.9 23.4 23.8 25.9 26.1 24.7 25.9 26.2 26.0 22.1 20.9 24.7 21.9 24.4 27.2 22.4 22.3 27.8 23.9 25.9 24.1 23.3 32.3 26.9 23.6 25.5 26.2 27.0 26.9 [95% CI] [19.7–23.6] [25.4–26.9] [25.1–27.5] [25.4–29.3] [22–26.2] [26.3–30.4] [26.8–28.6] [25.8–27.6] [26.7–27.6] [23.9–26.9] [26.5–28.3] [26.9–30.7] [27.2–29.2] [20.4–21.6] [27.5–30] [24.6–28.8] [24.5–26.4] [27.9–29.8] [22.8–24] [23.2–24.4] [25–26.9] [25.1–27.1] [23.9–25.5] [25.4–26.5] [24.1–28.3] [25.1–27] [21.5–22.6] [19.6–22.2] [23.9–25.5] [21.3–22.5] [23.7–25.3] [26.6–27.8] [21.3–23.5] [21.3–23.3] [27.2–28.4] [23.4–24.4] [25.4–26.5] [23.5–24.7] [22.3–24.2] [31.4–33.2] [26.3–27.5] [22.9–24.3] [24.4–26.7] [25.1–27.1] [25.9–28] [26.2–27.6] Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic

201

Global status report on NCDs 2014 … Indicates no data were available

2010 Mean BMI Country name Region Males Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea–Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho SEAR AFR EUR EMR AMR AMR AMR EMR AMR AFR AFR EUR AFR WPR EUR EUR AFR AFR EUR EUR AFR EUR AMR AMR AFR AFR AMR AMR AMR EUR EUR SEAR SEAR EMR EMR EUR EUR EUR AMR WPR EMR EUR AFR WPR EMR EUR WPR EUR EMR AFR 21.8 21.8 25.9 22.6 24.6 25.5 26.0 27.3 26.4 24.7 20.2 26.7 20.0 25.9 26.4 25.9 24.3 22.5 26.7 26.8 23.1 27.3 24.8 25.6 22.0 22.0 24.6 23.8 25.2 27.3 26.6 21.5 21.9 25.0 26.7 27.7 26.0 26.6 25.1 23.5 27.8 26.8 21.7 28.6 29.0 25.2 21.9 26.4 27.4 22.4 [95% CI] [19.3–24.2] [20.5–23.1] [25.2–26.5] [20.3–25] [23.6–25.5] [24.3–26.7] [25.2–26.8] [26.8–27.7] [25–27.9] [22.2–27.1] [19.5–20.8] [25.7–27.7] [19.3–20.7] [25.3–26.5] [26–26.8] [25.2–26.6] [22.9–25.7] [21.8–23.2] [25.8–27.5] [26.2–27.3] [22.4–23.8] [26.4–28.3] [23.9–25.6] [24.3–26.8] [20.7–23.2] [19.9–24.3] [23.7–25.5] [21.5–26.3] [23.7–26.7] [26.2–28.4] [25.3–27.9] [21.1–21.9] [21.3–22.6] [24.7–25.4] [25.8–27.6] [27.2–28.2] [25.3–26.7] [26.2–27.1] [24.3–25.8] [23.1–23.8] [27.1–28.4] [25.1–28.6] [20–23.4] [27.6–29.5] [28.1–29.8] [24.5–25.9] [21.1–22.7] [25.2–27.7] [26.7–28.1] [21.8–23] Females 21.8 22.1 24.4 23.7 28.5 26.9 27.3 30.2 27.6 25.6 20.8 24.3 20.7 28.3 25.4 24.5 25.9 24.5 26.8 25.5 24.6 27.2 28.1 26.7 23.0 23.5 27.1 23.5 26.9 25.2 25.1 21.7 23.0 26.8 28.4 26.8 26.1 25.2 28.6 21.8 29.5 27.1 23.6 30.3 30.4 26.4 22.3 25.1 27.1 26.8 [95% CI] [18.5–25] [21.4–22.7] [23.6–25.2] [20.8–26.7] [27.4–29.5] [25.7–28.2] [26.5–28.1] [29.7–30.7] [26.8–28.3] [22.4–28.8] [20.1–21.4] [22.8–25.8] [20–21.4] [27.6–29] [25–25.8] [23.7–25.4] [25.1–26.7] [23.7–25.3] [26–27.8] [24.9–26.2] [24–25.2] [26–28.3] [27.1–29.1] [26–27.4] [22.3–23.7] [22.5–24.5] [26–28.1] [22.7–24.3] [26.2–27.5] [23.6–26.9] [23.5–26.8] [21.3–22.1] [22.3–23.7] [26.4–27.2] [27.4–29.4] [26.2–27.3] [25.3–26.9] [24.7–25.7] [27.8–29.4] [21.5–22.2] [29–29.9] [25.7–28.5] [22.8–24.4] [29.2–31.4] [29.5–31.4] [25.7–27] [21.7–23] [23.6–26.6] [26.3–27.9] [26.1–27.4] Both sexes 21.8 21.9 25.1 23.2 26.5 26.2 26.6 28.7 27.0 25.1 20.5 25.4 20.3 27.1 25.9 25.2 25.1 23.5 26.8 26.1 23.8 27.3 26.4 26.1 22.5 22.8 25.8 23.6 26.0 26.2 25.9 21.6 22.5 25.9 27.5 27.2 26.1 25.9 26.9 22.6 28.6 27.0 22.6 29.4 29.5 25.8 22.1 25.7 27.3 24.6 [95% CI] [19.7–23.9] [21.2–22.6] [24.6–25.6] [21.3–25.2] [25.8–27.3] [25.4–27] [26.1–27.1] [28.4–29.1] [26.2–27.9] [23.1–27.1] [20–20.9] [24.5–26.3] [19.8–20.8] [26.6–27.6] [25.6–26.2] [24.6–25.7] [24.4–25.9] [23–24.1] [26.2–27.3] [25.7–26.6] [23.4–24.3] [26.5–28] [25.8–27.1] [25.4–26.8] [21.8–23.2] [21.7–24] [25.1–26.5] [22.4–25] [25.2–26.9] [25.2–27.3] [24.8–26.9] [21.3–21.9] [22–22.9] [25.7–26.2] [26.8–28.2] [26.9–27.6] [25.5–26.6] [25.5–26.2] [26.3–27.4] [22.4–22.9] [28.2–29] [25.9–28.1] [21.7–23.5] [28.7–30.1] [28.9–30.2] [25.3–26.2] [21.6–22.6] [24.6–26.7] [26.8–27.8] [24.2–25.1]

202

Annex 4.6: Body mass index

2014 Mean BMI Country name Males 21.9 21.8 26.0 22.7 25.1 26.0 26.4 27.6 26.8 25.0 20.1 27.0 20.2 26.1 26.5 26.1 24.6 23.0 27.2 27.0 23.4 27.4 25.2 25.8 22.1 22.2 25.0 24.2 25.5 27.5 26.7 21.8 22.4 25.3 27.2 27.9 26.3 26.8 25.5 23.6 28.2 27.4 21.9 28.7 29.5 25.6 22.4 26.8 28.0 22.7 [95% CI] [19.2–24.5] [20.3–23.4] [25.1–26.9] [20.3–25.2] [23.9–26.3] [24.6–27.5] [25.5–27.2] [26.9–28.3] [25.1–28.4] [22.5–27.7] [19.2–20.9] [25.8–28.4] [19.3–21] [25.3–26.9] [25.9–27.1] [25.1–27.1] [23–26.1] [22–23.9] [26.2–28.1] [26.2–27.8] [22.5–24.4] [26.2–28.6] [24.3–26.2] [24.4–27.3] [20.8–23.5] [19.9–24.6] [24–26.1] [21.7–26.8] [23.9–27.1] [26.3–28.9] [25.2–28.4] [21.1–22.4] [21.5–23.4] [24.7–25.9] [26.1–28.3] [27.2–28.6] [25.2–27.3] [26.1–27.5] [24.5–26.6] [23–24.2] [27.3–29.1] [25.4–29.4] [20–23.8] [27.5–29.8] [28.4–30.6] [24.8–26.4] [21.6–23.2] [25.2–28.3] [27–28.9] [22–23.4] Females 21.8 22.5 24.5 23.9 29.0 27.4 27.7 30.7 28.0 26.1 21.0 24.3 21.0 28.4 25.3 24.6 26.4 25.1 27.3 25.6 25.1 27.2 28.7 27.1 23.3 23.9 27.6 24.0 27.3 25.2 25.1 22.1 23.4 27.2 28.8 27.1 26.2 25.2 29.2 21.7 29.7 27.5 24.0 30.5 30.8 26.8 22.7 25.1 27.6 27.1 [95% CI] [18.3–25.2] [21.7–23.3] [23.5–25.5] [20.9–27] [27.7–30.3] [25.8–29] [26.7–28.6] [30–31.5] [26.9–29] [22.7–29.4] [20.1–21.9] [22.4–26] [20.1–21.9] [27.5–29.4] [24.7–25.9] [23.5–25.7] [25.4–27.3] [24.1–26.1] [26.2–28.3] [24.7–26.5] [24.2–25.9] [25.7–28.7] [27.6–29.8] [26.1–28.1] [22.5–24.2] [22.7–25] [26.4–28.8] [23–24.9] [26.5–28.1] [23.2–27.2] [23.2–27] [21.4–22.8] [22.4–24.4] [26.5–27.9] [27.6–30.1] [26.3–27.8] [25.1–27.4] [24.5–26] [28.2–30.3] [21.1–22.3] [29–30.4] [25.7–29.2] [23–25.1] [29.1–31.8] [29.7–32.1] [26.1–27.5] [22–23.5] [23.2–26.9] [26.5–28.6] [26.2–27.9] Both sexes 21.8 22.2 25.3 23.3 27.0 26.7 27.0 29.2 27.4 25.6 20.5 25.5 20.6 27.2 25.9 25.3 25.5 24.0 27.2 26.3 24.2 27.3 27.0 26.5 22.7 23.1 26.3 24.1 26.4 26.3 25.9 21.9 22.9 26.2 28.0 27.5 26.3 26.0 27.4 22.6 28.9 27.4 23.0 29.6 30.0 26.2 22.6 25.8 27.8 24.9 [95% CI] [19.6–24] [21.3–23] [24.6–25.9] [21.3–25.5] [26.2–27.9] [25.6–27.7] [26.4–27.6] [28.6–29.7] [26.4–28.4] [23.4–27.9] [19.9–21.1] [24.5–26.7] [20–21.2] [26.6–27.8] [25.5–26.3] [24.5–26] [24.5–26.3] [23.3–24.7] [26.5–27.9] [25.7–26.8] [23.6–24.9] [26.3–28.2] [26.2–27.7] [25.6–27.4] [22–23.5] [21.7–24.4] [25.6–27.1] [22.7–25.5] [25.5–27.3] [25.1–27.4] [24.7–27.1] [21.5–22.4] [22.3–23.6] [25.8–26.7] [27.2–28.8] [26.9–28.1] [25.5–27.1] [25.5–26.5] [26.6–28.2] [22.2–23] [28.4–29.5] [26.2–28.7] [21.9–24.1] [28.6–30.4] [29.2–30.8] [25.7–26.8] [22–23.1] [24.7–27.1] [27.1–28.5] [24.3–25.4] Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea–Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho

203

Global status report on NCDs 2014 … Indicates no data were available

2010 Mean BMI Country name Region Males Liberia Libya Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (Federated States of) Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Korea Republic of Moldova Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines AFR EMR EUR EUR AFR AFR WPR SEAR AFR EUR WPR AFR AFR AMR WPR EUR WPR EUR EMR AFR SEAR AFR WPR SEAR EUR WPR AMR AFR AFR WPR EUR EMR EMR WPR AMR WPR AMR AMR WPR EUR EUR EMR WPR EUR EUR EUR AFR AMR AMR AMR 23.1 26.8 27.0 27.3 20.9 22.0 24.6 23.9 22.3 27.3 28.3 23.0 24.7 27.2 27.6 ... 24.9 26.2 24.8 21.4 21.7 22.5 32.2 22.0 25.7 27.7 25.7 21.1 22.4 31.1 26.6 26.3 23.0 29.2 26.0 24.8 25.3 25.2 22.6 26.7 26.5 28.3 24.0 26.0 25.4 25.7 21.1 28.0 28.1 25.9 [95% CI] [22.4–23.7] [26–27.6] [25.9–28] [26.5–28.1] [19.7–22.1] [21.3–22.8] [24.1–25.1] [23–24.7] [21.1–23.4] [25.7–28.9] [27.2–29.4] [21.5–24.4] [24–25.3] [26.8–27.6] [26.9–28.4] ... [24.5–25.4] [23.9–28.6] [23.8–25.9] [20.5–22.4] [20.9–22.5] [21.5–23.5] [31.4–33.1] [21.3–22.8] [25–26.3] [27.3–28.1] [24.3–27.2] [20.2–21.9] [21.7–23.2] [30.4–31.9] [25.8–27.5] [25.3–27.3] [22.2–23.8] [28.3–30.2] [24.9–27] [23.9–25.6] [22.9–27.6] [24.6–25.9] [21.9–23.4] [26–27.3] [25.7–27.4] [27.7–28.9] [23.6–24.4] [25.2–26.9] [24.3–26.5] [25.1–26.3] [20.5–21.6] [26.6–29.3] [27.3–29] [23.6–28.2] Females 24.3 29.2 26.0 25.4 21.0 22.9 25.3 25.7 22.6 26.8 30.0 26.0 25.9 28.3 30.8 ... 25.8 25.5 25.6 22.7 22.8 25.3 33.0 21.4 24.9 27.5 27.4 21.9 23.7 32.9 25.1 26.8 24.0 29.5 27.2 25.3 25.6 26.6 23.1 25.7 25.7 29.6 23.1 27.0 24.9 26.7 22.3 30.3 29.4 27.6 [95% CI] [23.7–25] [28.3–30.1] [24.7–27.2] [24.4–26.3] [20.2–21.7] [22.3–23.4] [24.8–25.8] [25–26.3] [21.9–23.3] [24.8–28.8] [28.8–31.2] [24.9–27.2] [25.1–26.7] [27.9–28.7] [30–31.6] ... [25.3–26.4] [22.5–28.4] [24.8–26.4] [22–23.4] [21.9–23.7] [24.4–26.1] [32–34] [20.9–22] [24.1–25.7] [27.1–27.9] [26.6–28.2] [21.3–22.5] [23.2–24.2] [32–33.7] [24.2–26.1] [25.6–27.9] [23.4–24.5] [28.4–30.5] [26–28.4] [24.2–26.3] [22.6–28.6] [26.2–26.9] [22.3–23.9] [24.8–26.5] [24.7–26.6] [28.9–30.3] [22.8–23.5] [26.2–27.6] [23.5–26.3] [26.1–27.3] [21.7–22.9] [28.9–31.7] [28.5–30.4] [24.7–30.5] Both sexes 23.7 28.0 26.4 26.4 20.9 22.5 25.0 24.8 22.4 27.1 29.1 24.5 25.3 27.8 29.2 ... 25.4 25.9 25.2 22.1 22.3 23.9 32.6 21.7 25.3 27.6 26.6 21.5 23.1 32.0 25.9 26.5 23.4 29.4 26.6 25.0 25.4 25.9 22.9 26.1 26.1 28.6 23.6 26.5 25.2 26.2 21.7 29.2 28.8 26.8 [95% CI] [23.2–24.2] [27.4–28.5] [25.6–27.2] [25.8–27] [20.2–21.6] [22–22.9] [24.6–25.4] [24.2–25.3] [21.8–23.1] [25.8–28.3] [28.4–29.9] [23.5–25.4] [24.7–25.8] [27.5–28] [28.6–29.7] ... [25–25.8] [24–27.7] [24.6–25.9] [21.5–22.7] [21.7–22.8] [23.3–24.6] [32–33.2] [21.3–22.2] [24.8–25.8] [27.3–27.9] [25.7–27.4] [20.9–22] [22.6–23.5] [31.4–32.5] [25.3–26.5] [25.8–27.2] [22.9–23.9] [28.6–30] [25.8–27.4] [24.3–25.7] [23.6–27.2] [25.5–26.3] [22.3–23.4] [25.6–26.7] [25.4–26.8] [28.1–29.2] [23.3–23.8] [26–27] [24.3–26.1] [25.8–26.7] [21.3–22.1] [28.2–30.1] [28.2–29.4] [24.9–28.7]

204

Annex 4.6: Body mass index

2014 Mean BMI Country name Males 23.2 27.2 27.3 27.6 20.9 22.3 25.0 24.2 22.6 27.5 28.4 23.2 25.0 27.5 27.8 ... 25.5 26.5 25.2 21.6 22.1 22.9 32.1 22.4 25.9 28.0 26.0 21.3 22.8 31.4 26.9 26.8 23.3 29.4 26.4 25.0 25.6 25.7 22.9 27.0 26.7 29.0 24.3 26.3 25.7 26.1 21.3 28.4 28.9 26.5 [95% CI] [22.5–23.9] [26.2–28.2] [25.9–28.6] [26.6–28.6] [19.5–22.4] [21.4–23.2] [24.3–25.8] [23.3–25.2] [21.2–24] [25.7–29.3] [27.1–29.7] [21.6–24.8] [24–25.9] [26.9–28.1] [26.9–28.7] ... [24.9–26.2] [24.1–29] [23.9–26.6] [20.4–22.8] [21.1–23.1] [21.6–24.1] [30.9–33.2] [21.6–23.2] [24.9–26.8] [27.4–28.5] [24.3–27.7] [20.2–22.3] [21.8–23.7] [30.6–32.2] [25.8–28] [25.6–28] [22.2–24.5] [28.4–30.3] [25.1–27.7] [23.9–26.1] [23.1–28] [24.8–26.7] [22–24] [26.1–28] [25.7–27.8] [28.2–29.7] [23.7–24.9] [25.5–27.2] [24.3–27.1] [25.2–27.1] [20.6–22] [26.9–30] [28–29.9] [24–28.9] Females 24.9 29.6 26.0 25.5 21.2 23.3 25.6 25.9 23.0 26.8 30.0 26.4 26.2 28.7 31.0 ... 26.4 25.5 25.9 23.0 23.2 25.6 32.8 22.0 25.0 27.8 27.8 22.2 24.0 33.1 25.2 27.1 24.4 29.5 27.7 25.6 26.0 26.9 23.4 25.7 25.7 30.1 23.4 27.1 24.9 26.8 22.7 30.9 30.2 28.1 [95% CI] [24.2–25.6] [28.5–30.7] [24.3–27.5] [24.3–26.6] [20.2–22.1] [22.5–24.1] [24.9–26.4] [25.1–26.8] [22.2–23.8] [24.5–29.1] [28.6–31.5] [25–27.8] [25.2–27.3] [28.1–29.3] [30–32] ... [25.6–27.1] [22.3–28.6] [24.8–26.9] [22.1–23.9] [22.1–24.2] [24.5–26.7] [31.6–34.1] [21.4–22.7] [23.9–26] [27.2–28.3] [26.7–28.9] [21.4–23] [23.3–24.7] [32.2–34.1] [23.9–26.4] [25.7–28.6] [23.7–25.1] [28.5–30.6] [26.2–29.1] [24.4–26.9] [22.9–29.1] [26.4–27.5] [22.2–24.5] [24.6–26.9] [24.5–26.9] [29.3–31] [22.7–24.1] [26.2–27.9] [23.2–26.6] [25.9–27.8] [21.9–23.4] [29.3–32.5] [29.1–31.3] [25.1–31.1] Both sexes 24.0 28.4 26.6 26.5 21.1 22.8 25.3 25.1 22.8 27.2 29.2 24.8 25.6 28.1 29.4 ... 26.0 26.0 25.6 22.3 22.6 24.3 32.5 22.2 25.4 27.9 26.9 21.7 23.4 32.3 26.0 26.9 23.8 29.4 27.1 25.3 25.8 26.3 23.2 26.4 26.2 29.2 23.9 26.7 25.3 26.5 22.0 29.7 29.6 27.3 [95% CI] [23.5–24.6] [27.7–29.1] [25.5–27.7] [25.8–27.3] [20.2–22] [22.2–23.4] [24.8–25.9] [24.4–25.7] [22–23.5] [25.7–28.5] [28.2–30.2] [23.7–26] [24.9–26.3] [27.7–28.5] [28.7–30] ... [25.4–26.4] [23.9–27.9] [24.7–26.4] [21.6–23.1] [21.9–23.4] [23.5–25.1] [31.6–33.3] [21.7–22.8] [24.7–26.1] [27.5–28.2] [25.9–27.8] [21.1–22.4] [22.7–24] [31.6–32.9] [25.2–26.8] [26–27.8] [23.1–24.5] [28.7–30.2] [26.1–28] [24.5–26.1] [23.8–27.8] [25.8–26.9] [22.4–23.9] [25.6–27.2] [25.4–27] [28.7–29.9] [23.4–24.3] [26.1–27.3] [24.2–26.5] [25.8–27.1] [21.5–22.5] [28.5–30.7] [28.8–30.3] [25.5–29.2] Liberia Libya Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (Federated States of) Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Korea Republic of Moldova Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines

205

Global status report on NCDs 2014 … Indicates no data were available

2010 Mean BMI Country name Region Males Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand the former Yugoslav Republic of Macedonia Timor–Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United Republic of Tanzania United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe WPR EUR AFR EMR AFR EUR AFR AFR WPR EUR EUR WPR EMR AFR AFR EUR SEAR EMR AMR AFR EUR EUR EMR EUR SEAR EUR SEAR AFR WPR AMR EMR EUR EUR WPR AFR EUR EMR EUR AFR AMR AMR EUR WPR AMR WPR EMR AFR AFR 29.7 ... 23.6 27.8 21.6 26.2 25.2 21.8 24.1 27.0 27.2 24.5 21.2 25.0 23.4 27.2 22.0 23.4 26.0 23.8 26.4 26.4 26.8 25.1 23.2 26.1 21.1 22.2 30.3 27.2 25.5 26.7 25.8 28.5 20.8 26.1 28.2 27.2 22.0 28.5 26.3 25.4 25.5 27.1 21.0 24.8 21.3 21.7 [95% CI] [29.1–30.3] ... [23–24.3] [27.1–28.6] [20.9–22.4] [25.7–26.8] [24.6–25.8] [21.2–22.4] [23.6–24.5] [26.2–27.9] [24.8–29.4] [23.6–25.4] [18.9–23.6] [24.6–25.4] [22.5–24.3] [26.7–27.7] [21.3–22.8] [22.5–24.3] [23.7–28.3] [22.9–24.7] [25.7–27.1] [25.8–27.1] [25.8–27.9] [22.7–27.4] [22.6–23.8] [23.8–28.4] [18.7–23.5] [21.4–23.1] [29.6–30.9] [25.9–28.4] [24.6–26.5] [26.2–27.1] [25–26.6] [26.2–30.8] [20.2–21.5] [23.7–28.5] [27.1–29.3] [27–27.5] [21.4–22.6] [28.2–28.9] [25.3–27.3] [24.3–26.4] [24.8–26.1] [26.3–27.9] [20.5–21.6] [22.5–27.2] [20.1–22.4] [21.1–22.3] Females 33.1 ... 25.2 28.4 23.8 25.2 27.7 23.3 23.1 25.6 26.2 26.3 22.3 28.7 26.3 26.0 23.0 26.3 27.7 28.4 24.8 23.9 28.6 24.8 24.4 25.2 20.7 23.6 33.3 28.8 27.1 28.2 25.8 29.7 22.6 25.8 29.5 26.9 23.5 28.5 26.6 25.7 26.6 26.9 21.2 26.2 23.4 24.8 [95% CI] [32.4–33.9] ... [24.4–26] [27.6–29.3] [23.1–24.5] [24.3–26.1] [27–28.4] [22.7–23.9] [22.6–23.6] [24.7–26.5] [23.4–29.2] [25.3–27.2] [19.3–25.2] [28.3–29.1] [25.3–27.4] [25.4–26.6] [22.2–23.9] [25.3–27.4] [24.8–30.6] [27.4–29.5] [24–25.7] [22.7–25] [27.5–29.8] [23.9–25.8] [23.7–25] [23.7–26.7] [19.7–21.7] [22.8–24.4] [32.5–34] [27.3–30.2] [26–28.2] [27.8–28.7] [25.1–26.6] [26.8–32.6] [21.8–23.3] [24.2–27.3] [28.3–30.7] [26.6–27.1] [23–24] [28.1–28.9] [25.4–27.6] [24.5–26.9] [25.9–27.3] [26–27.8] [20.6–21.8] [23.2–29.3] [22.6–24.1] [24.2–25.5] Both sexes 31.4 ... 24.4 28.1 22.7 25.7 26.4 22.5 23.6 26.3 26.7 25.4 21.7 26.9 24.9 26.6 22.5 24.9 26.8 26.2 25.6 25.1 27.7 24.9 23.8 25.7 20.9 22.9 31.8 28.0 26.3 27.5 25.8 29.1 21.7 25.9 28.6 27.0 22.8 28.5 26.4 25.6 26.0 27.0 21.1 25.5 22.3 23.3 [95% CI] [30.9–31.9] ... [23.9–24.9] [27.5–28.6] [22.2–23.2] [25.2–26.2] [26–26.9] [22.1–23] [23.3–23.9] [25.7–26.9] [24.8–28.6] [24.7–26.1] [19.8–23.8] [26.7–27.2] [24.2–25.6] [26.2–27] [22–23.1] [24.2–25.6] [25–28.7] [25.4–26.9] [25.1–26.1] [24.5–25.8] [27–28.5] [23.7–26.2] [23.3–24.2] [24.4–27.1] [19.6–22.2] [22.3–23.5] [31.3–32.3] [26.9–29] [25.6–27] [27.1–27.8] [25.2–26.4] [27.1–30.9] [21.2–22.2] [24.5–27.2] [27.8–29.4] [26.9–27.2] [22.4–23.1] [28.2–28.8] [25.7–27.2] [24.9–26.3] [25.5–26.5] [26.4–27.6] [20.7–21.5] [23.6–27.4] [21.6–23] [22.9–23.7]

206

Annex 4.6: Body mass index

2014 Mean BMI Country name Males 29.9 ... 23.9 28.3 21.8 26.4 25.6 22.0 24.3 27.4 27.5 24.5 21.2 25.4 23.7 27.4 22.5 23.7 26.5 24.1 26.7 26.7 27.2 25.5 23.6 26.4 21.5 22.4 30.4 27.9 26.0 27.1 26.4 28.7 21.0 26.4 28.6 27.5 22.2 28.8 26.7 25.9 25.6 27.4 21.5 25.2 21.5 21.8 [95% CI] [29.2–30.7] ... [23.1–24.8] [27.3–29.3] [21–22.7] [25.7–27.1] [24.9–26.4] [21.3–22.6] [23.7–24.9] [26.5–28.3] [25–29.8] [23.4–25.5] [18.8–23.8] [24.7–25.9] [22.5–24.8] [26.6–28.2] [21.5–23.6] [22.5–24.8] [24.1–29] [23–25.3] [25.5–27.7] [25.9–27.5] [26–28.5] [23–28] [22.7–24.4] [23.9–28.8] [19–24] [21.5–23.4] [29.6–31.3] [26.3–29.5] [24.9–27.3] [26.5–27.8] [25.5–27.2] [26.3–31.1] [20.2–21.8] [23.9–28.9] [27.3–30] [27–27.9] [21.5–22.9] [28.2–29.3] [25.5–28] [24.6–27.2] [24.8–26.4] [26.3–28.4] [20.7–22.4] [22.7–27.7] [20.2–22.8] [21–22.6] Females 33.5 ... 25.6 28.7 24.1 25.2 28.0 23.6 23.2 25.7 26.3 26.4 22.5 29.1 26.7 26.0 23.5 26.7 28.2 28.9 24.9 23.8 29.0 25.3 24.6 25.3 21.0 24.0 33.5 29.4 27.5 28.5 26.4 29.9 23.0 25.8 29.7 27.1 24.0 28.8 26.9 26.3 26.8 27.1 21.6 26.5 23.8 25.0 [95% CI] [32.6–34.4] ... [24.7–26.5] [27.6–29.9] [23.1–25] [24–26.5] [27.2–28.8] [22.9–24.4] [22.5–23.9] [24.7–26.7] [23.3–29.5] [25.3–27.5] [19.4–25.6] [28.5–29.8] [25.5–28] [25.1–26.9] [22.4–24.7] [25.5–28] [25.1–31.2] [27.6–30.2] [23.7–26] [22.5–25.2] [27.6–30.4] [24.3–26.4] [23.7–25.5] [23.5–27.1] [19.9–22.1] [23–25.1] [32.6–34.4] [27.6–31.3] [26.2–28.9] [27.9–29.2] [25.5–27.2] [26.9–32.9] [22–24] [24–27.5] [28.3–31.3] [26.7–27.6] [23.3–24.6] [28.2–29.4] [25.5–28.2] [24.8–27.7] [25.9–27.7] [26–28.3] [20.7–22.5] [23.4–29.7] [22.8–24.8] [24.1–25.9] Both sexes 31.7 ... 24.8 28.5 23.0 25.8 26.8 22.8 23.7 26.5 26.9 25.5 21.9 27.3 25.2 26.7 23.0 25.2 27.4 26.5 25.8 25.3 28.1 25.4 24.1 25.8 21.2 23.2 31.9 28.7 26.8 27.8 26.4 29.3 22.0 26.0 29.0 27.3 23.1 28.8 26.8 26.1 26.2 27.2 21.6 25.8 22.6 23.4 [95% CI] [31.1–32.3] ... [24.1–25.4] [27.7–29.2] [22.3–23.6] [25.1–26.5] [26.2–27.4] [22.3–23.3] [23.3–24.2] [25.8–27.2] [24.8–28.9] [24.7–26.2] [19.8–23.9] [26.9–27.7] [24.4–26.1] [26.1–27.4] [22.2–23.8] [24.4–26.1] [25.5–29.2] [25.7–27.4] [25–26.6] [24.5–26] [27.2–29] [24.1–26.6] [23.4–24.7] [24.2–27.3] [19.7–22.6] [22.5–23.9] [31.3–32.6] [27.4–29.9] [25.9–27.7] [27.4–28.3] [25.8–27] [27.4–31.1] [21.4–22.6] [24.5–27.5] [27.9–30] [27–27.6] [22.6–23.5] [28.4–29.2] [26–27.7] [25.1–27] [25.7–26.8] [26.5–28] [20.9–22.2] [23.7–27.8] [21.8–23.5] [22.8–24] Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand the former Yugoslav Republic of Macedonia Timor–Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United Republic of Tanzania United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe

207

Global status report on NCDs 2014

4.7a Overweight and Obesity Comparable estimates of prevalence of overweight (population aged 18+ years), 2010 Overweight (BMI≥25) Crude adjusted estimates Males Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic EMR EUR AFR EUR AFR AMR AMR EUR WPR EUR EUR AMR EMR SEAR AMR EUR EUR AMR AFR SEAR AMR EUR AFR AMR WPR EUR AFR AFR AFR WPR AFR AMR AFR AFR AMR WPR AMR AFR AFR WPR AMR AFR EUR AMR EUR EUR 10.6 55.0 49.4 73.3 18.5 52.3 60.4 51.7 69.4 62.3 50.9 63.3 66.4 12.7 55.7 58.5 66.9 42.9 16.6 20.0 42.4 55.0 29.1 50.9 44.6 64.7 14.2 6.7 25.2 10.4 20.4 69.9 12.1 14.5 60.7 31.5 49.8 13.4 22.0 76.1 54.2 20.3 64.8 52.7 62.4 70.3 [95% CI] [7.3–14.6] [48.6–61.4] [43.9–54.9] [68.3–77.9] [13.1–24.8] [44.3–60] [54.4–66.3] [44.8–58.6] [65.5–73.1] [56.5–67.9] [43.7–58] [57.5–69] [61.3–71.5] [9.3–16.7] [48.2–63.3] [51.9–64.8] [61.7–71.9] [36.6–49.4] [13.1–20.6] [15.4–25.1] [36–49.1] [47.6–62.3] [23.2–35.5] [45.6–56.5] [36.6–52.8] [58.4–70.6] [10.8–18.2] [4.1–10.1] [20.5–30.3] [7.5–13.8] [16.2–25.2] [65.7–73.9] [8.1–16.8] [10.8–18.8] [55.2–66.4] [26.6–36.6] [44.3–55.1] [10.1–17.5] [16.1–28.7] [71.1–80.8] [48.7–59.5] [16.1–24.9] [58.6–70.8] [45.2–60.1] [56.3–68] [64.7–75.6] Females 14.3 47.8 56.7 64.1 30.1 66.4 57.8 54.1 58.2 47.3 54.4 70.4 69.3 16.9 68.3 56.7 50.5 53.1 30.7 23.3 50.9 51.4 49.5 49.9 44.5 57.6 23.9 16.9 35.4 17.5 33.9 61.4 23.2 26.9 61.9 29.5 55.7 27.7 33.7 80.3 59.0 31.2 56.9 63.6 56.7 60.5 [95% CI] [10.8–18.5] [40.8–54.6] [51.1–62.1] [58.1–69.9] [23.5–37] [58.9–73.2] [51.6–64] [47.6–60.5] [54.1–62.3] [41.6–53] [47.6–61.1] [64.5–75.8] [64.1–74.1] [13.2–20.9] [61.5–74.8] [49.4–63.6] [44.5–56.4] [46.7–59.7] [26.4–34.9] [18.9–28.3] [44.6–57] [43.7–58.9] [42.9–56.2] [44.5–55.2] [36.6–52.2] [50.4–64.5] [19.9–28] [12.8–21.6] [30.3–40.5] [13.7–21.5] [29.6–38.7] [56.8–65.8] [18–28.8] [22.3–31.7] [56.1–67.4] [24.5–34.8] [50.6–60.7] [23.3–32.2] [27.4–39.8] [75.8–84.4] [53.7–64.1] [26.8–35.9] [49.6–63.8] [56.6–70.1] [50.5–62.9] [53.6–67] Both sexes 12.4 51.4 53.0 68.6 24.3 59.4 59.1 52.8 63.8 54.6 52.7 66.9 67.5 14.8 62.0 57.5 58.5 48.0 23.7 21.5 46.6 53.2 39.3 50.4 44.5 61.0 19.1 11.9 30.3 14.0 27.1 65.6 17.7 20.7 61.3 30.5 52.8 20.5 27.9 78.1 56.6 25.6 60.7 58.1 59.6 65.3 [95% CI] [9.8–15] [46.8–56.1] [48.7–56.9] [64.8–72.5] [19.7–28.9] [53.9–64.8] [55.2–63.3] [48.3–57.8] [60.9–66.3] [50.3–58.8] [47.7–57.6] [62.3–71.1] [63.8–71.4] [12.1–17.5] [57–67.2] [52.5–62.2] [54.7–62.5] [43.6–52.5] [20.9–26.6] [18.3–25] [42–50.9] [47.4–57.7] [34.5–44.1] [46.5–54] [38.9–49.9] [56.5–65.6] [16.5–21.7] [9.3–14.6] [27–33.8] [11.7–16.6] [23.7–30.3] [62.6–68.7] [14.1–21.3] [17.5–23.8] [57.4–65] [27–34.1] [48.9–56.5] [17.6–23.2] [23.5–32] [74.9–81.5] [52.9–60.1] [22.6–28.5] [56–65.7] [53.2–62.9] [55.5–63.9] [60.7–69.6]

Country name

Region

208

Annex 4.7a: Overweight and Obesity

… Indicates no data were available Overweight (BMI≥25) Age-standardized adjusted estimates Males 12.0 54.5 52.4 70.2 21.0 52.7 60.8 52.6 67.6 59.3 52.7 63.5 67.7 13.5 54.1 57.2 63.8 46.5 18.4 21.8 45.3 53.0 33.1 51.9 44.3 61.6 16.4 7.7 28.4 11.5 23.3 67.2 13.5 16.7 60.4 31.1 51.3 14.7 24.3 77.4 55.4 21.9 61.7 50.5 62.0 67.7 [95% CI] [8.3–16.4] [48.2–61] [46.8–58.1] [65.3–74.9] [14.9–27.9] [44.7–60.5] [54.8–66.6] [45.7–59.5] [63.7–71.4] [53.6–64.7] [45.3–59.9] [57.7–69.3] [62.8–72.5] [9.9–17.6] [46.8–61.5] [50.7–63.5] [58.6–68.8] [39.9–53.3] [14.6–22.8] [16.8–27.4] [38.5–52.5] [45.9–60.1] [26.5–40.1] [46.4–57.5] [36.3–52.5] [55.6–67.5] [12.6–20.7] [4.7–11.4] [23.2–33.9] [8.4–15.2] [18.5–28.5] [63–71.2] [9–18.8] [12.6–21.5] [54.9–66.1] [26.3–36.2] [45.7–56.7] [11–19] [17.7–31.5] [72.5–82] [50–60.8] [17.4–26.9] [55.7–67.6] [43.2–57.7] [55.9–67.6] [62.2–73.1] Females 16.9 46.5 60.6 60.3 34.6 66.4 57.3 53.2 55.8 43.8 55.7 69.9 72.4 18.8 65.5 53.3 46.9 57.6 34.6 27.1 53.6 48.1 55.4 50.3 45.0 52.8 27.5 20.1 38.8 19.1 38.7 58.1 26.2 31.7 60.9 29.1 56.7 31.0 37.7 81.4 60.1 35.1 52.4 60.4 55.3 56.6 [95% CI] [12.8–21.7] [39.6–53.2] [55–65.8] [54.3–66.1] [27.2–42.2] [58.9–73.3] [51–63.4] [46.7–59.6] [51.6–59.9] [38.3–49.4] [48.9–62.3] [64.1–75.4] [67.6–76.7] [14.9–23.3] [58.6–72] [46.1–60.1] [41.1–52.6] [51.2–64] [30–39.2] [22–32.5] [47.2–59.9] [40.6–55.4] [48.6–62.1] [45–55.7] [37.1–52.5] [45.9–59.7] [23.1–31.9] [15.6–25.1] [33.4–44.2] [15.1–23.3] [34.1–43.7] [53.4–62.5] [20.6–32.1] [26.6–36.9] [55.1–66.5] [24.1–34.3] [51.5–61.7] [26.4–35.8] [31–44.3] [77.1–85.4] [54.9–65.2] [30.5–40] [45.3–59.3] [53.5–67.1] [49.1–61.5] [49.8–63.2] Both sexes 14.4 50.5 56.4 65.2 27.8 59.6 59.0 52.9 61.6 51.3 54.2 66.8 69.4 16.1 59.8 55.1 55.2 52.0 26.5 24.3 49.5 50.5 44.2 51.1 44.6 57.1 22.0 14.0 33.6 15.4 31.0 62.6 19.9 24.2 60.7 30.1 54.0 22.8 31.0 79.4 57.7 28.4 56.9 55.4 58.7 62.1 [95% CI] [11.4–17.5] [45.8–55.1] [52.6–60.2] [61.6–69] [22.6–33.4] [54–64.6] [54.8–63.2] [47.8–57.4] [58.6–64.2] [47.7–55.6] [49–59.1] [62.7–70.8] [65.8–72.9] [13.1–19] [54.7–64.8] [50.4–60] [51.6–59] [47.5–56.5] [23.4–29.5] [20.5–28.1] [44.6–54.4] [45.4–56.2] [39.5–49.1] [47.2–55.1] [38.8–50.6] [53–61.4] [18.9–25] [10.9–17.3] [30–37.4] [12.7–18.4] [27.6–34.4] [59.6–65.6] [16.1–23.9] [21–28] [56.7–64.6] [26.7–33.8] [50.3–57.8] [19.9–25.9] [26.2–35.5] [76.3–82.4] [54.2–61.5] [24.8–31.8] [52.3–61.5] [50.6–60.3] [54.3–62.8] [57.7–66.2] Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic

Country name

209

Global status report on NCDs 2014 … Indicates no data were available Overweight (BMI≥25) Crude adjusted estimates Males Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea–Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho SEAR AFR EUR EMR AMR AMR AMR EMR AMR AFR AFR EUR AFR WPR EUR EUR AFR AFR EUR EUR AFR EUR AMR AMR AFR AFR AMR AMR AMR EUR EUR SEAR SEAR EMR EMR EUR EUR EUR AMR WPR EMR EUR AFR WPR EMR EUR WPR EUR EMR AFR 18.5 11.0 65.8 22.2 49.6 46.3 46.9 50.2 46.7 30.7 10.0 61.0 9.6 65.2 63.7 68.0 34.0 20.3 52.5 64.7 18.8 67.4 44.2 41.2 15.8 16.2 39.2 26.3 40.6 67.0 64.7 16.7 17.2 52.8 44.7 66.5 66.4 66.8 47.9 28.6 55.0 55.6 14.4 65.8 71.4 39.5 11.4 60.7 64.3 15.0 [95% CI] [12.2–26.2] [6.8–16.1] [60.5–71] [16.2–28.9] [43–56.1] [39.9–53] [40.3–53.6] [45.1–55.5] [41.1–52.6] [21.9–40.5] [7.2–13.1] [54.5–67.4] [6.8–12.6] [59–71] [59–68.3] [62.5–73.4] [26.1–41.9] [16–25.1] [45.3–59.8] [59.7–69.4] [14.3–24] [61.8–72.7] [37.6–51.1] [35.4–47.3] [12.3–19.5] [12.5–20.5] [32.4–46.4] [19.9–33.2] [34.9–46.5] [61.3–72.5] [58.9–70.2] [13.4–20.4] [13.3–21.6] [48.3–57.3] [38.8–50.7] [61.5–71.6] [61–71.7] [61.9–71.5] [42–54.2] [24.2–33] [49.2–60.6] [48.9–62.2] [10.8–18.5] [59.4–71.7] [66.3–76.3] [32.7–46.9] [8.3–14.9] [54.2–67.1] [58.8–69.5] [11.1–19.4] Females 21.4 22.2 48.1 30.6 60.6 55.2 52.9 63.4 55.4 42.2 20.3 55.9 20.6 72.1 52.0 56.3 43.3 30.6 56.6 50.8 35.9 58.4 58.6 50.1 27.0 26.8 56.9 38.4 49.2 56.5 51.2 21.2 24.4 58.6 54.4 53.7 58.8 57.3 63.0 22.3 62.9 55.2 26.8 76.8 70.1 43.7 17.4 58.2 65.0 42.8 [95% CI] [14.9–28.6] [16.9–28.3] [42.2–54] [23.9–37.6] [54.5–66.7] [48.9–61.3] [46.4–59.2] [58.6–68.1] [50.2–60.7] [32.8–51.7] [16.3–24.6] [48.5–63.1] [16.7–24.9] [67–76.9] [46.9–56.7] [50–62.5] [36.2–50.3] [25.8–35.8] [49.8–63.1] [45.7–55.8] [30.6–41.4] [52.5–64.2] [52.2–65.2] [44.7–55.6] [23–31.2] [22.4–31.6] [49.8–63.5] [32–45] [44–54.7] [49.5–63.3] [44.9–57.4] [17.8–25] [20–29] [54.2–62.9] [48.6–60.2] [48.7–59] [52.9–64.5] [51.9–62.6] [57.1–68.5] [18.6–26.2] [57.9–67.8] [48.3–61.8] [22.3–31.6] [71.9–81.3] [64.7–75.1] [37.2–50] [13.6–21.5] [50.7–65] [59.6–70.1] [36.8–49] Both sexes 20.0 16.6 56.9 26.4 55.1 50.8 49.9 56.8 51.3 36.3 15.2 58.3 15.1 68.6 57.7 62.0 38.6 25.5 54.6 57.6 27.4 62.8 51.4 45.7 21.4 21.5 47.9 32.4 44.9 61.5 58.0 18.9 20.8 55.7 49.5 60.1 62.5 61.9 55.6 25.3 58.9 55.4 20.6 71.2 70.9 41.6 14.4 59.4 64.6 29.1 [95% CI] [15.1–25] [13–20.2] [52.9–60.6] [21.5–31.1] [50.6–59.6] [46.3–55.2] [45.2–54.4] [53.1–60] [47.7–55.2] [30.2–43.4] [12.7–17.8] [53.2–63.2] [12.5–17.5] [64.8–72.5] [54.4–61] [57.8–65.9] [32.9–43.9] [22.2–28.9] [49.8–59.8] [54.4–61.3] [23.4–31.2] [58.7–67] [46.8–56] [41.9–49.5] [18.6–24.2] [18.4–24.5] [43.1–53.1] [27.9–37.1] [41–48.8] [57.2–65.8] [53.8–62.2] [16.4–21.3] [17.7–23.8] [52.7–58.9] [45.5–53.5] [56.8–63.6] [58.5–66.4] [58.2–65.6] [51.6–59.8] [22.3–28.2] [54.9–62.7] [50.8–60.2] [17.5–23.9] [67.5–75] [67.5–74.4] [37–46.2] [12.1–17.1] [54.7–64] [60.8–68.5] [25.5–32.8]

Country name

Region

210

Annex 4.7a: Overweight and Obesity

Overweight (BMI≥25) Age-standardized adjusted estimates Males 18.0 12.2 62.6 24.4 50.0 48.2 48.7 52.8 50.6 32.1 11.5 59.1 10.8 66.9 60.2 65.2 37.1 22.9 51.5 60.7 20.7 64.2 47.6 45.5 17.4 17.8 41.1 28.9 44.4 64.6 63.2 17.3 17.3 56.1 49.5 64.6 66.2 62.7 48.7 27.2 59.0 57.0 16.5 66.8 72.8 42.7 12.8 59.0 64.5 18.1 [95% CI] [11.8–25.6] [7.7–17.8] [57.3–67.6] [17.9–31.8] [43.3–56.6] [41.6–54.9] [42–55.5] [47.4–58.2] [44.7–56.6] [22.9–42.3] [8.3–15] [52.7–65.4] [7.7–14.2] [60.7–72.7] [55.7–64.8] [59.8–70.6] [28.8–45.7] [18.2–28.2] [44.4–58.7] [55.9–65.4] [15.8–26.4] [58.7–69.5] [40.7–54.7] [39.3–52] [13.6–21.5] [13.8–22.5] [34–48.6] [21.9–36.3] [38.3–50.6] [59–70.1] [57.5–68.7] [13.8–21.1] [13.4–21.7] [51.4–60.6] [43.2–55.8] [59.7–69.6] [60.7–71.5] [58–67.3] [42.7–55.1] [23.2–31.5] [53.1–64.7] [50.2–63.7] [12.4–21.1] [60.4–72.8] [67.9–77.4] [35.5–50.7] [9.4–16.8] [52.6–65.2] [59–69.8] [13.5–23.1] Females 20.6 25.3 44.3 34.4 60.6 57.3 54.6 66.0 58.0 45.7 23.9 51.7 23.6 73.6 47.3 52.6 47.0 35.8 53.8 45.8 39.8 54.0 62.1 54.5 30.1 30.0 59.9 42.2 53.7 52.4 49.2 22.3 25.2 62.8 59.7 52.0 57.6 52.0 63.6 19.4 68.0 55.4 31.2 77.9 73.9 46.9 19.9 53.9 67.4 48.1 [95% CI] [14.3–27.5] [19.5–31.8] [38.6–50.1] [27.2–41.9] [54.5–66.8] [51.1–63.4] [48–60.9] [61.1–70.7] [52.8–63.2] [35.9–55.4] [19.4–28.7] [44.5–58.7] [19.3–28.3] [68.6–78.2] [42.4–51.9] [46.4–58.7] [39.5–54.4] [30.6–41.5] [47.3–60.3] [41–50.7] [34.3–45.5] [48.2–59.8] [55.6–68.7] [49–60] [25.8–34.5] [25.3–35.3] [52.9–66.5] [35.5–49.2] [48.4–59.2] [45.5–59.1] [43–55.3] [18.7–26.2] [20.8–29.9] [58.4–67] [54–65.2] [47–57.4] [51.6–63.4] [46.6–57.3] [57.7–69] [15.9–23] [63.1–72.6] [48.5–62.1] [26.3–36.4] [73–82.3] [69–78.3] [40.1–53.4] [15.8–24.3] [46.5–60.7] [61.9–72.4] [41.8–54.7] Both sexes 19.3 18.8 53.4 29.4 55.3 52.7 51.6 59.4 54.5 38.7 17.7 55.1 17.2 70.2 53.6 58.7 42.1 29.4 52.8 53.1 30.3 59.1 54.9 50.1 23.7 24.0 50.4 35.6 49.1 58.2 56.3 19.7 21.2 59.4 54.5 58.3 61.8 57.2 56.3 23.2 63.4 56.2 23.9 72.2 73.3 44.8 16.4 56.2 66.0 33.4 [95% CI] [14.7–24.3] [14.6–23] [49.6–57] [24.3–34.5] [50.9–59.9] [48.4–56.9] [47.2–56.5] [55.9–63.1] [50.3–58.4] [32–45.8] [14.7–20.2] [50.4–60] [14.2–20] [66.4–73.9] [50.2–57] [54.6–62.7] [36.3–47.8] [25.6–33] [48.1–57.2] [49.7–56.3] [26.6–34.1] [55.2–63] [50.3–60] [46–54.4] [20.8–26.5] [20.4–27.2] [45.3–55.4] [30.9–40.7] [44.9–53.4] [53.7–62.6] [51.8–60.5] [17.2–22.2] [18.2–24.1] [56.5–63] [50.3–58.9] [54.7–62] [57.4–65.6] [53.3–60.9] [52.6–60.6] [20.3–26.1] [59.5–67.1] [51.2–61.4] [20.6–27] [68.2–76.1] [69.9–76.7] [39.7–49.5] [13.6–19.1] [51.7–61.1] [62.1–69.7] [29.5–37.2]

Country name

Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea–Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho

211

Global status report on NCDs 2014 … Indicates no data were available Overweight (BMI≥25) Crude adjusted estimates Males Liberia Libya Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (Federated States of) Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Korea Republic of Moldova Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines AFR EMR EUR EUR AFR AFR WPR SEAR AFR EUR WPR AFR AFR AMR WPR EUR WPR EUR EMR AFR SEAR AFR WPR SEAR EUR WPR AMR AFR AFR WPR EUR EMR EMR WPR AMR WPR AMR AMR WPR EUR EUR EMR WPR EUR EUR EUR AFR AMR AMR AMR 14.3 60.4 60.6 68.3 12.9 10.5 31.5 20.8 15.3 69.3 70.7 21.0 36.6 58.5 56.1 ... 43.4 61.4 46.8 11.0 10.9 24.4 74.3 12.6 64.7 68.0 38.3 11.7 20.8 68.4 65.9 57.0 17.5 75.3 54.3 50.1 42.9 48.7 17.8 64.9 62.3 73.1 33.9 43.7 62.0 58.3 9.3 50.4 47.7 46.8 [95% CI] [10.7–18.7] [55.5–65.2] [54.2–66.7] [62.9–73.5] [9.7–16.5] [7.7–13.7] [26–37.1] [14.9–27.4] [11.6–19.4] [63.4–74.7] [65.2–75.9] [16.2–26.3] [29.9–43.4] [53.8–63.3] [50.6–61.6] ... [36.8–50.2] [54.9–67.4] [40.9–52.4] [8–14.4] [7.8–14.8] [19.3–30] [67.6–80.5] [9.3–16.4] [59.6–69.5] [64–72] [32.4–44.5] [8.5–15.4] [16.9–25] [63–73.5] [60.9–70.7] [51.7–62.2] [13.3–22.3] [70–80] [48.4–60.1] [43.1–56.9] [36.9–49.2] [42.3–55.3] [13.7–22.2] [59.4–70.3] [56.2–68.5] [67.6–78.3] [29–39] [36.5–50.6] [55.8–67.9] [52.2–64.2] [6–13.3] [43.4–57.5] [40.2–55.4] [40.3–53.2] Females 26.3 65.2 59.8 49.4 24.1 24.0 34.0 27.7 24.9 61.7 77.1 29.3 49.4 62.3 68.0 ... 43.5 52.2 56.0 24.0 17.9 47.2 78.9 17.4 50.3 59.9 48.8 21.2 33.0 76.0 54.2 60.4 20.6 79.2 61.9 60.2 43.7 57.1 22.4 58.4 52.6 73.5 28.4 47.2 54.9 59.3 21.4 62.9 60.2 57.8 [95% CI] [21.8–31.3] [60.5–70] [52.6–66.3] [43.3–55.3] [19.7–28.7] [20.1–28.2] [28.8–39.4] [21.6–34.2] [20.8–29.2] [55.4–67.9] [72.3–81.7] [24.3–34.8] [42.6–56.3] [57.7–66.9] [62.9–72.9] ... [37–50] [45.3–59.1] [50.4–61.4] [19.8–28.4] [14–22.2] [40.8–53.6] [73.1–83.9] [13.8–21.3] [45–55.5] [55.6–64.2] [43.1–54.4] [17.3–25.3] [28.6–37.4] [71.3–80.3] [48.8–59.4] [55–65.7] [16.7–25] [74.5–83.4] [56.4–67.3] [53.9–66.1] [37.3–50.2] [51.5–62.6] [18–27] [51.7–64.8] [46.3–58.9] [68.3–78.6] [23.6–33.5] [40.3–54] [47.9–61.6] [53.1–65.3] [16.8–26.4] [55.9–69.5] [52.9–67.4] [51.5–64.1] Both sexes 20.3 62.8 60.2 58.8 18.5 17.3 32.8 24.2 20.0 65.5 73.9 25.1 43.1 60.5 61.9 ... 43.4 56.7 51.5 17.6 14.5 36.2 76.6 15.0 57.4 63.9 43.6 16.4 26.8 72.1 60.1 58.4 19.0 77.2 58.1 55.0 43.3 52.9 20.1 61.5 57.3 73.2 31.1 45.5 58.3 58.8 15.5 56.7 54.1 52.2 [95% CI] [17.3–23.3] [59.4–66] [55.5–64.7] [54.8–62.9] [15.8–21.2] [14.7–19.7] [28.9–36.6] [19.6–28.4] [17.2–22.8] [61.6–69.4] [70.3–77.4] [21.6–28.5] [38.4–47.9] [57.2–63.7] [58.4–65.8] ... [38.9–47.8] [52.1–61.8] [47.3–55.4] [14.8–20] [11.9–17.3] [31.8–40.5] [72.4–80.4] [12.3–17.8] [53.9–61] [60.9–66.9] [39.5–47.4] [13.8–19] [23.8–29.7] [68.7–75.5] [56.4–63.5] [54.5–62.3] [16–22.3] [74–80.6] [54.2–62.1] [50.2–59.8] [39–47.7] [48.8–57.4] [17.2–23] [56.9–65.8] [52.9–61.2] [69–77.5] [27.4–34.5] [40.5–50.5] [53.9–62.9] [54.5–63.1] [12.4–18.5] [51.7–61.8] [48.9–59.3] [47.7–56.9]

Country name

Region

212

Annex 4.7a: Overweight and Obesity

Overweight (BMI≥25) Age-standardized adjusted estimates Males 15.8 63.4 59.5 65.3 14.3 12.1 32.7 22.9 17.4 66.4 71.8 23.0 35.5 60.4 62.8 ... 46.6 59.5 48.8 12.5 11.2 27.4 75.3 13.2 61.2 66.2 41.9 12.4 23.0 69.8 63.2 62.8 19.2 76.3 55.4 54.3 45.5 50.6 18.9 63.4 59.3 74.5 32.7 43.4 60.3 57.2 10.6 50.8 48.1 47.6 [95% CI] [11.9–20.5] [58.5–68.1] [53.2–65.5] [60.1–70.5] [10.7–18.2] [8.9–15.7] [27–38.6] [16.5–30] [13.3–22.1] [60.6–72] [66.2–77] [17.7–28.7] [29–42.3] [55.7–65.3] [57.1–68.4] ... [39.5–53.6] [53.2–65.5] [42.7–54.5] [9.2–16.3] [7.9–15.2] [21.8–33.5] [68.5–81.5] [9.8–17.3] [56.3–65.9] [62.1–70.1] [35.7–48.5] [9–16.2] [18.8–27.6] [64.4–74.9] [58.3–67.9] [57.5–67.7] [14.7–24.5] [71.1–81] [49.5–61.2] [47.1–61.5] [39.3–52.1] [44–57.2] [14.6–23.8] [57.9–68.7] [53.5–65.2] [69.2–79.2] [27.9–37.8] [36.2–50.3] [54.3–66.1] [51.2–63] [7–15.2] [43.8–58] [40.5–55.8] [41.1–54.2] Females 29.5 68.8 56.5 46.4 27.4 27.7 36.0 31.2 28.6 57.9 78.2 32.6 47.8 63.6 73.3 ... 46.9 49.2 58.4 27.0 18.7 51.9 79.9 19.1 46.4 57.3 52.9 24.1 36.8 77.2 50.9 67.5 23.3 80.3 62.9 64.6 46.7 59.0 24.2 55.2 48.5 76.9 26.6 45.3 51.9 55.6 24.9 62.9 60.5 59.1 [95% CI] [24.6–34.8] [64.3–73.3] [49.4–63.1] [40.4–52.2] [22.7–32.5] [23.3–32.2] [30.7–41.6] [24.7–38.1] [24.1–33.3] [51.5–64.1] [73.4–82.6] [27.3–38.4] [41.1–54.7] [59–68.1] [68.5–77.9] ... [40.2–53.5] [42.3–56] [52.7–63.8] [22.6–31.7] [14.7–23.1] [45.4–58.2] [74.2–84.8] [15.3–23.4] [41.2–51.5] [53.1–61.6] [47.1–58.6] [19.9–28.6] [32.2–41.5] [72.6–81.4] [45.5–56.1] [62.4–72.2] [19.1–28] [75.7–84.3] [57.3–68.1] [58.3–70.3] [40.2–53.1] [53.2–64.5] [19.5–29] [48.6–61.7] [42.3–54.7] [72.2–81.3] [21.9–31.5] [38.6–52] [45–58.6] [49.4–61.8] [19.9–30.3] [55.9–69.6] [53.2–67.7] [52.8–65.4] Both sexes 22.6 66.0 57.9 55.8 20.9 19.9 34.4 27.0 23.0 62.1 75.0 27.8 41.7 62.1 67.9 ... 46.7 54.3 53.7 19.9 15.0 40.0 77.6 16.2 53.7 61.7 47.4 18.2 29.8 73.4 57.1 64.7 21.2 78.3 59.1 59.4 46.1 54.8 21.5 59.2 53.7 75.1 29.6 44.4 56.0 56.4 17.9 56.9 54.4 53.3 [95% CI] [19.1–26.1] [62.7–69.3] [53–62.2] [51.8–59.5] [17.7–24] [17.1–22.6] [30.6–38.1] [22.1–31.9] [19.7–26] [58.1–66.4] [71.6–78.4] [23.4–31.5] [37–46.6] [59–65.4] [64.1–71.9] ... [41.9–51.6] [49.8–59.1] [49.8–58] [16.9–22.9] [12.2–17.9] [35.3–44.4] [73.3–81.6] [13.3–18.8] [50.3–57.1] [58.8–64.7] [43.4–51.6] [15.4–21] [26.8–32.8] [70.1–76.9] [53.5–60.7] [61–68.3] [17.7–24.7] [75.1–81.4] [55–63.2] [54.5–64.4] [41.3–50.7] [50.3–59.2] [18.4–24.7] [54.9–63.5] [49.6–58] [71.2–79] [26–33.1] [39.7–49.4] [51.6–60.5] [52.2–60.4] [14.3–21.1] [52–61.5] [48.9–59.8] [48.7–57.8]

Country name

213

Global status report on NCDs 2014 … Indicates no data were available Overweight (BMI≥25) Crude adjusted estimates Males Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand the former Yugoslav Republic of Macedonia Timor–Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United Republic of Tanzania United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe WPR EUR AFR EMR AFR EUR AFR AFR WPR EUR EUR WPR EMR AFR AFR EUR SEAR EMR AMR AFR EUR EUR EMR EUR SEAR EUR SEAR AFR WPR AMR EMR EUR EUR WPR AFR EUR EMR EUR AFR AMR AMR EUR WPR AMR WPR EMR AFR AFR 65.4 ... 20.5 64.0 18.2 59.5 44.3 14.7 35.8 65.0 67.1 47.5 12.8 36.7 18.1 67.8 16.2 18.1 49.4 21.6 63.6 64.7 48.2 34.8 23.7 58.9 8.4 14.2 65.6 51.6 54.7 59.8 47.3 66.6 10.3 54.5 64.2 68.7 13.4 72.2 59.6 40.6 57.0 57.0 13.8 32.6 15.5 12.7 [95% CI] [59.1–71.3] ... [16.1–25.4] [58.8–69] [14.4–22.4] [53.4–65.4] [36.7–52] [11.4–18.3] [30.8–40.9] [59–70.9] [60.6–73.5] [40.7–54.2] [8.8–17.4] [31.7–41.8] [13.8–22.8] [62.7–72.6] [11.9–21.3] [13.8–22.8] [42.8–55.9] [16.7–27] [58.7–68.2] [59.6–69.6] [42.9–53.4] [27.6–42.2] [19.1–28.9] [52.3–65.1] [5.7–11.8] [10.9–17.7] [59.6–71.4] [42.1–61.3] [49.6–59.6] [55.2–64.4] [40.6–54.4] [60.9–72] [7–14.3] [47.6–61.2] [58.9–69.7] [65.3–72] [10.2–17] [68.4–75.8] [53.4–65.7] [33.5–47.8] [50.7–63] [51.6–62.4] [10.4–17.7] [26.3–39.2] [11.8–19.4] [8.8–17.3] Females 76.7 ... 34.5 65.3 30.7 50.9 60.5 27.0 27.7 57.3 58.1 60.4 21.3 59.2 27.7 58.2 28.4 27.7 60.3 45.8 50.6 48.8 54.9 41.8 31.6 51.7 14.0 27.7 76.4 65.1 62.9 65.8 49.8 74.2 22.7 55.1 65.5 60.1 26.6 63.4 60.2 45.3 67.3 60.6 19.7 44.8 29.3 35.9 [95% CI] [71.9–81.3] ... [29.4–40] [60.2–70.5] [26.2–35.3] [44–57.4] [53.3–67.5] [23.1–31.3] [23.2–32.5] [50.1–64] [50.5–65.6] [54.5–66.5] [16.4–26.5] [54.2–64.2] [22.8–32.9] [52.6–63.6] [22.6–34.4] [22.8–32.9] [53.9–66.4] [39.2–52.4] [45.5–55.7] [43.2–54.3] [49.3–60.6] [35–48.6] [26.6–36.9] [44.6–58.5] [10.5–18] [23.5–32.1] [71.7–80.8] [56.4–73] [58.1–67.7] [61.5–70.1] [43.2–56.3] [69.4–78.8] [18.2–27.8] [47.8–62] [59.8–71.1] [56.5–63.8] [22.7–30.8] [59.3–67.4] [53.7–66.4] [38.5–52] [61.9–72.4] [55.2–65.8] [15.6–24.1] [37.8–51.8] [24.6–34.2] [29.6–42.6] Both sexes 70.9 ... 27.6 64.6 24.6 55.1 52.3 20.9 31.7 61.1 62.6 53.9 17.0 48.3 22.9 62.9 22.4 22.9 54.8 33.9 57.1 56.6 51.5 38.3 27.7 55.3 11.2 21.0 71.0 58.4 58.8 62.9 48.6 70.3 16.5 54.8 64.6 64.3 20.0 67.7 59.9 42.9 62.1 58.8 16.8 38.6 22.4 24.5 [95% CI] [67–75.1] ... [24.1–31] [61.1–68.4] [21.8–27.6] [50.5–59.5] [47.2–57.9] [18.4–23.8] [28.5–34.9] [56.4–65.6] [57.6–67.3] [49.4–58.4] [13.9–20.3] [44.5–51.9] [19.6–26.2] [59.2–66.6] [18.4–26.2] [19.6–26.2] [50.8–59.6] [29.6–38.1] [53.7–60.8] [52.9–60.7] [47.2–55.3] [33.1–43.2] [24–31.2] [50.6–60] [8.7–13.6] [18.3–23.8] [67.2–74.7] [52.4–64.5] [55.4–62.3] [59.8–65.9] [43.7–53.3] [66.9–74] [13.4–19.4] [50.2–59.9] [60.5–68.6] [61.9–67] [17.3–22.7] [65–70.3] [55.6–64.3] [38.4–48.1] [58.1–66] [55.1–62.7] [13.7–19.8] [34–43.2] [19.4–25.5] [20.5–28.6]

Country name

Region

214

Annex 4.7a: Overweight and Obesity

Overweight (BMI≥25) Age-standardized adjusted estimates Males 68.0 ... 23.7 65.3 21.0 57.6 43.9 16.2 34.2 63.6 64.1 52.0 14.2 39.3 20.0 64.6 16.0 20.0 50.1 25.8 60.8 61.5 52.2 38.6 22.7 57.5 9.7 16.1 69.1 51.5 56.0 61.1 50.7 68.0 12.0 53.3 71.0 65.9 15.3 70.3 58.9 43.8 61.2 58.6 14.2 38.0 17.8 15.5 [95% CI] [61.8–73.9] ... [18.8–29.2] [60.2–70.1] [16.7–25.7] [51.7–63.4] [36.3–51.6] [12.6–20.1] [29.3–39.2] [57.6–69.4] [57.7–70.2] [44.8–59] [9.9–19.3] [33.9–44.7] [15.3–25.1] [59.7–69.3] [11.7–21.1] [15.3–25.1] [43.4–56.8] [20.2–32] [56–65.4] [56.5–66.2] [46.8–57.7] [30.9–46.5] [18.2–27.7] [51–63.7] [6.6–13.4] [12.5–20] [63.1–74.8] [41.9–61.1] [50.9–60.9] [56.6–65.7] [43.6–58] [62.3–73.4] [8.2–16.5] [46.5–59.9] [66–75.6] [62.6–69.4] [11.7–19.1] [66.5–74] [52.8–64.9] [36.3–51.4] [54.8–67.4] [53.2–64.2] [10.6–18.3] [31–45.3] [13.7–22.2] [10.9–20.7] Females 78.9 ... 39.5 69.9 35.0 47.7 60.1 30.6 26.0 54.6 54.0 65.9 24.2 61.4 31.2 54.0 27.8 31.2 60.9 52.1 47.1 45.2 59.9 46.6 30.1 49.5 16.1 31.7 78.8 64.6 64.1 66.5 53.0 75.5 26.8 51.5 74.6 56.8 30.5 60.8 58.1 48.6 71.9 62.2 20.5 51.8 34.8 42.5 [95% CI] [74.2–83.2] ... [34–45.3] [65.1–74.5] [30.2–40] [41–54.2] [52.9–66.9] [26.3–35.1] [21.8–30.7] [47.5–61.3] [46.6–61.4] [60.1–71.7] [18.9–29.9] [56.4–66.5] [26–36.6] [48.4–59.3] [22.1–33.8] [26–36.6] [54.5–67] [45.3–58.7] [42–52] [39.8–50.6] [54.2–65.3] [39.4–53.7] [25.3–35.3] [42.5–56.2] [12.2–20.4] [27.2–36.5] [74.3–83.1] [55.8–72.5] [59.2–68.8] [62.1–70.7] [46.3–59.5] [70.7–80] [21.7–32.3] [44.3–58.3] [70–78.9] [53.1–60.5] [26.2–35] [56.8–64.9] [51.6–64.3] [41.8–55.4] [66.9–76.7] [56.8–67.3] [16.3–25] [44.7–59.2] [29.7–40.2] [35.5–49.7] Both sexes 73.3 ... 31.7 67.3 28.1 52.5 51.9 23.5 30.1 58.9 59.0 58.9 19.2 50.7 25.6 59.2 22.0 25.6 55.5 39.2 53.9 53.2 56.0 42.6 26.5 53.5 12.8 24.0 74.0 58.1 60.1 63.8 51.9 71.7 19.4 52.3 72.0 61.3 22.9 65.5 58.5 46.2 66.5 60.4 17.4 44.8 26.4 29.2 [95% CI] [69.3–77.2] ... [28–35.8] [63.6–71.1] [24.5–31.4] [47.8–56.8] [46.9–57.1] [20.5–26.2] [26.8–33.2] [54.4–63.5] [54.3–63.8] [54.4–63.5] [15.6–22.9] [47.1–54.2] [22.1–29.3] [55.7–62.9] [18.4–25.5] [22.1–29.3] [50.8–60.2] [34.9–43.5] [50.3–57.2] [49.8–56.9] [52.1–59.8] [37.5–47.4] [22.9–30.1] [48.7–58.1] [10.3–15.5] [21.1–27.2] [70.1–77.4] [51.7–64.2] [56.7–63.5] [61–67.2] [46.6–56.5] [67.8–75.3] [16–23.1] [47.3–56.8] [68.5–75.7] [58.9–63.6] [19.7–25.7] [62.7–68.2] [54.1–63.1] [41.2–51.1] [62.6–70.5] [56.8–64.2] [14.5–20.3] [39.6–50] [22.9–29.4] [25.1–33.8]

Country name

Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand the former Yugoslav Republic of Macedonia Timor–Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United Republic of Tanzania United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe

215

Global status report on NCDs 2014

4.7a Overweight and Obesity (continued) Comparable estimates of prevalence of overweight (population aged 18+ years), 2010 Obesity (BMI≥30) Crude adjusted estimates Males Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic EMR EUR AFR EUR AFR AMR AMR EUR WPR EUR EUR AMR EMR SEAR AMR EUR EUR AMR AFR SEAR AMR EUR AFR AMR WPR EUR AFR AFR AFR WPR AFR AMR AFR AFR AMR WPR AMR AFR AFR WPR AMR AFR EUR AMR EUR EUR 1.2 14.9 15.3 27.6 3.9 19.2 20.8 14.7 26.5 19.9 14.8 26.4 26.8 1.6 21.6 18.7 22.1 12.9 3.1 3.5 9.7 15.3 8.4 14.7 13.6 20.9 2.3 0.5 5.9 1.1 4.1 26.2 1.6 2.8 21.2 4.4 13.7 1.8 4.6 42.6 16.5 3.7 21.6 17.1 20.1 25.6 [95% CI] [0.6–2.2] [10.4–20] [11.4–19.7] [21.9–33.7] [2–6.6] [13.1–26.5] [15.8–26.3] [9.9–20] [22.6–30.6] [15–25.5] [9.8–20] [20.4–33.3] [21.2–32.6] [0.8–2.6] [15.2–28.8] [13.4–24.8] [17.2–27.2] [9–17.7] [1.9–4.7] [2.1–5.5] [6.1–13.8] [10.3–21.5] [5.4–12.2] [11.1–18.6] [8.8–19.7] [15.6–27] [1.4–3.7] [0.2–1.1] [3.9–8.5] [0.6–1.9] [2.6–6.2] [21.7–30.9] [0.8–2.9] [1.6–4.5] [16.5–26.4] [2.8–6.4] [10–17.6] [1–2.9] [2.5–7.4] [35.6–49.5] [12.6–20.9] [2.3–5.6] [16–27.6] [11.8–23.3] [14.9–25.8] [19.9–31.7] Females 2.7 18.2 26.3 31.1 9.9 36.3 26.5 21.1 27.7 16.6 22.4 40.6 38.2 3.6 37.9 25.5 18.7 24.2 10.6 6.2 18.3 20.7 25.0 20.1 18.3 25.2 6.5 2.7 13.2 3.0 12.2 29.3 5.7 8.7 30.1 6.5 23.0 7.9 11.8 52.1 26.3 10.2 25.2 30.9 25.0 28.7 [95% CI] [1.5–4.2] [12.8–24.3] [20.8–32.2] [24.3–38.3] [6–14.9] [28.1–44.9] [20.8–32.6] [15.7–27.1] [23.6–31.7] [12–21.8] [16.7–28.7] [33.1–47.9] [31.8–44.7] [2.3–5.2] [30.2–46] [18.3–33.1] [13.9–24] [18.3–30.8] [8–13.5] [4.1–8.9] [13.5–23.8] [14.4–28.1] [18.7–31.7] [16.1–24.5] [12.6–25] [18.7–32.2] [4.6–8.7] [1.5–4.3] [9.7–17.1] [1.9–4.5] [9.3–15.5] [24.7–34] [3.4–8.7] [6.1–11.8] [24.5–36.1] [4.3–9.1] [18.5–27.6] [5.6–10.8] [8.1–16.3] [45.3–59.1] [21.3–31.7] [7.6–13.3] [18.6–32.5] [23.9–38.4] [18.8–31.4] [21.7–35.8] Both sexes 1.9 16.5 20.7 29.4 7.0 27.8 23.7 17.8 27.1 18.2 18.6 33.6 31.1 2.6 29.8 22.4 20.4 18.5 6.8 4.7 14.0 18.1 16.7 17.4 15.9 23.1 4.4 1.6 9.6 2.1 8.2 27.7 3.7 5.7 25.7 5.4 18.4 4.8 8.2 47.3 21.3 6.9 23.4 24.0 22.5 27.2 [95% CI] [1.1–2.7] [12.8–20.2] [17.3–24.2] [24.5–33.9] [4.2–9.6] [22.4–33.2] [19.8–27.6] [14.2–21.3] [24.2–29.8] [14.2–22] [14.9–22.6] [29.1–38.4] [26.8–35.2] [1.8–3.4] [25–34.9] [17.7–27.3] [17–23.6] [14.7–22.4] [5.4–8.3] [3.4–6.2] [10.8–17.2] [13.7–22.1] [13.1–20.3] [14.7–20.2] [11.9–20.3] [18.9–27.4] [3.3–5.5] [0.9–2.3] [7.5–11.8] [1.4–2.8] [6.4–10] [24.6–31] [2.4–5.1] [4.2–7.3] [22.1–29.8] [4–7] [15.4–21.3] [3.5–6.1] [5.9–10.5] [42.2–52.1] [18–24.6] [5.4–8.5] [18.8–28] [19.4–28.6] [18.3–26.8] [22.7–31.8]

Country name

Region

216

Annex 4.7a: Overweight and Obesity

… Indicates no data were available Obesity (BMI≥30) Age-standardized adjusted estimates Males 1.4 14.6 16.6 26.1 4.6 19.4 21.0 15.1 25.6 18.5 15.5 26.4 27.7 1.7 20.7 18.1 20.6 14.4 3.5 3.9 10.6 14.5 10.0 15.1 13.4 19.5 2.8 0.6 6.9 1.2 4.9 24.6 1.9 3.3 21.0 4.3 14.2 2.0 5.2 43.5 17.0 4.0 20.1 16.1 20.0 24.2 [95% CI] [0.7–2.5] [10.2–19.7] [12.4–21.2] [20.7–31.9] [2.4–7.7] [13.3–26.8] [16–26.5] [10.2–20.5] [21.8–29.7] [13.9–23.8] [10.3–20.9] [20.4–33.4] [22.2–33.4] [0.9–2.8] [14.5–27.7] [12.9–24] [15.9–25.4] [10.1–19.7] [2.2–5.2] [2.3–6.2] [6.7–15.1] [9.8–20.4] [6.4–14.4] [11.4–19.1] [8.5–19.5] [14.6–25.3] [1.6–4.3] [0.2–1.2] [4.5–9.9] [0.6–2.1] [3.1–7.3] [20.3–29.1] [0.9–3.3] [1.9–5.3] [16.4–26.2] [2.7–6.3] [10.5–18.3] [1.1–3.2] [2.9–8.4] [36.5–50.3] [13–21.6] [2.5–6.1] [14.8–25.9] [11.1–22.1] [14.8–25.7] [18.7–30] Females 3.3 17.5 28.7 28.8 12.0 36.4 26.2 20.7 26.3 15.0 23.2 40.2 40.5 4.2 35.9 23.6 16.9 27.2 12.4 7.5 19.9 19.0 29.0 20.4 18.4 22.7 7.8 3.5 15.1 3.4 14.7 27.2 6.8 10.8 29.6 6.4 23.6 9.2 13.8 53.1 27.1 12.0 22.7 28.9 24.2 26.3 [95% CI] [1.9–5.1] [12.3–23.5] [23–34.7] [22.5–35.6] [7.5–17.7] [28.2–45] [20.6–32.3] [15.4–26.6] [22.4–30.3] [10.8–19.8] [17.4–29.7] [32.7–47.6] [34.1–46.8] [2.7–6] [28.3–43.8] [16.9–30.9] [12.5–21.8] [20.9–33.9] [9.5–15.7] [5–10.6] [14.8–25.7] [13.1–25.9] [22.3–36.1] [16.4–24.7] [12.7–25.1] [16.7–29.2] [5.6–10.4] [2–5.5] [11.1–19.3] [2.1–5.1] [11.3–18.5] [22.8–31.7] [4.1–10.2] [7.7–14.5] [24–35.5] [4.2–8.9] [19–28.2] [6.6–12.5] [9.6–18.8] [46.3–60] [22–32.6] [9.1–15.5] [16.7–29.6] [22.2–36.1] [18.1–30.6] [19.8–33.1] Both sexes 2.4 16.1 22.6 27.5 8.3 28.0 23.7 17.8 26.0 16.7 19.4 33.5 32.5 2.9 28.3 21.0 18.7 20.8 8.0 5.5 15.3 16.8 19.4 17.8 15.9 21.2 5.3 2.0 11.0 2.3 9.8 25.9 4.4 7.1 25.3 5.3 19.0 5.6 9.5 48.2 21.9 7.9 21.4 22.5 22.0 25.3 [95% CI] [1.4–3.2] [12.3–19.9] [19.1–26.2] [23.2–31.8] [5.1–11.3] [22.4–33.2] [19.9–27.8] [14.1–21.5] [23–28.7] [13.5–19.9] [15.4–23.5] [28.4–38.4] [28.4–36.6] [2–3.9] [23.4–33.8] [16.7–25.7] [15.7–22.3] [16.8–24.8] [6.1–9.7] [3.9–7.3] [11.8–18.6] [12.9–20.5] [15.6–23.7] [14.9–20.7] [11.7–20] [16.9–25.3] [3.9–6.8] [1.1–2.9] [8.5–13.6] [1.5–3.2] [7.7–12] [22.8–29.3] [2.7–6.1] [5.2–8.8] [21.3–29] [4–6.8] [15.7–22] [4.1–7.2] [7–12] [43.1–53.3] [18.5–25.1] [6.1–9.6] [17.3–25.6] [17.9–27] [18.1–26.1] [21.1–29.3] Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic

Country name

217

Global status report on NCDs 2014 … Indicates no data were available Obesity (BMI≥30) Crude adjusted estimates Males Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea–Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho SEAR AFR EUR EMR AMR AMR AMR EMR AMR AFR AFR EUR AFR WPR EUR EUR AFR AFR EUR EUR AFR EUR AMR AMR AFR AFR AMR AMR AMR EUR EUR SEAR SEAR EMR EMR EUR EUR EUR AMR WPR EMR EUR AFR WPR EMR EUR WPR EUR EMR AFR 1.5 1.2 21.6 4.3 15.7 14.4 12.0 16.7 12.9 9.5 1.1 20.9 1.1 28.4 21.5 23.1 9.7 4.0 15.3 21.8 3.7 21.3 13.9 10.2 2.5 2.7 11.4 5.3 9.7 23.4 23.1 2.5 2.5 16.5 12.8 24.3 21.5 20.6 15.4 2.8 18.4 18.3 2.0 31.0 31.5 9.1 1.2 20.5 22.9 2.7 [95% CI] [0.6–3] [0.5–2.4] [16.5–26.8] [2.3–7.3] [11.1–21.1] [10.1–19.5] [8–16.6] [12.8–21] [9.3–17.3] [5.1–15.6] [0.6–1.9] [15.5–27.2] [0.6–1.8] [22.4–35] [17.5–25.9] [17.8–28.8] [5.7–14.8] [2.5–6] [10.3–21.2] [17.5–26.5] [2.2–5.7] [16–27] [9.5–18.9] [7–14.3] [1.5–3.8] [1.6–4.2] [7.5–16.1] [3–8.5] [6.7–13.4] [18.1–29.3] [17.4–29.2] [1.6–3.5] [1.5–3.8] [13.2–20] [9.1–17.5] [19.4–29.6] [16.7–27] [16.4–25.1] [11.2–20.2] [1.9–4.1] [13.8–23.6] [12.7–24.2] [1.1–3.3] [24.2–38.2] [25.7–37.5] [5.7–13.4] [0.7–2] [14.8–26.8] [17.7–28.6] [1.6–4.3] Females 3.0 4.9 17.2 10.0 30.1 25.4 19.9 32.9 23.4 18.4 4.5 24.5 4.3 39.8 20.8 24.1 18.4 10.7 23.2 19.8 13.9 25.1 29.1 19.5 7.5 7.9 27.3 12.8 19.2 25.1 21.3 5.3 5.9 27.1 24.2 23.8 26.2 23.1 32.5 3.3 32.5 23.2 7.1 46.3 40.2 14.1 3.0 26.8 32.2 18.5 [95% CI] [1.3–5.8] [2.9–7.6] [12.6–22.1] [6.3–14.5] [23.7–36.9] [19.7–31.4] [14.7–25.6] [27.8–38.2] [18.6–28.7] [11.2–26.6] [2.9–6.5] [17.6–32.1] [2.8–6.2] [33.1–46.4] [17–25.1] [18.4–30.4] [13.2–24.3] [7.7–14.3] [17.4–29.5] [15.7–24.4] [10.5–17.8] [19.3–31.4] [22.7–35.9] [15.1–24.3] [5.4–10] [5.5–10.7] [20.9–34.4] [8.9–17.4] [14.9–24.1] [18.6–32.2] [15.9–27.1] [3.9–7] [4–8.2] [22.9–31.5] [18.8–30.2] [18.8–28.8] [20.6–32.1] [18.4–28.1] [26.5–38.5] [2.3–4.7] [27.5–37.8] [17.3–29.8] [5–9.8] [39.4–53.5] [33.6–47] [10–18.8] [1.9–4.5] [19.3–34.8] [26.1–38.1] [13.8–23.9] Both sexes 2.3 3.1 19.4 7.1 22.9 19.9 15.9 24.7 18.4 13.8 2.8 22.8 2.7 34.0 21.2 23.6 14.0 7.4 19.5 20.8 8.9 23.2 21.5 15.0 5.0 5.3 19.2 9.1 14.5 24.3 22.2 3.8 4.2 21.7 18.5 24.0 23.9 21.9 24.1 3.1 25.3 20.8 4.6 38.6 35.0 11.6 2.1 23.9 27.5 10.8 [95% CI] [1–3.5] [1.9–4.4] [16.2–23] [4.8–9.6] [18.9–26.9] [16.1–24.1] [12.6–19.7] [21.4–27.8] [15–21.7] [9.4–18.5] [1.9–3.7] [18.2–27.5] [1.8–3.6] [29.3–38.7] [18.1–24] [19.5–28] [10.6–17.6] [5.6–9.3] [15.6–23.6] [17.5–23.7] [6.9–11] [19.5–27.3] [17.4–25.7] [11.9–18.1] [3.8–6.3] [4–6.8] [15.1–23.2] [6.4–11.7] [11.7–17.2] [19.9–28.7] [17.8–26.6] [2.9–4.7] [2.9–5.4] [19.1–24.6] [14.8–21.7] [20.5–27.6] [20.2–28] [18.7–25.3] [20.3–27.6] [2.3–3.9] [21.8–29.1] [16.8–25] [3.4–5.9] [33.4–43.6] [30.6–39.3] [8.7–14.4] [1.3–2.9] [19.2–29] [23.5–31.2] [8.1–13.3]

Country name

Region

218

Annex 4.7a: Overweight and Obesity

Obesity (BMI≥30) Age-standardized adjusted estimates Males 1.4 1.4 20.0 4.9 15.8 15.2 12.6 17.7 14.4 9.9 1.3 20.0 1.2 29.4 19.8 21.8 10.9 4.7 15.0 19.9 4.2 20.0 15.4 11.7 2.8 3.0 12.1 6.0 11.0 22.1 22.4 2.5 2.5 18.0 14.7 23.3 21.5 18.8 15.7 2.9 20.4 18.8 2.4 31.5 32.5 10.1 1.4 19.6 23.0 3.4 [95% CI] [0.6–2.9] [0.6–2.7] [15.3–24.8] [2.6–8.2] [11.2–21.2] [10.6–20.4] [8.4–17.5] [13.7–22.3] [10.4–19.2] [5.3–16.4] [0.7–2.2] [14.8–26.1] [0.6–2.1] [23.2–36.2] [16.1–23.9] [16.7–27.3] [6.5–16.5] [2.9–6.9] [10.1–20.7] [15.9–24.2] [2.5–6.4] [15–25.4] [10.7–20.7] [8.2–16.2] [1.7–4.3] [1.8–4.7] [7.9–17] [3.4–9.5] [7.6–15] [17.1–27.9] [16.9–28.2] [1.6–3.7] [1.5–3.8] [14.4–21.8] [10.6–19.8] [18.7–28.5] [16.6–26.9] [14.9–23] [11.4–20.6] [1.9–4.1] [15.6–25.9] [13.1–25] [1.3–3.9] [24.6–38.9] [26.8–38.4] [6.3–14.8] [0.8–2.4] [14.2–25.7] [17.8–28.7] [2–5.3] Females 2.8 5.9 15.5 11.7 30.1 26.8 20.9 34.8 25.1 20.3 5.7 22.3 5.3 40.9 18.3 22.3 20.6 13.2 21.8 17.2 16.0 22.6 31.8 22.1 8.8 9.2 29.3 14.6 21.9 22.8 20.2 5.6 6.1 29.9 27.5 22.8 25.5 20.3 33.0 2.9 36.2 23.4 8.9 47.2 43.2 15.7 3.6 24.4 34.0 21.8 [95% CI] [1.2–5.5] [3.5–9.1] [11.3–19.9] [7.4–16.8] [23.7–36.9] [20.9–33] [15.6–26.8] [29.5–40.3] [20.1–30.6] [12.6–29.2] [3.7–8] [16–29.3] [3.4–7.5] [34.1–47.5] [14.8–22.2] [17–28.1] [15–27] [9.7–17.4] [16.3–27.9] [13.6–21.2] [12.2–20.2] [17.3–28.4] [25–38.7] [17.3–27.3] [6.4–11.5] [6.5–12.3] [22.7–36.6] [10.3–19.7] [17.2–27.1] [16.7–29.6] [15.1–25.9] [4.1–7.4] [4.1–8.6] [25.5–34.4] [21.8–33.7] [18–27.8] [20–31.3] [16–24.9] [27.1–39.1] [2–4.1] [30.8–41.6] [17.4–30] [6.2–12] [40.2–54.3] [36.7–49.6] [11.3–20.8] [2.3–5.4] [17.4–32] [27.8–40.1] [16.5–27.8] Both sexes 2.2 3.7 17.7 8.3 23.0 21.0 16.8 26.2 20.0 15.0 3.5 21.2 3.3 35.0 19.0 22.0 15.7 9.0 18.6 18.5 10.1 21.3 23.6 17.1 5.8 6.1 20.5 10.4 16.5 22.5 21.3 4.0 4.3 23.9 21.0 23.1 23.5 19.6 24.5 2.9 28.1 21.2 5.6 39.2 36.8 13.0 2.5 22.2 28.4 12.8 [95% CI] [1–3.3] [2.2–5.2] [14.5–20.9] [5.7–10.9] [19–27] [17.2–24.9] [12.8–20.3] [22.8–29.6] [16.4–23.7] [10.2–20] [2.4–4.7] [16.8–25.8] [2.3–4.5] [30.2–39.5] [16.2–21.7] [17.9–25.8] [11.9–19.8] [6.8–11.1] [14.5–22.3] [15.8–21] [7.8–12.3] [17.6–25.1] [19.6–28.1] [14.1–20.3] [4.2–7.3] [4.6–7.7] [16.4–24.7] [7.6–13.3] [13.5–19.5] [17.9–26.7] [17.4–25.2] [3.1–5] [3–5.5] [21.3–26.9] [17.1–24.5] [19.6–26.3] [19.8–27.6] [16.4–22.5] [20.9–28.3] [2.1–3.6] [24.4–31.7] [16.8–25.8] [4.1–7.2] [34.2–43.9] [32.4–40.9] [9.7–16.2] [1.6–3.5] [17.3–26.7] [24.1–32.3] [9.8–15.6]

Country name

Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea–Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho

219

Global status report on NCDs 2014 … Indicates no data were available Obesity (BMI≥30) Crude adjusted estimates Males Liberia Libya Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (Federated States of) Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Korea Republic of Moldova Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines AFR EMR EUR EUR AFR AFR WPR SEAR AFR EUR WPR AFR AFR AMR WPR EUR WPR EUR EMR AFR SEAR AFR WPR SEAR EUR WPR AMR AFR AFR WPR EUR EMR EMR WPR AMR WPR AMR AMR WPR EUR EUR EMR WPR EUR EUR EUR AFR AMR AMR AMR 2.0 21.9 20.9 25.5 1.7 1.2 7.7 3.4 2.6 24.1 35.1 4.4 9.7 19.8 25.5 ... 11.0 18.5 13.4 1.3 1.0 6.4 39.5 1.5 21.0 25.7 8.7 1.6 4.1 34.2 23.8 20.8 2.8 40.8 17.1 18.8 10.7 12.8 2.6 21.8 19.0 34.3 3.7 10.1 19.2 18.2 0.8 18.1 16.1 14.8 [95% CI] [1.2–3.3] [17.5–26.8] [15.4–27.1] [20.2–31.2] [0.9–2.7] [0.6–1.9] [5.3–10.8] [1.7–5.9] [1.5–4.1] [18.4–30.4] [28.4–42] [2.6–6.7] [6.3–14] [15.8–24.2] [20.1–31.2] ... [7.3–15.3] [13.5–24.3] [9.6–17.7] [0.7–2.2] [0.5–1.7] [4–9.4] [31.4–48.1] [0.8–2.5] [16.4–25.8] [21.6–30.1] [5.8–12.4] [0.8–2.6] [2.7–5.9] [28.2–40.6] [19–28.8] [16–26.1] [1.6–4.5] [34.1–47.7] [12.8–22.1] [13.3–25] [7.1–15] [8.8–17.5] [1.6–4.1] [17–27.1] [13.9–24.5] [28.1–40.8] [2.3–5.4] [6.5–14.7] [14–24.9] [13.6–23] [0.4–1.6] [12.8–24.4] [10.9–22.3] [10.5–20] Females 7.4 34.1 28.7 19.4 5.9 5.8 12.1 8.0 6.9 29.3 47.0 10.1 21.6 29.9 38.3 ... 14.8 21.3 24.5 6.0 3.0 22.7 50.3 3.4 18.7 29.6 19.1 4.8 11.6 46.3 22.5 30.0 5.4 50.2 29.3 28.8 15.9 22.3 4.9 26.9 21.0 43.8 5.4 17.8 23.4 28.6 4.1 33.0 30.4 27.7 [95% CI] [5.2–10.1] [28.5–39.8] [21.5–36.3] [14.4–24.9] [3.8–8.2] [4–7.9] [8.8–16] [4.9–12.1] [4.9–9.3] [22.7–36.4] [39.9–53.9] [7.2–13.8] [16.2–27.6] [25.3–34.5] [32.3–44.4] ... [10.5–19.6] [15.3–28.2] [19.4–29.8] [4.1–8.3] [1.8–4.6] [17.1–28.6] [42.2–57.9] [2.1–4.9] [14.4–23.4] [25.3–34.2] [14.5–24.2] [3.3–6.7] [8.9–14.8] [39.7–52.7] [17.7–27.2] [24.3–36] [3.7–7.8] [43.1–57] [23.5–35.4] [22.3–35.6] [11.3–21.4] [17.7–27.1] [3.2–7.2] [21–33.5] [15.6–26.8] [36.9–50.8] [3.6–7.6] [12.3–23.9] [17.1–30.3] [22.5–34.6] [2.6–6.2] [25.8–40.6] [23.3–37.9] [21.5–34.6] Both sexes 4.7 27.9 25.1 22.4 3.8 3.5 10.0 5.7 4.7 26.7 40.9 7.2 15.7 25.0 31.8 ... 12.9 19.9 19.1 3.7 2.0 14.8 44.8 2.5 19.9 27.7 14.0 3.2 7.8 40.1 23.1 24.6 4.1 45.4 23.1 23.7 13.3 17.5 3.8 24.5 20.0 36.6 4.6 14.1 21.3 23.8 2.5 25.6 23.4 21.2 [95% CI] [3.4–6.1] [24.1–31.6] [20.1–29.8] [18.8–26.2] [2.5–5] [2.4–4.4] [7.4–12.1] [3.6–7.7] [3.4–5.9] [22.1–31.3] [35.8–45.7] [5.4–9.2] [12.3–19.1] [21.9–28] [27.7–35.9] ... [10–15.8] [15.9–24.3] [15.7–22.5] [2.6–4.9] [1.2–2.8] [11.4–18.1] [39.2–50.6] [1.6–3.2] [16.7–23] [24.7–30.8] [11–16.9] [2.2–4.1] [6.1–9.4] [35.8–44.3] [19.9–26.6] [21–28.6] [2.8–5.4] [40.8–50.1] [19.7–26.9] [19.6–27.9] [10.4–16.7] [14.2–20.6] [2.6–5] [20.2–28.3] [15.9–23.9] [30.9–41.8] [3.2–5.8] [10.6–17.8] [17–25.9] [19.7–27.4] [1.6–3.6] [20.6–30.4] [18.5–28.1] [17.1–25.2]

Country name

Region

220

Annex 4.7a: Overweight and Obesity

Obesity (BMI≥30) Age-standardized adjusted estimates Males 2.3 23.5 20.3 23.9 1.9 1.4 7.9 3.9 3.1 22.6 35.6 4.9 9.3 20.7 29.2 ... 12.2 17.7 14.1 1.5 1.0 7.3 39.9 1.6 19.4 24.8 9.8 1.7 4.6 35.0 22.4 23.9 3.2 41.4 17.6 20.9 11.6 13.5 2.8 21.0 17.8 35.4 3.5 10.0 18.5 17.6 1.0 18.3 16.3 15.1 [95% CI] [1.3–3.7] [18.9–28.6] [15–26.4] [18.8–29.3] [1.1–3.1] [0.7–2.3] [5.5–11.2] [2–6.7] [1.8–4.8] [17.1–28.7] [28.9–42.7] [2.9–7.4] [6–13.5] [16.6–25.1] [23.2–35.4] ... [8.1–17] [12.8–23.2] [10.1–18.7] [0.8–2.5] [0.5–1.8] [4.7–10.7] [31.7–48.6] [0.8–2.6] [15.1–23.9] [20.8–29.2] [6.6–13.9] [0.9–2.8] [3–6.6] [28.9–41.4] [17.9–27.3] [18.9–29.3] [1.8–5.1] [34.6–48.4] [13.2–22.6] [14.9–27.6] [7.8–16.2] [9.3–18.4] [1.7–4.4] [16.2–26.2] [13–23] [29.3–41.6] [2.2–5.1] [6.4–14.4] [13.5–24] [13.1–22.4] [0.4–1.9] [12.9–24.7] [11–22.5] [10.7–20.4] Females 8.6 36.7 26.7 17.9 7.0 7.0 13.0 9.5 8.4 26.9 47.8 11.6 20.7 30.7 42.4 ... 16.5 19.8 26.0 7.1 3.1 25.7 51.0 3.8 16.7 28.1 21.5 5.8 13.4 47.3 20.7 34.9 6.4 51.0 30.0 31.7 17.5 23.5 5.5 25.1 18.9 46.5 4.9 16.9 21.7 26.2 5.2 33.1 30.7 28.6 [95% CI] [6.1–11.7] [31.1–42.5] [19.9–34.1] [13.2–23] [4.6–9.8] [4.9–9.5] [9.5–17.1] [5.9–14.2] [6–11.2] [20.6–33.8] [40.7–54.7] [8.3–15.7] [15.4–26.5] [26.1–35.4] [36.2–48.6] ... [11.8–21.6] [14.1–26.3] [20.6–31.4] [4.9–9.7] [1.9–4.9] [19.6–32.1] [43–58.6] [2.4–5.6] [12.8–21.1] [24–32.6] [16.6–27] [4–8] [10.3–16.9] [40.7–53.5] [16.2–25.3] [29–40.9] [4.4–9.1] [44–57.7] [24.1–36.1] [24.9–38.7] [12.6–23.4] [18.7–28.4] [3.6–7.9] [19.4–31.3] [14–24.3] [39.9–53.1] [3.3–7] [11.6–22.7] [15.9–28.3] [20.4–32.1] [3.3–7.8] [25.8–40.7] [23.6–38.2] [22.3–35.7] Both sexes 5.4 30.0 23.8 20.8 4.5 4.2 10.5 6.7 5.7 24.7 41.7 8.2 15.0 25.9 35.6 ... 14.4 18.7 20.2 4.4 2.1 16.8 45.4 2.7 18.0 26.5 15.7 3.7 8.9 41.0 21.6 28.4 4.7 46.1 23.7 26.2 14.5 18.5 4.1 23.1 18.4 38.1 4.2 13.6 20.2 22.2 3.1 25.7 23.6 21.8 [95% CI] [3.9–6.8] [26.3–33.8] [19.1–28.3] [17.5–24.4] [3.1–5.8] [3–5.4] [8.2–12.8] [4.5–9.1] [4.3–7.2] [20.4–29.1] [36.7–46.5] [5.8–10.3] [11.6–18.2] [22.4–29.2] [31.4–39.9] ... [10.9–17.7] [14.6–22.6] [16.7–23.6] [3–5.6] [1.3–3] [13.5–20.5] [39.7–51.1] [1.8–3.7] [15–21] [23.4–29.6] [12.6–19] [2.7–4.8] [7.1–10.8] [36.2–45.5] [18.3–24.7] [24.5–32.1] [3.3–6.2] [41.1–51.2] [20–27.7] [21.3–30.5] [11.3–18] [15.3–21.8] [2.8–5.4] [19–27.1] [14.8–22.1] [33.2–43.3] [3.1–5.4] [10.1–17.1] [16.3–24.4] [18.6–26.2] [2–4.4] [21–30.6] [19.2–28.1] [17.6–25.9]

Country name

221

Global status report on NCDs 2014 … Indicates no data were available Obesity (BMI≥30) Crude adjusted estimates Males Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand the former Yugoslav Republic of Macedonia Timor–Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United Republic of Tanzania United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe WPR EUR AFR EMR AFR EUR AFR AFR WPR EUR EUR WPR EMR AFR AFR EUR SEAR EMR AMR AFR EUR EUR EMR EUR SEAR EUR SEAR AFR WPR AMR EMR EUR EUR WPR AFR EUR EMR EUR AFR AMR AMR EUR WPR AMR WPR EMR AFR AFR 32.4 ... 4.1 26.0 3.5 17.5 14.4 2.3 4.8 22.6 23.8 17.9 1.7 11.8 3.0 22.6 2.3 3.0 16.2 4.9 21.5 21.7 13.8 7.5 4.4 17.1 0.8 2.2 32.1 19.3 17.2 19.7 13.1 31.7 1.0 15.7 26.3 25.5 1.9 30.8 20.1 9.4 24.8 18.1 1.5 8.0 2.4 1.7 [95% CI] [25.8–39.4] ... [2.6–6.2] [20.9–31.4] [2.1–5.2] [13–22.9] [9.4–20.1] [1.4–3.4] [3.2–6.8] [17.2–28.6] [17.5–30.6] [12.9–23.6] [0.8–3] [8.9–15.2] [1.8–4.8] [18.1–27.4] [1.3–3.8] [1.8–4.8] [11.6–21.5] [3–7.5] [17.1–26.3] [17.1–26.6] [10.1–18.1] [4.4–11.5] [2.8–6.5] [12.3–22.8] [0.4–1.4] [1.4–3.4] [25.6–39.1] [12.2–27.6] [13.1–21.5] [16–23.9] [8.8–17.9] [25–38.4] [0.5–1.9] [10.8–21.5] [20.5–32.7] [22.2–28.9] [1.1–3] [26.7–35.1] [14.8–26.2] [5.9–13.9] [19.2–30.7] [13.7–23.1] [0.8–2.5] [5–11.9] [1.3–3.7] [0.9–3] Females 48.1 ... 13.1 35.4 10.7 20.7 32.4 8.3 6.1 26.5 26.5 28.6 5.0 33.1 7.9 25.7 7.5 7.9 29.8 21.2 18.9 17.2 24.3 13.2 9.7 21.1 2.1 8.5 46.8 35.0 30.5 32.9 18.8 43.6 4.9 23.6 36.0 28.5 7.4 34.0 28.7 15.0 36.2 26.9 3.3 17.9 9.0 13.4 [95% CI] [41.5–54.9] ... [9.7–16.9] [29.7–41.4] [7.9–13.9] [15.1–26.9] [25.4–40] [6.1–10.9] [4.1–8.6] [19.9–33.2] [19.1–34.6] [22.5–34.9] [3–7.6] [28.1–37.9] [5.3–11] [20.8–30.9] [4.8–10.9] [5.3–11] [23.2–36.9] [15.6–27.4] [14.6–23.6] [12.7–21.8] [19–30.1] [9.1–18.1] [6.9–13.3] [15–28] [1.2–3.3] [6.1–11.3] [40.2–53.5] [26.2–44.5] [25.1–36] [28.2–37.7] [13.7–24.4] [36.8–50.6] [3.1–7.2] [16.8–31] [29.4–42.8] [25.1–31.9] [5.5–9.8] [29.8–38.4] [22.3–35.5] [10.4–20.3] [30–42.4] [21.7–32.4] [1.9–5.2] [12.6–23.9] [6.4–12] [9.4–18.1] Both sexes 40.0 ... 8.7 30.1 7.1 19.2 23.2 5.3 5.4 24.6 25.2 23.2 3.3 22.8 5.4 24.2 4.9 5.4 23.0 13.2 20.2 19.4 18.9 10.3 7.1 19.1 1.4 5.4 39.5 27.2 23.9 26.4 16.0 37.5 2.9 20.0 29.1 27.0 4.6 32.4 24.6 12.2 30.4 22.5 2.4 12.9 5.7 7.7 [95% CI] [35.1–44.4] ... [6.6–10.8] [25.9–33.8] [5.4–8.7] [15.4–23.5] [18.7–28] [4–6.7] [4–6.9] [20.4–28.9] [19.8–30.5] [18.9–27.5] [2–4.6] [19.7–25.8] [3.8–7.2] [20.7–27.7] [3.3–6.5] [3.8–7.2] [18.6–27.4] [10–16.4] [16.8–23.2] [16–22.7] [15.6–22.2] [7.6–13.3] [5.1–9] [15.2–23.2] [0.8–2] [4–6.8] [34.7–44.2] [21.5–33.2] [20.5–27.4] [23.2–29.6] [12.5–19.5] [32.8–42.6] [1.8–4] [15.6–24.5] [24.5–33.6] [24.5–29.5] [3.5–5.8] [29.3–35.4] [20–28.9] [9.4–15.5] [25.5–34.6] [19.2–26.1] [1.4–3.3] [9.8–15.9] [4.2–7.1] [5.2–9.9]

Country name

Region

222

Annex 4.7a: Overweight and Obesity

Obesity (BMI≥30) Age-standardized adjusted estimates Males 34.0 ... 5.0 26.8 4.2 16.7 14.2 2.6 4.4 21.8 22.2 20.1 1.9 12.9 3.4 21.1 2.3 3.4 16.5 6.2 20.4 20.2 15.5 8.6 4.1 16.5 0.9 2.6 34.3 19.1 17.8 20.4 14.4 32.4 1.2 15.3 30.9 24.1 2.2 29.8 19.8 10.5 27.1 18.8 1.5 9.8 2.8 2.2 [95% CI] [27.2–41.3] ... [3.1–7.5] [21.8–32.4] [2.6–6.2] [12.4–21.8] [9.2–20] [1.6–3.8] [2.9–6.4] [16.5–27.7] [16.3–28.8] [14.5–26.3] [0.9–3.4] [9.8–16.6] [2–5.5] [16.8–25.5] [1.3–3.8] [2–5.5] [11.8–21.9] [3.8–9.3] [16.2–24.9] [15.9–24.7] [11.4–20.1] [5–13.1] [2.7–6.2] [11.8–22.1] [0.4–1.6] [1.6–3.9] [27.6–41.5] [12.1–27.4] [13.6–22.2] [16.6–24.7] [9.7–19.5] [25.7–39.2] [0.6–2.3] [10.5–20.8] [25.1–36.8] [21–27.5] [1.3–3.5] [25.8–34.1] [14.6–25.7] [6.5–15.4] [21.1–33.5] [14.2–23.8] [0.8–2.5] [6.1–14.4] [1.6–4.4] [1.1–3.8] Females 50.0 ... 15.7 38.8 12.7 19.1 32.1 9.8 5.6 24.9 24.2 32.2 5.9 34.7 9.2 23.1 7.3 9.2 30.2 25.2 17.2 15.5 27.5 15.6 9.1 19.9 2.5 10.2 49.0 34.6 31.3 33.4 20.6 44.6 6.3 21.7 43.2 26.8 9.0 32.5 27.5 16.8 39.7 27.9 3.6 21.8 11.4 17.1 [95% CI] [43.4–56.7] ... [11.7–20.1] [33–44.7] [9.5–16.5] [13.7–24.9] [25.3–39.7] [7.3–12.7] [3.8–7.9] [18.5–31.4] [17.4–31.8] [25.8–38.8] [3.5–9] [29.6–39.7] [6.3–12.7] [18.5–28.1] [4.7–10.7] [6.3–12.7] [23.6–37.4] [19–32] [13.2–21.5] [11.5–19.8] [21.9–33.3] [10.9–21] [6.5–12.4] [14.1–26.5] [1.4–3.9] [7.4–13.4] [42.3–55.6] [25.8–44] [25.9–36.9] [28.7–38.2] [15.2–26.5] [37.8–51.6] [4.1–9.1] [15.3–28.7] [36.9–49.3] [23.6–30.2] [6.7–11.8] [28.4–36.9] [21.2–34.1] [11.8–22.4] [33.3–46] [22.6–33.5] [2–5.5] [15.8–28.6] [8.2–15.1] [12.1–22.7] Both sexes 41.8 ... 10.4 32.0 8.5 17.9 23.0 6.2 5.0 23.4 23.2 26.1 3.9 24.1 6.3 22.1 4.8 6.3 23.4 15.9 18.8 17.8 21.3 12.1 6.7 18.2 1.7 6.5 41.6 27.0 24.6 27.0 17.6 38.4 3.7 18.7 34.5 25.5 5.6 31.2 23.8 13.6 33.3 23.3 2.6 15.7 7.1 9.7 [95% CI] [37.1–46.7] ... [8.1–12.7] [28.1–36.1] [6.6–10.5] [14.2–21.4] [18.4–27.3] [4.7–7.8] [3.7–6.3] [18.9–27.5] [18.4–28.2] [21.7–30.4] [2.3–5.5] [21.3–27.3] [4.4–8.1] [18.7–25.4] [3.3–6.4] [4.4–8.1] [19–27.3] [12.2–19.7] [15.7–21.8] [15–20.9] [17.8–24.8] [8.8–15.2] [4.8–8.4] [14.3–22.3] [1–2.4] [4.8–8.2] [36.8–46.4] [21.2–32.9] [21–27.8] [24–30.2] [13.9–21.6] [33.5–43.3] [2.3–5.1] [14.4–22.8] [29.9–39.1] [23.3–27.7] [4.2–6.9] [28.2–34.2] [19.3–28.2] [10.2–17.1] [28.7–37.6] [19.5–27.2] [1.5–3.5] [12.1–19.5] [5.1–9] [7.1–12.4]

Country name

Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand the former Yugoslav Republic of Macedonia Timor–Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United Republic of Tanzania United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe

223

Global status report on NCDs 2014

4.7b Overweight and Obesity Comparable estimates of prevalence of overweight and obesity (population aged 18+ years), 2014 Overweight (BMI≥25) Crude adjusted estimates Males Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic EMR EUR AFR EUR AFR AMR AMR EUR WPR EUR EUR AMR EMR SEAR AMR EUR EUR AMR AFR SEAR AMR EUR AFR AMR WPR EUR AFR AFR AFR WPR AFR AMR AFR AFR AMR WPR AMR AFR AFR WPR AMR AFR EUR AMR EUR EUR 11.8 57.8 53.9 76.0 21.1 55.3 63.9 56.1 72.0 64.4 56.3 66.4 69.2 14.4 59.2 63.1 69.0 45.4 18.1 23.3 45.3 57.4 33.1 55.3 48.3 67.8 15.2 7.4 29.1 12.1 22.1 72.0 13.2 15.2 63.9 37.2 53.2 14.3 24.6 78.2 58.0 21.8 67.8 57.3 64.7 72.8 [95% CI] [7.6–16.8] [49.8–65.7] [46.5–61] [69.3–81.7] [14.2–29.1] [45.4–65.1] [56.4–70.9] [47.6–64.3] [66.8–77.1] [56.7–71.6] [47.6–64.7] [59.2–73.3] [62.6–75.4] [9.9–19.7] [49.4–68.6] [54.8–71.2] [62.1–75.5] [37.2–53.9] [13.3–23.5] [17.3–30.3] [37.2–53.7] [48.4–66.2] [25.6–41.3] [47.9–62.6] [38.5–58.5] [59.6–75.1] [10.7–20.4] [4.2–11.5] [22.6–36.1] [7.9–17.2] [16.3–28.6] [66.2–77.5] [8.1–19.2] [10.6–20.7] [56.7–71] [30.2–44.6] [45.9–60.3] [9.9–19.6] [17.4–33] [72.4–83.3] [50.9–65] [16.1–28.1] [59.9–75] [47.9–66.3] [56.8–71.9] [65.6–79.5] Females 16.1 49.2 60.3 66.5 33.1 68.7 60.6 56.4 60.9 49.2 58.4 72.4 72.1 19.6 70.6 59.2 52.3 55.5 33.7 26.6 53.4 51.9 53.2 53.2 47.2 59.7 26.1 19.3 38.9 20.6 36.9 63.4 25.3 29.0 64.4 33.6 58.3 30.7 36.4 81.9 61.9 33.7 58.4 66.6 58.7 61.8 [95% CI] [11.7–21.6] [40.3–57.8] [53–67.1] [58.5–74] [25–41.8] [59.6–77.1] [52.7–68.2] [48.3–64.4] [55.3–66.4] [41.8–56.7] [50.3–66.2] [65.3–78.6] [65.8–77.9] [14.7–25.2] [61.9–78.4] [50.1–67.6] [44.6–59.9] [47.4–63.6] [28–39.5] [20.8–33.2] [45.6–61.2] [42.4–60.9] [45.3–61] [46.1–60.2] [37.5–56.7] [50.4–68.3] [20.8–31.8] [14–25.3] [32.1–45.6] [15.2–26.5] [31–43.1] [57.2–69.3] [18.7–32.6] [22.8–35.3] [57–71.2] [26.6–41.1] [51.5–64.8] [25–37] [28.6–44.2] [76.8–86.2] [55.2–68.3] [27.9–39.9] [49.2–67.1] [58.2–74.4] [50.7–66.4] [52.8–70.2] Both sexes 13.9 53.5 57.1 71.2 27.1 62.1 62.2 56.2 66.4 56.6 57.4 69.5 70.3 17.0 64.9 61.0 60.5 50.5 25.9 24.8 49.3 54.6 43.0 54.2 47.8 63.6 20.7 13.4 34.0 16.4 29.5 67.7 19.3 22.1 64.2 35.4 55.8 22.5 30.5 80.0 59.9 27.6 62.9 61.9 61.8 67.2 [95% CI] [10.6–17] [47.7–59.5] [51.6–61.6] [66.4–76.1] [21.5–32.8] [55.2–68.2] [56.8–67.2] [50.4–62.1] [62.7–70.1] [52–62] [51.6–63] [64.5–74.6] [65.6–74.8] [13.4–20.5] [58.4–70.9] [54.7–67] [55.3–65.8] [44.9–56] [22.2–29.8] [20.5–29.2] [43.9–55.1] [48–61.2] [37.2–48.2] [49.1–59.5] [40.7–54.3] [57.4–69.5] [16.9–24.5] [10.1–16.9] [29–38.5] [12.7–20.2] [25.1–33.8] [63.7–71.9] [15.2–23.8] [18.3–26] [59.2–69.3] [30.4–40.8] [50.8–60.6] [18.6–26.4] [25.1–35.6] [76.3–83.2] [55.1–64.7] [23.6–32] [57.4–68.5] [56.2–68.8] [56.7–67.1] [61.7–72.7]

Country name

Region

224

Annex 4.7b: Overweight and Obesity

… Indicates no data were available Overweight (BMI≥25) Age-standardized adjusted estimates Males 13.4 57.5 55.7 72.0 23.9 55.4 63.9 56.3 69.9 61.1 57.4 66.3 70.2 15.0 57.2 61.2 65.7 48.5 20.0 24.6 48.2 55.4 37.1 55.6 47.5 64.1 17.4 8.2 31.8 13.1 25.1 69.0 14.6 17.6 63.2 36.2 54.3 15.4 26.9 79.4 58.5 23.7 64.4 54.4 63.6 69.6 [95% CI] [8.8–19.2] [49.5–65.4] [48.2–62.9] [65.5–77.8] [16.2–33] [45.5–65.2] [56.4–71] [47.8–64.4] [64.7–75] [53.6–68.2] [48.5–65.8] [59.1–73.2] [63.9–76] [10.3–20.6] [47.4–66.3] [53–69.2] [59–72.1] [39.8–57.4] [14.7–25.9] [18.2–32.1] [39.8–56.8] [46.6–64] [28.7–46.2] [48.2–62.8] [37.7–57.6] [56.2–71.3] [12.4–23.2] [4.7–12.9] [24.8–39.2] [8.7–18.6] [18.5–32.3] [63.2–74.5] [9.1–21.3] [12.3–23.8] [56–70.3] [29.4–43.6] [46.9–61.4] [10.7–21.1] [19–36] [73.6–84.4] [51.4–65.5] [17.5–30.4] [56.9–71.5] [45.4–63.3] [55.9–70.8] [62.6–76.3] Females 19.1 47.9 62.6 61.9 37.8 68.3 59.7 54.7 58.1 45.4 58.7 71.5 74.0 21.3 67.4 55.2 48.4 59.1 37.7 30.0 56.0 48.5 59.0 52.8 46.5 54.4 29.8 22.6 41.9 21.9 41.8 59.8 28.4 34.1 63.0 32.3 58.6 33.8 40.3 82.7 62.3 37.7 53.6 62.8 56.9 57.3 [95% CI] [14.1–25.2] [38.9–56.4] [55.4–69.3] [53.9–69.3] [29–47.1] [59.1–76.7] [51.7–67.4] [46.7–62.7] [52.4–63.7] [38.2–52.8] [50.6–66.6] [64.4–77.8] [68.1–79.5] [16.1–27.3] [58.6–75.4] [46.3–63.6] [40.9–55.7] [51–67.1] [31.6–43.8] [23.7–37] [48.2–64] [39.2–57.4] [51–67] [45.7–59.8] [37.1–55.7] [45.3–63] [24.1–36] [16.8–28.9] [34.9–48.9] [16.4–28.1] [35.7–48.2] [53.5–65.7] [21.3–36.3] [27.4–41] [55.5–69.9] [25.4–39.7] [51.9–65.1] [27.7–40.4] [32.1–48.5] [77.6–86.9] [55.6–68.6] [31.6–44.2] [44.5–62.2] [54.4–70.6] [48.8–64.7] [48.5–65.7] Both sexes 16.2 52.7 59.1 66.9 30.9 61.9 61.7 55.5 64.0 53.1 58.1 69.0 71.7 18.1 62.3 58.0 56.9 53.8 28.9 27.1 52.1 51.8 48.0 54.1 47.0 59.1 23.6 15.5 36.9 17.6 33.5 64.4 21.6 25.8 63.1 34.4 56.5 24.6 33.6 81.0 60.4 30.6 58.8 58.6 60.3 63.4 [95% CI] [12.1–19.9] [47.1–57.9] [54.5–64.1] [62.2–72] [24.8–37.1] [55.4–68.4] [56.5–67.7] [49.6–61.7] [60.6–67.9] [47.9–58.3] [51.7–64.1] [64.1–73.8] [67.4–76.2] [14.4–21.9] [56.4–68.7] [52.5–64.2] [51.6–62.1] [47.9–59.5] [24.3–33.1] [22.3–31.7] [45.8–58.1] [44.8–58] [42–53.7] [48.7–59.3] [40.2–54.5] [53–64.9] [19.6–27.6] [12.2–19.1] [31.8–41.7] [13.8–21.3] [28.6–37.9] [60.2–68.2] [16.9–26.5] [21.1–30] [58.3–68.4] [29.6–39.3] [51.6–61] [20.9–28.6] [28–39.4] [77.6–84.8] [55.5–65.3] [26–35.2] [52.9–64.3] [53–64.1] [55–66.2] [57.6–69] Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic

Country name

225

Global status report on NCDs 2014 … Indicates no data were available Overweight (BMI≥25) Crude adjusted estimates Males Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea–Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho SEAR AFR EUR EMR AMR AMR AMR EMR AMR AFR AFR EUR AFR WPR EUR EUR AFR AFR EUR EUR AFR EUR AMR AMR AFR AFR AMR AMR AMR EUR EUR SEAR SEAR EMR EMR EUR EUR EUR AMR WPR EMR EUR AFR WPR EMR EUR WPR EUR EMR AFR 19.8 12.0 67.5 24.9 53.5 51.2 50.1 53.8 49.2 33.7 10.6 64.2 10.1 66.8 65.6 69.9 37.4 22.7 55.8 67.0 21.5 69.6 48.2 43.1 16.7 17.7 42.2 29.4 43.3 69.4 66.9 19.0 20.7 58.0 48.7 68.8 68.6 68.7 51.2 30.4 58.9 59.8 15.8 66.5 74.3 42.5 13.6 64.3 67.0 16.3 [95% CI] [11.9–29.7] [6.9–18.6] [60.7–74] [17.1–33.7] [45.3–61.5] [43–59.6] [42.1–58.1] [46.7–61.1] [41.9–56.5] [23–45.4] [6.9–14.9] [55.8–72.4] [6.5–14.4] [59.6–73.5] [59.2–71.7] [62.9–76.5] [27.7–47.2] [16.8–29.2] [47–64.4] [60–73.5] [15.4–28.5] [62.4–76.3] [39.8–56.7] [35.7–50.8] [12.1–21.9] [12.7–23.7] [33.5–51.3] [21–38.9] [35.6–50.9] [62.1–76.3] [59.5–73.8] [14.1–24.8] [15–27.5] [51.5–64.2] [40.8–56.2] [62.1–75.1] [61.8–75] [61.8–75.2] [43.2–59.1] [24.2–37.1] [51.5–66] [51.5–67.8] [11–21.3] [58.8–73.2] [67.8–80.2] [34.2–51.2] [9.3–18.8] [55.8–72.1] [60.4–73] [11.3–22.1] Females 22.4 24.3 50.0 33.7 63.6 58.4 55.5 66.3 57.4 44.9 22.8 56.9 22.9 74.0 53.4 58.6 45.2 34.1 59.4 52.7 39.9 60.2 61.9 52.1 29.3 29.3 60.1 41.4 52.0 57.8 52.9 23.9 28.1 63.1 57.8 57.1 60.4 59.5 65.5 22.8 66.0 57.7 30.4 78.2 72.8 46.6 20.0 59.1 67.6 45.3 [95% CI] [14.5–31.4] [17.9–32.1] [42.6–57.5] [25.4–42.3] [56.3–70.9] [50.7–66] [47.6–63.1] [59.7–72.3] [50.6–64.1] [34.1–55.8] [17.3–28.9] [47.6–65.8] [17.6–28.9] [68.1–79.4] [46.6–59.9] [50.6–66.2] [36.8–53.8] [27.6–41] [51.2–67] [45.8–59.7] [33.2–47.1] [52.4–67.6] [53.9–69.7] [45–59.1] [23.9–35.1] [23.3–35.8] [51.4–68.1] [33.1–49.9] [45.2–58.9] [48.9–66.2] [44.8–60.6] [18.9–29.5] [21.9–34.9] [56.9–69.2] [50.6–65.1] [50.4–64] [52.7–67.8] [52.2–66.7] [58.2–72.3] [17.8–28.4] [59.4–72] [49.3–65.8] [24.3–36.9] [72.4–83.2] [66.3–78.7] [38.7–54.3] [14.8–25.8] [49.3–67.8] [61.1–73.6] [37.8–53.1] Both sexes 21.2 18.2 58.7 29.3 58.6 54.8 52.8 60.0 53.5 39.1 16.7 60.3 16.5 70.4 59.4 64.1 41.3 28.5 57.7 59.7 30.8 64.9 55.0 47.7 23.0 23.5 51.0 35.5 47.6 63.3 59.9 21.4 24.4 60.5 53.2 62.9 64.5 64.0 58.4 26.5 62.3 58.7 23.1 72.3 73.7 44.5 16.8 61.5 67.3 31.0 [95% CI] [15.4–27.3] [13.5–23.2] [53.7–63.6] [23.7–34.8] [53.1–63.9] [49.3–60.5] [47.2–58.6] [55.3–65] [48.8–58.6] [31.6–46.5] [13.1–20.5] [53.6–66.7] [13.1–20.2] [66.3–74.6] [54.7–63.8] [59.2–69.5] [34.3–47.7] [24.1–33.3] [51.7–63.8] [54.9–64.3] [26–35.6] [59.8–69.5] [49.5–60.8] [42.6–52.8] [19.3–26.4] [19.1–27.7] [45.2–57.3] [29.8–41.9] [42.2–52.4] [57.5–69] [54.7–65.3] [17.7–24.9] [19.9–28.9] [56.2–64.9] [48.3–59] [58.1–67.6] [59.4–69.6] [58.7–68.7] [53.1–63.9] [22.3–30.6] [57.4–67] [53.1–64.4] [19–27.1] [67.5–77] [69.4–78.1] [38.6–50.7] [13.1–20.6] [55.3–67.7] [62.9–71.7] [26.4–35.5]

Country name

Region

226

Annex 4.7b: Overweight and Obesity

Overweight (BMI≥25) Age-standardized adjusted estimates Males 19.3 13.4 64.4 26.9 53.5 52.7 51.5 55.8 53.1 35.3 11.8 61.7 11.5 67.8 62.1 67.1 40.6 25.6 54.3 62.7 23.5 65.8 50.6 47.6 18.4 19.4 43.9 31.9 46.9 66.6 65.2 19.5 20.6 59.5 53.3 66.2 68.2 64.3 52.1 29.0 62.0 60.5 17.7 67.4 75.2 45.2 15.3 62.0 67.4 19.3 [95% CI] [11.5–28.9] [7.8–20.7] [57.8–70.8] [18.6–36.3] [45.3–61.6] [44.3–61.3] [43.3–59.7] [48.5–63.1] [45.5–60.7] [24–47.6] [7.7–16.6] [53.5–69.7] [7.4–16.3] [60.5–74.4] [55.9–68.1] [60.2–73.6] [30.3–50.9] [19–32.7] [45.8–62.8] [55.9–69] [16.9–31] [58.9–72.3] [41.9–59.4] [39.7–55.9] [13.4–24.1] [14–25.9] [34.8–53.4] [22.9–41.8] [38.8–54.9] [59.4–73.4] [57.8–71.9] [14.4–25.4] [14.9–27.5] [53–65.8] [45–61.2] [59.6–72.4] [61.3–74.7] [57.5–70.7] [44–60.2] [23.1–35.3] [54.5–69.1] [52.1–68.5] [12.3–23.8] [59.7–74.3] [68.9–80.6] [36.3–54.5] [10.4–21.1] [53.6–69.7] [60.8–73.4] [13.5–26] Females 21.4 27.6 46.2 37.0 63.2 59.9 56.7 68.2 59.8 48.4 26.2 52.3 26.3 74.7 48.6 54.7 49.0 39.3 56.0 47.2 43.6 55.2 64.5 56.2 32.6 32.6 62.1 44.9 56.0 53.3 50.5 24.7 28.4 65.1 62.7 54.6 59.0 53.7 65.9 19.7 70.0 57.1 34.6 78.9 75.8 49.1 22.6 54.5 70.1 51.1 [95% CI] [13.8–30.2] [20.6–35.8] [39–53.5] [28.2–46.2] [55.8–70.5] [52.1–67.5] [48.7–64.3] [61.7–74.2] [52.9–66.5] [37.2–59.8] [20.2–32.7] [43–61.2] [20.4–32.8] [68.8–80] [41.9–54.9] [46.8–62.3] [40.2–57.9] [32.3–46.8] [48–63.7] [40.6–54] [36.5–50.8] [47.6–62.6] [56.4–72.2] [49–63.2] [26.8–38.6] [26.2–39.7] [53.5–70.1] [36.4–53.9] [49.1–63] [44.5–61.6] [42.6–58.3] [19.6–30.4] [22.2–35.2] [59–71.2] [55.7–69.7] [47.9–61.4] [51.2–66.4] [46.3–60.9] [58.6–72.7] [15.1–24.9] [63.6–75.8] [48.7–65.1] [28.1–41.5] [73.2–83.9] [69.8–81.1] [41.1–56.9] [17–28.7] [45–63.1] [63.7–75.9] [43.2–59.2] Both sexes 20.4 20.6 55.2 31.9 58.4 56.3 54.1 62.0 56.7 41.7 19.0 56.7 18.9 71.2 55.2 60.7 44.8 32.5 55.2 54.8 33.6 60.5 57.5 52.0 25.5 26.1 52.9 38.5 51.5 59.6 57.9 22.0 24.5 62.3 57.9 60.3 63.5 58.8 59.1 24.2 65.9 58.8 26.2 73.1 75.4 47.2 19.0 57.9 68.7 35.4 [95% CI] [14.3–25.9] [15.6–25.4] [50.1–60.2] [25.5–38.2] [52.7–63.7] [50.6–62.1] [48.3–59.7] [57.3–66.7] [51.5–61.6] [33.6–50.5] [15.2–23] [50.4–62.7] [15.1–23.1] [66.5–75.3] [50.8–59.7] [55.3–66] [37.8–51.4] [27.6–37.2] [49.5–60.8] [49.9–59.6] [28.4–38.6] [55.3–65.6] [51.5–63.1] [46.6–57.5] [21.9–29.5] [21.9–31] [46.7–59.1] [32.1–45] [46–56.8] [54.2–65.1] [52.4–63.2] [18.3–25.5] [20.4–28.9] [57.8–66.9] [52.6–63] [55.7–65.4] [58.6–68.7] [53.7–63.5] [53.9–63.8] [20.7–28] [61–70.9] [52.7–64.8] [21.9–31] [68.6–77.7] [71.3–79.4] [41–53.1] [15.5–23] [51.4–63.8] [64.1–73.2] [30–40.8]

Country name

Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea–Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho

227

Global status report on NCDs 2014 … Indicates no data were available Overweight (BMI≥25) Crude adjusted estimates Males Liberia Libya Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (Federated States of) Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Korea Republic of Moldova Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines AFR EMR EUR EUR AFR AFR WPR SEAR AFR EUR WPR AFR AFR AMR WPR EUR WPR EUR EMR AFR SEAR AFR WPR SEAR EUR WPR AMR AFR AFR WPR EUR EMR EMR WPR AMR WPR AMR AMR WPR EUR EUR EMR WPR EUR EUR EUR AFR AMR AMR AMR 15.9 65.0 64.2 70.7 13.7 11.2 36.2 24.1 16.9 71.6 71.7 23.3 39.5 61.6 57.1 ... 48.7 63.7 50.5 11.9 13.3 27.1 74.6 13.6 67.2 70.4 40.7 11.8 23.6 70.2 67.9 58.8 19.1 76.6 58.4 51.3 45.6 52.8 19.9 68.2 65.0 76.6 38.4 47.3 65.2 62.8 10.3 53.0 51.0 51.1 [95% CI] [11–21.8] [58.4–71] [56.1–72] [63.6–77] [9.5–18.7] [7.4–15.6] [28.8–44.2] [17.1–32.4] [11.9–22.6] [64.1–78.2] [65.2–77.8] [16.9–30.5] [30.9–48.6] [55.3–67.9] [50.1–64] ... [40.7–57] [55.5–71.4] [42.9–58] [7.9–16.4] [8.8–19] [20.3–34.4] [66–81.8] [9.4–18.8] [60.2–73.6] [64.8–75.6] [32.8–48.9] [7.8–16.6] [18–29.5] [63.7–76.1] [61.2–74.1] [51.8–65.5] [13.7–25.6] [70.4–81.9] [50.7–65.6] [42.9–59.8] [37.9–53.7] [44.7–60.9] [14.2–26.3] [60.7–75.2] [57.1–72.7] [69.9–82.7] [31.3–45.7] [38.4–56.1] [57.3–72.7] [54.9–70.8] [6.3–15.5] [43.7–62.3] [41.1–60.9] [42.8–59.4] Females 29.5 69.0 61.7 51.5 26.7 26.8 38.3 30.6 27.2 63.7 78.2 32.3 53.9 65.0 69.1 ... 47.8 53.3 59.6 26.6 21.3 50.4 79.5 19.6 52.6 62.5 51.3 23.1 36.9 77.5 55.2 64.0 22.7 80.3 65.2 62.4 46.5 60.7 24.7 60.5 55.0 76.6 32.6 49.2 56.5 61.2 24.3 65.2 63.6 60.8 [95% CI] [23.6–36.2] [62.9–74.8] [52.5–69.9] [43.7–59.2] [20.9–33.2] [21.3–32.7] [31–45.6] [23.4–38.6] [21.8–33.4] [55.4–71.4] [72.4–83.3] [25.8–39.3] [45.3–62.4] [58.8–70.9] [62.9–74.9] ... [39.8–55.5] [44.2–62] [52.2–66.7] [21.1–32.9] [15.9–27.3] [42.5–58.2] [72.6–85.3] [15–25.2] [45.3–59.6] [56.9–68.1] [43.9–58.4] [18.1–28.8] [30.9–43] [72.1–82.3] [48.1–62.1] [56.8–70.6] [17.6–28.5] [75–85] [58.2–71.6] [54.7–69.6] [38.5–54.3] [53.6–67.4] [18.5–31.4] [51.7–68.8] [46.6–62.8] [70.2–82.4] [25.5–40] [40.7–57.9] [47.6–65.2] [52.9–69] [18.5–30.8] [56.8–73] [54.5–72.2] [52.9–68.4] Both sexes 22.6 67.0 62.8 61.0 20.3 19.0 37.3 27.4 22.0 67.6 74.9 27.8 46.8 63.4 63.0 ... 48.2 58.4 55.1 19.4 17.4 39.1 77.0 16.7 59.8 66.4 46.1 17.4 30.1 73.8 61.6 60.6 20.8 78.4 61.7 56.7 46.1 56.8 22.3 64.2 59.8 76.6 35.5 48.3 60.8 62.0 17.5 59.1 57.4 55.9 [95% CI] [18.6–26.9] [62.4–71.5] [56.7–69.3] [55.8–66.4] [16.4–24.1] [15.7–22.8] [31.9–42.6] [21.6–33] [18.1–25.9] [62.6–72.7] [70.5–79.5] [23–32.5] [40.5–53.3] [59.1–67.8] [58.1–68] ... [42.8–53.7] [52.6–64.5] [50.1–60.2] [15.7–22.8] [13.4–21.2] [33.6–44.1] [71.9–82.2] [13.5–20.3] [54.9–64.6] [62.2–70.4] [40.2–51.7] [14.1–20.7] [25.9–34.2] [69.7–77.7] [56.8–66.5] [55.4–65.8] [16.6–24.5] [74.6–82.3] [56.5–66.7] [51–62.4] [40.3–51.4] [51.4–62] [18.1–26.6] [58.4–69.6] [54.6–65.2] [71.5–82.2] [30.7–40.6] [41.8–54.5] [54.9–66.1] [56.6–67.5] [13.6–21.2] [53.1–65] [51–64.1] [50.1–61.9]

Country name

Region

228

Annex 4.7b: Overweight and Obesity

Overweight (BMI≥25) Age-standardized adjusted estimates Males 17.4 66.5 62.6 67.8 15.2 12.9 37.2 25.9 19.1 68.5 72.7 25.2 38.2 63.1 63.7 ... 50.9 61.7 52.0 13.5 13.4 30.2 75.5 14.4 63.6 68.5 43.9 12.7 26.0 71.4 65.2 66.1 20.8 77.6 59.0 55.3 48.0 54.3 21.0 65.8 61.4 77.8 37.0 46.4 62.7 60.9 11.6 53.0 51.1 51.3 [95% CI] [12–23.8] [59.9–72.5] [54.5–70.2] [60.9–74.1] [10.5–20.7] [8.6–17.8] [29.6–45.4] [18.4–34.6] [13.5–25.4] [61.2–75.2] [66.1–78.8] [18.3–33] [29.7–47] [56.7–69.5] [56.3–70.8] ... [42.6–59.3] [53.6–69.3] [44.2–59.6] [9.1–18.6] [8.8–19.1] [22.8–38.2] [66.9–82.8] [9.9–19.9] [56.8–69.9] [62.9–73.7] [35.7–52.6] [8.4–17.9] [19.9–32.3] [64.8–77.4] [58.5–71.4] [59.3–72.4] [14.9–27.9] [71.4–82.9] [51.4–66.3] [46.6–64] [40–56.4] [46–62.6] [15.1–27.9] [58.5–72.8] [53.8–68.9] [71.5–83.1] [30.1–44.2] [37.5–55.1] [55–70] [53.1–68.7] [7.1–17.3] [43.8–62.4] [41.2–61.1] [43–59.7] Females 32.7 70.9 57.9 48.3 30.3 30.9 39.8 33.5 31.1 59.6 78.9 35.5 51.8 65.6 74.5 ... 49.9 50.1 60.8 29.8 21.6 54.8 80.2 21.4 48.2 59.7 54.8 26.3 40.9 78.4 51.8 69.8 25.3 81.0 65.5 66.3 49.1 62.0 26.3 56.7 50.2 78.9 30.1 46.7 52.7 56.8 27.7 64.7 63.4 61.3 [95% CI] [26.4–39.8] [65.1–76.5] [48.8–66.3] [40.7–56.1] [23.9–37.2] [24.9–37.3] [32.4–47.2] [25.8–41.6] [25.2–37.6] [51.3–67.5] [73.2–83.9] [28.6–42.8] [43.2–60.2] [59.4–71.4] [68.5–79.8] ... [41.7–57.8] [41.2–58.8] [53.4–67.9] [24–36.4] [16.1–27.7] [46.7–62.7] [73.3–86] [16.4–27.3] [41.2–55.2] [54.1–65.4] [47.3–62] [20.8–32.4] [34.6–47.2] [73–83.1] [44.7–58.8] [63–75.7] [19.7–31.6] [75.7–85.6] [58.7–72] [58.7–73.2] [40.9–57] [54.8–68.8] [19.9–33.2] [48–65.1] [42.1–58] [73.2–84] [23.2–37.2] [38.4–55.4] [44.1–61.3] [48.6–64.6] [21.5–34.6] [56.3–72.6] [54.3–72] [53.3–68.9] Both sexes 25.0 68.7 60.1 58.0 22.8 21.9 38.5 29.6 25.1 64.0 75.8 30.3 45.1 64.4 68.9 ... 50.4 55.8 56.5 21.8 17.6 42.9 77.8 18.0 55.9 64.0 49.4 19.4 33.3 74.9 58.5 67.4 23.0 79.3 62.2 60.7 48.5 58.2 23.6 61.1 55.6 78.1 33.5 46.6 57.6 58.7 19.8 58.9 57.4 56.3 [95% CI] [20.5–29.3] [64.6–72.7] [54.2–66.4] [53.1–63.1] [18.7–27] [18.2–25.7] [33.1–44.1] [23.9–35] [20.9–29.3] [58.1–69.1] [71.3–80] [25–35.7] [39.2–50.8] [60.1–68.7] [64.1–73.3] ... [44.7–56.4] [50–61.2] [51.4–61.5] [18.2–25.6] [14–21.7] [37.2–48.8] [72.6–82.9] [14.2–21.6] [51–60.6] [60.1–67.9] [44–54.9] [15.5–23.2] [28.8–37.6] [70.9–79.2] [53.5–62.9] [62.8–71.9] [18.6–27.2] [75.5–83] [57.2–67.2] [55–66.4] [42.6–54.2] [52.4–63.6] [19.2–28.4] [55.1–66.9] [50.4–60.8] [73.1–82.9] [28.7–38.5] [40.6–53] [51.7–62.9] [53.4–64.1] [15.8–23.8] [53.2–65] [50.7–64.5] [50.2–62]

Country name

229

Global status report on NCDs 2014 … Indicates no data were available Overweight (BMI≥25) Crude adjusted estimates Males Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand the former Yugoslav Republic of Macedonia Timor–Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United Republic of Tanzania United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe WPR EUR AFR EMR AFR EUR AFR AFR WPR EUR EUR WPR EMR AFR AFR EUR SEAR EMR AMR AFR EUR EUR EMR EUR SEAR EUR SEAR AFR WPR AMR EMR EUR EUR WPR AFR EUR EMR EUR AFR AMR AMR EUR WPR AMR WPR EMR AFR AFR 66.3 ... 23.8 67.5 19.6 62.3 48.3 16.1 39.2 68.5 69.9 48.8 13.2 41.0 19.5 70.3 18.9 19.5 53.5 23.0 65.9 66.7 51.5 37.5 27.7 61.7 9.3 15.4 66.2 56.9 59.0 63.5 51.8 68.4 11.3 58.2 70.5 71.1 15.1 74.1 63.3 43.9 58.9 59.9 17.2 34.5 17.1 13.7 [95% CI] [58.7–73.2] ... [17.8–30.5] [60.6–74] [14.5–25.3] [54.6–69.9] [38.8–57.7] [11.7–21] [32.7–46] [60.6–75.7] [61.6–77.7] [40.3–56.9] [8.4–19] [34.1–48] [14.2–25.7] [63.2–76.5] [12.6–26.4] [14.2–25.7] [45.4–61.9] [16.7–30.3] [59.2–72.3] [59.7–73.1] [44.4–58.4] [28.8–46.6] [20.9–35.5] [53.6–69.6] [5.7–13.9] [11–20.5] [59–73] [44.4–69] [52.2–65.6] [57.2–69.5] [43.5–60.1] [61.5–74.7] [7.3–16.2] [49.5–66.9] [63.6–77] [66–75.8] [10.9–20] [68.8–78.9] [55.4–70.6] [35.3–52.5] [51.2–66.2] [52.8–67.1] [12–23.6] [26.9–42.8] [12.1–22.7] [8.6–19.9] Females 78.0 ... 38.5 69.2 33.5 52.8 64.5 30.4 30.0 59.7 59.7 62.7 23.2 62.2 30.5 60.9 32.9 30.5 63.3 48.8 52.4 50.0 58.7 44.7 35.4 53.2 15.3 30.5 77.5 69.1 66.5 68.7 53.3 76.0 25.9 56.6 70.9 62.4 30.0 65.3 63.2 48.7 69.7 62.6 23.5 46.8 33.1 38.4 [95% CI] [72.2–83] ... [31.9–45.7] [62.7–75.4] [27.5–39.7] [44–61.5] [55.9–72.5] [24.9–36.3] [24.1–36.6] [50.6–68.1] [50.1–69] [55.3–69.8] [17–30] [55.9–68.4] [24.1–37.5] [53.1–68.1] [24.9–41.3] [24.1–37.5] [55.5–70.7] [40.6–56.8] [45.4–59.5] [42.6–57.4] [51.5–65.5] [36.5–53.1] [28.4–42.6] [44.3–62] [10.7–20.8] [24.7–36.8] [71.9–82.5] [58.3–78.8] [60.1–72.6] [62.8–74.3] [45.1–61.1] [70.2–81] [20–32.5] [47.3–65] [64.1–77.3] [57.2–67.5] [24.6–35.8] [59.7–70.7] [55.1–70.7] [40.3–57.1] [63.4–75.8] [55.6–69.2] [17.6–30] [38.4–55.2] [26.7–39.9] [30.4–46.7] Both sexes 72.0 ... 31.2 68.2 26.7 57.5 56.3 23.3 34.6 64.0 64.8 55.6 18.3 51.9 25.0 65.6 26.1 25.0 58.4 36.1 59.2 58.2 55.0 41.1 31.6 57.5 12.3 23.1 71.8 63.1 62.8 66.1 52.5 72.1 18.6 57.3 70.6 66.7 22.6 69.6 63.2 46.3 64.2 61.3 20.4 40.6 25.1 26.2 [95% CI] [67.6–76.7] ... [26.8–36] [63.7–73] [22.6–30.7] [51.9–63.5] [49.8–62.3] [19.1–26.8] [30.1–38.9] [57.8–69.4] [58.4–70.8] [50.3–61.2] [14.1–22.6] [47.4–56.5] [20.6–29.8] [60.5–70.3] [20–31.2] [20.6–29.8] [53.1–63.9] [31.1–42.1] [54.4–64.1] [53.3–63.4] [50.1–59.8] [35–47.3] [26.7–36.7] [51.8–63.6] [8.9–15.4] [19–26.9] [67.4–76.3] [55–71.4] [58.3–67.2] [62.3–70.3] [46.9–58.1] [68–76.5] [14.7–22.4] [51.1–63.5] [65.3–75.7] [63.4–70.3] [19–26.3] [66–73.5] [58.1–68.8] [40.2–52] [59.3–68.7] [56.5–66.5] [16.2–24.6] [34.5–46.3] [21–29.3] [21.1–31]

Country name

Region

230

Annex 4.7b: Overweight and Obesity

Overweight (BMI≥25) Age-standardized adjusted estimates Males 69.1 ... 26.7 68.0 22.4 59.9 47.4 17.6 37.6 66.1 66.1 53.2 14.9 43.2 21.5 66.2 18.4 21.5 53.7 27.3 63.1 63.3 54.8 41.0 26.2 59.8 11.0 17.2 69.9 55.4 59.3 64.1 54.6 69.6 13.2 56.3 73.1 68.1 17.1 72.1 62.4 46.6 62.6 61.0 17.3 39.9 19.5 16.2 [95% CI] [61.3–76.1] ... [20.1–34] [61.2–74.2] [16.6–28.7] [52.4–67.4] [37.9–56.6] [12.9–23] [31.3–44.3] [58.5–73.2] [58.2–73.7] [44.2–61.8] [9.5–21.3] [36–50.5] [15.6–28.3] [59.3–72.2] [12.3–25.8] [15.6–28.3] [45.6–62.1] [19.9–35.6] [56.5–69.5] [56.5–69.5] [47.5–61.9] [31.5–50.6] [19.8–33.7] [51.8–67.6] [6.9–16.4] [12.3–22.8] [62.6–76.6] [43.1–67.4] [52.5–65.9] [57.8–70.1] [46.1–63.1] [62.7–76] [8.5–18.8] [47.8–64.9] [66.8–78.9] [63.1–72.8] [12.3–22.5] [66.8–77] [54.5–69.8] [37.6–55.6] [54.7–69.9] [53.7–68.2] [12–23.9] [31.4–49] [13.9–25.7] [10.4–23.2] Females 80.0 ... 42.8 71.9 37.7 49.2 63.4 34.0 28.1 56.2 55.1 67.4 26.5 64.0 34.1 55.7 31.6 34.1 63.3 55.2 48.8 46.4 62.3 48.8 33.0 50.5 18.1 34.4 79.6 67.2 66.4 68.5 55.7 76.8 30.4 52.4 75.8 58.8 34.1 62.6 60.9 51.4 73.4 63.5 23.8 53.7 38.9 44.8 [95% CI] [74.3–84.8] ... [35.9–50.2] [65.7–77.7] [31.3–44.2] [40.6–57.7] [55–71.4] [28.1–40.3] [22.3–34.4] [47.2–64.6] [45.4–64.4] [60.2–74.1] [19.8–33.9] [57.6–70.1] [27.2–41.3] [48.2–62.8] [23.8–39.8] [27.2–41.3] [55.5–70.7] [46.6–63.4] [42–55.7] [39.1–53.6] [55.2–69] [40.4–57.5] [26.3–40.1] [41.7–59.1] [13–24.1] [28.1–41.1] [74.2–84.5] [56.4–77] [59.9–72.4] [62.5–74.1] [47.5–63.6] [71.1–81.9] [23.9–37.4] [43.4–60.9] [70–81.2] [53.5–64] [28.4–40.2] [57–68.1] [52.8–68.6] [43–59.9] [67.3–79] [56.6–70.1] [17.9–30.4] [45.1–62.4] [32–46.1] [36.3–53.5] Both sexes 74.3 ... 34.8 69.6 30.2 54.5 55.3 25.8 32.8 61.0 60.6 60.2 20.7 53.9 27.8 60.9 25.2 27.8 58.5 41.4 55.9 54.7 58.5 44.9 29.7 55.2 14.5 25.9 74.8 61.4 62.9 66.3 55.2 73.2 21.8 54.2 74.0 63.4 25.6 67.3 61.7 49.0 67.9 62.3 20.6 46.8 29.2 30.7 [95% CI] [69.7–79.2] ... [30–39.4] [65.1–74.4] [26.2–34.6] [49–59.9] [49.3–61.5] [21.7–29.8] [28.4–37.5] [55.3–66.6] [54.5–66.5] [54.4–65.7] [16.1–25.6] [49.2–58.5] [22.9–32.6] [56.4–66.3] [19.6–30.4] [22.9–32.6] [52.7–64.2] [35.3–47.2] [51.1–60.9] [49.8–59.6] [53.5–63.2] [38.6–51.8] [24.8–34.4] [49.2–61.2] [11–18.2] [21.6–30.2] [70–79.3] [53.7–69.9] [58.6–67.2] [62.2–70.8] [49.6–60.4] [69–77.4] [17.6–25.8] [48.5–60.3] [69.6–78.3] [59.7–66.9] [21.8–29.7] [63.3–70.9] [56.3–67.6] [42.7–55.7] [63.2–72.8] [57.8–67.1] [16.1–24.9] [40.4–52.7] [24.6–33.7] [25.5–35.9]

Country name

Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand the former Yugoslav Republic of Macedonia Timor–Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United Republic of Tanzania United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe

231

Global status report on NCDs 2014

4.7b Overweight and Obesity (continued) Comparable estimates of prevalence of overweight and obesity (population aged 18+ years), 2014 Obesity (BMI≥30) Crude adjusted estimates Males Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic EMR EUR AFR EUR AFR AMR AMR EUR WPR EUR EUR AMR EMR SEAR AMR EUR EUR AMR AFR SEAR AMR EUR AFR AMR WPR EUR AFR AFR AFR WPR AFR AMR AFR AFR AMR WPR AMR AFR AFR WPR AMR AFR EUR AMR EUR EUR 1.5 16.7 18.0 30.7 5.1 22.8 23.6 17.1 29.4 22.1 18.5 29.8 29.7 2.0 25.6 22.1 24.0 14.8 3.7 4.6 11.1 17.1 10.9 17.2 16.7 23.6 2.8 0.6 7.7 1.5 4.9 28.6 1.9 3.3 23.7 6.2 15.7 2.0 5.7 45.8 19.0 4.3 24.3 20.4 22.3 28.1 [95% CI] [0.7–2.9] [10.8–23.7] [12.3–24.3] [22.9–38.7] [2.4–9.3] [14.4–32.7] [16.6–31.2] [10.8–24.4] [23.7–35.5] [15.4–29.8] [11.9–26.1] [21.7–38.6] [22.4–37.5] [0.9–3.5] [16.9–35.6] [14.8–30.5] [17.5–31.1] [9.4–21.5] [2–6] [2.5–7.6] [6.4–17] [10.7–25.2] [6.5–16.8] [11.9–23] [9.9–25.5] [16.3–31.8] [1.4–4.7] [0.2–1.4] [4.5–11.9] [0.7–2.9] [2.7–8] [22.3–35.4] [0.8–3.8] [1.7–5.9] [17.2–31] [3.4–9.7] [10.6–21.4] [1–3.7] [2.8–9.8] [37.5–54] [13.4–25.5] [2.4–7.1] [16.9–32.3] [13.1–29] [15.4–30.1] [20.7–36.1] Females 3.3 19.4 29.3 33.4 11.9 39.0 29.4 22.9 30.5 18.1 25.9 43.2 41.3 4.6 40.7 27.8 20.2 26.4 12.4 7.5 20.6 21.2 28.2 22.9 20.6 27.5 7.7 3.6 15.7 4.2 14.3 31.5 6.7 9.9 33.1 8.5 25.5 9.6 13.7 54.4 29.2 11.8 26.8 34.0 26.8 30.1 [95% CI] [1.8–5.4] [12.6–27.2] [22–37] [25–42.5] [6.8–18.5] [28.8–49.6] [22.2–37.4] [16–30.7] [24.8–36.2] [12.2–25] [18.5–34.1] [34.2–51.9] [32.9–49.5] [2.7–7] [30.8–50.6] [18.7–37.3] [14–27.4] [18.8–34.6] [8.8–16.7] [4.6–11.3] [14.3–27.9] [13.7–30.1] [20.4–36.5] [17.4–29.2] [13.1–29.3] [19.1–36.6] [5.1–11] [1.9–6] [10.7–21.1] [2.4–6.8] [10.2–18.8] [25.2–38.1] [3.7–10.8] [6.4–14.1] [25.6–41.1] [5–12.9] [19.4–32.1] [6.4–13.6] [8.8–19.5] [46.5–62.2] [22.6–36.4] [8.3–16] [18.6–36.2] [25.2–43.2] [18.9–35] [21.3–39.2] Both sexes 2.4 18.1 23.6 32.1 8.5 31.0 26.5 19.9 29.9 20.1 22.2 36.6 34.1 3.3 33.2 25.2 22.1 20.6 8.1 5.9 15.8 19.2 19.5 20.1 18.6 25.6 5.2 2.1 11.7 2.9 9.6 30.1 4.4 6.6 28.5 7.3 20.7 5.8 9.7 50.0 24.0 8.0 25.6 27.2 24.5 29.1 [95% CI] [1.2–3.5] [13.5–22.8] [18.8–28.1] [26.4–37.6] [5–11.8] [24.1–38.6] [21.3–31.4] [15–24.8] [25.9–33.9] [15.3–24.8] [16.2–27.4] [30.8–42.4] [28.4–39.8] [2–4.6] [26.1–40.2] [19.7–31.4] [17.6–26.9] [15.5–25.4] [5.9–10.1] [3.9–8] [11.5–19.8] [13.8–24.8] [14.8–24] [16–24] [12.6–24.1] [20.1–31.4] [3.5–6.9] [1–3.3] [8.7–14.8] [1.6–4.2] [7–12.3] [25.1–34.7] [2.5–6.4] [4.4–8.9] [23.1–33.9] [5–9.8] [16.2–24.8] [3.7–7.6] [6.3–13] [44–55.4] [19.5–28.9] [5.6–10.2] [19.8–31.5] [21–33.4] [19.2–29.9] [23.3–35.5]

Country name

Region

232

Annex 4.7b: Overweight and Obesity

… Indicates no data were available Obesity (BMI≥30) Age-standardized adjusted estimates Males 1.8 16.5 18.8 28.5 6.0 22.8 23.6 17.2 28.4 20.5 19.0 29.7 30.5 2.1 24.4 21.0 22.3 16.1 4.1 4.9 12.1 16.3 12.7 17.3 16.2 21.8 3.2 0.7 8.6 1.7 5.8 26.8 2.2 4.0 23.3 5.9 16.1 2.2 6.4 46.6 19.2 4.7 22.5 19.0 21.9 26.2 [95% CI] [0.8–3.3] [10.7–23.4] [12.9–25.4] [21.1–36.1] [2.9–10.8] [14.4–32.8] [16.7–31.3] [10.9–24.5] [22.8–34.3] [14.2–27.7] [12.2–26.8] [21.5–38.5] [23.2–38.2] [1–3.7] [16–34] [14–29.3] [16.1–28.9] [10.3–23.4] [2.3–6.8] [2.7–8.2] [6.9–18.4] [10.1–24] [7.6–19.3] [12–23.1] [9.5–24.7] [15.1–29.6] [1.7–5.5] [0.2–1.5] [5.1–13.2] [0.8–3.2] [3.2–9.3] [20.8–33.4] [0.9–4.3] [2–6.9] [16.8–30.5] [3.2–9.3] [10.8–21.9] [1.1–4] [3.2–10.9] [38.2–54.8] [13.5–25.7] [2.6–7.9] [15.6–30.2] [12.1–27.3] [15.1–29.6] [19.2–34] Females 4.1 18.7 30.8 30.5 14.2 38.7 28.9 22.0 28.8 16.3 26.1 42.5 42.8 5.1 38.2 25.5 18.2 28.8 14.5 8.8 22.2 19.4 32.3 22.7 20.1 24.5 9.2 4.5 17.4 4.6 17.1 29.1 8.0 12.3 32.2 8.0 25.7 11.0 15.7 55.1 29.5 13.8 24.1 31.5 25.7 27.3 [95% CI] [2.2–6.7] [12–26.3] [23.4–38.5] [22.5–39.1] [8.4–21.7] [28.6–49.3] [21.7–36.9] [15.2–29.5] [23.3–34.5] [10.9–22.6] [18.6–34.2] [33.6–51.3] [34.6–50.6] [3–7.8] [28.5–48] [16.9–34.5] [12.6–24.8] [20.9–37.3] [10.3–19.3] [5.5–13] [15.6–29.8] [12.4–27.9] [24–41.1] [17.2–28.9] [12.8–28.7] [16.8–33] [6.1–13] [2.4–7.5] [12.1–23.3] [2.6–7.4] [12.4–22.3] [23.1–35.4] [4.5–12.6] [8.2–17.4] [24.8–40.1] [4.7–12.3] [19.6–32.3] [7.3–15.4] [10.2–22.1] [47.2–62.9] [22.9–36.7] [9.8–18.4] [16.5–33.1] [23–40.4] [18.1–33.9] [19.1–36] Both sexes 2.9 17.6 24.8 29.5 10.2 30.9 26.3 19.5 28.6 18.4 22.5 36.2 35.1 3.6 31.3 23.4 20.2 22.5 9.3 6.7 17.1 17.9 22.4 20.0 18.1 23.2 6.3 2.6 13.0 3.2 11.4 28.0 5.1 8.1 27.8 6.9 21.0 6.6 11.0 50.8 24.3 9.2 23.3 25.2 23.8 26.8 [95% CI] [1.6–4.2] [12.7–22.2] [19.7–29.8] [23.8–35.1] [6–14.3] [24–38] [21.3–31.4] [14.7–24.4] [24–32.9] [13.7–23] [17.4–28.1] [29.9–42.4] [29.9–40.7] [2.2–5] [25–37.9] [17.4–29.5] [15.3–24.4] [17.4–27.8] [6.7–11.8] [4.4–9.1] [12.5–21.6] [12.6–22.6] [17.3–27.5] [15.8–24] [13–23.5] [17.6–28.5] [4.2–8.1] [1.3–3.9] [9.7–16.4] [1.8–4.5] [8.5–14.4] [23.9–32.6] [3.1–7.3] [5.4–10.8] [22.8–32.7] [4.5–9.2] [16.7–24.8] [4.3–8.8] [7.5–14.5] [45.2–56.3] [19.9–28.4] [6.6–11.7] [18–29.2] [19.4–30.3] [18.3–28.7] [21.3–32.2] Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic Country name

233

Global status report on NCDs 2014 … Indicates no data were available Obesity (BMI≥30) Crude adjusted estimates Males Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea–Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho SEAR AFR EUR EMR AMR AMR AMR EMR AMR AFR AFR EUR AFR WPR EUR EUR AFR AFR EUR EUR AFR EUR AMR AMR AFR AFR AMR AMR AMR EUR EUR SEAR SEAR EMR EMR EUR EUR EUR AMR WPR EMR EUR AFR WPR EMR EUR WPR EUR EMR AFR 1.7 1.4 23.3 5.1 18.5 17.6 13.9 19.4 14.2 11.9 1.2 23.5 1.3 30.2 23.4 25.3 11.6 5.0 17.9 24.1 4.9 23.6 16.9 11.3 2.8 3.2 13.9 6.4 11.1 25.5 25.0 3.1 3.6 19.3 15.3 27.3 23.7 22.5 18.0 3.4 21.0 21.3 2.5 32.5 34.8 10.6 1.8 23.2 26.1 3.3 [95% CI] [0.5–3.8] [0.5–3.1] [16.7–30.2] [2.4–9.1] [12.3–26.1] [11.3–24.9] [8.5–20.2] [13.9–25.8] [9.3–20.3] [5.8–20.4] [0.5–2.3] [16.1–32.1] [0.6–2.4] [22.8–38] [17.7–29.5] [18.2–32.7] [6.3–18.4] [2.8–7.9] [11.4–25.5] [17.8–31] [2.6–8.1] [16.6–31.2] [10.8–24.1] [6.9–16.6] [1.5–4.8] [1.6–5.5] [8.5–20.7] [3.2–11.2] [6.9–16.2] [18.4–33.6] [17.8–33.1] [1.7–5] [1.9–6.3] [14.1–24.9] [10–21.7] [20.5–34.3] [16.9–31] [16.6–29.1] [11.9–24.9] [1.9–5.5] [14.9–28] [14–29.4] [1.2–4.5] [24.5–41] [27.3–42.7] [6.1–16.5] [0.9–3.4] [15.8–31.9] [19.5–33.1] [1.7–5.4] Females 3.3 5.9 18.8 12.0 33.2 28.4 22.2 36.0 25.3 20.7 5.6 25.4 5.4 41.9 22.2 26.1 20.1 13.1 25.9 21.4 16.8 26.7 32.3 21.2 8.9 9.4 30.2 14.8 21.6 26.5 22.8 6.5 7.8 30.6 27.3 26.8 27.8 24.8 35.3 3.6 35.6 25.4 9.2 48.0 43.5 16.0 4.1 27.7 35.7 20.4 [95% CI] [1.2–7] [3.2–9.6] [13–25.3] [7–18.2] [25.2–41.7] [21–36.7] [15.6–29.5] [29.2–43.3] [19–32.4] [12–31.2] [3.3–8.7] [16.7–35] [3.2–8.4] [34.1–49.5] [16.9–28.2] [18.8–33.9] [13.7–27.6] [8.8–18.4] [18.5–33.9] [15.8–27.9] [12–22.4] [19.4–34.7] [24–40.7] [15.4–27.8] [5.9–12.4] [6.1–13.3] [21.9–39.1] [9.5–21.3] [15.9–28.1] [18.2–35.7] [15.8–30.3] [4.2–9.2] [4.7–11.7] [24.5–37.1] [20.4–35.2] [20.3–33.5] [20.7–35.8] [18.6–31.9] [27.5–43.3] [2.1–5.7] [28.6–42.6] [17.9–33.8] [6–13.4] [39.9–56.1] [35–51.8] [10.8–22.2] [2.3–6.5] [18.4–37.8] [28–42.8] [14.5–27.2] Both sexes 2.5 3.7 21.0 8.5 25.9 23.0 18.0 27.7 20.1 16.2 3.4 24.5 3.3 35.9 22.8 25.7 15.8 9.1 22.1 22.7 10.9 25.1 24.6 16.4 5.9 6.3 21.9 10.7 16.3 26.0 23.9 4.7 5.7 24.9 21.2 27.0 25.8 23.7 26.8 3.5 28.1 23.5 5.9 40.1 38.3 13.3 3.0 25.6 30.8 11.9 [95% CI] [0.8–4.3] [2–5.4] [16.7–26] [5.1–11.9] [20.6–30.8] [17.8–28] [13.8–22.6] [23.4–32.2] [15.6–24] [9.9–21.9] [2–4.9] [18.3–30.7] [1.9–4.7] [30.3–41.2] [18.3–27.2] [20.5–30.9] [11–20.2] [6.3–11.9] [16.4–27.4] [18.4–27.3] [8–14.3] [19.5–30.5] [18.8–29.9] [12.3–20.6] [3.9–7.6] [4.2–8.4] [16.8–27.1] [7.2–14.1] [12.6–20.4] [20.2–32.3] [18.7–29] [3.2–6.2] [3.6–7.7] [20.8–28.9] [16.7–25.9] [22.2–31.9] [20.5–30.9] [18.7–28.5] [21.7–32.1] [2.2–4.8] [23–32.8] [18–28.9] [3.8–7.9] [34.1–46.2] [33–44] [9.3–17.2] [1.8–4.1] [19.2–32] [25.8–35.8] [8.6–15.2]

Country name

Region

234

Annex 4.7b: Overweight and Obesity

Obesity (BMI≥30) Age-standardized adjusted estimates Males 1.6 1.6 21.7 5.6 18.5 18.2 14.4 20.3 15.9 12.5 1.4 22.2 1.5 30.8 21.6 23.8 12.9 5.8 17.2 21.9 5.4 21.9 18.1 13.0 3.2 3.6 14.4 7.2 12.4 24.0 24.1 3.2 3.5 20.1 17.2 25.9 23.5 20.4 18.4 3.4 22.7 21.6 2.8 32.9 35.5 11.5 2.1 22.0 26.3 4.1 [95% CI] [0.5–3.7] [0.6–3.6] [15.6–28.1] [2.7–10] [12.3–26.2] [11.7–25.8] [8.9–20.9] [14.6–26.9] [10.5–22.5] [6.1–21.6] [0.6–2.6] [15.2–30.4] [0.7–2.7] [23.3–38.7] [16.3–27.4] [17–30.9] [7.1–20.2] [3.2–9.2] [11–24.7] [16.2–28.2] [2.9–9.1] [15.5–29] [11.7–25.5] [8.1–19] [1.7–5.4] [1.8–6.2] [8.8–21.5] [3.5–12.4] [7.7–18] [17.2–31.8] [17.1–31.9] [1.8–5.1] [1.9–6.2] [14.7–25.9] [11.5–24.1] [19.3–32.7] [16.8–30.8] [14.9–26.4] [12.2–25.4] [2–5.5] [16.2–30.1] [14.2–29.9] [1.4–5.1] [24.9–41.6] [28.2–43.1] [6.6–17.8] [1–3.8] [15–30.5] [19.7–33.4] [2.1–6.8] Females 3.1 7.1 17.0 13.5 33.0 29.5 22.9 37.5 27.0 22.7 6.9 22.9 6.6 42.3 19.6 24.0 22.5 15.8 24.0 18.5 18.9 23.8 34.3 23.9 10.3 10.8 31.6 16.6 24.1 23.9 21.5 6.7 7.9 32.0 30.5 25.3 27.0 21.6 35.7 3.2 38.6 25.0 11.1 48.5 45.9 17.3 4.9 25.1 37.7 24.0 [95% CI] [1.2–6.6] [3.9–11.4] [11.6–22.9] [8.1–20.3] [25–41.5] [21.8–37.8] [16.3–30.4] [30.5–44.9] [20.4–34.2] [13.4–33.9] [4.1–10.5] [15–31.9] [4–10.1] [34.4–49.9] [14.7–25] [17.3–31.7] [15.5–30.4] [10.8–21.7] [17.1–31.6] [13.5–24.2] [13.7–24.8] [17.1–31.3] [25.7–42.9] [17.5–30.8] [7–14.3] [7.1–15.2] [23.2–40.5] [10.8–23.6] [17.9–30.9] [16.1–32.7] [14.8–28.7] [4.4–9.6] [4.8–11.8] [25.8–38.6] [23.1–38.7] [19.1–31.7] [19.9–34.9] [15.8–28] [27.8–43.7] [1.8–5] [31.5–45.8] [17.6–33.4] [7.3–15.9] [40.4–56.6] [37.7–54] [11.8–23.8] [2.8–7.7] [16.5–34.7] [29.9–44.8] [17.3–31.6] Both sexes 2.4 4.4 19.3 9.6 25.8 23.9 18.7 28.9 21.8 17.5 4.1 22.6 4.0 36.4 20.6 23.9 17.6 10.9 20.8 20.1 12.2 22.9 26.2 18.6 6.8 7.2 22.9 11.9 18.2 24.0 22.8 4.9 5.7 26.1 23.8 25.6 25.3 21.0 27.2 3.3 30.5 23.4 7.0 40.6 39.7 14.4 3.5 23.7 31.9 14.2 [95% CI] [0.8–4.1] [2.3–6.2] [15.1–23.5] [5.9–12.8] [20.5–31.1] [18.6–29.2] [13.8–23.1] [24.3–33.6] [17.4–26.5] [10.9–24] [2.5–5.8] [16.9–28.2] [2.6–5.5] [31.2–41.8] [16.7–24.3] [18.9–29.1] [12.8–22.8] [7.7–14] [16.2–26] [15.9–23.9] [9–15.4] [17.8–27.7] [20.8–32] [14–22.9] [4.9–8.7] [4.9–9.5] [17.7–28.3] [8.3–15.8] [14.1–22.2] [18.4–29.5] [17.7–27.9] [3.4–6.4] [3.5–7.9] [22–30.5] [18.9–28.9] [21.2–30.2] [20.1–30.3] [17–24.9] [21.9–32.7] [2.1–4.4] [25.5–35.7] [18–28.9] [4.6–9.2] [34.8–46.8] [33.8–45.3] [10.4–18.5] [2.1–4.9] [17.6–29.3] [27.2–37.4] [10.5–18.1] Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea–Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Country name

235

Global status report on NCDs 2014 … Indicates no data were available Obesity (BMI≥30) Crude adjusted estimates Males Liberia Libya Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (Federated States of) Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Korea Republic of Moldova Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines AFR EMR EUR EUR AFR AFR WPR SEAR AFR EUR WPR AFR AFR AMR WPR EUR WPR EUR EMR AFR SEAR AFR WPR SEAR EUR WPR AMR AFR AFR WPR EUR EMR EMR WPR AMR WPR AMR AMR WPR EUR EUR EMR WPR EUR EUR EUR AFR AMR AMR AMR 2.5 25.8 24.0 28.3 1.9 1.4 10.3 4.6 3.2 26.2 36.4 5.3 11.8 22.1 27.2 ... 13.7 20.3 15.6 1.6 1.4 8.0 39.3 1.7 23.2 28.7 9.7 1.7 5.3 37.0 26.1 22.7 3.3 42.6 20.3 20.6 12.2 15.2 3.4 24.8 21.4 38.9 5.1 11.8 21.8 21.3 1.0 21.2 19.7 17.8 [95% CI] [1.2–4.4] [19.7–32.7] [16.7–32.5] [21.1–36] [0.9–3.5] [0.6–2.6] [6.4–15.5] [2.2–8.3] [1.6–5.5] [18.6–34.6] [28.2–44.6] [2.7–8.7] [6.8–18.2] [16.6–28.3] [20.3–34.5] ... [8.6–19.7] [13.6–28.2] [10.4–21.9] [0.7–2.9] [0.6–2.7] [4.6–12.5] [29.3–49.8] [0.8–3.2] [16.8–30] [23–34.8] [5.8–14.8] [0.8–3.1] [3.1–8.3] [29.6–44.7] [19.4–33.1] [16.3–30.2] [1.7–5.7] [34.4–50.6] [14–27.4] [14–28.2] [7.5–18] [9.6–21.8] [1.7–6] [17.9–32.2] [14.5–28.9] [30.6–47.3] [2.7–8.2] [6.9–18.2] [14.8–29.5] [14.9–28.5] [0.4–2.2] [13.8–29.9] [12.3–28.7] [11.7–25.2] Females 9.2 38.0 30.5 21.3 7.2 7.3 15.3 9.6 8.2 31.1 48.3 12.1 25.7 32.7 39.5 ... 17.7 22.5 27.6 7.4 4.2 25.2 51.1 4.1 20.6 32.5 21.1 5.7 14.3 48.2 23.5 33.5 6.4 51.7 32.8 30.7 18.0 25.5 6.1 29.1 22.8 47.8 7.5 19.2 24.9 30.4 5.4 35.6 34.0 30.5 [95% CI] [6–13.1] [30.4–45.3] [21.5–40.2] [14.9–28.7] [4.3–11] [4.6–10.6] [10.4–20.9] [5.6–14.8] [5.5–11.8] [22.7–40.2] [40–56.3] [8–17.3] [18.4–33.8] [26.3–39.3] [32.1–46.8] ... [12–24.4] [14.8–31.3] [20.6–35] [4.7–10.9] [2.3–6.8] [18.2–32.7] [41.2–60.3] [2.4–6.3] [14.9–27.2] [26.8–38.4] [15–28] [3.5–8.4] [10.4–19.1] [40.8–55.8] [17.2–30.2] [25.9–41.6] [4–9.6] [43.3–59.6] [25.2–40.6] [22.9–39] [12.1–25.3] [19.5–32.2] [3.5–9.5] [21–37.8] [15.8–30.4] [39–56.6] [4.4–11.7] [12.3–27] [16.8–33.7] [22.2–38.7] [3.2–8.5] [26.5–45] [24.9–43.4] [22.5–39.3] Both sexes 5.8 31.9 27.5 24.8 4.6 4.3 12.9 7.0 5.7 28.7 42.3 8.6 18.8 27.6 33.2 ... 15.7 21.4 21.7 4.5 2.9 16.8 45.1 2.9 21.9 30.6 15.5 3.7 9.7 42.5 24.8 26.5 4.8 47.1 26.5 25.5 15.1 20.4 4.7 27.0 22.1 41.0 6.3 15.7 23.4 26.2 3.3 28.4 27.0 24.1 [95% CI] [3.9–7.7] [27–36.7] [21.1–33.8] [20.1–29.5] [2.9–6.4] [2.8–5.9] [9.3–16.2] [4.1–9.8] [3.9–7.6] [22.9–34.4] [36.4–47.5] [5.9–11.4] [14.1–23.7] [23.3–31.9] [28.1–38.5] ... [11.6–19.9] [15.8–26.6] [17.3–26.2] [2.9–6.3] [1.5–4.2] [12.7–21.5] [37.6–52.3] [1.8–4.1] [17.6–26.7] [26.2–34.9] [11.6–19.4] [2.3–5.1] [7.2–12.3] [37.1–47.6] [19.7–29.5] [21.4–31.7] [3–6.6] [41.6–52.5] [21.4–31.8] [20.4–31.1] [11–19.2] [16.5–24.7] [3–6.5] [21–32.6] [17–27.3] [34.3–47.5] [4–8.5] [11.2–20.6] [17.9–29.3] [20.5–31.8] [1.8–4.6] [22–34.9] [20.5–33.1] [19–29.3]

Country name

Region

236

Annex 4.7b: Overweight and Obesity

Obesity (BMI≥30) Age-standardized adjusted estimates Males 2.7 26.6 23.1 26.6 2.2 1.6 10.6 5.0 3.8 24.6 36.9 5.8 11.2 22.8 31.0 ... 14.6 19.3 16.2 1.8 1.4 9.2 39.7 1.8 21.4 27.7 10.8 1.9 5.9 37.7 24.6 27.2 3.7 43.1 20.6 22.6 13.1 15.8 3.6 23.5 19.8 40.0 4.8 11.4 20.5 20.3 1.2 21.2 19.7 17.9 [95% CI] [1.3–4.9] [20.3–33.5] [15.9–31.4] [19.7–33.9] [1–4] [0.7–3.1] [6.5–15.9] [2.4–9.1] [1.9–6.4] [17.4–32.6] [28.7–45.3] [3–9.5] [6.5–17.4] [17.1–29.1] [23.4–39.1] ... [9.1–21] [13–27] [10.8–22.7] [0.8–3.4] [0.6–2.7] [5.4–14.2] [29.5–50.3] [0.9–3.4] [15.3–27.8] [22.1–33.7] [6.4–16.4] [0.9–3.4] [3.4–9.2] [30.1–45.5] [18.3–31.4] [20.4–34.7] [1.9–6.4] [34.8–51.3] [14.3–27.8] [15.4–30.9] [8–19.4] [10–22.6] [1.8–6.4] [16.8–30.6] [13.4–26.8] [31.8–48.1] [2.6–7.7] [6.7–17.6] [13.8–27.9] [14.1–27.3] [0.5–2.6] [13.8–30] [12.4–28.7] [11.8–25.3] Females 10.6 39.5 28.3 19.7 8.6 8.9 16.0 10.8 9.9 28.5 48.9 13.6 24.3 33.1 43.7 ... 18.8 20.7 28.3 8.7 4.3 28.2 51.6 4.6 18.3 30.8 23.2 6.8 16.3 49.0 21.7 37.7 7.3 52.2 33.1 33.4 19.5 26.5 6.6 26.7 20.3 49.7 6.7 17.9 22.7 27.4 6.6 35.3 33.9 30.9 [95% CI] [7–15] [31.9–46.7] [19.8–37.6] [13.7–26.6] [5.2–12.9] [5.7–12.8] [10.9–21.8] [6.4–16.6] [6.6–14] [20.5–37.2] [40.6–56.8] [9.1–19.3] [17.2–32.3] [26.6–39.7] [36.1–51.2] ... [12.9–25.7] [13.5–29.1] [21.3–35.8] [5.5–12.6] [2.4–7] [20.6–36.1] [41.7–60.7] [2.7–7.1] [13–24.4] [25.2–36.6] [16.7–30.5] [4.3–10] [12–21.5] [41.5–56.6] [15.7–28] [29.9–45.7] [4.6–10.9] [43.9–60.2] [25.4–40.9] [25.3–41.9] [13.3–27.1] [20.3–33.2] [3.8–10.3] [19.1–35.1] [13.9–27.3] [41.4–57.8] [3.9–10.5] [11.4–25.4] [15.2–31.2] [19.6–35.4] [3.9–10.2] [26.3–44.7] [24.8–43.3] [22.8–39.7] Both sexes 6.6 33.1 25.9 23.1 5.4 5.3 13.3 7.9 6.8 26.6 42.8 9.7 17.9 28.1 37.2 ... 16.7 20.0 22.3 5.3 2.9 18.9 45.6 3.3 19.8 29.2 17.1 4.3 11.0 43.2 23.1 30.9 5.4 47.6 26.8 27.9 16.3 21.1 5.1 25.2 20.1 42.3 5.8 14.9 21.7 24.1 4.0 28.3 26.9 24.3 [95% CI] [4.4–8.9] [28.1–38.1] [19.8–32.2] [18.4–27.9] [3.4–7.6] [3.5–7] [9.6–16.8] [5–11.1] [4.5–9] [21.4–32] [37.3–48.5] [6.5–12.8] [12.9–22.5] [23.4–32.5] [31.9–42.5] ... [12.2–21.1] [14.7–24.9] [17.5–26.9] [3.5–7.1] [1.5–4.1] [14.4–23.5] [38.6–52.8] [1.9–4.6] [15.7–24.1] [25.2–33.1] [12.6–21.4] [2.8–5.9] [8.2–13.9] [37.8–48.8] [18.6–27.7] [25.5–36.4] [3.6–7.3] [42.4–53.5] [21.5–31.7] [22.5–34] [11.8–20.4] [16.8–25.8] [3.2–7.2] [19.9–30.5] [14.8–25.3] [35.9–48.4] [3.7–8] [10.2–20] [16.1–27.4] [18.9–29.3] [2.3–5.7] [22.5–34.5] [21.4–33] [18.7–29.3] Liberia Libya Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (Federated States of) Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Korea Republic of Moldova Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Country name

237

Global status report on NCDs 2014 … Indicates no data were available Obesity (BMI≥30) Crude adjusted estimates Males Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand the former Yugoslav Republic of Macedonia Timor–Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United Republic of Tanzania United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe WPR EUR AFR EMR AFR EUR AFR AFR WPR EUR EUR WPR EMR AFR AFR EUR SEAR EMR AMR AFR EUR EUR EMR EUR SEAR EUR SEAR AFR WPR AMR EMR EUR EUR WPR AFR EUR EMR EUR AFR AMR AMR EUR WPR AMR WPR EMR AFR AFR 34.3 ... 5.4 29.5 4.0 19.7 17.6 2.8 6.1 25.9 26.7 19.6 1.8 14.6 3.6 24.9 3.5 3.6 19.4 6.0 23.6 23.8 15.9 8.8 6.1 19.2 1.0 2.6 34.0 24.9 20.2 22.6 15.9 33.8 1.3 17.9 31.6 28.5 2.4 33.7 22.9 11.2 27.2 19.8 2.3 9.1 2.9 1.9 [95% CI] [26.2–43] ... [3.1–8.6] [22.5–37.2] [2.2–6.5] [13.5–26.9] [10.9–25.5] [1.5–4.6] [3.6–9.2] [18.4–34.2] [18.2–35.8] [13.3–26.9] [0.7–3.5] [10.2–20.1] [1.9–6.2] [18.4–31.9] [1.6–6.4] [1.9–6.2] [13–26.7] [3.2–9.9] [17.1–30.7] [17.5–30.8] [10.7–21.8] [4.7–14.5] [3.4–10] [12.6–26.9] [0.4–2] [1.4–4.4] [26–42.8] [14.5–37.4] [14.5–26.4] [17.2–28.5] [10.3–22.4] [25.9–42] [0.5–2.5] [11.4–25.5] [23.7–40.1] [23.4–34.1] [1.3–4.1] [27.7–39.9] [16–30.9] [6.4–17.1] [19.9–35] [13.8–26.6] [1–4.4] [5–14.4] [1.5–5] [0.8–3.6] Females 49.5 ... 15.8 39.5 12.5 22.5 36.7 10.4 7.4 28.9 28.2 30.5 6.0 36.0 9.6 28.0 10.0 9.6 32.9 23.5 20.4 18.3 27.5 15.1 12.1 22.4 2.6 10.1 48.2 39.5 33.9 35.9 21.7 45.7 6.5 24.9 41.2 31.1 9.5 36.3 31.9 17.4 38.7 28.8 4.8 19.4 11.5 14.8 [95% CI] [41.6–57.3] ... [11.2–21.2] [31.8–47.3] [8.8–17] [15.1–30.8] [27.8–45.7] [7.1–14.1] [4.7–11] [20.3–37.7] [19.1–38.5] [22.9–38.4] [3.3–9.7] [29.4–42.6] [6–14.1] [21.1–35.2] [5.8–15.5] [6–14.1] [24.5–42.1] [16.3–31.4] [14.4–26.9] [12.6–24.7] [20.6–34.9] [9.8–21.4] [7.9–17.5] [14.8–31] [1.3–4.4] [6.7–14.3] [40.1–56.2] [27.8–51.3] [26.8–41.3] [29.4–42.6] [15.1–28.9] [37.8–53.6] [3.9–10] [16.3–34.3] [32.6–49.9] [26.1–36.3] [6.6–13.2] [30.3–42.3] [23.7–40.5] [11.6–24.5] [31–46.3] [21.9–36.2] [2.4–8] [12.8–27.1] [7.7–16.3] [9.5–21.1] Both sexes 41.6 ... 10.6 33.7 8.3 21.1 26.9 6.6 6.8 27.4 27.4 25.0 3.9 25.6 6.6 26.5 6.8 6.6 26.1 14.8 22.0 21.0 21.6 12.0 9.2 20.8 1.8 6.4 41.1 32.3 27.1 29.4 18.8 39.6 3.9 21.7 34.5 29.8 5.9 35.0 27.6 14.3 32.9 24.3 3.5 14.2 7.2 8.4 [95% CI] [35.7–47.2] ... [7.6–13.5] [28.3–38.8] [6–10.8] [15.8–26.1] [21–33.1] [4.6–8.6] [4.8–8.9] [21.3–33.1] [20.5–34.2] [19.8–30.2] [2–5.7] [21.8–29.6] [4.1–8.7] [21.7–31.4] [4–9.4] [4.1–8.7] [20.8–31.7] [10.9–19] [17–26.5] [16.6–25.6] [17–25.9] [8.3–15.8] [6.3–12.1] [15.3–26.1] [0.9–2.7] [4.4–8.3] [35.2–46.6] [24.4–40.3] [22.3–31.6] [25.1–33.7] [14.6–23.4] [33.6–45.3] [2.3–5.5] [15.8–27.1] [28–40.9] [26.1–33.5] [4.1–7.6] [30.7–39.3] [21.9–33.4] [10.4–18.5] [27.6–38.5] [19.7–29.5] [1.8–5.1] [10.3–18.4] [4.6–9.6] [5.6–11.6]

Country name

Region

238

Annex 4.7b: Overweight and Obesity

Obesity (BMI≥30) Age-standardized adjusted estimates Males 36.0 ... 6.2 29.9 4.8 18.6 17.1 3.1 5.7 24.6 24.6 21.8 2.1 15.7 4.0 22.8 3.4 4.0 19.4 7.5 22.5 22.3 17.4 9.9 5.7 18.3 1.2 3.0 36.4 24.1 20.3 22.9 17.1 34.5 1.6 17.1 33.8 26.9 2.8 32.6 22.5 12.1 29.4 20.3 2.3 11.1 3.4 2.4 [95% CI] [27.6–45] ... [3.5–10.1] [22.9–37.7] [2.6–7.7] [12.8–25.5] [10.5–25.1] [1.7–5.1] [3.4–8.7] [17.4–32.7] [16.7–33.3] [14.9–29.9] [0.8–4] [11–21.5] [2.1–7] [16.7–29.3] [1.6–6.2] [2.1–7] [13–26.8] [4.1–12.3] [16.4–29.3] [16.4–28.8] [11.8–23.7] [5.3–16.2] [3.2–9.4] [12–25.7] [0.5–2.5] [1.6–5] [28.1–45.4] [14–36.2] [14.6–26.6] [17.5–28.9] [11–24] [26.4–42.8] [0.7–3.1] [10.9–24.4] [26–41.7] [22.1–32.2] [1.5–4.8] [26.7–38.7] [15.6–30.3] [7–18.6] [21.7–37.5] [14.2–27.2] [1–4.4] [6.2–17.2] [1.7–5.9] [1–4.5] Females 51.3 ... 18.2 41.4 14.6 20.5 35.9 12.0 6.8 26.7 25.5 33.7 7.2 37.3 11.1 24.7 9.5 11.1 32.9 27.8 18.6 16.5 29.9 17.3 11.1 20.9 3.2 11.9 50.1 38.0 33.8 35.8 23.1 46.4 8.3 22.6 45.1 29.2 11.4 34.7 30.6 18.9 41.5 29.4 4.8 23.4 14.3 18.5 [95% CI] [43.4–59.1] ... [13.1–24.1] [33.8–49.1] [10.4–19.8] [13.5–28.3] [27.3–44.9] [8.3–16.2] [4.3–10.1] [18.7–35.2] [17.1–35.2] [25.7–41.8] [4–11.5] [30.6–43.9] [7.1–16.1] [18.5–31.4] [5.5–14.7] [7.1–16.1] [24.5–42] [19.7–36.5] [13.1–24.8] [11.3–22.5] [22.7–37.5] [11.3–24.1] [7.2–16.1] [13.6–29.2] [1.7–5.5] [8–16.5] [42–58] [26.6–49.7] [26.7–41.1] [29.2–42.4] [16.2–30.6] [38.4–54.3] [5.1–12.5] [14.6–31.5] [36.9–53.3] [24.4–34.2] [8–15.5] [28.9–40.7] [22.5–38.9] [12.7–26.4] [33.7–49.2] [22.5–36.9] [2.5–8.1] [15.8–31.9] [9.7–19.8] [12.1–25.9] Both sexes 43.4 ... 12.3 34.7 9.8 19.5 26.3 7.6 6.2 25.7 25.1 27.7 4.6 26.8 7.5 23.7 6.5 7.5 26.1 17.7 20.5 19.4 23.5 13.6 8.5 19.6 2.2 7.5 43.3 31.1 27.1 29.5 20.1 40.3 4.9 20.1 37.2 28.1 7.1 33.7 26.7 15.5 35.4 24.8 3.6 17.2 8.9 10.5 [95% CI] [37.4–49.1] ... [8.8–15.5] [29.6–40.1] [6.9–12.5] [14.6–23.8] [20.5–31.7] [5.5–9.8] [4.3–8.2] [20–31.3] [19.3–31] [22.4–33.1] [2.6–6.6] [22.8–31.3] [4.9–10.2] [19.5–28.1] [3.9–9.1] [4.9–10.2] [20.7–31.9] [13.5–22.2] [16.3–25.2] [15.6–23.5] [18.7–28.3] [9.5–17.7] [5.8–11.3] [14.7–24.7] [1.1–3.3] [5.1–10] [37.1–49.2] [23.6–38.6] [22.6–31.7] [25.2–33.8] [15.5–24.9] [34.2–46.7] [3–6.9] [14.2–25] [30.9–43.4] [24.5–31.8] [5.1–9.1] [29.6–37.7] [20.8–32.1] [10.7–19.6] [29.7–40.8] [20.3–30] [1.9–5.4] [11.9–22] [6–11.6] [6.7–14.2] Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand the former Yugoslav Republic of Macedonia Timor–Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United Republic of Tanzania United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe Country name

239

Global status report on NCDs 2014

4.8a Raised blood glucose Comparable estimates of prevalence of raised blood glucose (population aged 18+ years), 2010 Raised blood glucose (fasting glucose ≥7.0 mmol/l (126 mg/dl) or on medication for raised blood glucose or with a history of diagnosis of diabetes) Crude adjusted estimates Males Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic EMR EUR AFR EUR AFR AMR AMR EUR WPR EUR EUR AMR EMR SEAR AMR EUR EUR AMR AFR SEAR AMR EUR AFR AMR WPR EUR AFR AFR AFR WPR AFR AMR AFR AFR AMR WPR AMR AFR AFR WPR AMR AFR EUR AMR EUR EUR 6.0 8.8 10.4 10.6 7.9 10.7 8.9 10.2 8.4 7.8 10.5 11.0 12.1 7.1 13.3 9.2 7.4 7.3 6.1 9.0 5.0 11.6 6.6 7.1 10.1 10.4 5.2 2.9 7.0 5.4 5.9 9.1 5.5 6.6 9.7 8.7 6.9 6.2 6.4 26.9 7.9 6.0 10.4 8.6 9.3 9.9 [95% CI] [3–10] [4.7–14] [6.6–15.3] [6.6–16.1] [3.9–14.1] [5–18.7] [4.9–14.1] [5.9–16.1] [5.6–11.6] [4.7–12.1] [6–16.4] [6.1–18] [7.6–17.9] [4–11.2] [6.4–23] [4.9–15.3] [4.3–11.5] [3.9–12.5] [3.3–9.8] [5.4–13.3] [2.3–8.5] [6.2–18.4] [3.3–11.2] [4–11.1] [5.3–16.3] [6–16.2] [2.8–8.4] [1.2–5.7] [4.1–11.1] [2.9–8.6] [3.3–9.5] [5.7–13.2] [2.7–10.1] [3.4–10.9] [5.6–14.8] [5.5–13.2] [3.9–10.9] [3.5–9.9] [3.1–11.9] [18.5–36.8] [4.6–12.1] [3.1–10.1] [5.8–16.4] [4.4–15] [5.5–14.2] [5.8–15.4] Females 5.8 8.2 11.0 9.1 7.2 13.0 8.6 12.7 6.8 6.2 12.8 12.3 11.7 6.5 16.3 10.1 6.2 9.7 5.8 8.4 6.7 11.2 8.5 6.8 9.8 10.1 4.6 3.0 7.2 6.2 5.6 7.5 5.6 5.4 9.7 7.5 7.5 6.3 6.2 24.2 7.8 4.6 9.2 10.4 7.5 9.0 [95% CI] [3.1–9.5] [4.7–13.1] [7.1–15.8] [5.9–13.3] [3.6–13] [6.5–22.3] [5.1–13.2] [7.9–18.8] [4.7–9.2] [3.8–9] [7.7–19.6] [7–19.5] [7.2–17.1] [3.9–10] [8.5–27.1] [5.7–17] [3.8–9.2] [5.3–16.3] [3.3–9.1] [5.1–12.5] [3.4–10.8] [6.3–17.4] [4.6–13.8] [4–10.3] [5.2–16.2] [6.1–15.4] [2.6–7.5] [1.3–5.7] [4.4–10.9] [3.6–9.7] [3.2–9] [5–10.9] [2.8–10.3] [2.8–8.9] [5.9–14.3] [4.7–11.3] [4.5–11.4] [3.6–9.8] [3.2–11.6] [16.7–33.5] [4.8–11.7] [2.4–7.8] [5.5–14.1] [5.9–17.3] [4.6–11.3] [5.3–14.1] Both sexes 5.9 8.5 10.7 9.8 7.5 11.8 8.7 11.4 7.6 7.0 11.7 11.6 11.9 6.8 14.8 9.7 6.8 8.5 6.0 8.7 5.8 11.4 7.5 7.0 10.0 10.2 4.9 3.0 7.1 5.8 5.8 8.3 5.5 6.0 9.7 8.1 7.2 6.3 6.3 25.6 7.8 5.3 9.8 9.5 8.4 9.5 [95% CI] [3.5–8.3] [5.5–12] [7.7–14.1] [6.9–12.6] [4–10.8] [6.6–17.2] [5.7–11.8] [7.8–15.1] [5.8–9.6] [4.8–9.1] [7.8–15.4] [7.5–15.7] [8.3–15.6] [4.5–9.2] [8.5–20.8] [6–13.3] [4.6–9] [5.2–11.8] [3.6–8.1] [6.1–11.3] [3.3–8.4] [7–15.7] [4.4–10.7] [4.6–9.3] [5.9–13.7] [7.1–13.8] [3–6.8] [1.4–4.6] [4.9–9.5] [3.7–7.9] [3.7–8] [5.9–10.6] [2.9–8.2] [3.7–8.3] [6.9–12.7] [5.7–10.8] [4.8–9.7] [4–8.4] [3.4–9.2] [19.3–31.8] [5.4–10.3] [3.3–7.4] [6.3–13.1] [5.8–13.6] [5.7–10.9] [6.2–12.8]

Country name

Region

240

Annex 4.8a: Raised blood glucose

… Indicates no data were available Raised blood glucose (fasting glucose ≥7.0 mmol/l (126 mg/dl) or on medication for raised blood glucose or with a history of diagnosis of diabetes) Age-standardized adjusted estimates Males 8.8 8.1 13.0 9.1 11.3 10.9 8.9 10.3 7.3 6.3 12.1 11.6 16.4 8.8 12.3 8.5 5.8 9.9 8.8 11.7 6.3 9.9 9.9 7.9 11.2 8.4 8.2 4.6 9.8 7.2 8.5 7.6 7.7 9.8 9.6 8.7 7.9 8.7 8.9 28.3 8.8 7.8 8.3 7.7 9.0 8.5 [95% CI] [4.8–14] [4.4–13] [8.5–18.7] [5.4–13.9] [5.9–19.2] [5.1–19] [4.9–14.2] [6–16.4] [4.8–10.1] [3.6–9.8] [7.1–18.3] [6.6–18.6] [10.9–23.1] [5.1–13.5] [6–21.3] [4.5–14.2] [3.3–9.2] [5.5–16.5] [5–13.6] [7.1–17] [3.1–10.5] [5.1–16] [5.2–16.3] [4.5–12.2] [6.2–17.5] [4.7–13.5] [4.7–12.8] [1.9–8.5] [5.9–15.1] [4–11.3] [4.9–13.2] [4.7–11.1] [3.9–13.6] [5.3–15.6] [5.6–14.6] [5.5–13] [4.6–12.3] [5.2–13.3] [4.5–15.7] [19.7–38.1] [5.3–13.3] [4.1–12.6] [4.6–13.5] [3.9–13.4] [5.3–13.8] [4.8–13.4] Females 8.2 7.5 13.5 6.8 10.0 12.9 7.7 11.7 5.4 4.2 13.9 12.1 15.3 8.5 14.2 7.9 4.1 12.7 7.9 11.3 7.9 9.0 11.4 7.1 11.1 7.1 6.6 4.8 8.6 7.4 7.9 5.7 7.3 7.8 9.1 7.3 8.2 8.5 8.3 25.3 8.4 6.6 6.4 8.9 6.5 6.7 [95% CI] [4.6–13] [4.2–12] [8.9–19.1] [4.2–10.5] [5.3–17.5] [6.4–22.2] [4.3–12.2] [7.2–17.6] [3.6–7.5] [2.5–6.4] [8.5–20.7] [7–19.2] [10–21.4] [5.2–12.8] [7.2–24] [4.1–13.7] [2.3–6.4] [7.1–20.5] [4.7–12] [7–16.4] [4.1–12.7] [4.8–14.4] [6.3–17.9] [4.2–10.7] [6.3–17.5] [3.9–11.5] [3.8–10.3] [2.3–8.6] [5.3–13] [4.3–11.4] [4.6–12.3] [3.7–8.5] [3.7–13.1] [4.2–12.5] [5.4–13.4] [4.6–11] [5–12.2] [5.1–12.9] [4.4–15.1] [17.7–34.7] [5.2–12.6] [3.6–10.6] [3.5–10.4] [4.8–15] [3.9–10.1] [3.7–10.9] Both sexes 8.5 7.8 13.3 7.9 10.7 11.9 8.3 11.0 6.3 5.2 13.0 11.9 16.0 8.6 13.3 8.2 4.9 11.3 8.3 11.5 7.1 9.4 10.6 7.5 11.1 7.7 7.4 4.7 9.2 7.3 8.2 6.6 7.5 8.8 9.3 8.0 8.0 8.6 8.6 26.8 8.6 7.2 7.4 8.3 7.8 7.6 [95% CI] [5.5–11.7] [4.8–10.8] [9.9–16.9] [5.3–10.4] [6.1–14.9] [6.1–17.6] [5.3–11.3] [7.5–14.8] [4.5–8] [3.3–6.9] [9–17.3] [7.6–16.2] [11.5–20.5] [5.7–11.5] [7.6–18.9] [4.7–11.6] [3.1–6.8] [6.9–15.4] [5.6–11.2] [8.1–14.8] [4.3–9.7] [5.7–12.9] [6.6–14.5] [4.9–10] [7.1–15] [4.7–10.6] [4.7–10.1] [2.2–7] [6.2–12.2] [4.6–9.8] [5.3–11] [4.7–8.6] [3.9–11] [5.6–12.2] [6.2–12.2] [5.6–10.6] [5.2–10.7] [5.8–11.3] [4.8–12.4] [20.6–32.3] [6–11.4] [4.5–10.2] [4.5–10.3] [4.4–11.9] [5.2–10.4] [4.8–10.2] Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic

Country name

241

Global status report on NCDs 2014 … Indicates no data were available Raised blood glucose (fasting glucose ≥7.0 mmol/l (126 mg/dl) or on medication for raised blood glucose or with a history of diagnosis of diabetes) Crude adjusted estimates Males Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea–Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho SEAR AFR EUR EMR AMR AMR AMR EMR AMR AFR AFR EUR AFR WPR EUR EUR AFR AFR EUR EUR AFR EUR AMR AMR AFR AFR AMR AMR AMR EUR EUR SEAR SEAR EMR EMR EUR EUR EUR AMR WPR EMR EUR AFR WPR EMR EUR WPR EUR EMR AFR 4.7 4.0 7.4 6.8 7.4 7.7 6.4 13.1 8.3 12.6 3.9 9.8 4.9 13.3 9.7 9.1 9.6 6.2 13.3 9.1 5.7 9.4 7.6 7.5 5.2 5.5 6.9 5.7 6.3 10.1 9.2 7.8 6.5 8.7 10.6 9.0 7.1 9.6 8.4 12.1 10.2 11.0 4.2 19.8 14.2 7.0 5.5 9.4 11.2 5.2 [95% CI] [1.8–9.3] [1.5–8.4] [4.3–11.8] [3.3–12.2] [4–12.6] [4.2–12.8] [3.1–10.7] [8.5–18.5] [4.9–12.8] [5.6–23.2] [2.1–6.4] [5.2–15.9] [2.6–8.1] [8.4–20] [6.2–13.8] [5.3–13.9] [4.8–17] [3.3–10.2] [8.3–20] [5.7–13.4] [2.8–10] [5.6–14.5] [3.8–13.2] [4.2–12.3] [2.8–8.4] [2.9–9] [3.2–12.7] [2.7–10.3] [3.5–10.2] [6.1–15.6] [5.1–14.7] [4.6–11.9] [3.6–10.3] [5.6–12.7] [6.6–15.9] [5.6–13.5] [4–11.5] [6.3–13.9] [4.8–13.9] [8.6–16.3] [6.2–15.3] [6.3–17.5] [2.2–6.9] [13.2–28.2] [8.7–21.2] [3.9–11.2] [3–8.7] [5–15.4] [6.3–17.7] [2.7–8.6] Females 6.3 3.9 5.8 6.1 10.6 8.6 7.3 16.7 9.3 10.2 4.0 9.3 4.7 15.8 8.1 6.9 8.8 5.6 14.2 7.5 5.5 8.8 10.7 7.9 4.9 5.4 9.5 5.8 7.1 8.9 6.1 7.8 7.4 9.7 12.0 6.9 6.7 8.1 11.6 9.2 11.1 12.0 4.9 18.8 12.6 8.9 6.1 9.7 9.1 9.0 [95% CI] [2.8–11.4] [1.6–7.8] [3.5–8.8] [3–10.8] [6.1–17.2] [4.9–14.4] [3.8–11.6] [11.4–22.7] [5.6–13.8] [4.4–19.8] [2.2–6.6] [5.1–15.6] [2.6–7.9] [10.4–22.5] [5.3–11.4] [4.4–10.3] [4.5–16.1] [3–9.2] [9.1–20.4] [4.9–10.6] [2.8–9.4] [5.5–12.9] [5.8–17.5] [4.4–12.2] [2.8–7.9] [3–8.7] [4.8–16.2] [2.9–10.5] [4.2–11] [5.2–13.8] [3.5–9.6] [4.7–11.8] [4.4–11.1] [6.5–13.7] [7.7–17.4] [4.3–10.2] [4.1–10.4] [5.6–11.3] [7–18.3] [6.7–12.3] [7.1–16.1] [7.2–18.2] [2.8–7.8] [12.3–26.8] [7.5–19.2] [5.2–13.9] [3.6–9.1] [5.4–16.1] [5.2–14.4] [5.1–14.1] Both sexes 5.5 4.0 6.6 6.5 9.0 8.1 6.9 14.9 8.8 11.4 4.0 9.5 4.8 14.5 8.9 7.9 9.2 5.9 13.8 8.3 5.6 9.1 9.1 7.7 5.0 5.5 8.2 5.8 6.7 9.5 7.6 7.8 6.9 9.2 11.3 7.9 6.9 8.8 10.0 10.6 10.6 11.5 4.6 19.3 13.6 8.0 5.8 9.6 10.2 7.1 [95% CI] [2.4–8.5] [1.6–6.2] [4.4–8.9] [3.6–9.4] [5.7–12.7] [5–11.2] [3.9–9.5] [11.2–18.4] [6–11.8] [5.8–17.3] [2.3–5.5] [6.2–13.4] [3–6.8] [10.1–18.5] [6.4–11.2] [5.3–10.5] [5.3–13.6] [3.4–8.4] [9.6–18.1] [5.8–10.7] [3.1–8] [6–11.9] [5.4–13.1] [4.6–10.7] [3.2–6.9] [3.3–7.5] [4.5–11.8] [3.1–8.4] [4.1–9] [6.4–12.4] [4.8–10.6] [5.2–10.2] [4.5–9.2] [6.7–11.6] [7.7–14.7] [5.6–10.3] [4.6–9.4] [6.5–11.3] [6.3–13.6] [8.3–13] [7.5–14.1] [7.8–15.2] [2.9–6.3] [13.9–24.4] [9.5–18] [5.2–10.9] [3.9–7.7] [6–13.3] [6.7–13.8] [4.4–9.6]

Country name

Region

242

Annex 4.8a: Raised blood glucose

Raised blood glucose (fasting glucose ≥7.0 mmol/l (126 mg/dl) or on medication for raised blood glucose or with a history of diagnosis of diabetes) Age-standardized adjusted estimates Males 5.1 5.9 5.7 9.2 7.6 8.7 7.4 15.0 9.9 14.7 6.6 8.5 6.8 14.7 7.5 7.2 12.0 9.0 12.1 6.8 7.9 7.5 9.3 9.7 7.1 7.6 9.2 7.4 8.3 8.7 8.1 9.1 7.7 11.0 14.7 8.3 6.7 7.4 8.8 8.9 13.7 12.4 6.5 20.6 18.8 9.1 7.7 8.1 11.3 8.1 [95% CI] [2.1–9.8] [2.4–11.6] [3.2–9.2] [4.7–15.9] [4.1–12.8] [4.8–14.3] [3.7–12.2] [9.9–20.9] [5.9–15.3] [7.1–25.9] [3.8–10.3] [4.4–14.1] [3.7–11] [9.5–21.8] [4.7–10.8] [4.1–11.3] [6.2–20.7] [5–14.3] [7.5–18.4] [4.2–10.4] [4–13.4] [4.3–11.9] [4.7–15.9] [5.4–15.6] [4–11.1] [4.2–12] [4.6–15.8] [3.7–13] [4.7–13.2] [5.1–13.7] [4.4–13.2] [5.6–13.7] [4.5–11.9] [7.2–15.8] [9.4–21.2] [5.1–12.5] [3.7–11] [4.7–10.9] [5–14.4] [6.1–12.4] [8.7–20] [7.3–19.3] [3.7–10.4] [13.9–29] [12.2–26.8] [5.3–14.2] [4.4–11.7] [4.2–13.5] [6.5–17.8] [4.3–13] Females 5.7 5.4 3.9 8.2 10.5 9.7 8.1 18.4 10.3 12.5 6.2 6.5 6.5 16.9 5.4 4.7 10.4 8.6 11.9 4.8 7.3 6.1 11.9 10.1 6.5 7.3 11.5 7.4 9.3 6.3 5.0 8.8 8.4 12.1 15.5 6.0 5.7 5.3 11.9 5.8 14.7 12.1 7.3 19.8 17.3 10.7 8.0 6.8 9.8 11.3 [95% CI] [2.6–10.6] [2.4–10.4] [2.2–6.2] [4.2–14] [6–17.1] [5.6–15.9] [4.2–12.9] [12.7–24.9] [6.2–15.4] [6–22.8] [3.6–9.8] [3.2–11.8] [3.6–10.4] [11.3–23.8] [3.3–7.9] [2.7–7.4] [5.4–19.1] [5–13.4] [7.3–17.4] [3–7.2] [3.9–12.2] [3.6–9.6] [6.4–19.8] [5.7–15.3] [3.8–10.2] [4.2–11.3] [6.1–19.1] [3.7–12.9] [5.5–14] [3.4–10.4] [2.7–8.1] [5.4–13.2] [5.2–12.5] [8.3–16.8] [10.2–22] [3.6–9] [3.3–9.1] [3.4–7.8] [7.1–18.9] [3.9–8.2] [9.8–20.7] [7.3–18.3] [4.4–11.2] [13.1–28] [10.9–25] [6.4–16.2] [4.9–11.8] [3.4–12.2] [5.6–15.5] [6.5–17.6] Both sexes 5.4 5.7 4.8 8.7 9.1 9.2 7.8 16.7 10.1 13.6 6.4 7.4 6.7 15.8 6.4 5.9 11.2 8.8 12.0 5.8 7.6 6.8 10.6 9.9 6.8 7.4 10.3 7.4 8.8 7.5 6.6 9.0 8.0 11.5 15.1 7.1 6.2 6.3 10.4 7.3 14.2 12.2 6.9 20.2 18.2 9.9 7.8 7.4 10.6 9.7 [95% CI] [2.6–8.1] [2.5–8.6] [3–6.6] [4.7–12.6] [5.7–12.7] [5.4–12.6] [4.6–10.9] [12.8–20.9] [7.1–13.5] [7.3–20.3] [4.1–8.6] [4.2–10.6] [4.1–9.1] [11–20.4] [4.5–8.3] [3.9–8] [6.3–16] [5.3–12.1] [8.4–15.9] [4.1–7.7] [4.5–10.8] [4.5–9.3] [6.6–15] [6.3–13.5] [4.3–9.4] [4.9–10] [6.2–14.4] [4.2–10.6] [5.5–12] [4.7–10.1] [4–9.2] [6.2–11.9] [5.4–10.6] [8.3–14.7] [11.1–19.3] [5–9.4] [3.9–8.3] [4.7–8.2] [6.3–14] [5.4–9.1] [10.6–18.3] [8–16.5] [4.7–9.1] [15.2–25.7] [13–23.2] [6.4–13.8] [5.4–10.4] [4.4–10.5] [6.7–14.6] [6.1–13.6]

Country name

Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea–Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho

243

Global status report on NCDs 2014 … Indicates no data were available Raised blood glucose (fasting glucose ≥7.0 mmol/l (126 mg/dl) or on medication for raised blood glucose or with a history of diagnosis of diabetes) Crude adjusted estimates Males Liberia Libya Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (Federated States of) Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Korea Republic of Moldova Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines AFR EMR EUR EUR AFR AFR WPR SEAR AFR EUR WPR AFR AFR AMR WPR EUR WPR EUR EMR AFR SEAR AFR WPR SEAR EUR WPR AMR AFR AFR WPR EUR EMR EMR WPR AMR WPR AMR AMR WPR EUR EUR EMR WPR EUR EUR EUR AFR AMR AMR AMR 5.1 11.7 10.3 9.1 4.8 5.0 9.3 7.8 5.5 10.1 18.3 6.1 11.6 8.9 15.4 ... 7.6 8.2 10.6 5.2 4.9 6.3 25.2 8.3 7.7 9.9 6.8 5.3 5.2 24.0 9.6 9.5 7.7 22.4 8.3 11.1 5.7 6.2 4.9 9.8 9.8 14.4 9.2 8.5 8.1 8.6 3.4 12.7 11.8 8.5 [95% CI] [2.4–9.1] [7.9–16.7] [5.6–16.9] [5.3–14] [2.6–8] [2.7–7.9] [5.8–14] [3.8–13.4] [2.9–9.2] [6.1–16.2] [11.8–26.3] [3.2–10.3] [6.9–18.1] [5.3–13.5] [10.4–22] ... [4.2–12.2] [4.6–13.4] [6.4–16] [2.9–8.5] [2.6–8.1] [3.2–10.6] [14.6–37.6] [4.9–12.5] [4.7–11.5] [6.5–14.1] [3.6–11.1] [2.7–9] [2.9–8.4] [16.3–32.9] [5.8–14.4] [5.8–14.4] [4.5–12.1] [15.1–31.1] [4.8–13.1] [6.2–17.5] [2.9–9.3] [3.2–9.8] [2.7–8] [5.9–15] [5.6–15.3] [8.7–21.7] [5.9–13.4] [4.3–14.2] [4.5–12.9] [4.5–14.2] [1.5–6.5] [6.4–21.5] [5.5–20.3] [4.6–14.2] Females 5.1 12.6 10.6 6.2 4.3 5.3 8.2 7.2 5.1 8.4 18.2 7.2 11.1 9.3 18.3 ... 8.1 8.0 10.6 5.4 6.1 7.5 22.6 6.8 6.4 8.0 8.0 4.7 5.1 24.1 7.2 9.2 7.8 19.3 9.0 10.5 5.6 7.1 5.8 9.3 8.0 13.8 7.5 10.9 8.5 11.0 3.7 15.0 12.7 9.9 [95% CI] [2.6–8.7] [8.4–17.8] [6.2–17.2] [3.7–9.5] [2.4–6.9] [3–8.2] [5–12.4] [3.4–12.6] [2.8–8.4] [5.2–12.9] [12–26.3] [4–11.6] [6.8–16.7] [5.7–14.1] [12.5–25.6] ... [4.6–12.7] [4.6–12.6] [6.7–15.7] [3.1–8.6] [3.4–9.7] [4.1–12.1] [13.2–34.1] [3.9–10.5] [4–9.3] [5.4–11.4] [4.5–12.6] [2.5–7.8] [2.9–8] [16.8–32.8] [4.5–10.4] [5.8–13.8] [4.4–12.3] [12.7–27.6] [5.3–13.7] [5.9–16.8] [3.1–9.1] [3.8–11.1] [3.3–9.1] [5.6–14] [5–12.1] [8.3–20.8] [5–10.7] [6.1–17.8] [5–13.3] [6.3–18.3] [1.7–6.7] [8.1–24.6] [6.4–21.9] [5.6–16.3] Both sexes 5.1 12.1 10.5 7.6 4.5 5.1 8.7 7.5 5.3 9.3 18.2 6.7 11.3 9.1 16.8 ... 7.8 8.1 10.6 5.3 5.6 6.9 23.9 7.5 7.0 8.9 7.4 5.0 5.1 24.0 8.4 9.4 7.7 20.9 8.7 10.8 5.6 6.7 5.3 9.5 8.9 14.2 8.4 9.7 8.3 9.9 3.6 13.9 12.3 9.2 [95% CI] [2.9–7.2] [9–15.4] [6.6–14.2] [5–10.2] [2.8–6.3] [3.2–7] [5.9–11.4] [4.2–11] [3.3–7.6] [6–12.4] [13.4–23.5] [3.9–9.3] [7.5–14.9] [6.1–12.2] [12.6–21] ... [5–10.7] [5.1–10.9] [7.3–13.9] [3.2–7.4] [3.4–7.9] [4.2–9.6] [16.1–31.6] [5.1–10] [4.9–9.3] [6.3–11.3] [4.7–10.3] [3–7.1] [3.4–6.9] [18.2–29.7] [5.7–10.9] [6.3–12.2] [5–10.3] [15.8–26.6] [5.9–11.5] [6.6–14.8] [3.6–7.9] [4.1–9] [3.4–7.4] [6.5–12.7] [6–11.8] [8.7–19.5] [6–10.7] [5.8–13.8] [5.3–11.4] [6.1–13.7] [1.7–5.4] [8.4–19] [7.2–17.6] [5.7–12.8]

Country name

Region

244

Annex 4.8a: Raised blood glucose

Raised blood glucose (fasting glucose ≥7.0 mmol/l (126 mg/dl) or on medication for raised blood glucose or with a history of diagnosis of diabetes) Age-standardized adjusted estimates Males 7.2 14.7 9.6 7.8 6.9 7.3 10.7 10.2 8.3 8.3 19.1 8.6 11.4 10.3 19.1 ... 10.2 7.2 12.4 7.4 6.1 9.0 26.0 9.4 6.0 8.4 8.9 6.8 7.4 25.3 7.9 15.3 9.8 23.3 9.2 14.6 6.9 7.2 6.5 8.8 8.0 20.3 8.6 8.1 7.2 8.2 5.4 13.0 12.1 9.3 [95% CI] [3.6–12.5] [10.1–20.5] [5.1–15.8] [4.5–12.1] [3.9–11] [4.2–11.4] [6.8–15.9] [5.1–16.9] [4.6–13.5] [4.9–13.4] [12.6–27.1] [4.8–14] [6.9–17.5] [6.3–15.4] [13.1–26.9] ... [6–15.9] [4–11.8] [7.7–18.3] [4.2–11.9] [3.3–9.7] [4.8–14.6] [15.5–38.3] [5.6–14] [3.6–9.1] [5.4–12.2] [4.8–14.2] [3.7–11.2] [4.3–11.5] [17.5–34.2] [4.6–12.1] [10–21.8] [5.8–15.1] [16–32] [5.3–14.3] [8.6–22] [3.6–11.2] [3.9–11.3] [3.7–10.2] [5.2–13.5] [4.4–12.8] [13.2–28.7] [5.6–12.4] [4.2–13.5] [3.9–11.6] [4.3–13.4] [2.5–9.8] [6.6–21.9] [5.8–20.7] [5.2–15.2] Females 6.9 15.7 8.2 4.7 6.1 7.2 9.8 9.8 7.1 6.3 19.2 9.5 10.3 10.2 21.3 ... 10.2 6.4 12.1 7.2 7.1 9.7 23.7 8.3 4.5 6.5 10.1 6.5 7.0 25.2 5.2 13.9 10.0 20.3 9.6 13.3 6.7 8.0 7.1 7.3 5.7 19.3 6.3 9.3 6.7 8.8 5.7 14.9 12.9 10.5 [95% CI] [3.8–11.4] [10.7–21.7] [4.4–14] [2.7–7.4] [3.6–9.4] [4.2–11] [6.2–14.4] [4.9–16.4] [4.1–11.4] [3.8–10] [13–27.5] [5.5–14.7] [6.4–15.6] [6.3–15.2] [14.8–29.1] ... [6.1–15.6] [3.5–10.4] [7.8–17.7] [4.2–11.1] [4.1–11] [5.6–15.3] [14.1–35.3] [4.9–12.5] [2.7–6.8] [4.3–9.5] [5.9–15.7] [3.7–10.5] [4.2–10.7] [17.8–34.1] [3.1–7.9] [9.1–19.9] [5.8–15.4] [13.6–28.8] [5.7–14.5] [7.9–20.4] [3.7–10.8] [4.3–12.4] [4.2–10.9] [4.1–11.4] [3.3–9.1] [12.4–27.6] [4.1–9.2] [5–15.7] [3.7–10.8] [4.7–15.3] [2.8–9.8] [7.9–24.6] [6.4–22.2] [6–17.3] Both sexes 7.1 15.2 8.8 6.2 6.5 7.2 10.2 10.0 7.8 7.3 19.2 9.0 10.8 10.2 20.2 ... 10.2 6.8 12.3 7.3 6.6 9.4 24.9 8.8 5.3 7.4 9.5 6.7 7.2 25.3 6.5 14.7 9.9 21.8 9.4 13.9 6.8 7.6 6.8 8.0 6.8 20.0 7.5 8.7 6.9 8.5 5.6 13.9 12.5 9.9 [95% CI] [4.3–10] [11.3–19.3] [5.4–12.2] [4–8.5] [4.1–8.7] [4.8–9.9] [7.1–13.1] [5.8–14.1] [4.8–10.5] [4.6–9.8] [13.9–24.2] [5.8–12.2] [7.1–14.5] [7–13.3] [15.1–25.1] ... [6.7–13.6] [4.1–9.6] [8.5–15.8] [4.8–10] [4.3–9.1] [5.9–12.5] [17.1–33.2] [6–11.7] [3.5–6.9] [5.3–9.6] [6.3–12.8] [4.3–9.2] [4.9–9.6] [19.6–31.4] [4.4–8.7] [10.6–18.9] [6.6–13.2] [16.4–27.3] [6.3–12.6] [9.2–18.4] [4.2–9.3] [5–10.4] [4.5–9.1] [5.3–10.9] [4.4–9.5] [13.2–26.6] [5.4–9.7] [5.3–12.4] [4.3–9.7] [5.2–12] [3.1–8.2] [8.4–20.1] [7.1–18] [6–13.8]

Country name

245

Global status report on NCDs 2014 … Indicates no data were available Raised blood glucose (fasting glucose ≥7.0 mmol/l (126 mg/dl) or on medication for raised blood glucose or with a history of diagnosis of diabetes) Crude adjusted estimates Males Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand the former Yugoslav Republic of Macedonia Timor–Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United Republic of Tanzania United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe WPR EUR AFR EMR AFR EUR AFR AFR WPR EUR EUR WPR EMR AFR AFR EUR SEAR EMR AMR AFR EUR EUR EMR EUR SEAR EUR SEAR AFR WPR AMR EMR EUR EUR WPR AFR EUR EMR EUR AFR AMR AMR EUR WPR AMR WPR EMR AFR AFR 18.5 ... 6.1 14.1 5.7 9.0 12.9 5.1 10.8 9.6 11.0 11.1 4.8 8.7 6.3 10.2 7.7 6.3 9.4 6.2 9.3 7.9 9.0 7.5 9.0 8.7 5.0 5.4 18.3 12.9 10.9 10.6 9.8 18.1 3.2 8.6 8.0 10.0 4.8 10.0 9.4 7.7 13.8 8.5 4.7 9.4 4.7 3.7 [95% CI] [11.2–27.5] ... [3.2–10.1] [8.9–20.6] [3.1–9.3] [5–14.3] [7.7–20.1] [2.7–8.5] [6.9–15.6] [5.5–14.7] [6–17.7] [6.6–17.2] [2.3–8.7] [4.9–13.8] [3.6–10.1] [6.6–14.9] [4.1–12.7] [3.6–10.1] [5.3–15.5] [3.1–10.4] [5.8–13.5] [4.8–11.6] [5.4–13.7] [4–12.8] [5.3–13.6] [4.8–13.9] [2.5–8.5] [3–8.6] [11.9–25.9] [5.1–24.2] [7.1–15.7] [7.1–15] [6–15] [11.9–25.6] [1.3–6.2] [4.3–14.2] [4.7–12.6] [7.3–13.4] [2.8–7.4] [6.9–13.9] [5.3–14.9] [4.2–12.6] [8.5–20.2] [5–12.9] [2.6–7.5] [5.2–15.2] [2.6–7.7] [1.7–6.7] Females 21.9 ... 5.8 11.9 6.0 8.6 12.8 5.0 7.7 8.8 10.4 12.0 4.5 11.6 7.5 8.3 9.1 7.5 11.0 9.4 7.3 5.7 10.0 7.9 9.8 8.1 5.0 5.3 22.5 14.9 11.6 12.1 10.6 17.8 3.6 10.2 7.9 8.5 5.3 8.7 9.9 8.8 13.1 7.6 5.7 10.2 5.2 5.3 [95% CI] [13.6–31.6] ... [3.1–9.5] [7.6–17.4] [3.4–9.5] [5–13.4] [7.7–19.3] [2.7–8.1] [4.9–11.1] [5.3–13.3] [6.1–16.1] [7.2–18.2] [2.2–8] [6.9–17.9] [4.3–11.7] [5.6–12] [5.1–14.4] [4.3–11.7] [6.5–17.7] [5–15.3] [4.7–10.4] [3.5–8.3] [6.2–14.9] [4.2–12.8] [6.2–14.5] [4.6–13] [2.7–8.2] [3–8.4] [15.2–31.2] [6.6–27] [7.7–16.4] [8–16.9] [6.5–15.9] [12.1–24.8] [1.7–6.7] [5.8–16.6] [4.6–12.4] [6.2–11.2] [3.2–8.1] [6.2–12] [5.9–15] [4.9–13.9] [8–19.5] [4.6–11.3] [3.4–8.6] [5.9–16.2] [3.1–8.1] [2.6–9.3] Both sexes 20.2 ... 5.9 13.1 5.8 8.8 12.8 5.0 9.2 9.2 10.7 11.6 4.7 10.2 6.9 9.3 8.4 6.9 10.2 7.8 8.3 6.8 9.5 7.7 9.4 8.4 5.0 5.3 20.4 13.9 11.2 11.4 10.2 17.9 3.4 9.4 8.0 9.2 5.0 9.4 9.6 8.2 13.4 8.0 5.2 9.8 4.9 4.5 [95% CI] [14.3–26.1] ... [3.5–8.2] [9.1–17.2] [3.7–7.9] [5.7–11.9] [8.5–17.2] [3.2–7] [6.6–12] [6–12.4] [7.2–14.5] [8.2–15.2] [2.5–6.9] [6.6–13.7] [4.4–9.3] [6.7–11.8] [5.1–11.5] [4.4–9.3] [6.4–14] [4.7–11.1] [5.8–10.8] [4.7–8.8] [6.5–12.3] [4.8–10.7] [6.4–12.2] [5.3–11.6] [3–7.1] [3.2–7.2] [15–25.9] [6.9–20.7] [8.1–14.6] [8.4–14.5] [7.2–13.3] [13.1–22.4] [1.7–5.1] [5.8–13.1] [5–11.1] [7.4–11] [3.4–6.6] [6.9–11.5] [6.7–13] [5–11.2] [9.4–17.8] [5.4–10.8] [3.4–7] [6.4–13.3] [3.2–6.7] [2.5–6.4]

Country name

Region

246

Annex 4.8a: Raised blood glucose

Raised blood glucose (fasting glucose ≥7.0 mmol/l (126 mg/dl) or on medication for raised blood glucose or with a history of diagnosis of diabetes) Age-standardized adjusted estimates Males 20.8 ... 9.2 17.5 8.5 7.7 13.9 7.4 9.8 8.9 9.2 14.4 6.8 11.0 8.8 8.6 7.8 8.8 10.4 9.4 7.3 6.3 11.9 10.4 8.6 7.9 6.9 8.0 21.3 13.0 11.8 11.8 12.5 19.3 5.1 7.8 17.4 8.1 7.0 8.6 8.6 10.0 16.9 9.6 5.8 13.7 7.3 5.8 [95% CI] [12.9–30.2] ... [5.1–14.9] [11.6–24.8] [4.8–13.5] [4.2–12.5] [8.6–21.2] [4.2–11.8] [6.3–14] [5.1–13.7] [4.9–15] [8.8–21.4] [3.3–11.8] [6.5–17] [5.2–13.5] [5.4–12.8] [4.2–12.7] [5.2–13.5] [6–16.9] [4.9–15.3] [4.4–10.8] [3.8–9.4] [7.4–17.6] [5.8–16.8] [5.2–13] [4.3–12.7] [3.6–11.3] [4.7–12.4] [14.1–29.5] [5.3–24.2] [7.9–16.9] [8–16.5] [7.9–18.6] [13–27] [2.2–9.5] [3.9–13.2] [11.5–24.6] [5.8–11] [4.2–10.6] [5.9–12] [4.7–13.8] [5.6–15.9] [10.8–24.1] [5.8–14.4] [3.3–9] [7.9–20.9] [4.2–11.6] [2.6–10.4] Females 23.8 ... 8.1 15.9 8.3 6.8 13.0 7.2 6.8 7.2 7.7 15.8 6.2 12.7 9.9 6.0 8.8 9.9 11.5 12.6 4.9 3.8 13.0 10.7 9.1 6.9 6.5 7.6 24.9 14.5 12.4 12.6 12.6 18.8 5.6 7.7 16.5 6.2 7.3 6.9 8.0 10.7 16.2 8.4 6.1 14.2 7.9 7.5 [95% CI] [15.1–33.9] ... [4.6–13] [10.6–22.5] [4.9–12.8] [3.7–10.9] [7.9–19.6] [4.2–11.2] [4.4–9.9] [4.2–11.1] [4.2–12.5] [9.9–23.1] [3.2–10.5] [7.6–19.4] [5.9–15.2] [3.8–9.1] [5–13.9] [5.9–15.2] [6.8–18.3] [6.9–19.8] [3–7.4] [2.3–5.8] [8.3–18.8] [6–16.6] [5.7–13.4] [3.8–11.3] [3.7–10.4] [4.5–11.5] [17.1–34.2] [6.4–26.3] [8.3–17.5] [8.3–17.5] [8–18.5] [12.9–25.9] [2.7–10] [4.1–13.4] [10.7–23.7] [4.4–8.5] [4.5–10.9] [4.7–9.6] [4.5–12.7] [6.2–16.6] [10.3–23.4] [5.2–12.4] [3.7–9.2] [8.5–21.4] [4.8–11.9] [3.7–12.9] Both sexes 22.3 ... 8.6 16.8 8.4 7.2 13.5 7.3 8.3 8.0 8.4 15.1 6.5 11.8 9.4 7.3 8.3 9.4 10.9 11.0 6.1 5.0 12.4 10.5 8.9 7.4 6.7 7.8 23.1 13.7 12.1 12.2 12.6 19.1 5.4 7.8 17.2 7.2 7.1 7.7 8.3 10.3 16.5 9.0 6.0 13.9 7.6 6.6 [95% CI] [16.1–28.2] ... [5.4–12.1] [12.5–21] [5.7–11.4] [4.3–10] [9.1–17.7] [4.6–9.8] [5.7–10.6] [5.4–10.9] [5.3–11.8] [10.5–19.4] [3.9–9.4] [8.1–16] [6.3–12.5] [5–9.7] [5.2–11.7] [6.3–12.5] [7–14.8] [6.9–15.3] [4–8.2] [3.2–6.7] [8.9–15.9] [6.8–14.6] [6.3–11.5] [4.6–10.2] [4–9.5] [5.1–10.2] [17–29.4] [6.9–20.3] [8.9–15.3] [8.9–15.3] [8.5–16.2] [14.1–23.8] [2.9–7.9] [4.5–11.2] [12.2–21.9] [5.5–8.9] [4.8–9.4] [6–9.7] [5.4–11.1] [6.8–14.1] [11.9–21.4] [6–11.9] [4.1–8] [9.1–18.6] [5.3–10.4] [3.7–9.6]

Country name

Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand the former Yugoslav Republic of Macedonia Timor–Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United Republic of Tanzania United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe

247

Global status report on NCDs 2014

4.8b Raised blood glucose Comparable estimates of prevalence of raised blood glucose (population aged 18+ years), 2014 Raised blood glucose (fasting glucose ≥7.0 mmol/l (126 mg/dl) or on medication for raised blood glucose or with a history of diagnosis of diabetes) Crude adjusted estimates Males Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic EMR EUR AFR EUR AFR AMR AMR EUR WPR EUR EUR AMR EMR SEAR AMR EUR EUR AMR AFR SEAR AMR EUR AFR AMR WPR EUR AFR AFR AFR WPR AFR AMR AFR AFR AMR WPR AMR AFR AFR WPR AMR AFR EUR AMR EUR EUR 6.8 9.4 11.9 12.0 9.2 13.0 10.0 11.0 9.1 8.9 13.1 12.6 13.9 8.0 15.8 10.5 8.0 8.5 6.7 10.3 5.4 12.2 7.8 8.0 11.7 11.8 5.9 3.2 8.0 6.4 6.5 10.1 6.1 7.4 11.1 11.3 7.8 6.7 7.3 30.0 8.8 6.5 11.5 9.7 10.2 11.2 [95% CI] [2.8–13] [4–17] [5.9–19.9] [5.6–20.9] [3.6–18.4] [4.5–26] [4.3–18.2] [5.1–19.6] [4.9–14.4] [4–15.9] [6.1–22.5] [5.4–23.3] [6.9–23.5] [3.6–14.5] [5.8–30.5] [4.3–19.8] [3.7–14.7] [3.4–16.9] [2.7–12.6] [5.2–16.7] [1.9–10.7] [5.4–22.3] [3.1–15] [3.6–14.8] [4.7–21.4] [5.4–20.9] [2.5–11.3] [1–7.2] [3.5–14.9] [2.7–12.1] [2.8–12.8] [5–17] [2.2–12.8] [3–14.2] [5.2–19.8] [5.6–20.2] [3.3–14.6] [3–12.1] [2.7–15.5] [18–43.7] [3.9–16.1] [2.5–12.6] [5.1–21] [3.9–19.2] [4.6–17.9] [5.2–20.2] Females 6.6 8.5 12.3 9.8 8.1 15.1 9.3 13.6 7.2 6.6 15.5 13.5 13.3 7.4 18.5 10.7 6.5 11.1 6.4 9.4 7.3 11.3 9.4 7.3 10.8 10.8 5.1 3.3 7.8 7.2 6.2 8.2 6.3 6.0 10.6 8.9 8.3 7.0 7.0 26.8 8.5 5.0 9.6 11.6 8.0 9.4 [95% CI] [2.8–12.3] [3.8–15.4] [6.3–20.6] [5.2–16.5] [3.1–17] [5.8–29.4] [4.4–16.4] [7–22.9] [4.1–11.5] [3.4–11.3] [7.7–26.1] [6–24.4] [6.3–22.3] [3.4–13] [7.6–34.4] [5–19.9] [3.2–11] [4.6–21.7] [2.8–11.8] [4.7–15.5] [2.8–13.9] [5.2–19.9] [4.2–17.4] [3.4–12.5] [4.4–20.5] [5.2–19] [2.2–9.5] [1.2–7.1] [3.8–13.9] [3.2–13.2] [2.6–11.8] [4.5–13.6] [2.5–13] [2.5–11.6] [5.1–18.3] [4.3–15.9] [3.8–14.9] [3.2–12.4] [2.7–14.7] [16.2–39.8] [4–14.8] [2–9.7] [4.6–17] [5.2–21.4] [3.9–13.9] [4.5–16.6] Both sexes 6.7 8.9 12.1 10.9 8.6 14.0 9.6 12.2 8.1 7.7 14.3 13.1 13.6 7.7 17.1 10.6 7.2 9.8 6.5 9.8 6.3 11.8 8.6 7.6 11.2 11.3 5.5 3.3 7.9 6.8 6.3 9.1 6.2 6.7 10.8 10.1 8.0 6.8 7.1 28.5 8.7 5.7 10.5 10.7 9.1 10.3 [95% CI] [3.3–10.3] [4.5–13.3] [7.2–16.7] [6.1–15.5] [3.8–13.8] [6.2–22] [5–14.2] [6.6–17.5] [5–11] [4.3–11.4] [8.1–20.9] [6.9–19.5] [7.5–19.6] [4.2–11.5] [8–26.6] [5–16.8] [4.1–10.5] [4.5–15] [3.1–9.6] [6.1–13.7] [2.9–9.7] [6–17.3] [4.1–12.7] [4.3–11.1] [5.1–17.1] [6.1–16.2] [2.8–8.3] [1.2–5.5] [4.1–11.2] [3.6–10.3] [3–9.9] [5.2–12.7] [2.3–10.2] [3.1–10] [5.8–15.7] [5.4–14.7] [3.9–12] [3.7–10] [3–11.6] [19.5–36.9] [4.7–12.6] [2.5–9.2] [5.8–15.2] [4.9–16.3] [4.6–13.2] [5.4–15.3]

Country name

Region

248

Annex 4.8b: Raised blood glucose

… Indicates no data were available Raised blood glucose (fasting glucose ≥7.0 mmol/l (126 mg/dl) or on medication for raised blood glucose or with a history of diagnosis of diabetes) Age-standardized adjusted estimates Males 9.9 8.6 14.0 9.8 13.0 12.9 9.9 10.9 7.6 7.0 14.3 12.7 18.0 9.6 14.2 9.5 6.1 11.0 9.4 12.7 6.7 10.4 11.4 8.5 11.9 9.4 9.1 5.0 10.6 8.2 9.3 8.1 8.5 11.0 10.6 10.6 8.5 9.1 9.7 30.8 9.3 8.4 9.1 8.2 9.6 9.3 [95% CI] [4.4–17.8] [3.6–15.9] [7.2–23.1] [4.3–17.5] [5.5–24.5] [4.5–25.8] [4.2–18.2] [5–19.6] [4–12.4] [3–12.8] [6.9–23.9] [5.6–23.3] [9.8–28.9] [4.5–16.8] [5.2–27.8] [4–18.1] [2.6–11.6] [4.7–21] [4.2–16.9] [6.7–20.3] [2.6–13] [4.4–19.3] [4.9–21.3] [3.9–15.4] [5.2–21.4] [4.1–17.3] [4.3–16.5] [1.8–10.4] [4.9–19] [3.5–15.1] [4.2–17.5] [3.9–14] [3.3–17.1] [4.8–20.1] [4.9–18.9] [5.3–18.9] [3.8–15.8] [4.3–15.7] [3.9–19.6] [18.7–44.4] [4.2–16.7] [3.5–15.7] [3.8–17.3] [3.2–16.3] [4.3–17] [4.1–17.3] Females 9.3 7.5 14.3 7.1 11.2 14.5 8.2 12.1 5.6 4.4 15.8 13.0 16.2 9.2 15.7 8.1 4.2 13.7 8.6 12.1 8.5 8.8 12.4 7.2 11.2 7.5 7.2 5.2 9.1 8.2 8.6 6.1 8.2 8.8 9.5 8.2 8.5 9.1 9.1 27.2 8.7 7.0 6.5 9.5 6.8 6.9 [95% CI] [4.3–16.5] [3.3–13.9] [7.5–23.3] [3.3–12.9] [4.7–21.9] [5.4–28.7] [3.6–15.3] [6–20.9] [3–9.3] [2–8.1] [8.1–26.3] [5.8–23.4] [8.4–26] [4.5–15.7] [6.2–30.1] [3.4–16.2] [1.8–7.8] [6.1–25.7] [4–15.1] [6.3–19.4] [3.3–16] [3.6–16.3] [5.6–22.2] [3.3–12.4] [4.9–20.4] [3.2–14.3] [3.4–12.8] [2.1–10.4] [4.4–16] [3.7–14.9] [3.9–15.8] [3–10.7] [3.4–16.6] [3.9–16.2] [4.4–16.8] [4–14.7] [4–15.1] [4.5–15.7] [3.8–18.3] [16.6–40.3] [4.1–15.1] [3.1–13] [2.7–12.7] [4–17.9] [3.1–12.4] [2.9–13.1] Both sexes 9.6 8.0 14.2 8.4 12.1 13.7 9.1 11.5 6.6 5.7 15.0 12.8 17.3 9.4 15.0 8.8 5.1 12.4 9.0 12.4 7.6 9.6 11.9 7.8 11.6 8.4 8.2 5.1 9.8 8.2 9.0 7.1 8.3 9.9 10.0 9.5 8.5 9.1 9.4 29.1 9.0 7.7 7.8 8.8 8.2 8.1 [95% CI] [5–14.2] [4–11.9] [8.7–19.6] [4.3–12.5] [5.6–18.9] [5.6–21] [4.4–14.1] [6.1–17.1] [3.9–9.2] [2.7–8.6] [8.9–20.9] [6.8–19.6] [10.8–24] [4.9–13.5] [7.2–23.5] [4–13.7] [2.5–7.8] [6.1–19.3] [5–13.3] [7.4–17.1] [3.3–11.7] [5.1–14.4] [6–17.9] [4.1–11.6] [6.2–17.1] [3.9–12.7] [4.3–11.7] [1.9–8.3] [5.1–14.7] [4.1–12.5] [4.6–13.5] [3.8–10.3] [3.6–13.4] [5.4–15.3] [5.5–14.7] [5–13.7] [4.4–12.4] [5.2–13] [3.6–14.9] [20.5–37.7] [4.5–12.9] [3.5–11.8] [3.5–11.7] [3.8–13.8] [4–12.4] [4–12] Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic

Country name

249

Global status report on NCDs 2014 … Indicates no data were available Raised blood glucose (fasting glucose ≥7.0 mmol/l (126 mg/dl) or on medication for raised blood glucose or with a history of diagnosis of diabetes) Crude adjusted estimates Males Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea–Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho SEAR AFR EUR EMR AMR AMR AMR EMR AMR AFR AFR EUR AFR WPR EUR EUR AFR AFR EUR EUR AFR EUR AMR AMR AFR AFR AMR AMR AMR EUR EUR SEAR SEAR EMR EMR EUR EUR EUR AMR WPR EMR EUR AFR WPR EMR EUR WPR EUR EMR AFR 5.2 4.3 8.2 7.0 8.5 8.7 7.1 15.3 8.6 15.2 4.2 11.1 5.4 15.6 10.3 9.9 10.3 7.1 16.0 9.9 6.4 10.1 9.0 7.9 5.8 6.0 8.6 6.1 6.9 11.3 9.6 8.6 7.7 9.8 12.3 10.6 7.4 10.5 9.6 13.1 11.4 12.6 4.8 21.5 16.1 8.1 6.2 10.2 13.4 5.6 [95% CI] [1.4–12.2] [1.2–10.5] [3.9–15] [2.5–14.6] [3.6–16.4] [3.6–16.9] [2.7–13.7] [8.4–24.3] [3.9–15.5] [5.6–30.2] [1.7–8.3] [4.6–20.8] [2.2–10.4] [8.3–25.8] [5.4–17.2] [4.5–17.2] [4.1–20.9] [2.9–13.6] [8.5–26.5] [4.9–16.8] [2.4–12.8] [4.7–17.9] [3.2–17.9] [3.4–15.1] [2.4–11] [2.4–11.7] [3–18.1] [2.1–13.1] [2.9–13.3] [5.4–20] [4.3–17.6] [3.9–15.1] [3.2–14.3] [5–17] [6–21] [5.2–18.1] [3.2–13.6] [5.6–17.5] [4.2–18.5] [7.8–20] [5.3–20] [5.5–22.9] [2–9.1] [12.2–33.9] [8.1–26.9] [3.6–14.6] [2.7–11.2] [4.3–19.2] [6.6–23] [2.3–10.7] Females 6.7 4.2 6.3 6.4 12.0 9.7 8.0 19.0 9.7 11.9 4.4 9.7 5.2 18.3 8.6 7.4 9.3 6.5 16.6 8.0 6.0 9.3 12.1 8.4 5.4 5.9 11.5 6.4 7.9 9.4 6.2 8.3 8.3 11.0 13.6 7.9 6.9 8.6 13.2 9.5 12.0 13.2 5.6 20.6 14.2 10.4 6.6 9.8 10.4 9.3 [95% CI] [2.4–14.6] [1.3–9.8] [3.2–10.8] [2.3–12.7] [5.6–22.1] [4.2–18.6] [3.2–15.1] [11–28.9] [4.6–16.9] [4.1–25.7] [1.8–8.4] [4.5–18.1] [2.2–9.8] [10.3–29.1] [4.8–13.8] [3.9–12.4] [3.7–18.9] [2.7–12.6] [9.3–26.1] [4.3–13.2] [2.4–12.2] [4.9–15.6] [5.2–22.8] [3.7–15.5] [2.4–10.4] [2.5–11.2] [4.4–22.2] [2.3–13.5] [3.5–14.6] [4.5–16.7] [2.9–11.4] [3.7–14.5] [3.8–15] [5.8–18.1] [7.1–22.6] [4.1–13.6] [3.3–12.1] [5–13.5] [6.2–24.1] [5.9–14.4] [6–20.3] [6.5–22.8] [2.5–10.3] [11.5–32] [6.7–24.8] [5.2–17.9] [3.2–11.4] [4.5–18.3] [5.1–17.8] [4.2–16.6] Both sexes 6.0 4.3 7.2 6.7 10.3 9.2 7.6 17.2 9.2 13.6 4.3 10.4 5.3 16.9 9.4 8.6 9.8 6.8 16.4 9.0 6.2 9.7 10.5 8.2 5.6 5.9 10.0 6.3 7.4 10.3 7.9 8.5 8.0 10.4 12.9 9.2 7.2 9.5 11.5 11.2 11.7 12.9 5.2 21.1 15.4 9.3 6.4 10.0 11.9 7.5 [95% CI] [1.8–10.2] [1–7.9] [3.8–10.7] [2.5–10.9] [5.1–15.6] [3.8–14] [3.6–11.4] [11.2–23.1] [4.7–13.3] [6.1–21.6] [2.1–6.6] [5.1–15.3] [2.3–8] [11.1–23] [5.9–13.2] [4.8–12.3] [4.3–15.3] [2.9–10.5] [10.2–22.7] [5.4–12.5] [2.7–9.9] [5.6–14] [4.8–16.5] [4.1–12.1] [2.5–8.6] [2.9–9.1] [4.3–16.1] [2.5–10] [3.7–11.1] [5.5–14.9] [3.9–11.9] [4.5–12.1] [4–11.8] [6.3–14.8] [7.6–18.1] [5.3–12.8] [3.8–10.6] [6–13.1] [5.7–17.3] [7.7–15.1] [6.5–16.6] [7.3–18.8] [2.4–7.9] [13.9–28.5] [9.1–22.1] [5–13.8] [3.4–9.4] [5.1–14.7] [6.3–16.8] [3.3–11.4]

Country name

Region

250

Annex 4.8b: Raised blood glucose

Raised blood glucose (fasting glucose ≥7.0 mmol/l (126 mg/dl) or on medication for raised blood glucose or with a history of diagnosis of diabetes) Age-standardized adjusted estimates Males 5.4 6.2 6.2 9.2 8.4 9.5 7.9 17.2 10.3 17.3 6.8 9.5 7.6 16.6 7.8 7.7 12.9 10.2 14.3 7.3 8.7 7.9 10.6 10.3 7.9 8.2 10.6 7.9 9.0 9.6 8.3 9.7 8.5 11.6 16.5 9.3 6.9 7.9 9.8 9.4 14.6 13.7 7.2 21.8 21.0 10.2 8.6 8.7 13.7 8.9 [95% CI] [1.6–12.1] [1.9–14.4] [2.8–11.8] [3.5–18.2] [3.6–16.2] [4–18.3] [3–15.1] [9.6–26.9] [4.7–18.3] [6.9–33.2] [3–12.6] [3.8–18.1] [3.3–14.2] [9.1–27] [3.9–13.4] [3.3–14] [5.3–25.1] [4.6–18.7] [7.4–24.1] [3.3–12.8] [3.5–16.6] [3.3–14.4] [3.9–20.7] [4.5–19.2] [3.5–14.5] [3.5–15.4] [4.1–21] [2.8–16.3] [3.9–16.7] [4.4–17.3] [3.5–15.5] [4.6–16.8] [3.7–15.5] [6.1–19.6] [8.6–26.9] [4.5–16.2] [2.8–12.9] [3.9–13.7] [4.3–18.7] [5.2–15.2] [7.3–24.4] [6.2–24.5] [3.2–13.1] [12.6–34.1] [11.5–32.9] [4.9–17.8] [4–15] [3.5–16.9] [6.8–23.5] [3.8–16.4] Females 5.9 6.0 4.1 8.2 11.4 10.4 8.5 20.6 10.7 14.2 6.6 6.7 7.2 18.8 5.6 5.0 11.2 9.6 13.6 5.1 7.9 6.4 13.2 10.6 7.2 7.8 13.1 8.0 9.9 6.6 4.9 9.2 9.0 12.7 17.2 6.7 5.8 5.4 13.2 5.7 15.3 12.8 8.0 21.0 18.9 12.0 8.7 6.8 11.5 12.1 [95% CI] [2–13.2] [2.1–12.9] [1.9–7.8] [3.2–15.8] [5.2–21.3] [4.5–19.8] [3.4–16] [12.1–31.2] [5–18.6] [5.5–28.9] [3–12] [2.6–13.9] [3.3–13.1] [10.8–29.8] [2.7–9.8] [2.3–9.2] [4.4–22.2] [4.4–17.4] [7.2–22.2] [2.4–9.1] [3.4–15.3] [2.9–11.6] [5.6–25.4] [4.7–19] [3.4–13.3] [3.6–14.5] [5.4–24.5] [3–16.2] [4.6–17.7] [2.8–12.7] [2.1–9.5] [4.3–15.7] [4.3–15.8] [6.9–20.4] [9.4–27.4] [3.2–11.8] [2.6–10.8] [2.7–9.3] [6.2–24.1] [3.1–9.6] [8–24.8] [6.3–22.2] [3.8–14] [11.8–32.4] [9.7–30.4] [6.2–20.2] [4.3–14.5] [2.6–13.9] [5.5–19.8] [5.5–21.2] Both sexes 5.6 6.1 5.2 8.7 9.9 10.0 8.2 18.9 10.5 15.8 6.7 8.0 7.4 17.7 6.7 6.3 12.0 9.9 13.9 6.2 8.3 7.1 11.9 10.5 7.5 8.0 11.8 7.9 9.5 8.0 6.6 9.5 8.7 12.2 16.8 8.0 6.3 6.6 11.5 7.5 14.9 13.2 7.6 21.4 20.1 11.1 8.6 7.6 12.6 10.5 [95% CI] [1.6–9.7] [1.5–10.6] [2.5–7.8] [4.2–13.5] [5.2–15.3] [4.7–15.6] [3.9–12.8] [12.5–25.3] [5.8–15.3] [7.2–24.4] [3.6–10.2] [3.6–12.6] [4.1–11.1] [11.3–24.1] [3.7–9.6] [3–9.4] [5.4–18.8] [4.9–14.5] [8.5–19.4] [3.1–9.2] [3.7–12.6] [3.8–10.4] [5.8–18.2] [5.3–15.6] [4–11] [4.1–12] [5.9–18.3] [3.6–12.7] [5.1–14] [4–12.2] [3.2–10.1] [5.4–13.4] [4.6–12.7] [7.3–16.8] [11–22.7] [4.5–11.6] [3.3–9.8] [3.7–9.7] [5.6–17.5] [4.5–10.4] [8.8–21] [7.4–19.3] [4.1–11.2] [14.2–28.5] [12.1–28.3] [6.3–15.7] [5–12.7] [3.4–11.8] [7.1–17.8] [5.8–15.7]

Country name

Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea–Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho

251

Global status report on NCDs 2014 … Indicates no data were available Raised blood glucose (fasting glucose ≥7.0 mmol/l (126 mg/dl) or on medication for raised blood glucose or with a history of diagnosis of diabetes) Crude adjusted estimates Males Liberia Libya Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (Federated States of) Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Korea Republic of Moldova Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines AFR EMR EUR EUR AFR AFR WPR SEAR AFR EUR WPR AFR AFR AMR WPR EUR WPR EUR EMR AFR SEAR AFR WPR SEAR EUR WPR AMR AFR AFR WPR EUR EMR EMR WPR AMR WPR AMR AMR WPR EUR EUR EMR WPR EUR EUR EUR AFR AMR AMR AMR 5.7 14.6 11.6 10.3 5.1 5.5 10.6 8.6 6.3 10.5 19.6 6.9 13.6 9.7 17.1 ... 9.2 8.8 12.4 5.6 5.7 7.3 25.3 9.0 8.6 10.7 7.3 6.0 5.9 27.1 10.2 9.1 8.5 24.3 9.8 13.1 6.4 7.0 5.6 11.6 10.9 16.5 10.7 9.7 9.0 9.7 3.9 15.1 15.0 9.7 [95% CI] [2–11.9] [8–23.6] [4.9–21.4] [4.7–18.5] [2–9.9] [2.4–10.2] [5.2–18.5] [3.5–16.4] [2.6–12.6] [4.8–19.5] [10.5–31.2] [2.8–13.7] [6.3–23.8] [4.5–17.2] [9.7–27] ... [4.3–16.5] [3.8–16.6] [6.1–21.5] [2.4–10.6] [2.1–11.2] [2.9–14] [11.9–42] [4.3–15.2] [4–15.1] [5.5–17.9] [2.9–14.2] [2.3–11.8] [2.6–11.4] [16.4–39.7] [4.8–17.9] [4.5–15.9] [3.9–15.1] [14.3–36.7] [4.3–17.8] [5.9–22.8] [2.6–12.2] [2.7–13.1] [2.3–11] [5.4–20] [4.7–19.6] [8.3–27.6] [5.6–17.4] [4.1–18.4] [3.9–16.6] [4–18.6] [1.4–8.1] [6–28.5] [5.3–29] [3.9–19] Females 5.9 15.0 11.0 6.7 4.6 5.8 9.1 7.8 5.6 8.7 19.5 7.9 12.4 10.1 20.3 ... 9.8 8.2 12.1 5.9 6.8 8.2 23.2 7.4 7.0 8.7 8.7 5.2 5.4 27.0 7.2 10.4 8.6 21.0 10.3 12.5 6.2 7.9 6.4 10.2 8.6 15.6 8.1 11.6 9.0 11.6 4.2 17.4 15.6 11.0 [95% CI] [2.3–11.8] [8.2–23.9] [5.3–20.1] [3.3–11.8] [1.9–8.8] [2.5–10.6] [4.3–16] [3–15.4] [2.4–10.7] [4.4–15.2] [10.7–31.4] [3.3–14.8] [6–21.3] [4.8–17.8] [11.8–31.1] ... [4.6–17.1] [3.6–15.1] [6.1–20.6] [2.7–11] [2.9–12.9] [3.7–15.3] [10.8–38.9] [3.4–13] [3.6–11.9] [4.7–14.4] [3.9–16.4] [2.1–10.2] [2.3–10.3] [16.5–39.5] [3.7–12.3] [5.1–17.8] [3.9–15.5] [12.1–33.2] [4.8–18.3] [5.8–22.1] [2.6–11.8] [3.2–14.8] [2.8–11.8] [4.9–17.6] [4.4–14.6] [7.8–26.3] [4.5–13.5] [5.6–20.7] [4.1–16.1] [5.5–21.6] [1.6–8.3] [7.4–31.8] [6.1–30.5] [4.8–20.9] Both sexes 5.8 14.8 11.3 8.5 4.8 5.6 9.9 8.2 6.0 9.6 19.6 7.4 13.0 9.9 18.7 ... 9.5 8.5 12.2 5.7 6.3 7.8 24.2 8.2 7.8 9.7 8.0 5.6 5.7 27.0 8.7 9.5 8.6 22.7 10.0 12.8 6.3 7.4 6.0 10.9 9.7 16.3 9.4 10.7 9.0 10.7 4.0 16.2 15.3 10.3 [95% CI] [2.5–9.2] [9.1–20] [5.5–17] [4.7–12.4] [2–7.5] [2.9–8.4] [5.5–14.2] [3.6–12.8] [2.9–9.3] [5–14.3] [12.1–26.9] [3.7–11.3] [7.2–18.8] [4.9–14.4] [12.2–25.7] ... [5.2–13.9] [4.5–12.8] [7.4–17.8] [3–8.6] [2.8–9.5] [3.5–11.8] [13.7–34.8] [4.6–12] [4.4–11.3] [5.6–13.5] [3.7–12.4] [2.3–8.6] [2.9–8.7] [19–35.2] [4.7–12.6] [5.5–13.7] [4.4–13] [15.1–30.5] [4.9–14.8] [6.9–17.9] [3–9.7] [3.4–11.5] [2.7–9.2] [6.1–15.5] [4.7–14.1] [8.5–24] [5.7–12.8] [5.3–15.7] [4.4–13.4] [4.8–16.3] [1.8–6.4] [8.5–24.5] [6.4–23.3] [4.5–16]

Country name

Region

252

Annex 4.8b: Raised blood glucose

Raised blood glucose (fasting glucose ≥7.0 mmol/l (126 mg/dl) or on medication for raised blood glucose or with a history of diagnosis of diabetes) Age-standardized adjusted estimates Males 7.8 16.8 10.6 8.7 7.2 8.1 11.8 10.8 9.4 8.3 20.0 9.3 12.7 10.8 21.4 ... 11.6 7.5 13.8 8.0 6.6 10.2 25.6 10.0 6.5 8.9 9.3 7.6 8.3 27.9 8.3 17.2 10.7 24.5 10.4 16.6 7.6 7.8 7.2 10.0 8.7 23.4 9.4 9.0 7.8 9.0 6.0 14.9 15.0 10.1 [95% CI] [3–15.6] [9.5–26.6] [4.5–19.6] [3.9–15.9] [3.1–13.4] [3.7–14.7] [5.9–20.4] [4.6–20.2] [4.1–17.8] [3.6–15.9] [10.8–31.5] [4–17.5] [5.9–22.1] [5.2–18.9] [12.5–32.8] ... [5.8–19.8] [3.2–14.4] [7–23.4] [3.6–14.7] [2.7–12.6] [4.4–18.7] [12.3–42.4] [4.9–16.7] [2.9–11.9] [4.5–15.2] [3.9–17.5] [3.2–14.4] [3.9–15.2] [17.1–40.4] [3.7–14.9] [9.3–27.4] [5.1–18.5] [14.6–37] [4.6–18.6] [8.1–27.6] [3.1–14.3] [3.2–14.5] [3.1–13.4] [4.5–17.7] [3.5–16.2] [13.1–36.1] [4.9–15.3] [3.8–17.1] [3.2–14.7] [3.7–17.2] [2.4–11.8] [5.9–28.1] [5.4–29] [4.2–19.3] Females 7.8 17.3 8.4 5.1 6.4 8.0 10.3 10.0 7.8 6.3 19.8 10.0 11.1 10.5 23.6 ... 11.5 6.4 13.1 7.7 7.5 10.5 23.5 8.9 4.7 6.9 10.7 7.3 7.5 27.4 5.2 15.1 10.9 21.4 10.5 15.2 7.2 8.5 7.5 7.8 5.9 21.4 6.5 9.8 6.8 9.1 6.2 16.8 15.4 11.1 [95% CI] [3.3–15] [9.7–27.1] [3.5–16.3] [2.3–9.5] [2.8–11.6] [3.7–14.1] [5.1–17.7] [4.2–18.9] [3.6–14.3] [2.9–11.7] [11–31.7] [4.6–18.2] [5.3–19.4] [5.1–18.5] [14.1–35.3] ... [5.8–19.4] [2.6–12.3] [6.8–21.8] [3.7–14] [3.4–13.7] [4.9–18.9] [11.2–39.1] [4.2–15.3] [2.2–8.7] [3.5–11.8] [4.8–19.5] [3.2–13.6] [3.5–13.4] [16.8–39.9] [2.4–9.5] [7.9–24.5] [5.2–18.8] [12.4–33.4] [4.9–18.7] [7.6–25.9] [3.1–13.6] [3.5–15.9] [3.4–13.6] [3.4–14.4] [2.7–10.9] [11.7–33.8] [3.4–11] [4.5–17.9] [2.8–13] [3.9–17.9] [2.6–11.7] [7–31] [5.9–30] [4.9–21.2] Both sexes 7.8 17.0 9.4 6.9 6.8 8.0 11.1 10.4 8.6 7.3 19.9 9.7 11.9 10.7 22.5 ... 11.5 7.0 13.5 7.8 7.1 10.4 24.5 9.4 5.6 7.9 10.0 7.5 7.9 27.6 6.7 16.4 10.8 23.0 10.4 15.9 7.4 8.2 7.3 8.9 7.2 23.0 7.9 9.4 7.3 9.0 6.1 15.9 15.2 10.6 [95% CI] [3.4–12] [10.7–23.1] [4.3–14.6] [3.7–10.4] [3.4–10.1] [4.1–11.6] [6.5–16.1] [4.8–15.9] [4.4–12.9] [3.6–11.2] [12.1–27.4] [4.9–14.4] [6.6–17.2] [6.3–15.3] [14.8–29.6] ... [6.6–16.6] [3.3–10.6] [7.6–19] [4.3–11.6] [3.4–10.6] [5.3–15.4] [14.6–34.8] [5.4–13.2] [2.9–8.3] [4.6–11.2] [5.1–14.6] [3.5–11.3] [3.9–11.4] [19.2–36.1] [3.1–10.2] [9.1–22.4] [6–15.3] [15–30.9] [5.5–15.1] [8.9–22.7] [3.4–11.1] [3.9–12.3] [3.8–10.9] [4.7–13.2] [3.6–10.9] [14.6–32.5] [4.7–11.2] [4.9–14.2] [3.4–11.4] [4.5–14.1] [2.9–9.5] [7.3–24] [6.5–24.6] [4.9–16]

Country name

253

Global status report on NCDs 2014 … Indicates no data were available Raised blood glucose (fasting glucose ≥7.0 mmol/l (126 mg/dl) or on medication for raised blood glucose or with a history of diagnosis of diabetes) Crude adjusted estimates Males Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand the former Yugoslav Republic of Macedonia Timor–Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United Republic of Tanzania United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe WPR EUR AFR EMR AFR EUR AFR AFR WPR EUR EUR WPR EMR AFR AFR EUR SEAR EMR AMR AFR EUR EUR EMR EUR SEAR EUR SEAR AFR WPR AMR EMR EUR EUR WPR AFR EUR EMR EUR AFR AMR AMR EUR WPR AMR WPR EMR AFR AFR 21.7 ... 6.6 16.3 6.3 10.1 15.3 5.8 11.7 11.4 12.9 12.8 5.0 10.0 7.0 11.0 9.7 7.0 10.9 7.2 10.0 8.9 10.7 9.0 10.7 9.6 5.4 5.8 21.3 17.2 12.8 12.5 12.3 20.2 3.8 9.2 10.7 11.1 5.2 11.3 10.5 9.3 16.4 8.9 5.6 10.5 5.2 3.7 [95% CI] [11.2–35.5] ... [2.7–12.8] [8.3–26.6] [2.6–11.9] [4.4–18.5] [7.4–25.9] [2.3–11.4] [6.1–19.1] [5.1–20.2] [5.5–23.4] [6.2–22.2] [1.8–10.3] [4.4–18.4] [3–12.9] [5.4–18.8] [4–18.5] [3–12.9] [4.6–21.1] [2.8–13.9] [5–16.7] [4.4–15.3] [5.2–18.5] [3.9–17.1] [5–18.7] [4–17.7] [2.1–10.7] [2.5–11.2] [11.8–33] [5.3–34.8] [6.6–21.2] [6.9–20.1] [6.5–20.7] [11.3–31.3] [1.3–8] [3.7–17.9] [4.8–19.3] [6.6–17.4] [2.5–9.2] [6.3–18.2] [4.6–19.1] [4.1–17.1] [8.8–26.7] [4–15.7] [2.3–10.8] [4.7–19.2] [2.2–10.1] [1.2–8.3] Females 25.3 ... 6.3 13.8 6.5 9.2 14.0 5.6 7.9 9.7 11.3 14.0 4.7 12.5 8.1 8.8 10.9 8.1 12.5 10.6 7.6 6.0 12.0 9.6 11.1 8.5 5.3 5.9 26.0 18.4 13.2 13.6 13.4 19.7 4.1 10.4 10.2 9.2 5.7 9.7 10.5 10.6 15.6 7.9 6.3 11.4 5.7 5.4 [95% CI] [13.8–39.8] ... [2.7–12.4] [7–23.1] [2.8–12.1] [4.3–16.4] [7.1–23.7] [2.3–10.9] [4.2–12.8] [4.8–16.6] [5.3–20.1] [7–24] [1.8–9.4] [5.9–22.2] [3.7–14.5] [4.9–14.7] [4.8–19.9] [3.7–14.5] [5.7–22.7] [4.5–19.5] [4–12.6] [3–10.2] [6.1–19.9] [4.3–17.3] [5.6–18.9] [3.8–15.6] [2.2–10.2] [2.6–11] [15.7–39.2] [6.1–36.3] [7.1–21.5] [7.4–21.4] [7.1–22] [11.4–30.7] [1.6–8.3] [4.8–19.2] [4.6–18.7] [5.7–14.1] [2.8–9.8] [5.7–15.4] [5.2–18] [5–18.9] [8.2–26] [3.6–13.9] [2.9–11.2] [5.3–20.3] [2.6–10.4] [2.1–11.2] Both sexes 23.5 ... 6.4 15.3 6.4 9.6 14.6 5.7 9.8 10.5 12.1 13.4 4.9 11.3 7.5 9.9 10.3 7.5 11.7 8.9 8.8 7.4 11.3 9.3 10.9 9.0 5.4 5.8 23.6 17.8 13.0 13.0 12.8 19.9 4.0 9.8 10.6 10.1 5.5 10.5 10.5 9.9 16.0 8.4 6.0 11.0 5.5 4.6 [95% CI] [14.1–31.6] ... [2.9–10] [9.1–21.8] [2.9–9.6] [4.8–14.4] [8.2–20.4] [2.5–8.7] [6.1–13.9] [5.9–15.4] [6.1–17.7] [7.3–19] [1.8–7.8] [5.9–16.7] [3.8–11.3] [5.5–14] [4.6–15.3] [3.8–11.3] [6–17.5] [4.4–13.4] [5.2–12.1] [4.2–10.5] [6.5–16.3] [4.8–13.6] [6.3–15.5] [4.4–13.5] [2.4–8.3] [2.8–8.8] [15.7–31.4] [6.7–28.2] [8.1–17.9] [8–18] [7.6–18] [13.3–26.5] [1.5–6.3] [4.7–14.8] [5–15.8] [6.9–13.7] [3–7.9] [6.6–13.9] [5.7–15] [5.4–14.7] [9.4–22.2] [4.2–12.2] [3.1–8.9] [5.4–16] [2.9–8.1] [1.7–7.5]

Country name

Region

254

Annex 4.8b: Raised blood glucose

Raised blood glucose (fasting glucose ≥7.0 mmol/l (126 mg/dl) or on medication for raised blood glucose or with a history of diagnosis of diabetes) Age-standardized adjusted estimates Males 23.7 ... 9.7 19.3 9.3 8.5 15.9 8.2 10.3 10.2 10.4 16.1 7.1 12.3 9.5 8.9 9.4 9.5 11.5 11.1 7.7 7.0 13.3 12.0 9.7 8.5 7.6 8.5 24.1 16.4 13.3 13.3 15.0 20.9 6.0 8.3 19.1 8.9 7.5 9.4 9.5 11.6 19.6 9.7 6.5 15.4 8.0 6.0 [95% CI] [12.5–37.8] ... [4.3–18.1] [10.4–30.1] [4.1–16.9] [3.6–16.1] [8.1–26.4] [3.6–15.5] [5.4–16.8] [4.6–18.2] [4.3–19.3] [8.2–26.7] [2.7–14] [5.7–21.8] [4.3–16.8] [4.1–15.6] [3.9–17.7] [4.3–16.8] [5.1–21.8] [4.6–20.4] [3.6–13.5] [3.3–12.4] [6.7–22.5] [5.6–21.6] [4.6–16.9] [3.5–15.9] [3.1–14.4] [3.9–15.6] [13.7–36.4] [5.1–33.5] [6.9–21.9] [7.4–21.2] [8.3–24.4] [12–32.2] [2.3–12] [3.2–16.2] [10.1–30.6] [5–14.3] [3.7–12.8] [5.2–15.5] [4.1–17.8] [5.4–20.5] [10.8–31] [4.5–16.9] [2.9–12.2] [7.4–26.4] [3.7–14.6] [2–12.8] Females 26.7 ... 8.5 16.9 8.9 7.1 13.8 7.8 6.7 7.6 8.2 17.6 6.6 13.5 10.6 6.1 10.0 10.6 12.5 14.2 5.1 4.0 14.5 12.3 9.7 7.0 7.1 8.1 27.9 17.1 13.4 13.5 15.2 20.1 6.4 7.7 17.6 6.7 7.7 7.5 8.5 12.4 18.5 8.4 6.5 15.7 8.5 7.8 [95% CI] [14.8–41.2] ... [3.8–16.2] [9–27] [4.2–15.8] [3–13.4] [7–23.4] [3.6–14.3] [3.5–11.1] [3.5–13.7] [3.4–15.7] [9.3–28.6] [2.7–12.5] [6.4–23.8] [5.2–18.1] [3–11] [4.4–18.5] [5.2–18.1] [5.8–22.7] [6.3–25.4] [2.4–9.3] [1.8–7.4] [7.6–23.3] [5.9–21.3] [4.8–16.6] [3–13.2] [3.1–13.2] [3.9–14.6] [17–41.4] [5.5–34.6] [7.2–21.6] [7.4–21.4] [8.3–24.5] [11.7–31.1] [2.6–12.3] [3.2–15.4] [9.2–28.4] [3.9–11] [3.9–13.1] [4.2–12.4] [3.8–15.6] [6.1–21.5] [10.2–29.7] [3.9–14.6] [2.9–11.5] [7.7–26.4] [4.2–14.9] [3–15.9] Both sexes 25.2 ... 9.1 18.3 9.1 7.8 14.9 8.0 8.5 8.9 9.3 16.8 6.8 12.9 10.0 7.5 9.7 10.0 12.0 12.7 6.4 5.5 13.9 12.1 9.7 7.7 7.4 8.3 26.0 16.8 13.3 13.4 15.1 20.5 6.2 8.0 18.6 7.8 7.6 8.4 9.0 12.0 19.0 9.0 6.5 15.5 8.3 6.9 [95% CI] [16.1–34.8] ... [4.5–13.8] [11.2–25.3] [4.6–13.2] [3.5–11.9] [8.9–21.3] [4.1–12.1] [5.2–11.9] [4.7–13.1] [4.6–14] [10.3–23] [3.1–10.5] [7.1–19.1] [5.8–14.5] [4.1–10.7] [5–14.5] [5.8–14.5] [6–17.8] [6.5–19.2] [3.6–9.6] [2.8–8.2] [8.3–19.2] [6.1–17.8] [5.6–14.3] [3.7–11.9] [3.7–11.2] [4.5–11.9] [17.7–34.9] [5.9–27.9] [8–18.4] [8.4–18.5] [9.6–20.9] [13.9–27.6] [2.9–9.9] [3.5–12.2] [11.2–26.4] [4.8–10.7] [4.4–11] [5.2–11.4] [4.7–13.4] [6.7–17.1] [12.6–25.9] [4.9–13.2] [3.4–9.9] [9.4–22.5] [4.7–12] [2.8–11]

Country name

Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand the former Yugoslav Republic of Macedonia Timor–Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United Republic of Tanzania United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe

255

Global status report on NCDs 2014

4.9a Raised blood pressure Comparable estimates of prevalence of raised blood pressure (population aged 18+ years), 2010 Raised blood pressure (SBP≥140 and/or DBP≥90) Crude adjusted estimates Males Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic EMR EUR AFR EUR AFR AMR AMR EUR WPR EUR EUR AMR EMR SEAR AMR EUR EUR AMR AFR SEAR AMR EUR AFR AMR WPR EUR AFR AFR AFR WPR AFR AMR AFR AFR AMR WPR AMR AFR AFR WPR AMR AFR EUR AMR EUR EUR 21.9 33.7 24.5 29.7 25.5 25.1 27.5 29.1 23.5 30.0 25.2 26.3 21.7 21.7 27.8 37.6 29.8 20.5 24.5 23.4 17.1 34.9 24.3 25.4 21.8 39.4 24.5 22.1 28.0 20.1 23.1 20.6 26.3 25.6 26.5 21.6 22.7 22.9 25.6 23.9 23.0 26.1 39.2 26.5 26.5 38.6 [95% CI] [15.1–29.8] [25.2–42.8] [18–31.7] [21.6–38.2] [16.6–36] [15.9–35.6] [19.3–36.6] [20.9–38.5] [18.4–28.8] [22.3–38.2] [17.3–34.5] [18.1–35.8] [15.3–28.9] [15.1–28.7] [18.2–38.6] [28.2–48] [22.2–37.4] [13.9–28.4] [18.3–31.1] [17.2–30.7] [10.4–25] [25.5–45] [17.2–32.5] [19.2–32.3] [14.1–31] [30.2–48.6] [17.6–32] [13.8–32.1] [20.9–35.9] [13.9–26.8] [16.9–29.7] [14.9–26.4] [17.7–36.3] [18.3–33.2] [19.4–34.9] [16.3–27.5] [16.5–29.7] [16.1–30.4] [17.4–35.5] [16.9–32.5] [17–29.7] [19.4–34] [30.3–48.5] [17.5–37.3] [18.9–35.1] [30.2–47.2] Females 21.0 28.2 23.4 23.0 23.8 20.5 21.7 28.1 18.3 23.7 23.2 19.5 17.5 20.3 25.3 33.5 22.2 16.2 23.7 20.5 13.9 33.5 24.0 20.8 14.1 34.4 25.0 21.6 26.4 20.7 20.8 17.0 25.7 24.4 20.6 18.7 19.1 21.7 22.4 19.8 18.4 21.5 34.0 24.3 20.4 29.7 [95% CI] [14.4–28.8] [20.4–36.7] [17.5–30] [16.6–30.2] [15.8–33.5] [13.1–29.8] [15.2–28.8] [20.8–36.2] [14.3–22.5] [17.4–30.7] [16.3–31.1] [13.4–27.2] [12.2–23.8] [14.3–27] [16.9–34.9] [24.4–43.6] [16–28.8] [10.8–23.1] [18.1–30.1] [15.1–27] [8.4–20.6] [24.7–43.3] [17.2–31.6] [15.6–26.8] [8.7–20.9] [25.9–43.6] [18.3–32.3] [13.8–31.1] [19.9–33.5] [14.9–27.1] [15.3–27] [12.5–22] [17.8–35.1] [18–32.3] [15–27.4] [14.1–24.1] [13.7–25.3] [15.4–28.8] [15.1–31.5] [13.5–27.4] [13.4–23.9] [15.6–28.1] [25.5–43.2] [16.4–33.9] [14.2–27.2] [22–37.6] Both sexes 21.5 31.0 24.0 26.3 24.6 22.8 24.6 28.6 20.8 26.8 24.2 22.9 20.1 21.0 26.5 35.4 25.9 18.3 24.1 22.0 15.5 34.2 24.2 23.1 18.0 36.8 24.8 21.9 27.2 20.4 22.0 18.8 26.0 25.0 23.6 20.2 20.9 22.3 24.0 21.9 20.7 23.9 36.5 25.4 23.5 34.0 [95% CI] [16.3–26.5] [24.7–37.4] [19.5–28.8] [21.1–31.6] [17.9–31.7] [16.4–29.2] [19.2–29.8] [23–34.6] [18–24.3] [21.7–31.6] [18.4–30.3] [17.4–28.5] [15.5–24.8] [16.2–25.8] [20.2–33.6] [29.1–42.2] [21.2–31.2] [13.4–23.1] [19.4–28.7] [17.5–26.4] [10.8–20.1] [28.1–40.7] [18.6–29.7] [18.8–27.5] [12.7–23.4] [30.3–43.2] [19.5–29.8] [15.4–28.1] [22.3–32.2] [15.9–24.6] [17.7–26.3] [15.2–22.6] [20–32.4] [19.8–30.1] [18.6–28.9] [16.6–24.3] [16.8–25.5] [17.2–27.6] [17.7–30.2] [16.6–27.6] [16.7–25] [19.2–29] [30.1–43.2] [18.9–31.7] [18.5–28.4] [28.2–40]

Country name

Region

256

Annex 4.9a: Raised blood pressure

… Indicates no data were available Raised blood pressure (SBP≥140 and/or DBP≥90) Age-standardized adjusted estimates Males 28.4 32.1 28.9 26.1 32.6 25.5 27.6 29.5 20.9 25.7 28.2 27.8 27.8 25.2 26.5 35.9 25.1 25.4 30.9 28.0 20.3 31.3 31.8 27.2 24.2 34.2 32.6 28.6 34.3 24.4 29.4 17.9 32.5 33.1 26.6 21.8 25.1 28.6 31.4 25.8 24.8 30.8 34.0 24.4 25.8 34.8 [95% CI] [20.1–37.5] [24–41.1] [21.6–36.8] [18.7–34] [22.1–44.3] [16.2–36] [19.2–36.7] [21.1–38.9] [16.3–25.9] [18.9–33.1] [19.8–37.8] [19.4–37.3] [20.4–35.8] [17.9–32.9] [17.4–36.9] [26.8–46.2] [18.4–32] [17.7–34.2] [23.8–38.3] [20.8–36.1] [12.6–29.3] [22.7–40.9] [23.2–41] [20.8–34.4] [16.2–33.5] [25.8–43] [24.2–41.1] [18.5–40.3] [26.2–42.8] [17.3–32.2] [22–36.8] [12.9–23.1] [22.4–43.6] [24.5–41.7] [19.5–34.8] [16.5–27.5] [18.5–32.6] [20.8–37.1] [21.9–42.2] [18.6–34.7] [18.6–31.8] [23.2–39.4] [25.9–42.8] [16–34.3] [18.3–34.3] [27–43.1] Females 29.0 25.7 28.9 16.6 32.1 20.0 19.0 25.4 14.1 16.6 25.5 19.6 24.7 26.2 21.4 26.3 15.1 21.7 31.0 27.2 16.7 26.9 31.4 21.6 17.4 24.8 33.1 30.9 30.6 24.3 28.2 12.4 32.4 33.4 19.0 18.3 20.8 28.6 29.1 21.5 19.8 29.1 24.5 20.4 17.6 22.4 [95% CI] [21–37.7] [18.4–33.9] [22.3–36.3] [11.4–22.8] [22.7–42.9] [12.6–29.3] [12.9–25.9] [18.5–33.3] [10.8–17.9] [11.8–22.4] [18.3–33.5] [13.5–27.1] [18.3–31.7] [19.2–33.7] [14–30.1] [18.3–35.7] [10.3–20.5] [15–29.7] [24.3–38] [20.7–34.8] [10.3–24.3] [19.1–35.8] [23.2–40.2] [16.2–27.7] [11.3–24.5] [17.8–33] [25.3–41.1] [21–41.8] [23.4–38.5] [17.8–31.5] [21.3–35.4] [9–16.5] [23.2–42.9] [25.7–42] [13.6–25.4] [13.8–23.6] [15.1–27.3] [21.2–36.7] [20.5–39.5] [14.8–29.3] [14.6–25.5] [21.9–36.5] [17.3–32.6] [13.5–29.2] [11.9–24] [15.8–29.4] Both sexes 28.7 28.9 28.9 21.3 32.3 22.7 23.2 27.5 17.5 21.1 26.8 23.6 26.6 25.7 23.9 30.7 20.0 23.5 30.9 27.7 18.5 29.1 31.6 24.4 20.8 29.4 32.9 29.8 32.5 24.4 28.8 15.1 32.4 33.2 22.7 20.1 22.9 28.6 30.3 23.7 22.4 30.0 29.1 22.4 21.8 28.5 [95% CI] [23.1–34.7] [23.4–34.7] [24–33.8] [16.5–25.9] [25.2–39.7] [16.5–29.1] [17.8–28.8] [21.4–32.9] [14.5–20.5] [16.3–25.2] [20.6–32.7] [18–29.2] [21.4–31.9] [20.6–30.5] [17.7–30.1] [24.5–36.9] [15.7–23.9] [18–29.1] [26.1–35.9] [22.3–32.7] [13.1–23.9] [23.6–35.1] [25.9–37.6] [20.2–28.6] [15.4–26.6] [23.8–34.8] [27–38.7] [22.4–37.4] [26.8–38.1] [19.1–29.5] [23.8–33.8] [12.1–18.3] [25.2–39.8] [27.1–39.5] [18.2–27.4] [16.5–23.9] [18.6–27.3] [22.8–34.2] [23.1–37.8] [18.3–29.1] [18–26.4] [24.6–35.2] [23.1–34.8] [16.6–28.8] [17–26.8] [23.2–33.8] Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic

Country name

257

Global status report on NCDs 2014 … Indicates no data were available Raised blood pressure (SBP≥140 and/or DBP≥90) Crude adjusted estimates Males Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea–Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho SEAR AFR EUR EMR AMR AMR AMR EMR AMR AFR AFR EUR AFR WPR EUR EUR AFR AFR EUR EUR AFR EUR AMR AMR AFR AFR AMR AMR AMR EUR EUR SEAR SEAR EMR EMR EUR EUR EUR AMR WPR EMR EUR AFR WPR EMR EUR WPR EUR EMR AFR 21.0 24.7 34.5 26.7 26.4 24.4 18.7 23.1 21.5 28.1 21.4 43.1 24.0 22.2 32.3 34.2 28.2 25.8 32.0 32.9 24.6 28.2 22.6 20.1 24.9 26.4 19.2 21.9 20.4 40.0 31.3 23.4 21.9 21.8 22.3 26.3 24.6 32.2 24.5 29.3 21.4 28.4 21.8 20.7 24.9 23.8 19.1 40.2 25.3 21.0 [95% CI] [11.7–32] [15.3–35.6] [26.9–42.8] [17.8–36.3] [18.5–35.4] [16.9–33.3] [11.9–26.5] [17.5–29.2] [15.5–28.5] [17.1–41.3] [14.8–28.4] [33.6–53.4] [16.9–31.7] [15.4–30.1] [26.1–38.6] [26.1–42.4] [19.3–38.5] [19–33.4] [23–41.6] [25.7–40.3] [18.3–31.8] [20.5–36.2] [15.3–30.9] [14–26.7] [18.4–32.4] [19.5–34.3] [12.2–27.7] [14.1–31.2] [14.4–27.3] [31.5–48.9] [22.8–40.1] [18.2–29.1] [16.5–28.2] [16.7–27.2] [15.8–29.6] [19.9–33.9] [17.6–31.9] [25.6–38.9] [17.3–32.7] [23.7–35.3] [15.4–28.1] [19.5–37.9] [15.5–29.2] [14–28.7] [17.6–33.1] [16.3–32.6] [13.3–25.3] [30.4–50.8] [18.1–33.9] [14.7–28.2] Females 21.7 23.3 23.2 22.3 21.6 19.8 14.8 24.3 19.1 24.0 20.7 37.2 24.0 19.7 26.0 25.7 23.9 21.1 31.7 25.9 21.8 24.3 19.8 17.5 24.9 25.1 17.0 20.9 17.2 33.3 19.8 22.3 20.4 20.0 21.9 19.5 18.6 28.0 20.3 23.8 17.4 25.4 19.3 17.9 16.7 22.5 18.9 36.0 20.3 25.6 [95% CI] [12.9–32.2] [14.8–33.9] [17.2–29.6] [14.8–31.4] [15.1–29.6] [13.7–27.4] [9.2–21.1] [18.8–30.2] [13.8–24.9] [14.3–35.9] [14.5–27.4] [27.6–47.6] [17.3–31.3] [13.5–26.7] [20.8–31.3] [19.2–32.7] [16.1–33.2] [15.2–27.8] [23.8–40.3] [19.4–32.3] [16.2–28.4] [17.6–31.2] [14–26.9] [12.2–23.3] [18.8–31.8] [18.4–33] [10.9–24.6] [13.7–29.7] [12.2–23.3] [24.9–41.7] [13.8–26.5] [17.5–27.5] [15.6–26.3] [15.5–24.9] [15.8–28.7] [14.5–25.5] [13–24.6] [22.2–34] [14.4–27.5] [19–28.8] [12.5–23] [18–33.6] [13.5–26] [12–25.1] [11.1–23.3] [15.9–29.8] [13.9–24.7] [26.6–46.2] [14.5–26.6] [18.7–33.3] Both sexes 21.4 24.0 28.8 24.5 24.0 22.1 16.7 23.7 20.3 26.1 21.0 39.9 24.0 20.9 29.1 29.8 26.0 23.4 31.8 29.3 23.1 26.2 21.2 18.8 24.9 25.8 18.1 21.4 18.8 36.5 25.6 22.9 21.2 20.9 22.1 22.9 21.6 30.0 22.4 26.5 19.4 26.8 20.6 19.3 21.6 23.1 19.0 37.9 22.8 23.3 [95% CI] [14.7–28.4] [17–30.2] [23.8–33.8] [17.7–30.9] [18.6–29.6] [16.9–26.9] [12.3–21.6] [19.9–27.9] [16.3–24.7] [18.2–33.9] [16.6–25.8] [33–46.6] [19.1–29.2] [16–26] [24.9–33.2] [24.3–35] [19.8–32.4] [18.9–28.2] [25.8–37.8] [24.4–34.3] [18.7–27.5] [21–31.6] [16.2–26.6] [14.6–22.9] [20.1–29.7] [20.9–30.9] [12.9–23.2] [15.5–27.1] [14.5–23.1] [30.3–42.5] [20.4–31.1] [19.1–26.7] [17.2–25.2] [17.2–24.4] [17.3–26.5] [18.3–27.7] [16.7–26.3] [25.5–34.4] [17.5–27.3] [23.1–30.2] [15.1–23.6] [21.1–32.9] [16.1–25.6] [14.4–24.5] [16–26.8] [17.5–28.4] [15.3–22.9] [30.5–44.6] [17.9–28.3] [18.2–28.2]

Country name

Region

258

Annex 4.9a: Raised blood pressure

Raised blood pressure (SBP≥140 and/or DBP≥90) Age-standardized adjusted estimates Males 22.0 31.0 29.1 32.6 26.8 26.7 20.7 26.2 24.3 32.2 29.2 39.6 29.7 24.7 27.0 29.3 32.8 32.7 29.7 27.1 30.2 23.6 26.0 24.0 30.4 32.4 23.8 26.3 24.8 36.3 28.8 26.3 24.6 25.8 28.3 24.7 23.6 26.4 25.4 22.8 26.8 31.1 28.7 22.4 31.1 28.7 24.2 36.8 25.7 27.9 [95% CI] [12.6–32.9] [20–43.2] [22.2–36.7] [22.5–43.1] [18.9–35.8] [18.7–35.9] [13.3–29.2] [20.1–32.8] [17.5–32] [20.5–45.6] [21–37.5] [30.6–49.7] [21.4–38.3] [17.4–33.1] [21.6–32.7] [21.9–37] [22.9–44.1] [24.7–41.1] [21.2–38.9] [21–33.7] [23.1–38.1] [16.8–30.8] [17.8–35.2] [17.1–31.6] [22.8–38.5] [24.3–41] [15.8–33.1] [17.3–36.7] [17.7–32.6] [28.3–44.9] [20.7–37.2] [20.7–32.3] [18.8–31.2] [20–31.8] [20.7–36.7] [18.5–32] [16.7–30.9] [20.7–32.4] [18–33.6] [18.1–28.1] [19.8–34.4] [21.8–40.9] [20.9–37.3] [15.4–30.7] [23–40.1] [20.2–38.2] [17.2–31.4] [27.4–47.1] [18.5–34.3] [19.8–36.6] Females 19.9 30.4 16.2 28.9 21.1 22.3 16.5 27.1 21.1 29.8 29.7 27.4 31.2 22.2 17.3 18.0 27.8 30.7 25.5 17.1 28.1 16.6 21.5 22.3 31.5 32.3 21.4 25.9 22.3 24.7 16.2 25.2 23.4 25.3 28.7 16.8 15.7 18.4 20.5 13.9 24.1 25.5 27.4 19.8 25.0 26.8 24.7 26.1 21.5 31.6 [95% CI] [11.6–29.7] [20.4–42.3] [11.4–21.4] [20–39] [14.6–29] [15.6–30.4] [10.4–23.4] [21.1–33.4] [15.2–27.4] [19.1–42] [21.9–37.5] [19.1–37] [23.3–39.4] [15.6–29.5] [13.5–21.5] [12.7–23.9] [19–38.2] [23.4–38.5] [18.4–33.4] [12.3–22.1] [21.5–35.5] [11.5–22.3] [15–29.4] [15.9–29.2] [24.6–39.1] [24.6–40.7] [14.3–29.9] [17.5–35.8] [16.3–29.5] [17.5–32.3] [10.9–22.2] [20–30.8] [18.1–29.5] [20.1–31] [21.4–36.4] [12.3–22.4] [10.5–21.4] [13.9–23.5] [14.4–27.8] [10.5–17.8] [18–30.7] [18.1–33.8] [20.2–35.4] [13.6–27.3] [18–32.7] [19.5–34.6] [18.5–31.6] [18.1–35.3] [15.3–28.4] [23.4–40.3] Both sexes 20.9 30.7 22.6 30.7 23.9 24.5 18.6 26.6 22.6 31.0 29.4 33.0 30.4 23.5 22.1 23.5 30.3 31.7 27.5 22.0 29.1 20.1 23.7 23.1 31.0 32.3 22.6 26.1 23.6 30.2 22.5 25.8 24.0 25.6 28.5 20.7 19.6 22.3 22.9 18.2 25.5 28.2 28.0 21.1 28.6 27.7 24.4 31.0 23.6 29.8 [95% CI] [13.9–28] [23–38.7] [18.3–27] [24–37.7] [19–29.5] [18.7–29.9] [13.4–23.7] [22.2–31.3] [17.8–27] [22.3–39.9] [23.6–35] [26.6–39.9] [24.9–36] [18.5–28.8] [18.5–25.6] [19.1–28.1] [23–37.8] [26–37.2] [21.8–33] [18.1–26.2] [24.1–33.9] [15.6–24.5] [18.1–29.8] [18.7–27.9] [25.7–36.4] [26.7–37.9] [17.4–28.4] [19.1–33.2] [18.8–28.3] [24.6–36.2] [17.8–27.6] [21.6–29.8] [19.7–28.2] [21.6–29.6] [22.7–33.8] [16.4–24.9] [15.3–24.2] [18.5–25.8] [18–28.1] [15.1–21.4] [20.4–30.3] [22.1–34.4] [22.3–33.3] [16.2–26.2] [22.7–34.3] [21.6–33.4] [19.6–29.1] [24.7–37.3] [18.8–28.9] [24.1–35.4]

Country name

Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea–Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho

259

Global status report on NCDs 2014 … Indicates no data were available Raised blood pressure (SBP≥140 and/or DBP≥90) Crude adjusted estimates Males Liberia Libya Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (Federated States of) Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Korea Republic of Moldova Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines AFR EMR EUR EUR AFR AFR WPR SEAR AFR EUR WPR AFR AFR AMR WPR EUR WPR EUR EMR AFR SEAR AFR WPR SEAR EUR WPR AMR AFR AFR WPR EUR EMR EMR WPR AMR WPR AMR AMR WPR EUR EUR EMR WPR EUR EUR EUR AFR AMR AMR AMR 25.0 23.6 38.0 33.8 23.8 22.4 23.2 19.5 25.3 31.0 22.5 28.9 28.8 22.2 19.3 ... 28.7 37.0 24.7 24.0 20.5 24.7 24.1 23.5 29.5 23.9 20.4 28.1 23.1 22.5 29.6 20.3 24.4 24.6 23.0 17.6 23.6 16.0 19.9 37.4 33.5 21.9 16.3 34.5 35.3 35.7 21.4 26.7 26.9 24.5 [95% CI] [17.6–33.2] [17.5–30.4] [28.9–48] [25.6–42.4] [17.1–31.5] [16–29.7] [17.4–30] [12.3–28.7] [18–33] [22.3–40.1] [15.5–31.1] [20.8–38.1] [20.8–37.5] [16.8–28.1] [14–25.7] ... [20.6–37.9] [28–46.2] [17.8–32.6] [17.4–31.9] [13.9–27.7] [17.6–33] [15.2–35.2] [16.7–31.4] [22.7–36.7] [18.3–30.4] [14.1–27.7] [20.2–36.8] [17–29.8] [16.2–30] [22.4–37.4] [14.6–26.5] [17.8–31.9] [17.3–33.8] [16.3–30.4] [10.6–25.5] [16.2–31.9] [10.9–21.6] [13.9–26.4] [29.9–45.6] [25.5–41.8] [15.2–29.6] [11.7–21.7] [25.3–44.4] [26.7–44.6] [27.2–44.8] [13.8–30.7] [18–36.2] [17.9–36.9] [17–33.3] Females 23.7 20.1 33.6 22.6 22.0 22.2 17.2 14.7 25.4 23.1 18.7 26.2 25.7 18.0 18.0 ... 22.9 30.1 25.1 23.9 20.8 24.3 19.1 22.4 22.0 18.7 18.0 27.0 21.2 20.2 21.7 17.3 21.1 20.1 18.4 17.2 18.1 12.4 17.0 31.0 27.8 15.7 12.7 33.0 30.5 32.8 20.6 22.7 22.2 20.4 [95% CI] [17–31.4] [15.1–26.2] [24.8–43.4] [16.3–29.6] [15.7–29.1] [16.1–29.4] [12.7–22.7] [9.1–22] [18.7–33.1] [15.9–30.9] [12.6–25.9] [18.5–34.7] [18.2–33.9] [13.5–23] [13.1–23.8] ... [16.2–30.6] [21.9–39] [18.4–32.7] [17.4–31.6] [14.5–28.1] [17.5–31.9] [11.8–28.8] [16.2–29.7] [16.5–28] [14.3–23.9] [12.6–24.2] [19.7–35] [15.6–27.6] [14.5–26.9] [16–28] [12.4–23.3] [15.3–27.8] [13.8–28.1] [12.9–24.8] [10.5–24.8] [12.3–25] [8.4–17] [12.1–22.7] [23.6–38.9] [20.7–35.4] [10.5–22.1] [9.1–16.6] [24.3–42.7] [22.6–39] [24.5–41.9] [13.2–29.3] [15.4–31.2] [14.9–30.9] [14.2–28] Both sexes 24.3 21.9 35.6 28.2 22.9 22.3 20.1 17.2 25.3 27.1 20.6 27.6 27.2 20.0 18.7 ... 25.8 33.5 24.9 24.0 20.7 24.5 21.6 22.9 25.8 21.2 19.2 27.5 22.2 21.4 25.6 19.0 22.8 22.4 20.8 17.4 20.8 14.2 18.4 34.1 30.6 20.4 14.5 33.7 32.8 34.1 21.0 24.7 24.5 22.5 [95% CI] [18.8–29.8] [17.7–26] [29.4–41.9] [22.8–33.3] [18.2–27.9] [17.5–27.2] [16.3–24.3] [12.2–22.4] [20.4–30.5] [21.7–32.8] [15.4–26.1] [21.8–33.4] [21.5–32.8] [16.2–23.7] [14.5–22.9] ... [20.6–31.5] [26.9–39.6] [20.1–29.9] [18.6–29.2] [15.9–25.4] [19.5–29.6] [15.2–28.1] [18–27.8] [21.3–30.2] [17.5–25.2] [14.5–23.4] [22–33.3] [17.9–26.4] [16.7–25.8] [21.1–30.5] [14.8–23.4] [18.2–27.4] [16.9–28.1] [16–25.4] [12.1–22.6] [16.3–26.4] [10.9–17.7] [14.4–22.4] [28.5–39.9] [24.8–35.8] [14.9–25.9] [11.7–17.7] [27–40.3] [26.4–38.6] [28–40] [15.1–26.6] [19.1–30.3] [18.4–31.1] [16.9–27.6]

Country name

Region

260

Annex 4.9a: Raised blood pressure

Raised blood pressure (SBP≥140 and/or DBP≥90) Age-standardized adjusted estimates Males 31.0 28.0 36.2 30.3 29.8 28.7 25.9 23.6 32.7 26.9 24.3 35.5 28.7 24.7 23.6 ... 34.8 34.0 28.1 30.2 23.5 31.1 25.9 25.8 25.0 21.1 24.7 32.8 28.9 24.4 25.7 28.4 28.9 26.4 24.7 22.4 26.9 18.0 24.0 34.9 28.8 29.4 15.7 33.6 32.8 34.6 28.2 27.1 27.5 26.3 [95% CI] [22.5–40.1] [21.3–35.7] [27.5–46] [22.8–38.3] [22–38.2] [21–37.3] [19.6–33.1] [15.2–33.9] [24.1–41.4] [19.1–35.3] [17.1–33] [26.4–45.2] [20.9–37.1] [18.9–31] [17.2–30.9] ... [25.8–44.5] [25.5–43] [20.7–36.5] [22.2–39.1] [16.3–31.2] [22.9–40.3] [16.6–37.2] [18.6–34.2] [19–31.5] [16.1–27.1] [17.4–32.9] [24.2–41.8] [22–36.5] [17.8–32] [19.3–33] [21.2–36.1] [21.4–37.1] [18.9–35.7] [17.5–32.4] [14–31.7] [18.6–35.9] [12.5–24.1] [17.3–31.3] [27.7–43] [21.6–36.5] [21.6–38] [11.4–20.8] [24.6–43.4] [24.6–41.9] [26.3–43.4] [18.7–39.2] [18.4–36.7] [18.3–37.5] [18.5–35.3] Females 30.6 25.7 26.0 17.5 29.1 29.3 21.0 20.4 33.5 17.2 20.6 33.2 24.0 19.9 21.9 ... 28.8 24.6 28.8 30.4 23.9 30.9 21.1 26.9 15.7 14.7 22.9 34.8 28.2 21.8 15.7 26.6 27.0 22.1 19.7 22.8 21.5 14.1 20.9 24.5 20.0 25.0 10.4 28.5 24.3 26.2 29.3 22.2 22.1 21.7 [95% CI] [22.8–39.1] [19.9–32.5] [18.3–35] [12.3–23.6] [21.8–37.3] [21.9–37.5] [15.9–27] [13.2–29.2] [25.5–41.8] [11.4–23.6] [14.2–28.1] [24.4–42.2] [17–31.9] [15.1–25.3] [16.1–28.5] ... [21.1–37.2] [17.4–32.7] [21.7–36.8] [22.9–39] [17–31.4] [23.1–39.1] [13.3–31] [19.8–34.9] [11.4–20.5] [11–19.1] [16.5–30.1] [26.5–43.4] [21.6–35.4] [15.9–28.7] [11.2–21.1] [19.9–33.9] [20.1–34.5] [15.6–30.3] [13.8–26.3] [14.7–31.4] [14.9–29.1] [9.7–19.1] [15.4–27.2] [18.1–31.8] [14.1–26.4] [18.3–32.6] [7.4–13.9] [20.4–37.7] [17.3–32.2] [18.9–34.7] [20–39.4] [14.9–30.6] [14.7–30.9] [15.2–29.5] Both sexes 30.8 26.9 30.7 23.9 29.5 29.0 23.4 22.0 33.1 22.0 22.5 34.3 26.3 22.2 22.8 ... 31.8 29.2 28.5 30.3 23.7 31.0 23.5 26.4 20.3 17.8 23.8 33.8 28.6 23.1 20.7 27.6 28.0 24.3 22.2 22.6 24.2 16.1 22.4 29.6 24.3 28.3 13.1 30.9 28.5 30.1 28.8 24.6 24.8 24.0 [95% CI] [24.4–36.8] [22.1–31.6] [24.9–37.2] [19–28.5] [23.5–35.5] [23.3–34.7] [19.2–28] [16–28.3] [26.9–39] [17–27.3] [17.3–27.5] [27.9–40.4] [20.8–31.7] [18.5–26] [18.2–27.6] ... [25.7–37.9] [23.2–34.9] [23.1–33.9] [24.7–36.2] [18.8–28.9] [25.2–36.8] [16.8–29.9] [21–31.7] [16.6–24.3] [14.5–21.4] [18.6–28.6] [27.5–40.4] [23.4–33.3] [18.4–27.8] [16.5–25] [22.1–32.8] [22.9–33.1] [18.8–29.9] [17.5–27.1] [16.5–28.4] [18.6–29.1] [12.5–19.5] [18–26.7] [24–34.4] [19.4–28.8] [21.6–34.8] [10.3–15.8] [25–37.3] [22.7–34.5] [24.4–35.7] [21.9–36.2] [18.6–30.3] [18.3–30.8] [18.4–29.4]

Country name

261

Global status report on NCDs 2014 … Indicates no data were available Raised blood pressure (SBP≥140 and/or DBP≥90) Crude adjusted estimates Males Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand the former Yugoslav Republic of Macedonia Timor–Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United Republic of Tanzania United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe WPR EUR AFR EMR AFR EUR AFR AFR WPR EUR EUR WPR EMR AFR AFR EUR SEAR EMR AMR AFR EUR EUR EMR EUR SEAR EUR SEAR AFR WPR AMR EMR EUR EUR WPR AFR EUR EMR EUR AFR AMR AMR EUR WPR AMR WPR EMR AFR AFR 20.9 ... 24.1 24.4 25.0 38.0 27.1 25.1 20.8 35.9 39.0 17.9 28.0 25.8 26.0 29.3 21.9 26.0 24.1 21.9 32.6 28.3 21.8 21.4 23.9 34.0 21.1 24.4 20.1 25.2 24.7 22.5 23.6 22.6 21.1 36.1 16.4 24.3 22.7 19.7 29.5 22.3 20.6 22.9 20.5 23.0 22.8 21.5 [95% CI] [14.2–28.7] ... [17.7–31.6] [18–31.6] [18.1–32.7] [30.2–46.3] [18.7–36.7] [18.7–32.6] [15.4–27] [27.6–44.2] [29–49.1] [12.1–24.5] [19–37.7] [20.1–32.2] [18.7–34.2] [23–35.9] [14.7–30.1] [18.7–34.2] [16.4–33.1] [15.1–30.3] [26.2–40.3] [21.6–35.5] [15.9–28.7] [13.9–30.6] [17.2–31.1] [25.3–43.4] [14.5–28.3] [17.8–31.7] [13.9–27.8] [14.8–37.2] [18.6–31.4] [17.7–27.9] [16.4–32] [15.8–30.7] [13.3–30.9] [26.8–46.1] [11.4–22.3] [20–28.8] [17.1–29.3] [14.6–25] [20.9–38.9] [14.8–31] [14.4–28.2] [16.9–29.9] [14.7–26.9] [15.8–30.9] [16.5–30.1] [14.3–30] Females 18.0 ... 21.2 19.2 23.5 32.7 21.6 23.9 14.6 29.1 32.9 17.5 24.7 26.1 22.4 23.6 21.5 22.4 20.9 22.5 24.5 21.4 19.6 19.9 22.0 28.7 21.4 23.3 18.5 22.5 24.1 23.8 21.6 20.0 19.1 34.3 9.7 20.9 21.7 16.5 25.3 20.9 18.2 17.3 20.1 23.4 19.3 22.6 [95% CI] [12.4–24.5] ... [15.4–28] [13.9–25.5] [17.3–30.9] [24.7–41.2] [14.7–29.8] [17.7–31] [10.7–19.4] [21.6–36.7] [23.7–42.8] [12.2–24] [16.6–33.9] [20.4–32.1] [16–29.8] [18.1–29.3] [14.9–29.1] [16–29.8] [14.4–28.7] [15.6–30.4] [18.8–30.5] [15.9–27.1] [14.1–25.6] [13.1–27.7] [16–28.6] [20.8–37.5] [14.9–28.6] [17.3–29.8] [13.1–24.9] [13.5–33.5] [18.3–30.9] [18.8–29.2] [15.3–28.7] [14.1–27.3] [12.3–27.8] [25.4–44.2] [6–14.3] [17.3–24.7] [16.4–27.6] [12.6–20.9] [18.2–33.2] [14.3–28.5] [12.8–24.8] [12.6–22.9] [14.5–25.9] [16.6–31.1] [14–25.9] [15.5–31.4] Both sexes 19.5 ... 22.6 22.1 24.2 35.3 24.4 24.5 17.7 32.4 35.9 17.7 26.3 26.0 24.2 26.4 21.7 24.2 22.5 22.2 28.6 24.8 20.8 20.7 22.9 31.4 21.2 23.8 19.3 23.9 24.4 23.1 22.6 21.3 20.1 35.2 14.4 22.6 22.2 18.1 27.3 21.6 19.4 20.1 20.3 23.2 21.0 22.1 [95% CI] [15–24.3] ... [17.8–27.5] [17.5–26.6] [19.8–29] [29.1–40.8] [18.6–30.3] [20.1–29.2] [13.9–21.3] [27.2–37.9] [29.1–42.9] [13.7–21.8] [19.8–31.9] [21.6–30.1] [18.7–29.4] [22.1–30.7] [16.8–26.9] [18.7–29.4] [17–28] [16.9–27.4] [24.3–33.3] [20.3–28.6] [16.6–25.2] [15–26] [18.7–28.3] [25–37.5] [16.7–26.2] [19.4–28.3] [14.8–23.6] [16.4–31] [19.9–28.8] [19.6–26.6] [17.1–27.9] [16.3–26] [14.5–25.8] [28.5–42.1] [10.3–18.2] [19.7–25.1] [18.2–26.3] [14.8–21.1] [21.6–32.9] [16.5–27.2] [15–23.8] [16.2–24.3] [16.2–24.2] [17.7–28.2] [16.5–25.4] [16.2–27.8]

Country name

Region

262

Annex 4.9a: Raised blood pressure

Raised blood pressure (SBP≥140 and/or DBP≥90) Age-standardized adjusted estimates Males 23.6 ... 31.3 29.4 32.1 34.6 29.2 31.7 19.6 34.3 34.6 22.1 34.4 30.4 32.1 25.7 22.2 32.1 26.2 29.1 27.3 24.1 26.8 27.0 23.4 32.0 26.1 31.3 22.9 25.7 26.5 24.4 28.5 24.4 28.0 34.2 27.5 20.6 28.8 17.5 27.6 27.0 24.5 25.3 23.6 30.1 30.0 28.7 [95% CI] [16.4–31.9] ... [23.6–39.9] [22.4–37.2] [24–40.8] [27.2–42.6] [20.6–38.8] [24.3–39.9] [14.6–25.3] [26.3–42.5] [25.4–44.2] [15.3–29.7] [24–45.2] [23.9–37.2] [23.6–41] [20–31.8] [15–30.3] [23.6–41] [18.2–35.3] [20.6–39] [21.6–34.3] [18.1–30.6] [19.8–34.6] [18.2–37.2] [17–30.4] [23.7–41.1] [18.4–34.5] [23.6–39.6] [16.1–31.3] [15.3–37.7] [20.2–33.4] [19.4–30.1] [20.4–37.9] [17.3–32.7] [18.3–39.6] [25.2–43.9] [20–35.4] [16.8–24.7] [22.1–36.3] [12.9–22.2] [19.3–36.7] [18.4–36.5] [17.4–33] [18.9–32.6] [17.2–30.4] [21.4–39.4] [22.5–38.6] [19.4–39] Females 20.0 ... 28.7 26.6 31.3 26.2 21.9 32.2 13.0 23.9 24.5 24.3 31.8 28.6 29.4 17.0 20.9 29.4 21.9 30.1 16.7 15.0 26.0 26.8 20.4 24.7 26.9 31.3 20.5 21.8 25.9 24.7 26.1 21.7 27.8 26.5 23.3 14.5 28.8 12.3 19.7 25.5 23.7 19.4 21.4 32.3 28.1 30.9 [95% CI] [13.9–27.1] ... [21.7–36.7] [20.3–33.9] [23.9–39.5] [19.1–34] [15–30.1] [24.9–40] [9.5–17.3] [17.2–31] [16.7–33.3] [17.7–32] [22.4–41.6] [22.5–34.9] [21.8–37.8] [12.4–21.8] [14.4–28.3] [21.8–37.8] [15.3–29.8] [21.5–39.3] [12.3–21.7] [10.8–19.6] [19.3–32.9] [18.5–35.6] [14.9–26.5] [17.4–32.9] [19.3–35] [24.2–38.6] [14.5–27.5] [13–32.5] [19.8–33] [19.6–30.2] [19–33.9] [15.4–29.2] [19.1–38.2] [18.7–35.6] [16.9–30.7] [11.6–17.6] [22.4–35.7] [9.1–15.9] [13.5–27.1] [18–33.8] [17.2–31.3] [14.2–25.3] [15.5–27.5] [23.9–40.9] [21.4–36] [21.6–41.6] Both sexes 21.9 ... 30.0 28.2 31.7 30.4 25.6 31.9 16.3 29.0 29.5 23.2 33.1 29.4 30.7 21.3 21.5 30.7 24.1 29.6 22.0 19.5 26.4 26.9 21.9 28.4 26.5 31.3 21.7 23.7 26.2 24.6 27.3 23.1 27.9 30.0 26.3 17.5 28.8 14.8 23.5 26.2 24.1 22.4 22.5 31.2 29.1 29.8 [95% CI] [16.8–26.9] ... [24.4–35.8] [23.3–33.4] [26.1–37.5] [24.7–36] [19.6–31.6] [26.6–37.5] [13–19.4] [23.5–34.2] [23.7–35.6] [17.9–28.4] [25.7–40.6] [25.1–34] [24.9–36.8] [17.4–25] [16.6–26.7] [24.9–36.8] [18.3–29.7] [23.2–35.8] [18–25.9] [15.9–23.3] [21.5–31] [20.5–33] [17.6–26.3] [22.4–34.5] [20.6–32.5] [26–36.6] [16.3–26.9] [16.6–31.5] [21.5–30.7] [21.1–28.2] [21.5–32.8] [17.7–28.2] [20.7–35.1] [23.7–36.5] [20.7–31.8] [15.1–20] [23.8–33.7] [12–17.7] [17.9–29] [20.5–32.5] [18.8–29.2] [17.9–26.7] [18.1–26.6] [24.9–36.9] [23.8–34.4] [22.9–36.8]

Country name

Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand the former Yugoslav Republic of Macedonia Timor–Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United Republic of Tanzania United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe

263

Global status report on NCDs 2014

4.9b Raised blood pressure Comparable estimates of prevalence of raised blood pressure (population aged 18+ years), 2014 Raised blood pressure (SBP≥140 and/or DBP≥90) Crude adjusted estimates Males Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic EMR EUR AFR EUR AFR AMR AMR EUR WPR EUR EUR AMR EMR SEAR AMR EUR EUR AMR AFR SEAR AMR EUR AFR AMR WPR EUR AFR AFR AFR WPR AFR AMR AFR AFR AMR WPR AMR AFR AFR WPR AMR AFR EUR AMR EUR EUR 28.5 31.4 28.1 23.2 31.8 24.5 26.3 29.0 18.4 23.1 27.7 26.1 26.1 25.1 25.2 34.4 22.5 24.4 30.3 27.7 19.7 30.9 30.3 26.4 22.6 33.4 32.8 29.5 33.7 24.4 28.8 15.7 32.9 33.1 25.4 20.4 24.2 28.8 31.0 25.3 23.8 30.7 33.0 23.3 23.5 33.2 [95% CI] [18.6–39.8] [21.2–42.9] [19.1–38.9] [14.6–32.8] [19.7–45.7] [13.6–38.3] [16.3–37.6] [18.7–40.5] [12.5–25.1] [14.8–32.6] [17.8–39.2] [16.1–38] [17.3–36.4] [16.1–34.9] [14.3–38.5] [23.4–47.2] [14.3–31.6] [14.7–36.1] [21.1–40.2] [18.9–37.8] [11.1–30.3] [20.3–42.7] [19.8–41.8] [17.8–36.3] [13.3–33.7] [22.5–45] [22.3–43.6] [17.6–43] [23.5–44.9] [15.6–34.4] [19.1–39] [9.8–22.4] [20.9–45.8] [22.4–44.3] [16.6–36.1] [13.6–29] [15.6–34.3] [19.2–39.6] [19.4–44.3] [16.3–37] [15.7–33] [20.9–41.7] [22.6–44.7] [13.6–35.6] [14.8–34] [23.1–44.3] Females 29.5 24.5 27.6 14.4 31.1 19.4 17.6 24.2 12.4 14.8 24.5 18.0 22.6 26.1 20.4 24.3 13.3 21.2 30.7 26.9 15.9 25.9 29.7 20.4 16.0 23.7 33.5 32.2 29.8 24.4 27.9 11.0 33.0 34.2 17.6 17.0 19.7 29.2 28.4 21.0 18.6 28.9 23.0 19.3 15.8 21.0 [95% CI] [19.6–40.5] [15.4–35.2] [19–37.5] [8.3–21.7] [19.9–44] [10.3–31.4] [10.5–26.6] [15.7–34] [8.2–17.2] [9–22] [15.7–34.7] [10.7–27.2] [14.7–31.9] [17.5–35.6] [11.5–31.7] [14.9–35.9] [7.6–19.9] [12.8–31.6] [22.1–40.1] [18.7–36.5] [8.5–25] [16.2–37.6] [19.6–40.7] [13.6–28.8] [9.1–24.7] [14.7–34.6] [24–43.6] [20.4–44.9] [20.4–40.1] [15.9–34.2] [19.1–38.2] [6.8–16.3] [21.7–45.7] [24.2–45.3] [11.1–26.1] [11.1–24.6] [12.6–28.7] [19.8–39.5] [18.1–40.6] [12.7–31.1] [12–26.4] [20.1–38.8] [14–33.4] [11.1–30] [9.2–23.6] [12.9–30.8] Both sexes 29.0 28.0 27.8 18.8 31.5 21.9 21.9 26.6 15.4 18.8 26.1 22.0 24.8 25.6 22.8 29.0 17.8 22.8 30.5 27.3 17.8 28.4 30.0 23.3 19.3 28.4 33.1 30.9 31.7 24.4 28.3 13.3 32.9 33.7 21.4 18.8 21.9 29.0 29.7 23.2 21.2 29.8 27.8 21.3 19.7 27.0 [95% CI] [21.4–36.8] [20.9–35.6] [21–34.3] [13–24.8] [22.4–40.2] [13.8–30.3] [15.3–28.2] [19.9–34.2] [11.7–19] [13.5–24.8] [19.1–33.2] [15.3–28.2] [18–31.5] [18.8–31.9] [15.2–31.2] [21.4–36.1] [12.8–23] [15.6–29.9] [23.8–37.4] [21.1–33.6] [11.4–24] [20.2–35.7] [22.8–37.3] [18–29.2] [12.4–26.3] [21.6–35.7] [26.1–39.5] [22.2–40.6] [24.3–38.7] [17.8–30.9] [21.3–35.4] [9.5–17.2] [23.8–41.8] [26.4–41] [15.5–27.3] [13.6–23.5] [15.8–28.1] [22.3–36.5] [21.3–38.1] [15.7–29.8] [15.2–26.8] [23.2–36.7] [20.3–35.8] [14.1–28.4] [13.9–25.9] [20.3–33.9]

Country name

Region

264

Annex 4.9b: Raised blood pressure

… Indicates no data were available Raised blood pressure (SBP≥140 and/or DBP≥90) Age-standardized adjusted estimates Males 22.0 33.2 24.6 27.5 24.9 24.7 26.6 29.1 21.2 27.7 25.4 25.5 20.6 22.0 27.1 36.5 27.4 20.1 24.1 23.8 16.7 34.8 23.4 25.4 21.4 39.1 24.8 23.0 28.1 20.5 22.6 18.8 26.6 25.5 26.2 21.1 22.5 23.4 25.6 24.0 22.7 25.9 38.9 26.4 24.8 37.7 [95% CI] [13.7–31.8] [22.6–44.9] [16.4–34.7] [17.6–38.3] [14.8–37.3] [13.7–38.5] [16.6–37.8] [19–40.5] [14.7–28.6] [18–38.3] [16–36.7] [15.6–37.5] [13–29.9] [13.8–31.1] [15.4–41.1] [24.9–49.7] [17.9–37.6] [11.8–30.4] [16.3–33.2] [16–33] [9.1–26.1] [23.3–47.3] [14.8–33.3] [17–35.2] [12.2–32.8] [27–51.4] [16.2–34.5] [13.2–34.7] [19.1–38.6] [12.9–29.3] [14.6–31.6] [11.9–26.4] [16.4–38.4] [16.5–35.5] [17.2–37.1] [13.9–30.1] [14.3–32.3] [15–33] [15.4–37.5] [15.2–35.4] [14.9–31.7] [17.1–36] [27.3–51.4] [15.5–39.9] [15.7–35.4] [26.7–49.3] Females 21.4 27.7 23.3 21.3 23.0 20.6 20.6 27.9 16.8 22.0 23.4 18.9 16.8 21.0 25.0 31.9 20.4 16.4 23.6 20.8 13.4 33.2 22.7 20.7 14.3 33.8 25.3 22.8 26.2 21.6 20.5 15.9 26.1 24.8 20.1 18.4 19.0 22.7 22.2 20.3 18.1 21.5 33.0 24.4 19.0 28.8 [95% CI] [13.3–31] [17.9–38.9] [15.5–32.6] [13.3–30.5] [13.7–34.3] [11.2–32.9] [13–29.9] [18.7–38.1] [11.6–22.6] [14.1–30.8] [14.6–33.5] [11.2–28.4] [9.9–25.2] [13.4–29.6] [14.6–37.6] [20.8–44.7] [12.7–28.7] [9.4–25.7] [16.2–31.9] [14–29.3] [7–21.5] [22.1–46.1] [14.6–32.1] [13.8–29.2] [7.5–23.1] [23–46.1] [17.2–34.7] [13.4–34.1] [17.8–35.7] [13.9–30.5] [13.4–29.4] [10.2–22.5] [16.5–37.8] [16.6–35.1] [12.9–29.1] [12–26.7] [12–28] [14.7–32.1] [13.4–33.2] [12.2–30.3] [11.6–25.8] [14–30] [21.9–44.9] [14.7–36.6] [11.6–27.4] [19.1–39.8] Both sexes 21.7 30.5 24.0 24.4 23.9 22.6 23.5 28.5 19.0 24.8 24.4 22.1 19.2 21.5 26.0 34.1 23.8 18.2 23.8 22.4 15.1 34.0 23.0 23.0 17.9 36.4 25.1 22.9 27.1 21.1 21.6 17.3 26.4 25.1 23.1 19.8 20.7 23.0 23.9 22.2 20.5 23.7 35.8 25.4 21.9 33.2 [95% CI] [15.3–28] [23.1–38.1] [17.5–30.2] [17.8–31.1] [16.3–31.1] [14.2–31] [16.5–29.8] [21.3–35.4] [14.6–23.4] [18.2–31] [17.5–31.5] [14.3–29.4] [13.2–24.6] [15.7–27.3] [17.5–34.1] [25.6–43.4] [17.3–29.9] [11.8–24.5] [18.4–29.4] [16.4–27.9] [9.4–20.4] [25.9–42.7] [16.5–29.7] [16.4–28.9] [11–24.3] [28.1–44.6] [18.5–31.3] [15.7–30.4] [20.8–33.5] [14.9–27.2] [16.1–27.4] [12.7–21.9] [18.7–34.3] [18–31.6] [17–29.8] [14.5–24.9] [14.7–26.7] [16.6–29] [16.5–30.9] [15.2–29] [15.3–25.8] [17.7–29.9] [27.7–44.2] [16.7–34.1] [15.6–28.3] [26.1–40.7] Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic

Country name

265

Global status report on NCDs 2014 … Indicates no data were available Raised blood pressure (SBP≥140 and/or DBP≥90) Crude adjusted estimates Males Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea–Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho SEAR AFR EUR EMR AMR AMR AMR EMR AMR AFR AFR EUR AFR WPR EUR EUR AFR AFR EUR EUR AFR EUR AMR AMR AFR AFR AMR AMR AMR EUR EUR SEAR SEAR EMR EMR EUR EUR EUR AMR WPR EMR EUR AFR WPR EMR EUR WPR EUR EMR AFR 22.1 32.1 26.0 31.8 25.8 25.7 19.9 25.6 23.3 30.9 29.6 38.3 30.2 25.2 24.5 26.3 31.7 32.6 30.0 24.2 29.9 21.9 25.1 23.3 30.8 32.6 23.4 26.4 24.3 34.6 26.1 25.9 24.0 24.1 28.0 21.3 21.5 23.4 24.5 21.4 26.3 30.4 28.7 23.0 29.1 28.8 23.7 36.1 25.8 27.7 [95% CI] [11.1–35.7] [18.5–46.9] [17.7–35.6] [19.8–44.7] [16.4–37] [15.9–37.5] [11.6–29.9] [17.5–34.8] [14.7–33.6] [17.6–46.5] [19.2–40.7] [26.9–50.6] [19.9–41.6] [16.2–36.2] [17.6–32.2] [17.2–36.1] [19.9–45.1] [22.2–43.8] [20.2–41.2] [16.1–33.3] [21–40] [13.6–31.2] [15.4–37] [14.7–33.2] [21.2–41.3] [22.3–44.3] [13.9–35.3] [15.2–39.6] [15.5–34.5] [24.3–45.7] [16.8–36.5] [18.1–34.4] [16.2–32.6] [16.4–32.7] [18.6–38.5] [13.9–30.2] [13.1–30.9] [15.8–31.7] [15.3–35.4] [14.9–28.9] [17.1–36.2] [19.4–42.8] [19.2–39.7] [14.2–33.7] [19–40.6] [19.1–40.1] [15.3–33] [24.3–48.8] [16.9–36.1] [18.1–38.7] Females 20.0 31.5 14.2 28.0 20.2 21.1 15.5 26.3 20.0 28.6 30.6 26.0 32.2 22.8 15.4 16.0 26.3 30.6 25.4 14.9 27.6 15.0 20.8 21.7 32.2 32.7 21.5 26.0 21.8 23.1 14.0 24.8 22.6 23.3 27.8 14.9 13.8 16.0 19.8 12.7 22.9 24.2 27.6 20.6 22.6 27.1 24.5 24.4 20.6 32.0 [95% CI] [10.3–32.7] [19.1–46.1] [8.7–20.7] [17.4–40.7] [12.3–30] [12.8–31.2] [8.7–23.8] [18.3–35.1] [12.6–28.8] [16.4–43.2] [20.5–41.2] [16.1–38] [22.3–43.1] [14.7–32.6] [10.5–21.1] [9.5–23.4] [16–38.3] [21.2–40.7] [16.9–35.2] [9–21.3] [19.2–37.2] [9–22.2] [12.7–30.5] [13.7–31.4] [23.1–42.2] [23–43.7] [12.8–32.6] [15.9–38.8] [14.1–31.3] [14.2–33.3] [8–21.1] [17.4–32.9] [15.6–30.8] [16–31.4] [18.5–37.6] [9.3–21.7] [7.9–20.8] [10.4–22.3] [12.3–29.2] [8.3–17.8] [15.1–31.6] [15.2–34.4] [18.6–37.8] [12.6–30.6] [14.3–32.3] [18.3–37.1] [16.7–33.4] [14.8–36.4] [13.4–29.5] [22.1–43] Both sexes 21.0 31.8 20.0 29.9 23.0 23.4 17.7 26.0 21.6 29.8 30.1 31.7 31.2 24.0 19.9 21.0 29.0 31.6 27.6 19.5 28.7 18.4 23.0 22.5 31.5 32.7 22.5 26.2 23.1 28.6 20.1 25.4 23.3 23.7 27.9 18.1 17.7 19.6 22.1 16.9 24.6 27.2 28.1 21.8 26.5 27.9 24.1 29.8 23.3 29.9 [95% CI] [12.8–29.3] [21.7–41.6] [14.5–25.3] [21.8–38.2] [16–30.3] [16.4–30.2] [11.7–23.3] [20.1–31.9] [15.6–27.6] [19.6–39.6] [22.9–36.9] [24.2–40.7] [23.7–38.9] [17.2–30.5] [15.3–24.6] [14.9–26.5] [20.5–37.5] [24.3–38.8] [20.3–34.3] [14.1–24.8] [22.1–35.6] [12.8–23.5] [16.1–30] [16.4–28.6] [24.9–37.8] [24.7–39.9] [15.2–30] [17.7–34.7] [16.9–29.2] [21.9–35.9] [14.5–26.4] [20.4–30.5] [17.7–29.1] [18.1–29.2] [21.2–34.8] [13.3–23.6] [12.5–23.3] [14.9–24.4] [14.8–28.8] [12.8–21.2] [18.5–30.7] [19.3–34.6] [20.9–35.1] [15–28.1] [19.6–33.7] [20.9–34.9] [18.3–30.4] [22.2–37.1] [17–29.4] [22.1–37.6]

Country name

Region

266

Annex 4.9b: Raised blood pressure

Raised blood pressure (SBP≥140 and/or DBP≥90) Age-standardized adjusted estimates Males 21.6 25.6 31.5 26.6 26.0 24.0 18.4 23.0 20.6 27.2 22.1 42.4 24.2 23.4 30.2 31.4 27.2 25.7 32.9 30.4 24.4 27.0 22.4 19.3 25.2 26.8 19.6 22.3 20.2 38.7 29.1 23.4 22.0 21.2 22.1 23.6 22.7 29.5 24.0 28.3 21.5 28.2 22.3 21.9 23.1 24.3 18.7 39.9 25.2 20.5 [95% CI] [10.4–35.6] [14–39.2] [21.9–42.2] [16–38.5] [16.5–37.3] [14.7–35.4] [10.7–27.9] [15.5–31.6] [13–29.9] [14.8–42.3] [13.8–31.7] [30.4–55.1] [15.4–34.4] [14.8–34] [22.1–38.7] [21.2–42] [16.7–39.5] [17–36] [22.6–44.6] [20.7–40.9] [16.7–33.7] [17.3–37.6] [13.5–33.2] [12–27.9] [16.8–34.8] [17.9–37.5] [11–30.8] [12.5–34.1] [12.6–29.2] [27.7–50.4] [19.1–40.1] [16.2–31.5] [14.7–30.4] [14.3–29.2] [14.2–31.5] [15.5–33.1] [14–32.3] [20.3–39] [14.9–34.8] [20.5–37.3] [13.5–30.5] [17.7–40.3] [14.4–31.9] [13.4–32.4] [14.4–33.6] [15.5–34.6] [11.8–26.7] [27.3–53] [16.4–35.5] [13–29.4] Females 22.6 24.0 21.1 22.2 21.5 19.5 14.5 24.0 18.4 23.2 21.8 36.3 24.7 21.5 24.2 23.9 22.2 21.4 32.6 23.9 21.5 23.1 19.5 17.2 25.4 25.6 18.0 21.3 17.2 32.1 18.0 22.6 20.7 19.6 21.4 18.2 16.8 25.8 20.2 23.1 16.9 24.9 19.9 19.7 15.0 23.3 18.8 34.7 18.9 25.1 [95% CI] [11.9–36.2] [13.7–37.3] [13.7–29.2] [13.1–33.8] [13.3–31.5] [11.7–29.2] [8.1–22.3] [16.5–32.4] [11.7–26.5] [12.2–36.9] [13.7–31.1] [24.6–49.6] [16.5–34.5] [13.5–31.2] [17.5–31.4] [15.6–32.8] [13.3–32.8] [13.8–30.4] [22.8–43.3] [15.6–32.1] [14.4–30.3] [15–32.2] [12–28.4] [10.6–25.4] [17.4–34.5] [17.1–36] [10.1–28.3] [12.5–32.8] [10.8–25.4] [21.3–43.4] [10.9–26] [15.6–30.4] [14–28.8] [13.1–27.1] [13.6–30.1] [11.7–25.8] [10.2–24.3] [18.1–33.8] [12.6–29.6] [16.6–30.3] [10.5–24.5] [15.7–35.2] [12.7–28.6] [11.9–29.6] [8.5–23.4] [15.3–32.7] [12.5–26.5] [23.1–47.7] [12.3–27] [16.9–34.7] Both sexes 22.1 24.8 26.3 24.4 23.7 21.8 16.5 23.5 19.5 25.2 21.9 39.2 24.4 22.5 27.1 27.5 24.7 23.5 32.8 27.1 23.0 25.0 20.9 18.2 25.3 26.2 18.8 21.8 18.7 35.2 23.6 23.0 21.3 20.4 21.8 20.9 19.7 27.6 22.1 25.7 19.3 26.5 21.1 20.8 19.9 23.8 18.8 37.1 22.1 22.8 [95% CI] [13.3–30.8] [16.2–32.7] [20.5–32.5] [16.6–31.4] [16.9–30.9] [15.6–28.8] [10.8–21.8] [17.8–29.6] [13.9–24.8] [15.8–34.6] [16.3–28.1] [30.5–47.8] [17.8–30.9] [16.2–28.6] [21.7–32.7] [20.3–33.7] [16.8–32.2] [16.5–29.8] [25.3–40.4] [20.7–33.2] [17.3–29] [18.3–31.3] [15.1–27.3] [12.7–23.4] [18.6–32.1] [19.9–33] [11.9–25.2] [14.8–29.2] [13.2–24.4] [26.8–43] [17–30.3] [18.1–28.7] [16.1–26.7] [15.3–25.5] [16–28] [15.4–26.5] [13.6–25.6] [21.8–33.9] [15.6–28.5] [20.5–31.1] [13.9–25] [19.4–34.6] [15.4–26.7] [14.1–27.5] [14–26.6] [16.9–30.6] [13.5–24.1] [28.2–45.6] [16.1–28.3] [16.6–28.7]

Country name

Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea–Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho

267

Global status report on NCDs 2014 … Indicates no data were available Raised blood pressure (SBP≥140 and/or DBP≥90) Crude adjusted estimates Males Liberia Libya Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (Federated States of) Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Korea Republic of Moldova Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines AFR EMR EUR EUR AFR AFR WPR SEAR AFR EUR WPR AFR AFR AMR WPR EUR WPR EUR EMR AFR SEAR AFR WPR SEAR EUR WPR AMR AFR AFR WPR EUR EMR EMR WPR AMR WPR AMR AMR WPR EUR EUR EMR WPR EUR EUR EUR AFR AMR AMR AMR 31.5 27.0 35.2 27.2 30.0 29.1 24.5 23.0 33.2 24.5 24.6 35.0 27.4 23.7 24.2 ... 34.3 32.8 27.7 30.3 23.6 30.0 25.9 25.9 22.4 19.1 24.2 33.1 28.1 24.6 23.2 27.0 28.9 26.5 23.7 23.2 25.9 16.4 23.5 33.4 26.6 27.0 13.2 33.9 31.8 33.5 28.3 26.1 26.5 25.2 [95% CI] [20.7–43.1] [18.4–37.3] [24–47.6] [18.3–37.2] [20.2–40.8] [19.3–40.7] [16.4–34.1] [13.7–34.4] [22.4–44.5] [15.4–35.1] [15.5–36.2] [23.8–47.4] [17.7–38.9] [16.2–32.2] [15.9–34.4] ... [23.7–45.9] [22.1–43.9] [18.4–38.7] [20.3–41.8] [14.8–33.8] [19.8–41.7] [14.2–40.8] [17.2–36.6] [15.1–31.1] [13–26.7] [14.9–34.9] [22.3–44.8] [19.4–38.2] [16.3–35.1] [15.3–32.3] [18.1–37.1] [19.5–39.3] [17–38.8] [14.9–33.7] [13.1–35.2] [16.1–37.1] [10.2–24] [15.2–33.3] [23.9–44.6] [17.5–36.6] [17.2–38.1] [8.1–19.6] [22.8–45.7] [21.3–43.4] [23–44.9] [17.4–40.8] [15.6–38.6] [15.7–39.3] [15.6–36.6] Females 31.4 24.0 24.3 15.2 29.6 30.1 19.8 20.1 34.0 15.2 20.9 32.8 23.1 18.5 23.0 ... 28.0 23.1 28.0 31.0 23.9 29.9 21.1 27.1 13.8 13.1 22.5 35.9 27.5 22.2 13.7 24.7 26.8 22.1 18.6 24.2 20.8 12.5 20.7 23.1 18.0 22.1 8.4 28.2 23.2 24.5 29.7 21.6 21.8 20.6 [95% CI] [21.3–42.6] [16.3–33] [14.9–35.7] [9.2–22.9] [20.1–40.1] [20.6–40.6] [13.1–27.9] [12–29.9] [23.9–45] [8.5–23.2] [12.6–31.1] [22.3–44.1] [14.5–33.5] [12.4–25.9] [15.4–32.1] ... [18.9–38] [14.3–33.6] [19–38.4] [21.5–41.9] [15.4–33.8] [20.2–40.6] [11.3–34.4] [18.3–37.2] [8.6–20.2] [8.6–18.9] [14.2–32.1] [25.8–46.9] [18.9–37.1] [14.6–31.8] [8.1–20.2] [16.2–34.4] [18.1–36.8] [13.8–32.5] [11.4–27.1] [14.4–35.8] [12.8–30.6] [7.6–18.3] [13.4–29.5] [14.6–32.7] [10.9–26.1] [14–31.8] [5.1–12.6] [18.5–39.5] [14.2–33.5] [15.4–35.5] [19–41.4] [12.6–32.4] [12.7–33.1] [12.6–30.8] Both sexes 31.5 25.5 29.3 21.2 29.8 29.6 22.1 21.6 33.6 19.8 22.8 33.9 25.2 21.0 23.6 ... 31.1 27.9 27.8 30.7 23.7 30.0 23.6 26.6 18.1 16.1 23.4 34.5 27.8 23.5 18.4 26.2 27.9 24.3 21.1 23.7 23.4 14.5 22.1 28.1 22.1 25.9 10.8 30.9 27.4 28.7 29.0 23.9 24.2 22.9 [95% CI] [23.8–38.9] [19.4–31.7] [21.2–36.5] [15.6–27] [22.6–37.3] [22.6–36.5] [16.4–27.8] [14.4–28.6] [26–41.1] [13.7–26.1] [15.5–29.6] [25.7–41.9] [18.2–32.6] [15.3–26.3] [17.4–30] ... [23.4–38.2] [19.8–34.8] [20.7–34.7] [23.1–38.3] [17.7–30.4] [22.5–37.1] [15.4–32.5] [19.1–33.3] [13.2–23.1] [11.9–20.1] [16.8–30.2] [26.9–42.2] [20.7–34.7] [17–29.3] [13.5–23.7] [19.5–33.5] [21.5–34.7] [16.3–31.1] [15.2–27] [16–31.1] [16.6–30] [10.1–18.9] [16.2–28.2] [21.3–34.9] [16.2–27.8] [17.9–34.3] [7.5–14] [22.9–38.9] [19.9–34.8] [21.2–35.9] [21.1–36.7] [16.4–31.3] [17–32.1] [16.2–29.7]

Country name

Region

268

Annex 4.9b: Raised blood pressure

Raised blood pressure (SBP≥140 and/or DBP≥90) Age-standardized adjusted estimates Males 25.6 23.9 37.4 30.8 24.1 22.5 22.4 19.5 25.8 29.1 23.5 28.9 28.4 21.8 20.0 ... 29.3 36.2 25.0 24.1 21.2 23.9 24.8 23.7 27.4 22.2 20.4 28.2 22.5 23.3 27.2 17.6 24.6 25.4 22.7 18.5 23.1 14.9 19.8 36.8 31.8 19.5 14.4 35.3 35.1 35.2 21.8 26.3 26.4 24.4 [95% CI] [16.3–36.2] [16–33.6] [25.7–50.1] [20.8–41.6] [15.7–34] [14.4–32.5] [14.8–31.5] [11.5–29.7] [16.6–36] [18.8–40.6] [14.6–34.9] [19–40.6] [18.2–40.2] [14.7–30] [13–28.7] ... [19.4–40.4] [24.8–47.9] [16.3–35.6] [15.6–34.1] [13.1–31] [15.2–34.3] [13.4–39.5] [15.5–33.9] [18.7–37.3] [15.2–30.5] [12.4–29.9] [18.4–39.4] [15.1–31.5] [15.2–33.6] [18.2–37.2] [11.4–24.8] [16.2–34] [16.1–37.5] [14.2–32.5] [10.1–29.2] [14.2–33.3] [9.1–22] [12.4–28.7] [26.7–48.2] [21.4–42.9] [11.5–29.2] [8.8–21.4] [24–47.3] [24–47.3] [24.4–47] [12.9–32.7] [15.7–38.9] [15.6–39.2] [14.9–35.6] Females 24.6 20.0 32.4 20.2 22.5 22.5 16.9 15.2 25.9 21.6 20.0 26.3 25.8 17.6 19.1 ... 23.5 29.2 25.5 24.6 21.8 23.7 20.2 22.8 20.5 17.6 18.3 27.8 20.7 21.5 19.5 16.5 21.3 21.1 18.2 18.9 17.9 11.5 17.4 30.4 26.3 13.6 11.3 33.3 30.1 31.7 21.4 23.0 22.6 20.2 [95% CI] [15.8–34.8] [13.1–28.3] [21.4–44.6] [12.8–29.1] [14.5–32.1] [14.8–31.6] [10.9–24.5] [8.6–23.6] [17.3–36.1] [12.9–31.4] [11.9–30] [17.1–37.1] [16.4–36.9] [11.6–24.7] [12.6–26.9] ... [15.1–33.1] [18.9–40.6] [16.9–35.7] [16.4–34.5] [13.7–31.4] [15.3–33.5] [10.6–33.4] [15–32.2] [13.5–28.7] [11.9–24.4] [11.2–26.7] [18.9–38.1] [13.4–29.3] [14–30.9] [12.4–27.5] [10.2–24.2] [13.8–30.2] [12.9–31.5] [11.3–26.6] [10.5–29.4] [10.8–26.7] [7–16.9] [10.9–25.4] [20.6–41] [17.2–36] [7.6–21.6] [7–16.4] [22.8–45.1] [19.6–41.5] [21.2–43.7] [12.8–31.7] [13.6–34] [13.3–34.1] [12.4–30.3] Both sexes 25.1 21.9 34.7 25.5 23.3 22.5 19.6 17.4 25.9 25.4 21.8 27.6 27.1 19.6 19.5 ... 26.4 32.6 25.3 24.3 21.5 23.8 22.6 23.3 23.9 19.8 19.4 28.0 21.6 22.4 23.3 17.2 23.0 23.3 20.5 18.7 20.5 13.2 18.6 33.5 29.0 18.1 12.8 34.3 32.5 33.3 21.6 24.6 24.5 22.3 [95% CI] [18.3–32] [15.9–28.1] [26.9–43.4] [19.2–32.9] [17.5–29.7] [16.6–28.4] [14.3–25] [12.1–24.2] [19.1–32.2] [18.6–32.8] [15.2–29.3] [20.2–34.8] [19.2–34.8] [14.2–24.7] [14.2–24.6] ... [19.8–33.1] [25–40.4] [18.5–31.8] [18.4–30.7] [15.4–27.8] [16.9–30] [14.1–31.4] [17–29.4] [18.1–30.1] [15.2–25] [13.8–25.1] [20.5–35.1] [16.2–27] [15.9–28.8] [17.5–29.6] [12.4–22.1] [16.6–28.6] [16.6–30.5] [15–26.5] [11.9–26] [14.3–26.9] [9.1–17.5] [13.3–24] [26.1–40.5] [22.1–35.5] [11.8–24.6] [8.7–16.6] [26.3–42.2] [24.8–40] [25–41.8] [14.9–28.3] [16.9–32.3] [16.9–32.2] [15.3–28.9]

Country name

269

Global status report on NCDs 2014 … Indicates no data were available Raised blood pressure (SBP≥140 and/or DBP≥90) Crude adjusted estimates Males Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand the former Yugoslav Republic of Macedonia Timor–Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United Republic of Tanzania United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe WPR EUR AFR EMR AFR EUR AFR AFR WPR EUR EUR WPR EMR AFR AFR EUR SEAR EMR AMR AFR EUR EUR EMR EUR SEAR EUR SEAR AFR WPR AMR EMR EUR EUR WPR AFR EUR EMR EUR AFR AMR AMR EUR WPR AMR WPR EMR AFR AFR 23.7 ... 30.8 28.0 31.7 33.2 27.7 31.7 17.2 32.5 33.0 22.9 34.6 29.3 31.9 23.0 21.6 31.9 25.2 28.1 24.4 22.2 26.3 27.3 22.9 31.0 26.0 31.4 23.4 24.7 25.5 23.0 28.0 24.9 28.4 33.4 25.5 18.0 28.8 15.9 25.9 26.8 25.0 23.7 23.4 30.3 30.0 28.8 [95% CI] [14.7–34.5] ... [21.1–42.1] [19–38.5] [21.7–43] [23.5–43.6] [17.5–39.1] [22–42.9] [11.3–24.3] [22.2–43.5] [21.6–45.2] [14.5–33.3] [22.1–47.8] [20.8–38.4] [21.5–43.2] [15.4–31.4] [12.8–32.4] [21.5–43.2] [15.5–36.3] [17.7–40.4] [16.7–33.4] [14.6–31.1] [17.5–36.2] [16.7–39.5] [14.7–32.3] [20.6–42.6] [16.5–36.8] [21.5–42.3] [15–34] [12.2–40.4] [17.2–34.8] [16.1–31.2] [18.6–39] [16–35.8] [17.4–41.3] [22.4–46] [16.3–36.1] [12.5–23.8] [20.3–38.5] [10.3–22.4] [16–37.5] [17–38.4] [16–35.9] [15.4–33.3] [15.2–32.9] [19.6–42.2] [20.6–41.2] [17.3–41.8] Females 20.6 ... 28.1 24.6 31.3 24.9 20.5 32.4 11.1 22.4 23.0 25.7 32.4 27.1 29.3 15.0 20.8 29.3 21.0 29.7 14.5 13.6 25.3 27.1 19.9 23.5 27.4 31.7 21.4 21.2 24.6 22.9 25.4 22.1 28.4 25.2 21.5 12.5 28.9 11.1 18.2 25.5 24.7 17.8 21.1 32.6 28.1 31.6 [95% CI] [12.9–30.1] ... [19.4–38.3] [16.5–33.9] [22–41.8] [15.9–35.7] [12.4–30.4] [23.2–42.5] [7–16.4] [14–32] [13.6–34.4] [17.1–36] [20.7–44.4] [19.3–35.9] [19.9–39.9] [9.3–21.5] [12.7–30.7] [19.9–39.9] [12.8–30.9] [19.3–41.4] [9–20.9] [8.4–19.8] [16.9–34.6] [17.1–38.2] [12.8–28.1] [14.5–34] [18–37.9] [22.3–41.6] [13.8–30.9] [10.3–35.1] [16.6–33.7] [15.8–30.6] [17.1–34.9] [14.1–32.2] [18.1–40.4] [15.8–36.5] [13.5–31.2] [8.8–16.9] [20.5–37.9] [7.2–15.9] [10.8–27.6] [16.5–36] [16.2–34.8] [11.2–25.7] [13.7–29.7] [22.1–43.8] [19.2–38.5] [19.8–45] Both sexes 22.2 ... 29.5 26.6 31.5 29.0 24.1 32.1 14.1 27.3 28.0 24.3 33.5 28.2 30.6 19.0 21.2 30.6 23.1 28.9 19.4 17.8 25.8 27.2 21.3 27.3 26.7 31.6 22.4 22.9 25.0 23.0 26.7 23.5 28.4 29.0 24.3 15.2 28.9 13.4 21.9 26.1 24.8 20.8 22.2 31.4 29.1 30.2 [95% CI] [15.9–28.6] ... [22.2–37.1] [19.9–33.5] [24.1–38.6] [21.9–35.6] [17–31] [25.3–38.8] [10–17.9] [20.4–34.4] [20.1–35.4] [17.9–30.7] [24.9–42.3] [22.2–33.8] [23.4–38.4] [14.2–23.7] [14.4–27.9] [23.4–38.4] [15.9–29.7] [21–37] [14.2–24.4] [12.8–22.2] [19.1–32.3] [19.7–35.6] [15.8–26.9] [19.1–34.7] [19.8–33.6] [24.6–39] [15.9–28.7] [13.4–32.1] [18.9–30.8] [17.8–28.1] [19.7–33.6] [16.8–30.4] [19.6–36.7] [21.5–37.3] [17.2–32] [11.9–18.6] [22.8–35.3] [10–17.1] [15.2–28.7] [18.7–33.2] [18.2–31.9] [14.9–26.3] [16.3–28.3] [23.4–39.6] [21.9–36] [21.1–38.2]

Country name

Region

270

Annex 4.9b: Raised blood pressure

Raised blood pressure (SBP≥140 and/or DBP≥90) Age-standardized adjusted estimates Males 21.3 ... 24.1 23.8 24.6 37.1 26.1 25.3 18.8 35.0 38.4 18.7 27.9 25.2 26.1 27.4 22.1 26.1 23.9 21.0 29.7 26.6 22.2 22.0 24.4 33.6 20.5 24.6 20.7 25.3 24.7 21.8 23.7 23.5 21.5 35.9 16.7 21.8 22.9 18.5 27.9 22.6 21.3 22.1 21.2 23.0 22.9 21.5 [95% CI] [13–31.5] ... [16–33.9] [15.4–33.8] [16.2–34.7] [26.7–47.9] [16.2–37.6] [16.9–35.4] [12.3–26.5] [24.2–46.4] [25.9–51.6] [11.5–27.9] [17.1–40] [17.6–33.6] [17–36.5] [18.6–36.6] [13.1–33.1] [17–36.5] [14.4–35] [12.8–31.5] [20.9–39.7] [17.8–36.6] [14.5–31.2] [13–32.8] [15.7–34.5] [22.7–45.5] [12.6–29.8] [16.3–34.5] [13–30.6] [12.5–41.4] [16.5–33.7] [15.1–29.6] [15.2–33.9] [15–34.3] [12.6–32.6] [24.4–48.7] [9.8–25] [15.5–28.3] [15.6–31.4] [12.1–25.8] [17.6–40] [14–33.3] [13.4–31.3] [14.2–31.3] [13.5–30.3] [14.4–33.3] [15.2–32.6] [12.6–32.2] Females 19.2 ... 21.3 19.1 23.7 32.0 20.7 24.4 13.2 28.4 32.2 19.4 24.9 25.2 22.7 22.2 22.6 22.7 20.8 22.0 22.1 19.9 20.4 21.0 22.9 28.3 21.0 24.0 20.0 23.3 24.1 23.0 21.7 21.4 19.5 33.4 10.3 18.9 21.8 15.6 23.8 21.5 19.8 16.6 20.7 23.5 19.4 22.7 [95% CI] [12–28.2] ... [13.9–30.4] [12.1–27.5] [15.9–33.3] [21.5–43.7] [12.6–30.8] [16.4–33.8] [8.4–19.3] [18.7–39] [20.7–45.3] [12.1–28.3] [15.2–36] [17.9–33.5] [14.6–32.1] [14.8–30.2] [14–33.1] [14.6–32.1] [12.7–30.7] [13.8–32.1] [14.8–29.9] [13–27.7] [13.2–28.9] [12.5–30.9] [14.9–32.2] [18.2–39.7] [13.5–29.9] [15.9–33] [13–28.9] [11.4–37.9] [16.2–33.3] [15.9–30.7] [14.2–30.6] [13.5–31.4] [11.5–29.8] [22.4–45.9] [5.3–17.4] [13.9–24.4] [14.9–29.6] [10.6–21.5] [15.2–34.2] [13.5–31.3] [12.5–28.9] [10.4–24.2] [13.4–29.2] [15–33.1] [12.4–28] [13.7–33.7] Both sexes 20.3 ... 22.7 21.8 24.2 34.5 23.5 24.9 16.0 31.6 35.3 19.0 26.4 25.2 24.4 24.8 22.4 24.4 22.3 21.5 25.9 23.2 21.3 21.5 23.6 31.0 20.8 24.3 20.4 24.3 24.4 22.4 22.7 22.5 20.5 34.6 14.7 20.3 22.3 17.0 25.8 22.1 20.5 19.4 21.0 23.3 21.1 22.1 [95% CI] [14.1–26.2] ... [16.5–28.2] [15.3–28.2] [18.1–30.6] [26.3–41.9] [16.1–30.9] [18–30.8] [11.5–20] [23.9–38.8] [26.8–43.7] [13.5–24.7] [18.8–33.7] [19.5–30.8] [17.8–30.9] [18.7–30.4] [15.5–29.6] [17.8–30.9] [15.7–29.3] [14.9–28] [20–31.7] [17.2–29.2] [15.6–27] [15–28.3] [16.8–29.5] [23.4–39] [14.8–26.6] [18.1–30.5] [14.3–26.2] [14.4–33.6] [18.6–30.7] [17.5–27.9] [16.2–29] [15.7–29.2] [13.4–27.2] [26.4–43] [9.1–20.4] [16.5–24.5] [16.8–27.5] [13.2–21.3] [18.3–33.3] [15–28.4] [14.5–26.4] [13.9–24.9] [15.3–26.8] [17–29.6] [15.2–26.7] [15.5–28.5]

Country name

Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand the former Yugoslav Republic of Macedonia Timor–Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United Republic of Tanzania United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe

271

Global status report on NCDs 2014

272

Index A accountability with national multisectoral action plans 117, 126-127, 130 acetylsalicylic acid (aspirin) xiii, 18, 101, 105 action plans, NCD see Global NCD Action Plan; national multisectoral action plans actions required to attain targets alcohol 29-30 diabetes 90-91 in Global NCD Action Plan, national multisectoral NCD action plans and 113-115, 117- 119 heart attack and stroke 98-101 hypertension 73-74 obesity 90-91 physical activity improvement 39-42 salt/sodium intake 48-49 tobacco 61-63 acute conditions, availability of medicines 106-107 adolescents and young people alcohol 28 obesity and overweight 85-88 physical inactivity 34-38, 39 tobacco 58 advertising alcohol 18,22, 29 tobacco xi, 18, 55, 58, 59, 60, 128 affordability see prices Africa (African Region) progress in 128 tobacco control 60 age blood pressure elevation and 67, 68,69 death rates and 10-11 diabetes/raised blood glucose 84, 85 heavy drinking and 28 obesity/overweight and 79, 80, 84, 85 physical inactivity and 33-39 salt/sodium intake and 46 tobacco use and 53-57 alcohol x, 23-30 actions required to achieve targets 29-30 cost-effective interventions see cost-effectiveness heavy episodic drinking x, 26, 27, 28 impact on health 25-27 monitoring harmful use 28 progress achieved 29 taxation 16, 18, 30

Americas progress in 128 salt reduction 45-46 angiotensin-converting enzyme inhibitor xiii, 96, 97, 101, 105 antihypertensive drugs/medication 96 Argentina, salt/sodium intake 46, 48 aspirin xiii, 18, 101, 105 asthma xiii, 9, 105, 106 atenolol 106 audit 101 Australia alcohol labelling/packaging/marketing 30 tobacco packaging 59

B Bahrain health system strengthening 98, 99 salt/sodium intake 48 behavioural risk factors 118, 119 hypertension 68, 72, 74, 101 best buys (WHO) 18, 28, 58, 120, 125 tobacco xi, 18, 54, 58, 59, 61 beta-blockers xiii, 96, 97, 101, 105 Bhutan, hypertension 74, bicycle hire, Iran 41 blood glucose/sugar see glucose blood pressure, raised see hypertension body mass index (BMI) 79, 80,81, 82 children and adolescents 88 Brazil Curitiba walkability areas 40 primary care access, expansion 100 school food policy 89 burden of NCD, reducing ix

C calcium channel blocker xiii, 101, 105 Canada, alcohol and fiscal interventions 30 cancer alcohol and 23 cervical 14, 18 liver 11, 14, 26 medicines 105 mortalities x, 9, 10, 14, 17

273

Global status report on NCDs 2014

captopril 106 cardiovascular disease (incl. ischaemic heart disease) medicines used in treatment and prevention of 106 mortalities/deaths ix, x, xi, 2, 9, 10, 23, 45, 94, 95 salt and xi, 45, 46 risk 67, 72, 95, 96, 97, 98 investment in programmes relating to 74 see also heart attacks; stroke cause of death global NCD deaths before age 70 years (2012) 10 in registration systems 14, 15, 17 tobacco as largest preventable 53 cerebrovascular disease see stroke cervical cancer 14, 18 children food and beverage marketing 89, 91 marketing of food/beverages 89, 91 overweight and obesity xii, 81, 84, 85, 88, 89 physical inactivity 32, 34, 38 salt/sodium intake 47 Pacific islands and Kiribati 47 tobacco secondhand smoke exposure 53 use xi, 53 see also adolescents; school-based interventions cholesterol measurement xiii, 97, 101, 105 chronic conditions, availability of medicines 107 civil registration systems 14-15, 118 collaboration intersectoral xiv, 49, 126 multisectoral ix, xiv, 1, 3, 49, 126 commitment and willpower eating outlets, salt reduction 48 political/state/government xiv, 1, 30, 62, 125, 130 high-level/head of state ix, 17 move to action from, by prioritizing high impact affordable interventions xiv, 125 primary care for heart attack and stroke prevention in Pacific islands 99 tobacco 61, 62 public, smoking cessation 61, 62 community interventions, obesity and diabetes 89 consultations with stakeholders (in national action plans) 115, 116 cost (economic) ix see also prices cost-effectiveness (of policies and interventions) 18-19, 120, 123 actions required to attain targets 90, 91 alcohol x, 28, 29, 30 cost and expenditure on cost-effective interventions 19 diabetes 88, 89 heart attack and stroke 95-97 hypertension 69, 72

medicines and technologies 105, 109.110 obesity 88-89 physical inactivity 38 primary care, technologies and essential medicines and xiii tobacco 54-55, 58 see also best buys Costa Rica, mobile phones and tobacco cessation 61 counselling, stroke and heart attack prevention xii-xiii, 8, 95-97 Curitiba (Brazil), walkability areas 40 cycle hire, Iran 41

D deaths (mortalities) alcohol-related 23, 28 cancer x, 8, 9, 10, 11, 14, 17, 18 cardiovascular disease see cardiovascular disease cause see cause of death diabetes x, 8-11, 18 premature ix x, 8, 10, 17, 18 leading worldwide causes 94-95 monitoring 10-14 probability from 30 to 70 11, 12, 13 registration systems see registration systems respiratory diseases (chronic) x, 8, 9, 10, 11 25×25 reduction target achievement/attainment actions required 17 risk factors contributing to 17-18, 126 developed countries see high-income countries diabetes xii, 79, 84-91, 101 actions required to attain targets 90-91 cost-effective policies and interventions 88, 89, 90 drug therapy 18 impact on health 84 insulin xiii, 105, 107 integrated primary care programmes for hypertension and 74 monitoring rates of 84-85, 90 mortalities x, 8, 10, 11, 18 self-care promotion 75 diet (and food and drinks/beverages) healthy food 49, 90, 91 prices 88 salt see salt/sodium unhealthy food hypertension and xii taxation 88, 89, 128 see also Global strategy on diet, physical activity and health drink-driving measures 30 driving and alcohol 30 drugs (medications) 95-103

274

Index

diabetes/glycaemic control 18 essential xiii, 105-111 generic xiii, 107, 109, 110 heart attack prevention xii-xiii, 95-103 smoking cessation 58 stroke prevention xii-xiii, 95-103 see also specific (types of) drugs

E Eastern Mediterranean Region, progress in 128 economic dimensions see cost; cost-effectiveness; fiscal interventions; funding; income level; investment; prices endgame approach to reduce tobacco consumption 60, 61 environment and physical inactivity 38 European countries (and European Region) heart attack and stroke prevention 98 progress in 128 evidence-based content of national multisectoral action plans 115 exercise see physical activity

Global NCD Action Plan (WHO 2013-2020) ix, xiv, 1-4 alcohol 28 commitments to building on guidance provided 4 heart attacks and stroke 98, 100 national multisectoral action plans to attain national targets and 113, 114, 115, 117, 118, 119 physical activity 39 status of implementation 124 tobacco 61 global NCD targets (general aspects) in executive summary ix-xiii, 1-3 most countries off course to meet xiv, 124-125 Global strategy on diet, physical activity and health 39 glucose, blood (glycemia; blood sugar) control (=glycaemic control) xii-xiii 18, 95, 97 raised 84, 85 glycaemia see glucose governance, national multisectoral action plans 117 Eastern Mediterranean Region 128

H HAI/WHO survey methods 106, 107 Health Action International/WHO survey methods 106-107 health impact alcohol 23-27 diabetes and raised blood glucose 84-88 hypertension 67-69 obesity 79-84 physical inactivity 33-38 salt/sodium intake 45-46 tobacco see tobacco warning about see health warnings health ministers see ministers of health health policies see public health policies health promotion school-based dietary and physical inactivity interventions 90 self-care, in hypertension and diabetes 75 Tonga, physical activity 40 workplace wellness programmes 75 health systems hypertension management 72 infrastructure status 15-16 investment xiv, 118, 126 monitoring quality of services 101 in national action plans 118-120 reorientation and addressing gaps 100-101 strengthening 99, 118 at all levels 17 surveillance and monitoring 118 universal coverage xiii, xiv, 99-100, 101, 118, 126, health warnings alcoholic drinks 30

F females (women) diabetes/raised blood glucose 85 hypertension 68 obesity 79, 80 physical inactivity 34-38 Tonga 40 Fiji, unhealthy food policies 89, 129 Finland obesity 90 salt intake 47 tobacco 60 fiscal interventions 16 alcohol 29, 30 food 91 salt/sodium 49 see also taxation food see diet Framework Convention on Tobacco Control (WHO FCTC) xi-xii, 52, 54, 55, 56, 60, 61, 128 Freiburg (Germany), sustainable transport 41 funding 15, 16

G gender see females; males generic drugs xiii, 107, 109, 110 Germany sustainable transport in Freiburg 41

275

Global status report on NCDs 2014

tobacco products xi, xii, 18, 53-55, 58-61, 128-129 health workers/professionals 126-127 alcohol and 22, 28 hypertension and 74 tobacco and 97 heart attacks (myocardial infarction) 95-103 actions required to attain targets 98-101 cost-effective policies and interventions 95-97 drug therapy xii-xiii, 95-103 progress achieved 97-98 recurrent 96 see also cardiovascular disease heart disease see cardiovascular disease high impact affordable interventions 99, 100 prioritizing xiv, 125 in WHO best buys 18 high-income (and developed) countries x alcohol consumption 27 cancer deaths 14 cardiovascular disease 95 diabetes 84 heart attack and stroke prevention 97 hypertension 72-73, 74 overweight and obesity 81, 82 physical activity/inactivity x-xi, 34, 39, 90 risk factor targets 16 tobacco use 54, 60 household surveys 109 human resources xv, 126-127 Hungary, unhealthy food policies 88 hypertension (raised blood pressure) xii, 67-77 cost-effective policies and interventions 69 drug therapy 18, 69, 72, 73, 96, 97, 107 impact on health 67-68 progress achieved 72-73, 73-74 risk factors 69 total risk approach xii, 18, 72-74, 96, 97

institutional resources xv, 126-127 insulin xiii, 105, 107 integrated programmes for hypertension and diabetes in primary care 74 Interagency Task Force (UN) xv, 3, 12, 127 International Society of Hypertension (ISH)/WHO cardiovascular risk prediction charts 96, 97 international stakeholders, medicines 110 intersectoral collaboration xiv, 49, 126 investment 41 cardiovascular risk management 74 health systems xiv, 120, 126 Iran, physical activity improvement 41 Ireland, tobacco 60 ischaemic heart disease see cardiovascular disease ISH/WHO cardiovascular risk prediction charts 96, 97

K Kampala, tobacco control 60 Kiribati, unhealthy foods and beverages 47 Korea (Republic of), salt/sodium intake 48 Kuwait, salt/sodium intake 48

L labelling alcoholic drinks 30 nutrition products 46, 48, , 49, 89, 128 tobacco 53, 49, 60 law see regulation liver cancer 11, 14, 26 losartan 106 low-income countries cardiovascular disease 95, 97 cost effective interventions 18 deaths 9, 10, 11-14, 95 cancer and chronic respiratory disease 10 premature x, 10, 95 diabetes/raised blood glucose xii, 84 funding and spending 15-16, 19 heart attack and strokes xiii, 97, 100 hypertension 74 medicine availability 106 national multisectoral NCD action plan implementation 120 national target attainment 123 overweight and obesity xii, 81 physical activity/inactivity 34 risk factor targets 16 salt/sodium intake xi tobacco use 54 universal health coverage 99

I inclusiveness in national multisectoral action plans 114 income level and economic wealth countries, alcohol consumption 28 see also high-income countries; low-income countries; middle-income countries individual interventions 18, 105, 125 alcohol x heart attacks and strokes 98 hypertension 69 obesity and diabetes 88, 89-90 inequality in national action plans 118 infrastructure of health systems, status 15-16 innovation 101

276

Index

M Madagascar, tobacco 58 males (men) diabetes/raised blood glucose 85 hypertension 67, 68 obesity 80, 81 physical inactivity 33, 37 Mauritius, unhealthy food policies 89 medications see drugs men see males Mexico, unhealthy food policies 89 middle-income countries alcohol consumption 27 cardiovascular disease 95, 97 cost effective interventions 30, 18 deaths 9, 10, 11-14, 95 cancer and chronic respiratory disease 10 premature x, 10, 95 diabetes xii, 84 heart attack and strokes xiii, 97, 100 hypertension 74 medicine availability 106 national multisectoral NCD action plan implementation 120 national targets attaining 123 setting, for reducing premature mortality 10 overweight and obesity xii, 81 physical inactivity x-xi, 34, 39 risk factor targets 16 salt/sodium intake xi spending in 15-16 tobacco use 54, 60 universal health coverage 99 Pacific Island countries, heart attack and stroke prevention 99 mobile phones and tobacco cessation, Costa Rica 61 Model List of Essential Medicines (WHO) WHO 106 Mongolia alcohol interventions 29 salt reduction 129 monitoring 118 alcohol harmful use 28 heart attack and stroke prevention 95-96 heart attack and stroke targets 97 hypertension prevalence 72 obesity and diabetes rates 84-88, 90 physical inactivity 38-39 premature mortality 10-13 progress achieved 47-48 quality of services 101 salt/sodium intake 46-47 technology and essential medicine affordability 107-109

tobacco use 58 mortalities see deaths motivation political leaders and xiv to reduce tobacco consumption 61 multisectoral action plans x, 126 national see national multisectoral action plans multisectoral collaboration ix, xiv, 17, 49, 62, 63, 91, 126 multisectoral problem for whole government, tobacco as 62 myocardial infarction see heart attacks

N national multisectoral action plans xiii, 17, 19, 113-121 accountability 118, 125-126, 127, 130 governance 118 health care 118-119 implementation 119-120 key domains 117-118 key elements 114-115 key steps in development 115-116 prevention in 117-118 prioritization 115 progress by WHO regions 128-129 national NCD targets 113-131 attaining xiv, 113-131 setting ix, xiv, xv, 17, 18, 19, 125, 126 factors to consider when 115, 116 salt/sodium intake xi, 48-49 national surveillance systems x, 17, 124 nifedipine 106

O obesity and overweight xii, 79-91 actions required to attain targets 90-91 cost-effective policies and interventions 88-89 impact on health 79-84 monitoring rates of 84-88, 90 population-based policies and interventions xii, 88-90 OneHealth Tool (UN) 120 outcomes improved by investment in health systems xiv, 126 overweight see obesity and overweight

P Pacific islands primary care for heart attack and stroke prevention 99 progress in 129 unhealthy foods and beverages 47 package of essential NCD interventions (WHO PEN) 99, 129 Palestine, health system strengthening 99 partnership to promote female physical activity in Tonga 40

277

Global status report on NCDs 2014

pharmaceutical industry 110 Philippines, health system strengthening 98 physical activity (exercise) healthy diet and 89 lack (physical inactivity) x-xi, 33-43 actions required to attain targets 39-41 cost-effective interventions 38 monitoring 38-39 progress achieved 39 political commitment see commitment Political Declaration (UN General Assembly 2011) ix, 1, 2, 3, 4 4, 113, 125 population-based interventions alcohol 28, 29-30 hypertension 69 in national action plans 118 obesity xii, 88-90 salt/sodium intake 46 population intake of salt see salt prices (and affordability) alcohol 29, 30 healthy food 88 medicines and technologies xiii, 105-111 tobacco 58, 59, 60 primary care audit 101 Brazil, expanding access 100 interventions affordable technologies and essential medicines xiii, 105,107,108, 109 heart attack and stroke 98 hypertension and diabetes 74 prioritization high impact affordable interventions xiv, 125 national multisectoral action plans 115, 117 private sector affordable technologies and essential medicines xiii, 105-111 salt consumption and 48 progress, achieving/making ix alcohol 29 heart attack and stroke 97-98 hypertension 72-73 majority of countries off course for xiv, 125 physical inactivity 29 salt/sodium intake 47, 48 tobacco and smoking 58-61 in WHO regions since 2011 128-129 promotion health see health promotion tobacco use xi-xii, 18, 55, 58-59, 128 public commitment and willpower, smoking cessation 61, 62 public health policies 17, 72-73, 118 diet 48

salt/sodium intake 72 hypertension 74 public places, smoking ban 128 public sector, affordable technologies and essential medicines xiii, 105.111

Q Qatar, salt/sodium intake 48 quality of services, monitoring 101

R registration systems 10-14, 17 civil 10-14, 118 vital 10-14 regulation(s) (and law/legal measures/litigation) 17, 114, 115, 118, 119, 128 alcohol x, 18, 29 food 88, 89 and salt/sodium intake 46, 47, 48, 49 medicines 107, 108 tobacco 55, 59, 60, 62-63 Republic of Korea, salt intake 48 resources adapting to limitations in 101 human xv, 126-127 institutional xv, 126-127 respiratory diseases, chronic, mortalities x, 8, 9, 10, 11 risk factors behavioural see behavioural risk factors contribution to achieving reduction in deaths 26–28, 127 hypertension 69, 73 in national action plans 118 WHO STEPwise approach to surveillance of NCD risk factors 86, 128, 129 see also cardiovascular disease; total risk approach Russian Federation, alcohol interventions 29

S salbutamol 106 salt/sodium intake xi, 18, 45-59 actions required to achieve target 48-49 impact on health 45-46 monitoring of population intake 46 progress achieved 47-48, 128, 129 SARA (Service Availability and Readiness Assessment) 107-109 school-based interventions diet 89, 90 physical inactivity 38, 90 screening, cardiovascular risk 72, 101

278

Index

secondary prevention of heart attacks and stroke 96, 97 self-care promotion in hypertension and diabetes 75 Service Availability and Readiness Assessment (SARA) 109 settings-based interventions, obesity and diabetes 89-91 sexes see females; males situation analysis 98, 114, 116 smoking see tobacco social marketing to promote female physical activity in Tonga 40 sodium intake see salt/sodium intake South Africa alcohol advertising ban 29 salt/sodium intake 48, 128 South-East Asia Region, progress in 129 sponsorship, tobacco industry xi-xii, 18, 55, 60, 128 stakeholders 116, 118, 130 pharmaceuticals 110 state commitment see commitment statins xiii, 96, 101 STEPwise approach to surveillance of NCD risk factors 88, 128, 129 strategic actions with national multisectoral action plans 117, 118, 119 strategic planning 119 tobacco 60 stroke (cerebrovascular disease) 95-103 actions required to attain targets 98-101 alcohol and 23 cost-effective policies and interventions 95 drug therapy in prevention of xii-xiii, 95-103 monitoring targets 97 progress achieved 97-98 recurrent 96 surveillance systems, national x, 17, 88, 90, 119, 124 Eastern Mediterranean Region 128 see also STEPwise approach to surveillance of NCD risk factors sustainability and sustainable development ix, xiii-xiv, 2, 124-125 transport 41

tobacco and smoking xi-xii, 18 actions required to attain targets 61-63 best buys (WHO) xi-xii, 18, 55, 58, 59, 60, 61, 62, cost-effective policies and interventions 54-55 health impact 53-54 warnings about xi-xii, 18, 55, 58, 59, 60, 61, 62, 129-130 monitoring use 58 progress achieved 58-61 taxation xi-xii, 16, 18, 55, 58, 59, 60, 61, 62, Tonga, partnership and social marketing to promote female physical activity 40 total risk approach heart attack and stroke prevention in primary care 95-98, 100, 101 hypertension (and other cardiovascular risk factors) xii, 18, 72, 74, 96-97 training 49, 127 health workers 17, 49, 74, 100, 110, 127 Philippines 99 transport, sustainable 41 Turkey, tobacco 58

U Uganda, Kampala, tobacco control 60 United Kingdom alcohol 29 salt/sodium intake 48 tobacco 60 United Nations (UN) General Assembly Political Declaration (2011) ix, 1, 4, 113, 125 Interagency Task Force xv, 4, 128 OneHealth Tool 119,-120 universal health coverage xiii, xv, 99-100, 101, 118, 126

V vital registration systems 14-15

T taxation alcohol 16, 18, 30 food 16, 88, 128 medicines and tax exemption 110 physical activity and tax exemption 39 tobacco xi-xii, 16, 18, 55, 58, 59, 60, 61, 62 technologies, available and affordable xiii, 105-111 Thailand salt/sodium intake 47 tobacco 59

W walkability areas, Curitiba (Brazil) 40 wellness programmes, workplace 75 Western Pacific Region, progress in 129 WHO 127 accountability framework 130 Framework Convention on Tobacco Control (FCTC) xi, xii, 52, 54, 55, 56, 60, 61, 62, 128 Global strategy on diet, physical activity and health 39 Model List of Essential Medicines 106 Package of essential NCD interventions (PEN) 74, 99, 128, 129

279

Global status report on NCDs 2014

role in prevention and control of NCDs 127 Service Availability and Readiness Assessment (SARA) 109 STEPwise approach to surveillance of NCD risk factors 88, 128, 129 WHO/Health Action International (HAI) survey methods 106-107 WHO/ISH cardiovascular risk prediction charts 97 willpower see commitment and willpower women see females workplace dietary interventions 90 physical inactivity interventions 38, 42 wellness programmes 75 World Health Organization see WHO

Y young people see adolescents and young people

280

A 25% relative reduction in the overall mortality from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases At least 10% relative reduction in the harmful use of alcohol, as appropriate, within the national context

A 10% relative reduction in prevalence of insufﬁcient physical activity

A 30% relative reduction in mean population intake of salt/sodium

A 30% relative reduction in prevalence of current tobacco use A 25% relative reduction in the prevalence of raised blood pressure or contain the prevalence of raised blood pressure, according to national circumstances

Halt the rise in diabetes and obesity

At least 50% of elligible people receive drug therapy and counseling (including glycamic control) to prevent heart attacks and strokes An 80% availability of the affordable basic technologies and essential medicines, including generics, required to treat major noncommunicable diseases in both public and private facilities

www.who.int/ncd ISBN 978 92 4 156485 4

WHO/NMH/NVI/15.1

2014 实现九个全球预防控制非传染性疾病目标：共同的责任

INFORME SOBRE LA SITUACIÓN MUNDIAL 2014 年全球非传染性疾病现状报告 de las enfermedades no transmisibles

2014 年全球非传染性疾病现状报告实现九个全球预防控制非传染性疾病目标：共同的责任

致谢本报告在助理总干事Oleg Chestnov支持下由以下人员撰写并制作。总干事办公厅（建议和指导）：副总干事Anarfi Asamoa-Baah、Chris Dye、Ian Smith 主要作者：Shanthi Mendis。各章节主要作者：Tim Armstrong、Douglas Bettcher、Francesco Branca、Jeremy Lauer、Cecile Mace、Shanthi Mendis、Vladimir Poznyak、Leanne Riley、Vera Da Costa E Silva、Gretchen Stevens 项目经理：Kwok Cho Tang 世卫组织日内瓦和里昂工作人员：Yulia Bakonina、Freddie Bray、Nick Banatvala、Melanie Bertram、Peter Beyer、Monika Bloessner、Alison A’Isha Commar、Edouard Tursan D’Espaignet、Mercedes De Onis、Alexandra Fleischmann、Silvia Franceschi、Etienne Krug、Chizuru Nishida、Colin Mathers、Bente Mikkelsen、Armando Peruga、Dag Rekve、Jane Robertsen、Gojka Roglic、Yasuyuki Sahara、Ruitai Shao、Andreas Ullrich、Meindert Van Hilten、Temo Waqanivalu、Christopher P Wild 世卫组织区域和国家办事处的工作人员：区域主任：非洲区域Luis Sambo、美洲区域Carissa Etienne、东地中海区域 Ala Alwan、欧洲区域 Jakab Zsuzsanna、东南亚区域Poonam Singh、西太平洋区域Young-soo Shin 其他工作人员：Ibtihal Fadhil、Renu Garg、Gauden Galea、Anselm Hennis、Branca Legitic、SamerJabbour、Frederiek Mantingh、Hai-Rim Shin、Susan Mercado、Steven Shongwe、Slim Slama、Elena Tsoyi、Cherian Varghese 外部审稿人和其他人员： George Alleyne、Robert Beaglegole、David Bramley、Joy Carrington、Rajiv Chowdhury、Michael Engelgau、Majid Ezzati、Charlie Foster、Oscar Franco、Valentin Fuster、Gerald Gartlehner、Danaei Goodarz、Vilius Grabauskas、Ian Graham、Murad Hassan、John Harold、Corinna Hawkes、Carl Heneghan、Konstantin Kotenko、Liming Li、Alan Lopez、Gabriel Masset、Jean Claude Mbanya、George Mensah、Rob Moodie、Venkat Narayan、Sania Nishtar、Srinath Reddy、Jurgen Rehm、Mike Rayner、Peter Scarborough、Yackoob Seedat、Surendra Shastri、Priya Shetty、Sidney Smith、Isolde Sommer、Laurence Sperling、David Stuckler、Doug Webb、Kremlin Wickramasinghe、David Wood、Qiao Youlin、Salim Yusuf 行政支持人员：Fabienne Besson、Maritha Osekre-Amey、Joel Tarel、Roelof Wuite 本出版物的印刷得到了挪威和俄罗斯联邦政府的慷慨资助。 WHO/NMH/NVI/15.1

© 世界卫生组织，2014年版权所有。世界卫生组织出版物可从世卫组织网站（www.who.int）获得，或者自WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland（电话：+41 22 791 3264；传真：+41 22 791 4857；电子邮件：bookorders@who.int）购买。要获得复制许可或翻译世界卫生组织出版物的许可 – 无论是为了出售或非商业性分发，应通过世卫组织网站http://www.who.int/about/ licensing/copyright_form/en/index.html）向世界卫生组织出版处提出申请。本出版物采用的名称和陈述的材料并不代表世界卫生组织对任何国家、领地、城市或地区或其当局的合法地位，或关于边界或分界线的规定有任何意见。地图上的虚线表示可能尚未完全达成一致的大致边界线。凡提及某些公司或某些制造商的产品时，并不意味着它们已为世界卫生组织所认可或推荐，或比其它未提及的同类公司或产品更好。除差错和疏忽外，凡专利产品名称均冠以大写字母，以示区别。世界卫生组织已采取一切合理的预防措施来核实本出版物中包含的信息。但是，已出版材料的分发无任何明确或含蓄的保证。解释和使用材料的责任取决于读者。世界卫生组织对于因使用这些材料造成的损失不承担责任。

来自总干事的信息陈冯富珍博士总干事世界卫生组织全世界已经走到非传染性疾病历史上的决定性时点，面临前所未有的改变非传染性疾病发展进程的机遇。世卫组织会员国已经商定了一整套有时间限制的到2025年要实现的9个自愿性全球目标，包括减少有害使用酒精、身体活动不足、食盐/钠摄入量、烟草使用和高血压，遏制糖尿病和肥胖的上升，以及提高预防心脏病和脑卒中措施的覆盖率。还有一个目标是使管理非传染性疾病的技术和基本药物更可获得也更可负担。各国需要在实现所有目标方面都取得进展方能实现到2025年将四种主要非传染性疾病造成的过早死亡减少25%的总体目标。 2012年，非传染性疾病导致3800万人死亡，其中40%多属于70岁以前的过早死亡。大部分非传染性疾病导致的过早死亡是可以预防的。本报告包括鼓舞人心的证据，表明确实可以大幅度减少全世界非传染性疾病导致的过早死亡。在许多高收入国家，由于政府采取了促进更健康生活方式并提供公平卫生保健的政策，心血管疾病造成的死亡已经大幅度降低。应采取措施保持这一积极趋势，酌情促进其在发达国家加速发展并在低收入和中等收入国家复制。非传染性疾病的驱动因素包括全球化对商品营销和贸易的影响、快速城市化及人口老龄化。这些因素不会因个人意志转移，传统的卫生部门对之也影响甚微。虽然个人的行为变化非常重要，处理非传染性疾病问题肯定需要政府最高级别发挥领导作用，需要制定政策时让所有政府部门都参与进来，还需要在实现全民健康覆盖方面取得进展。本报告的主要目标读者是各国卫生部长。报告提供有关自愿性全球目标及如何扩大各国努力以可持续方式实现目标的信息。报告内容包括有关非传染性疾病死亡率和风险因素的2010年基线评估，以便各国从2015年开始向世卫组织报告在实现目标方面取得的进展情况。本报告突出介绍了一些成功预防控制非传染性疾病的国别案例研究，可以供其他面临类似挑战的国家参考。正如本报告所探讨的那样，各国业已商定一整套非常具有成本效益且全球适用的针对非传染性疾病的干预措施，有助于到2025年实现全部9个目标。每个国家都需要根据本国国情和条件参考最佳可获得证据应用相关措施。2014年7月，各国部长在联合国大会上一致认为，任何国家，不论是低收入、中等收入还是高收入国家，都没有理由拖延相关措施的实施。推迟采取行动就意味着非传染性疾病负担加重，卫生保健费用上升。有关非传染性疾病问题的第二份全球报告包含的最重要信息是，今天，国际社会有机会改变非传染性疾病流行的进程。全世界已经有了预防控制非传染性疾病的真正全球议程，确定了各国根据具体目标需要共同承担的责任。这是处理非传染性疾病流行问题的历史性机遇，任何国家都不应错过。

iii

序言 Oleg Chestnov博士助理总干事非传染性疾病和精神卫生世界卫生组织非传染性疾病是21世纪的主要卫生和发展挑战之一，既导致患者承受痛苦，也危害各国社会经济，特别是低收入和中等收入国家。没有哪国政府能够负担得起忽视非传染性疾病负担上升的后果。如果不采取循证行动，非传染性疾病的人力、社会和经济成本将会继续上升并远远超出各国处理该问题的能力。世界各国领导人认识到非传染性疾病的破坏性社会、经济和公共卫生影响，于2011年9月通过政治宣言，其中包含处理全球非传染性疾病负担的强有力承诺，并要求世界卫生组织采取行动支持各国的努力。其中一项任务是制定世卫组织2013-2020年预防控制非传染性疾病全球行动计划，其中包括9个自愿性全球目标和1个全球监测框架。2013年，世界卫生大会批准了该全球行动计划及其自愿性全球目标。九个预防控制非传染性疾病自愿性全球目标强调各国需将其行动重点放在以下方面：减少有害使用酒精、身体活动不足、盐/钠摄入量、烟草使用和高血压；遏制肥胖和糖尿病上升；提高预防心脏病和脑卒中措施的覆盖面，并获得基本技术和药物。为支持实施预防控制非传染性疾病全球行动计划，世卫组织已建立全球协调机制，将加强对预防控制非传染性疾 v

病的活动、多利益攸关方参与和跨部门行动的协调。联合国秘书长建立了联合国预防和控制非传染性疾病机构间工作队协调各相关联合国组织和其他政府间组织的活动，该机制也将为实施全球行动计划提供支持。到实现国际商定的自愿性全球目标的预定日期只有十年时间了，第二份全球现状报告恰于此时发布。现在，我们对于预防控制非传染性疾病工作的未来比当代任何时候都更乐观。为实现全球目标，各国政府、国际伙伴和世卫组织需要开展合作，共享并交流证据和信息，采取必要措施缩小能力和资源差距。全世界迈出决定性步伐应对21世纪最大的公共卫生挑战之一。任何国家都不应该被落下。

2014年全球非传染性疾病现状报告

执行摘要本全球预防控制非传染性疾病现状报告是跟踪全世界预防和控制非传染性疾病工作进展情况三年期报告的第二份。所有国家均已感受到非传染性疾病的人力、社会和经济后果，这种后果对贫困和弱势人口而言尤为可怕。减少全球非传染性疾病负担比什么都重要，也是实现可持续发展的必要条件。非传染性疾病是全球死亡的主要原因。2012年，全世界共死亡5600万人，其中3800万（68%）死于非传染性疾病，其中40%多（1600 万）为70岁以下的过早死亡。非传染性疾病导致死亡中的四分之三（2800万）以及大部分过早死亡（82%）发生在低收入和中等收入国家。按照低收入和中等收入国家目前情况继续发展估算，2011-2025年非传染性疾病导致的累计经济损失将达7万亿美元。不采取行动的巨大代价远远超出实施一整套影响大干预措施减少非传染性疾病负担所需的费用（每年112亿美元）。 2011年9月，全世界领导人商定了处理非传染性疾病全球负担的具体承诺路线图，包括承诺到2013年制定预防控制非传染性疾病的多部门行动计划和政策。为加快各国处理非传染性疾病问题的努力，2013年世界卫生大会通过了到 2025年要实现的9个具体自愿性全球目标，并批准了围绕世卫组织2013-2020 年预防控制非传染性疾病全球行动计划组织的一系列行动。会员国、国际伙伴和世卫组织共同实施该计划将有助于兑现2011年9月各国领导人做出的承诺。 vi

这些行动围绕六个目标组织，旨在加强各国能力并促进国际合作，从而减少风险因素、加强卫生系统并监测全球实现相关目标的进展情况。 2014年7月，联合国大会对落实2011 年政治宣言的进展情况进行了审查评估并认可了2011年9月以来在国家层面取得的进展。联合国会员国还认识到实施 2011年政治宣言所载承诺路线图的进展不足且高度不均衡，有必要继续并加强努力，各国因而承诺在四个重点领域——治理、预防和减少风险因素、卫生保健以及监测——采取一整套措施。这些有时间限制的措施包括制定与全球目标一致的国家目标，到2015年制定国家多部门计划以及从2016年开始实施有关计划以实现国家目标。第二份全球预防控制非传染性疾病现状报告围绕9个自愿性全球目标撰写。报告提供有关目前形势的数据，指出面临的机遇和瓶颈以及实现目标所需采取的重点行动。此外，报告还提供2010年非传染性疾病死亡率和风险因素基线评估，以便各国从2015年起报告进展情况。

全球目标1：到2025年，心血管疾病、癌症、糖尿病、慢性呼吸系统疾病等疾病的总死亡率相对降低25% 一章介绍2012年死亡率数据。数据表明：(i)非传染性疾病影响所有国家；(ii) 其影响在低收入和中等收入国家特别严重；(iii)大部分非传染性疾病导致的过早死亡发生在低收入和中等收入国家。

执行摘要

各国实现这一目标的能力差别很大。低收入和中等收入国家或可以25% 为目标，已经实现主要非传染性疾病下降的高收入国家或许想要将其目标定得比25%更高。第一章概述全面多部门政策行动和干预措施以及实现该目标所需要的国家能力，包括民事/出生死亡登记和监测系统。许多国家缺乏资源，因而应将实施高性价比政策方案和干预措施（最合算措施）确定为最优先重点。

进展。更多国家已经制定或修改了本国酒精政策和行动计划。具备书面酒精政策的76个国家中，有52个国家已经采取行动落实有关政策。约160个世卫组织会员国有关于酒精饮料销售年龄限制的法规。

全球目标3：到2025年身体活动不足流行率减少10% 每年，身体活动不足造成6930万残疾调整生命年和320万死亡。和每周按照世卫组织建议进行150分钟中等强度活动或相当量活动的人相比，身体活动不足的成年人面临的全死因死亡风险更高。定期进行身体活动可以减少缺血性心脏病、脑卒中、糖尿病、乳腺癌和结肠癌的风险。 2014年，23%的18岁及以上成年人身体活动不足。妇女不如男性身体活动多，老年人不如年轻人身体活动多。从全球看，2014年，11-17岁青少年中有 81%身体活动不足。少女不如少男身体活动多，两组人群达到世卫组织建议活动量的比例分别为78%和84%。数个发达国家报告，由于落实了增加身体活动的国家政策和规划，过去十年间其人口增加了身体活动。近年来，更多低收入和中等收入国家也开始采取行动处理缺乏身体活动问题。达到身体活动目标需要交通、城市规划、娱乐和体育以及教育等多部门之间进行合作，创造有利于所有年龄组人口进行身体活动的安全环境。 vii

全球目标2：到2025年有害使用酒精至少减少10% 据估计，2012年酒精消费造成全世界所有死亡的5.9%（330万）和残疾调整生命年的5.1。其中半数以上死于非传染性疾病。 2010年，全世界15岁及以上人群人均酒精消费估计为6.2升纯酒精（相当于每天13.5克纯酒精）。短暂性狂饮流行率与酒精消费总水平有关，而且欧洲和美洲区域最高。存在减少有害使用酒精的具有成本效益的政策方案，包括定价政策、减少酒精供应和营销、改进卫生服务的应对以及有关酒驾的政策和措施。筛查有害饮酒和治疗酒精依赖等单项干预措施也是有效的，但这些措施比实施以人口为基础的措施费用更高。自世界卫生大会2010年批准《减少有害使用酒精全球战略》以来，在处理有害使用酒精问题方面已经取得一定

2014年全球非传染性疾病现状报告

全球目标4：到2025年人群平均食盐摄入量相对减少30% 高血压和心血管疾病风险上升与饮食过度摄入钠有关。全球每年心血管原因造成的165万例死亡与过量摄入钠有关。目前的估计表明，全球平均食盐摄入量约为每天10克（每天3.95克钠）。世卫组织建议将食盐摄入量降低到每天5 克（每天2克钠）以下，以减少高血压以及冠心病和脑卒中风险。在许多国家，食盐的主要来源是加工食品和熟食；在另外一些国家，食盐的主要来源则是家里烹饪时或在餐桌上加的盐。随着低收入和中等收入国家越来越多获得加工食品，钠的来源也正在快速转向这些食品。正如第四章所探讨的那样，确定食盐摄入量基线对于制定国家目标和设计有效的消费者宣传活动十分重要。需要针对每类食物制定减钠目标，其中重点是在人口食盐摄入中占比最大的食物。各国卫生部均需牵头制定并实施旨在减少全体人群食盐消费量的政策。有关政策应该是跨部门跨学科的，并且应该让所有利益攸关方都参与进来。政策应该可以适用于多种环境并利用所有可获得的工具，包括标签、立法、产品改良、鼓励生产和消费低钠食品的财政激励措施以及确保有关措施有效实施的消费者教育活动。一些国家已经在实施这些活动方面取得显著进展。

据估计，约有600万人死于烟草使用，其中包括60万死于接触二手烟，17 万死者为儿童。确保减少烟草使用的措施包括：通过“100%无烟”国家立法保护人们免遭二手烟侵害；提供戒烟帮助并就使用烟草的危害向人们提出警告；执行禁止烟草广告、促销和赞助的法律；将烟草税提高到任何烟草制品总零售价格的至少70%。近年来，全球控烟工作已取得显著进展，全世界为其人口提供保护的国家数量和全世界受到有效控烟措施保护的人口数量都增加了。2013年，95个国家已经按最高实现水平落实四项最合算控烟措施（非常具有成本效益的干预措施）中的一项，2个国家已经按最高实现水平落实全部四项最合算控烟措施。在实施最合算措施方面取得进展的许多国家是低收入和中等收入国家。第五章提及，许多国家需要做更多工作，通过并执行有效的控烟措施，包括在尚未实施有关措施的地方按照最高实现水平扩大落实最合算的减少需求措施，加强并保持包含全面措施的现有规划以及完整落实世卫组织烟草控制框架公约。大部分国家在减少烟草需求方面取得的成绩表明，不论国家大小和发展水平，应对烟草流行是可能的。

全球目标6：到2025年使高血压流行率下降25%或者根据本国情况控制高血压流行率据估计，2010年，高血压导致940 万人死亡和疾病负担的7%（按残疾调整生命年测算）。如不加控制，高血压会引起脑卒中、心肌梗死、心力衰竭、痴

全球目标5：到2025年15 岁以上人群当前烟草使用流行率相对降低30% viii

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呆症、肾功能衰竭和失明。强有力的科学证据表明，通过针对全体人群的干预措施和单项（行为和药理）干预措施降低血压会带来健康效益。2014年，18岁及以上成年人高血压（定义为收缩压和/ 舒张压等于或高于140/90 mm Hg）的全球流行率约为%。许多可改变因素导致高血压流行率高，包括食用含太多盐和脂肪的食物、水果和蔬菜摄入不足、超重和肥胖、有害使用酒精、缺乏身体活动、心理压力、社会经济决定因素以及不能充分获得卫生保健服务。由于卫生系统特别是初级保健存在薄弱环节，全世界高血压的发现、治疗和控制工作开展得不够充分。为实现该目标，需要针对全体人口的政策和干预措施，以处理这些可改变风险因素。此外，需要在初级保健层面建立综合规划，根据世卫组织建议以全风险思路提高发现并管理高血压和其它心血管风险因素的效率和有效性。

高风险人群可以通过适度减肥和每天进行适当身体活动减轻糖尿病风险。少数高收入国家已经将该干预措施扩大到全体人群。但是，低收入和中等收入国家大规模实施该措施有困难，部分原因是目前使用的确定高风险人群的方法既麻烦又昂贵。紧急需要进一步研究，以评估预防肥胖和糖尿病干预措施的有效性。

全球目标8：到2025年至少 50%符合条件者接受预防心脏病发作和脑卒中的药物治疗及咨询（包括控制血糖） 2012年，心血管疾病是非传染性疾病死亡的主要原因，导致1750万例死亡，占非传染性疾病死亡46%，估计其中740万死于心脏病（缺血性心脏病），670万死于脑卒中。该减少心脏病和脑卒中目标旨在使更多心血管疾病风险和已确定疾病风险高人群接受药物治疗和咨询。这种可负担措施在资源有限环境下也可以通过初级卫生保健实施。该措施的覆盖尚存在重大空白，特别是在低收入和中等收入国家。难以在初级保健中获得基本服务、实验室检验和药物超出负担能力、临床实践模式不当以及治疗依从性差是造成存在空白的主要原因。该措施应成为实现全民健康覆盖一揽子基本福利的一部分。此外，需要制定针对具体情况的策略应对与获得基本技术和药物、卫生人力、服务提供以及卫生信息和转诊有关的卫生系统薄弱环节，其中特别关注初级保健。 ix

全球目标7：到2025年遏制糖尿病和肥胖的上升肥胖导致罹患糖尿病、高血压、冠心病、脑卒中和一些癌症的可能性上升。自1980年以来，全世界肥胖症几乎翻了一番。2014年，18岁及以上男性有10% 肥胖，女性比例为14%。2013年全世界有4200万五岁以下儿童肥胖。2014年全球糖尿病流行率据估计为10%。通过同时针对食品生产、配送和营销的不同行业开展多部门行动并塑造支持和促进充分身体活动的环境，肥胖症和糖尿病是可以预防的。

2014年全球非传染性疾病现状报告

全球目标9：到2025年80%公立和私营医疗卫生机构可提供经济可负担的、治疗主要非传染性疾病所需的基本技术和基本药物，包括非专利药物该目标涵盖落实具有成本效益的初级保健干预措施处理心血管基本、糖尿病和哮喘所需技术和药物的基本要求。基本药物包括阿司匹林、他汀类药物、血管紧张素转换酶抑制剂、噻嗪类利尿剂、长效钙通道阻滞剂、长效β受体阻滞剂、二甲双胍、胰岛素、支气管扩张剂和类固醇吸入剂。基本技术至少包括血压计、体重计、血糖和血胆固醇检测仪（带试纸条）和尿白蛋白试纸条。这些是最低要求。如不满足这些要求，初级保健机构就无法实施基本的非传染性疾病干预措施。目前，在基本卫生技术和药物可负担性和可获得性方面仍存在重大差距，特别是在低收入和中等收入国家。由于难以获得这些基本技术和药物，患者只能推迟就医，进而不必要地罹患并发症或者支付高额自付费用导致家庭面临经济困难。有必要实现可持续卫生供资，以确保利用适当、可靠的采购和分发系统保障各级别卫生保健机构获得预防控制非传染性疾病的技术和基本药物供应，包括初级卫生保健机构。因此，实现全民健康覆盖的努力重点应包括制定国家政策鼓励提高基本卫生技术和基本药物的可获得性。应合理用药，因此必须遵守循证指南并就合理用药教育卫生保健专业人员和患者。预防控制非传染性疾病国家多部门行动计划应重视实现上述9个目标的政策和干预措施（第1-9章），并提供相应预算。第十章的内容是制定国家多部门计 x

划，强调该计划应覆盖的主要工作领域是治理、预防、卫生保健以及监测和监督。为尽可能有效实施计划，有必要让卫生和非卫生部门的利益攸关方都参与到计划制定的进程中来，包括民间社会和私营部门。最后一章描述到2025年实现9个自愿性全球目标的道路并强调本报告的重要信息

信息1. 预防控制非传染性疾病是实现可持续发展的重要推动力本报告提供的数据表明，非传染性疾病影响所有国家并且死亡和疾病负担主要集中于低收入和中等收入国家。过早死亡导致的劳动生产率损失以及个人和国家应对非传染性疾病的费用是减贫和可持续发展面临的重要障碍。因此，在预防控制非传染性疾病方面实现进展对于实现可持续发展目标至关重要。

信息2. 虽然一些国家正在取得进展，大部分国家将无法按计划实现预防控制非传染性疾病的全球目标正如许多鼓舞人心的案例研究表明，政治领导人表现出高度承诺的国家正在应对非传染性疾病方面取得重要进展。但是，已经取得的进展仍不平衡也不充分。本报告提供的数据表明，在加强治理、预防、卫生保健以及监测和监督方面丧失了很多机会，特别是在低收入和中等收入国家。

执行摘要

信息3. 各国可以通过以影响大、可负担的干预措施为重点将政治承诺落实为行动显然，在预防控制非传染性疾病方面进展不足并不是因为缺少干预措施。非传染性疾病发病率和死亡率高是由于在具有成本效益的干预措施方面投入不足，特别是在低收入和中等收入国家。应战略性使用资源以改善非传染性疾病结局。所有国家都可以通过优先落实非常具有成本效益的政策和干预措施（最合算措施）将承诺转化为行动。

作（跨部门合作）是公平地预防控制非传染性疾病并实现国家目标的关键。需要在预防控制非传染性疾病规划的计划阶段就建立促进多部门和跨部门合作的机制和进程，并在整个实施、公共政策制订以及监督和评估过程中加以利用。

信息6. 投资于卫生系统对于改善非传染性疾病结局至关重要对卫生系统的分析表明，卫生系统关键要素的差距对于为非传染性疾病患者提供公平的卫生保健服务形成了障碍。加强卫生系统——包括卫生供资、治理、卫生人力、卫生信息、医疗产品和技术以及卫生服务的提供——应成为扩大预防控制非传染性疾病工作的主要关注点。全球努力实现全民健康覆盖提供了机遇，可以明确将非常具有成本效益的非传染性疾病干预措施确定为一揽子基本福利的重点。

信息4. 所有国家都需要制定预防控制非传染性疾病国家目标并对其问责 9个自愿性全球目标清晰表明到2025 年全世界在预防控制非传染性疾病方面可以取得哪些成就。所有国家都需要制定国家目标并建立监督框架跟踪的进展情况。鉴于全球目标集中关注有限数量的重要非传染性疾病结局，制定国家目标并落实相关政策和干预措施将使各国能够实现资源的最佳利用。为取得最佳结果，应通过业务研究尽快将实施过程中的经验教训纳入决策。

信息7. 需要加强预防控制非传染性疾病的机构和人力资源能力实现国家目标需要有处理与预防控制非传染性疾病相关的复杂问题（例如与食品和农业系统、法律、贸易、交通运输和城市规划之间的联系）的机构和人力资源能力。将需要加强卫生人力队伍处理非传染性疾病的技能和能力，包括通过将预防控制非传染性疾病的公共卫生因素纳入对医疗人员、护理人员和辅助卫生工作者的教学课程并提供在职培训。 xi

信息5. 需要建立开展多部门和跨部门合作的结构和进程卫生以外各部门的合作（多部门合作）以及政府和非国家行为者之间的合

2014年全球非传染性疾病现状报告

各国政府必须继续承担其应对非传染性疾病挑战并为此制定国家目标和行动计划的首要责任。同时，实现全球目标需要在国家、区域和全球层面都有社会所有部门的努力和参与。已经建立了加快各国预防控制非传染性疾病行动的新全球机制。2013年6月，联合国秘书长建立了联合国预防控制非传染性疾病机构间工作队。该工作队由世卫组织牵头，正在协调相关联合国组织和其它政府间组织的活动，以支持实现世界领导人在2011年政治宣言中所作承诺，特别是通过实施世卫组织2013-2020年预防控制非传染性疾病全球行动计划。2014年 7月，联合国经社理事会通过工作队职权范围。2014年9月，世卫组织建立世卫组织预防和控制非传染性疾病全球协调机制，以促进并加强会员国、联合国组织和非国家行为者之间的活动协调，从而有助于实施全球行动计划。世卫组织在促进和监督预防控制非传染性疾病的行动中应发挥领导和协调作用。作为负责卫生的主要联合国专门机构，世卫组织将继续支持各国实施全球行动计划的努力。2015年及以后继续采取行动的重要领域包括向会员国提供技术援助，以制定预防控制非传染性疾病国家目标，制定并落实实现目标的国家政策和计划，评估趋势并监测进展。2015年，世卫组织计划完成相关工作，确定促进各国卫生和非卫生部门共同行动的框架以及登记并公布非国家行为者为实现9个自愿性全球目标所做贡献的方法。有效处理非传染性疾病流行的全球架构和国家承诺处于历史上最好的时期。到2025年实现9个预防控制非传染性疾病全球目标将遏制非传染性疾病的快速增长 xii

及其破坏性卫生和社会经济影响。这是一个充满挑战的艰巨任务。但是，子孙后代不会原谅我们的无所作为。如果我们错失这一改变历史的机遇，他们有权质问我们为什么没有采取决定性行动。

心血管疾病、癌症、糖尿病或慢性呼吸疾病总死亡率相对减少25% 酌情根据本国国情将有害使用酒精至少相对减少10%

身体活动不足流行率相对减少10% 人口平均盐/钠摄入量相对减少30%

当前烟草使用流行率相对减少30%

根据国情使高血压流行率相对减少25%或者遏制高血压流行遏制糖尿病和肥胖症的上升至少50%的符合条件者接受预防心脏病发作和脑卒中的药物治疗及咨询（包括控制血糖）

在80%的公立和私营医疗卫生机构，可提供经济可负担的，治疗主要非传染性疾病所需的基本技术和基本药物，包括仿制药

www.who.int/ncd

WHO/NMH/NVI/15.1

2014 2014

INFORME SOBRE LA SITUACIÓN MUNDIAL Доклад о ситуации в области неинфекционных заболеваний в мире de las enfermedades no transmisibles “Достижение девяти глобальных целей по НИЗ, общая ответственность”

неинфекционных заболеваний в мире 2014 “Достижение девяти глобальных целей по НИЗ, общая ответственность”

Доклад о ситуации в области

Выражение признательности В подготовке и выпуске настоящего доклада приняли участие следующие лица, которые работали под руководством помощника Генерального директора Олега Честнова: Канцелярия Генерального директора (консультации и руководство) Anarfi Asamoa-Baah, заместитель Генерального директора, Chris Dye, Ian Smith Ведущий автор: Shanthi Mendis. Ведущие авторы по главам: Tim Armstrong, Douglas Bettcher, Francesco Branca, Jeremy Lauer, Cecile Mace, Shanthi Mendis, Владимир Позняк, Leanne Riley, Vera Da Costa E Silva, Gretchen Stevens Руководитель проекта: Kwok Cho Tang Сотрудники ВОЗ в Женеве и Лионе: Юлия Баконина, Freddie Bray, Nick Banatvala, Melanie Bertram, Peter Beyer, Monika Bloessner, Alison A’Isha Commar, Edouard Tursan D’Espaignet, Mercedes De Onis, Alexandra Fleischmann, Silvia Franceschi, Etienne Krug, Chizuru Nishida, Colin Mathers, Bente Mikkelsen, Armando Peruga, Dag Rekve, Jane Robertsen, Gojka Roglic, Yasuyuki Sahara, Ruitai Shao, Andreas Ullrich, Meindert Van Hilten, Temo Waqanivalu, Christopher P Wild Сотрудники ВОЗ в региональных и страновых бюро Региональные директора: Африканский регион - Luis Sambo, Регион стран Америки - Carissa Etienne, Регион Восточного Средиземноморья - Ala Alwan, Европейский регион - Jakab Zsuzsanna, Регион Юго-Восточной Азии - Poonam Singh, Регион Западной части Тихого океана -Young-soo Shin Другие сотрудники: Ibtihal Fadhil, Renu Garg, Gauden Galea, Anselm Hennis, Branca Legitic, Samer Jabbour, Frederiek Mantingh, Hai-Rim Shin, Susan Mercado, Steven Shongwe, Slim Slama, Elena Tsoyi, Cherian Varghese Рецензенты со стороны и другие участники George Alleyne, Robert Beaglegole, David Bramley, Joy Carrington, Rajiv Chowdhury, Michael Engelgau, Majid Ezzati, Charlie Foster, Oscar Franco, Valentin Fuster, Gerald Gartlehner, Danaei Goodarz, Vilius Grabauskas, Ian Graham, Murad Hassan, John Harold, Corinna Hawkes, Carl Heneghan, Konstantin Kotenko, Liming Li, Alan Lopez, Gabriel Masset, Jean Claude Mbanya, George Mensah, Rob Moodie, Venkat Narayan, Sania Nishtar, Srinath Reddy, Jurgen Rehm, Mike Rayner, Peter Scarborough, Yackoob Seedat, Surendra Shastri, Priya Shetty, Sidney Smith, Isolde Sommer, Laurence Sperling, David Stuckler, Doug Webb, Kremlin Wickramasinghe, David Wood, Qiao Youlin, Salim Yusuf Административная поддержка: Fabienne Besson, Maritha Osekre-Amey, Joel Tarel, Roelof Wuite Издание настоящей публикации стало возможным за счет щедрой финансовой поддержки со стороны правительств Норвегии и Российской Федерации WHO/NMH/NVI/15.1 © Всемирная организация здравоохранения, 2014 г. Все права защищены. Публикации Всемирной организации здравоохранения имеются на веб-сайте ВОЗ (www. who.int) или могут быть приобретены в Отделе прессы ВОЗ, Всемирная организация здравоохранения, 20 Avenue Appia, 1211 Geneva 27, Switzerland (тел.: +41 22 791 3264; факс: +41 22 791 4857; эл. почта: bookorders@who.int). Запросы на получение разрешения на воспроизведение или перевод публикаций ВОЗ - как для продажи, так и для некоммерческого распространения - следует направлять в Отдел прессы ВОЗ через веб-сайт ВОЗ (http://www.who. int/about/licensing/copyright_form/en/index.html). Обозначения, используемые в настоящей публикации, и приводимые в ней материалы не отражают какого-либо мнения Всемирной организации здравоохранения относительно юридического статуса какой-либо страны, территории, города или района или их органов власти, либо относительно делимитации их границ. Пунктирные линии на географических картах обозначают приблизительные границы, в отношении которых пока еще может быть не достигнуто полное согласие. Упоминание конкретных компаний или продукции некоторых изготовителей не означает, что Всемирная организация здравоохранения поддерживает или рекомендует их, отдавая им предпочтение по сравнению с другими компаниями или продуктами аналогичного характера, не упомянутыми в тексте. За исключением случаев, когда имеют место ошибки и пропуски, названия патентованных продуктов выделяются начальными прописными буквами. Всемирная организация здравоохранения приняла все разумные меры предосторожности для проверки информации, содержащейся в настоящей публикации. Тем не менее, опубликованные материалы распространяются без какой-либо четко выраженной или подразумеваемой гарантии. Ответственность за интерпретацию и использование материалов ложится на пользователей. Всемирная организация здравоохранения ни в коем случае не несет ответственности за ущерб, возникший в результате использования этих материалов.

Обращение Генерального директора Д-р Маргарет Чен Генеральный директор Всемирная организация здравоохранения Мир достиг критической точки в истории борьбы с неинфекционными заболеваниями (НИЗ) и сейчас имеет беспрецедентную возможность изменить ее развитие. Государства-члены ВОЗ согласовали девять добровольных глобальных целей, которые должны быть достигнуты к 2025 году. Это цели по уменьшению вредного употребления алкоголя, распространенности недостаточной физической активности, потребления соли/натрия, употребления табака и распространенности повышенного кровяного давления, а также по прекращению роста числа случаев диабета и ожирения и улучшению охвата лечением для профилактики инфарктов и инсультов. Есть также цель по улучшению доступности и приемлемости по стоимости технологий и основных лекарственных средств для ведения НИЗ. Странам необходимо обеспечить прогресс в отношении всех этих целей для достижения общей цели по сокращению на 25% преждевременной смертности от четырех основных НИЗ к 2025 году. Из 38 миллионов случаев смерти в результате НИЗ в 2012 г. более 40% произошли преждевременно, среди людей в возрасте до 70 лет. Большинство преждевременных случаев смерти от НИЗ предотвратимо. В настоящем докладе представлены обнадеживающие фактические данные, свидетельствующие о том, что преждевременная смертность от НИЗ может быть значительно снижена во всем мире. Во многих странах с высоким уровнем дохода число случаев смерти от сердечно-сосудистых заболеваний значительно уменьшилось благодаря государственной политике, способствующей принятию более здорового образа жизни и предоставлению справедливой медицинской помощи. Необходимо закрепить этот положительный сдвиг и, по возможности, ускорить темпы в развитых странах и воспроизвести этот сдвиг в странах с низким и средним уровнями дохода. НИЗ находятся в зависимости от воздействия глобализации на маркетинг и торговлю, от быстрой урбанизации и старения населения – человек, как и общепринятый сектор здравоохранения, могут лишь в ограниченных пределах контролировать эти факторы. Важно изменить поведение человека, поэтому для борьбы с НИЗ совершенно необходимо обеспечить лидерство на самых высоких уровнях правительства, разрабатывать политику с участием всех подразделений правительства и добиваться прогресса на пути обеспечения всеобщего охвата медицинской помощью. Настоящий доклад предназначается, прежде всего, для министров здравоохранения. Он содержит информацию о добровольных глобальных целях и о путях устойчивой активизации национальных усилий по их достижению. В докладе приводятся базисные оценки смертности от НИЗ за 2010 г. и факторы риска с тем, чтобы страны могли начать сообщать ВОЗ о прогрессе, достигнутом на пути достижения целей, начиная с 2015 года. В докладе отмечается, что целевые исследования в странах в области успешной профилактики НИЗ и борьбы с ними могут быть полезными для других стран, сталкивающихся с аналогичными проблемами. В докладе сообщается о согласованном комплекте высокоэффективных по затратам – и осуществимых в глобальных масштабах – мероприятий по НИЗ для достижения всех девяти целей. Необходимо, чтобы каждая страна проводила их с учетом своих конкретных местных условий и контекста, опираясь на наилучший имеющийся опыт. На Генеральной Ассамблее Организации Объединенных Наций 2014 г. министры согласились с тем, что нет таких причин, по которым какая-либо страна – с низким, средним или высоким уровнем дохода – может отсрочить осуществление этих мероприятий. Отсрочивание действий приведет к усугублению бремени НИЗ и повышению расходов на здравоохранение. Основной идеей второго доклада о ситуации в области НИЗ в мире является то, что сегодня глобальное сообщество имеет возможность изменить развитие эпидемии НИЗ. Сейчас мир имеет действительно глобальную повестку дня в области профилактики НИЗ и борьбы с ними, за которую все страны несут общую ответственность на основе конкретных целей. И ни одна страна не может позволить себе упустить эту историческую возможность для борьбы с эпидемией НИЗ.

iii

Вступление Д-р Олег Честнов Помощник Генерального директора Неинфекционные заболевания и психическое здоровье Всемирная организация здравоохранения

Неинфекционные заболевания (НИЗ) являются одной из основных проблем в области здравоохранения и развития 21-го века как с точки зрения причиняемых ими человеческих страданий, так и с точки зрения их негативного воздействия на социально-экономическую структуру стран, особенно стран с низким и средним уровнями дохода. Ни одно правительство не может себе позволить игнорировать возрастающее бремя НИЗ. При отсутствии основанных на фактических данных действий последствия НИЗ для людей, общества и экономики будут продолжать усугубляться и превысят возможности стран для борьбы с ними. Признавая разрушительное воздействие НИЗ на общество, экономику и общественное здравоохранение, мировые лидеры приняли в сентябре 2011 г. политическую декларацию, содержащую твердые обязательства по борьбе с глобальным бременем НИЗ, и дали Всемирной организации здравоохранения (ВОЗ) ряд поручений для поддержки деятельности в странах. Одним из таких поручений была разработка Глобального плана действий ВОЗ по профилактике неинфекционных заболеваний и борьбе с ними на 2013–2020 гг. (известного как Глобальный план действий по НИЗ), включая девять добровольных глобальных целей и глобальную систему мониторинга. Глобальный план действий по НИЗ и добровольные глобальные цели были приняты Всемирной ассамблеей здравоохранения в 2013 году. Девять добровольных глобальных целей по НИЗ свидетельствуют о том, что страны должны уделять первоочередное внимание действиям, направленным на уменьшение вредного употребления алкоголя, распространенности недостаточной физической активности, потребления соли/натрия, употребления табака и распространенности повышенного кровяного давления, а также на прекращение роста числа случаев диабета и ожирения, улучшение охвата лечением для профилактики инфарктов и инсультов и обеспечение доступа к основным технологиям и лекарственным средствам.

Для поддержки осуществления Глобального плана действий по НИЗ ВОЗ создала Глобальный координационный механизм, который улучшит координацию деятельности по НИЗ, участие различных заинтересованных сторон и деятельность разных секторов. Дополнительную поддержку в осуществлении Глобального плана действий по НИЗ будет оказывать Межучрежденческая целевая группа Организации Объединенных Наций по профилактике НИЗ и борьбе с ними, учрежденная Генеральным секретарем для координации деятельности соответствующих учреждений Организации Объединенных Наций и других межправительственных организаций. Второй доклад о ситуации в области неинфекционных заболеваний в мире выходит всего лишь за 10 лет до срока, намеченного для достижения согласованных на международном уровне добровольных глобальных целей по НИЗ. Это также время, когда мы можем быть более оптимистичными, чем когда-либо ранее в новейшей истории, в отношении будущего развития профилактики НИЗ и борьбы с ними. Для достижения глобальных целей по НИЗ правительства, международные партнеры и ВОЗ должны работать вместе, обмениваться опытом и информацией и принимать необходимые меры для уменьшения пробелов в потенциальных возможностях и ресурсах. Ни одна страна не должна остаться упущенной по мере того, как человечество энергично приступает к решению одной из самых значительных проблем в области общественного здравоохранения 21-м века.

Доклад о ситуации в области неинфекционных заболеваний в мире 2014 г.

Резюме Доклад о положении дел в мире в области профилактики неинфекционных заболеваний (НИЗ) и борьбе с ними является вторым в трехгодичной серии докладов, отслеживающих глобальный прогресс в области профилактики НИЗ и борьбе с ними. Последствия НИЗ для человеческого, социального и экономического измерений ощущают на себе все страны, но особенно разрушительны они для малоимущего и незащищенного населения. Снижение бремени НИЗ в общемировом масштабе является главным приоритетом и необходимым условием для устойчивого развития. НИЗ — наиболее распространенная причина смерти в мире: в 2012 г. из 56 миллионов смертей 38 миллионов (68%) были вызваны именно ими. Более 40% (16 миллионов) умерли преждевременно, не дожив до 70 лет. Почти три четверти всех смертей от НИЗ (28 миллионов) и большинство преждевременных смертей (82%) приходятся на страны с низким и средним уровнем доходов. В 2011–2025 гг. при стабильном сценарии совокупные экономические потери, вызванные НИЗ, в странах с низким и средним уровнем доходов прогнозируются на уровне 7 трлн. долл. США. Бездействие обходится в колоссальную сумму, которая намного превышает годовые затраты на принятие высокоэффективных мер по снижению бремени НИЗ (11,2 млрд. долл. США в год). В сентябре 2011 г. мировые лидеры согласовали «дорожную карту» с конкретными обязательствами по снижению глобального бремени НИЗ, включая обязательство по разработке многосекторальных планов действий и стратегий профилактики НИЗ и борьбе с ними к 2013 году. В целях активизации национальных усилий по НИЗ Всемирная ассамблея здравоохранения в 2013 г. утвердила девять конкретных добровольных глобальных целей на 2025 г. и одобрила комплекс мероприятий в контексте Глобального плана действий ВОЗ по НИЗ на 2013-2020 гг., который при условии его совместного осуществления государствами-членами, международными партнерами и ВОЗ будет способствовать выполнению обязательств, принятых мировыми лидерами в сентябре 2011 года. Этот комплекс мероприятий построен вокруг шести целей, направленных на укрепление национального потенциала и расширение международного сотрудничества для снижения остроты факторов риска, совершенствования систем здравоохранения и отслеживания прогресса в достижении глобальных целей по НИЗ. В июле 2014 г. Генеральная Ассамблея Организации Объединенных Наций провела обзор прогресса, достигнутого в осуществлении Политической декларации 2011 г., и оценила прогресс, достигнутый на национальном уровне с сентября 2011 года. Признав, что прогресс в осуществлении «дорожной карты» обязательств, включенной в Политическую декларацию 2011 г., является недостаточным и крайне неравномерным и что необходимы дальнейшие и более активные усилия, члены Организации Объединенных Наций приняли обязательства в отношении комплекса мер в четырех приоритетных областях, касающихся руководства, профилактики и снижения факторов риска, здравоохранения и эпиднадзора. Эти ограниченные временными рамками меры включают установление национальных целей по НИЗ, соответствующих глобальным целям, разработку национальных многосекторальных планов по НИЗ к 2015 г. и начало реализации этих планов к 2016 г. для достижения национальных целей. Второй доклад о положении дел в мире в области профилактики неинфекционных заболеваний (НИЗ) и борьбе с ними составлен на основе девяти добровольных глобальных целей. В нем содержатся данные по текущей ситуации, приводится информация как о препятствиях, так и о возможностях и приоритетных действиях, необходимых для достижения целей. Кроме того, в доклад включены проведенные в 2010 г. базовые расчеты по связанным с НИЗ факторам риска и смертности, что дает странам возможность сообщать о прогрессе начиная с 2015 года.

Глобальная цель 1: Относительное сокращение на 25% общей смертности от сердечно-сосудистых заболеваний, онкологических заболеваний, диабета или хронических респираторных заболеваний к 2025 г. Прогресс в достижении всех других целей способствует достижению этой главной цели по преждевременной смертности. В Главе 1 представлены данные по смертности в 2012 г., которые говорят о том, что (i) от НИЗ страдают все страны; (ii) особенно тяжелым бременем НИЗ ложатся на страны с низким и средним уровнем доходов; и (iii) большинство

Резюме

преждевременных смертей от НИЗ приходится на страны с низким и средним уровнем доходов. Способность стран достичь этой цели будет сильно варьироваться между разными регионами планеты. Страны с низким и средним уровнем доходов могут ориентироваться на целевой уровень 25%, в то время как страны с высоким уровнем доходов, в которых уже отмечается снижение распространенности основных НИЗ, могут ориентироваться на более амбициозные целевые уровни. В Главе 1 описываются комплексные, многосекторальные стратегии и меры, необходимые для достижения этой цели, а также соответствующий потенциал стран, включая системы регистрации актов гражданского состояния и естественного движения населения и системы эпиднадзора. В условиях нехватки ресурсов во многих странах на приоритетной основе необходимо будет осуществлять наиболее затратоэффективные стратегии и меры («лучшие покупки»).

употребления алкоголя. Из 76 стран, имеющих документально закрепленную национальную политику по алкоголю, 52 предприняли шаги к ее практической реализации. Около 160 государств-членов ВОЗ регулируют возраст, с которого разрешена покупка алкогольных напитков.

Глобальная цель 3: Относительное сокращение распространенности недостаточной физической активности на 10% к 2025 г. Недостаточная физическая активность вызывает 69,3 миллиона ГЖПИ и 3,2 миллиона смертей ежегодно. Взрослые, не занимающиеся физической активностью в достаточной мере, подвержены более высокому риску смертности от любых причин по сравнению с теми, кто по меньшей мере 150 минут в неделю (или эквивалентный период) уделяют физической активности умеренной интенсивности в соответствии с рекомендациями ВОЗ. Регулярная физическая активность снижает риск развития ишемической болезни сердца, инсульта, диабета и рака молочной железы и толстой кишки. В 2014 г. 23% людей старше 18 лет не занимались достаточной физической активностью. Женщины менее активны, чем мужчины, а пожилые люди менее активны, чем молодежь. В 2014 г. 81% подростков в возрасте от 11 до 17 лет были недостаточно физически активны. Девушки менее активны, чем юноши: 78% соответствуют рекомендациям ВОЗ (для подростков мужского пола этот показатель составляет 84%). Несколько развитых стран сообщили об улучшении показателей физической активности за последнее десятилетие в результате осуществления национальных стратегий и программ, направленных на повышение физической активности. В последние годы целый ряд стран с низким и средним уровнем доходов также начали осуществление инициатив для решения проблемы недостаточной физической активности. Достижение целей по физической активности требует многосекторального взаимодействия между органами, отвечающими за транспорт, городское планирование, отдых, спорт и образование, что позволит сформировать безопасную среду, стимулирующую к физической активности самые разные возрастные группы.

Глобальная цель 2: Сокращение вредного употребления алкоголя по меньшей мере на 10% к 2025 г. В 2012 г. употребление алкоголя стало причиной около 5,9% (3,3 миллиона) всех смертей в мире и 5,1 лет жизни с поправкой на инвалидность (ГЖПИ). Более половины этих смертей было вызвано НИЗ. В 2010 г. мировое потребление алкоголя оценивалось в 6,2 л чистого алкоголя на человека старше 15 лет (соответствует 13,5 г чистого спирта в день). Распространенность запойного пьянства коррелирует с общим уровнем употребления алкоголя и выше всего в Европейском и Американском регионах. Существуют затратоэффективные методы регулирования, способствующие снижению вредного употребления алкоголя. К ним относятся политика ценообразования, ограничения в отношении доступа к алкоголю и его сбыта, предоставление более эффективных медико-санитарных услуг, а также нормы и меры по борьбе с вождением в нетрезвом состоянии. Свою эффективность также доказали такие меры индивидуального воздействия, как скрининг на вредное употребление алкоголя и лечение алкогольной зависимости, однако они обходятся дороже, чем меры, ориентированные на население в целом. После принятия Всемирной ассамблеей здравоохранения в 2010 г. Глобальной стратегии сокращения вредного употребления алкоголя в деле борьбы с вредным употреблением алкоголя был достигнут определенный прогресс. Растет число стран, разработавших или пересмотревших национальную политику и планы действий в отношении

Глобальная цель 4: Относительное сокращение на 30% среднего потребления соли среди населения к 2025 г. Чрезмерное потребление пищевой поваренной соли связано с повышенным риском развития

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Доклад о ситуации в области неинфекционных заболеваний в мире 2014 г.

гипертензии и сердечно-сосудистых заболеваний. Около 1,65 миллиона смертей в мире от сердечно-сосудистых заболеваний связаны с чрезмерным потреблением натрия. По текущим оценочным данным, среднее глобальное потребление соли в мире находится на уровне 10 г в день (3,95 г натрия в день). ВОЗ рекомендует сократить потребление соли до менее 5 г в день (2 г натрия в день), что позволит снизить кровяное давление и риск ишемической болезни сердца и инсульта. В одних странах основным источником соли являются переработанные продукты и готовое питание, в других — пищевая соль, добавляемая при приготовлении и употреблении пищи дома. По мере расширения доступа населения стран с низким и средним уровнем доходов к переработанным продуктам питания оно начинает получать больше натрия из этого источника. Как отмечается в Главе 4, для постановки национальных целей и разработки эффективных кампаний для потребителей необходимо определить исходный уровень потребления соли. Цели по снижению потребления натрия необходимо устанавливать для каждой категории продуктов и приоритизировать те, из которых население получает наибольший объем натрия. Министерства здравоохранения всех стран должны играть руководящую роль в разработке и осуществлении стратегий, направленных на снижение потребления соли населением. Эти стратегии должны носить межсекторальный и многодисциплинарный характер и предусматривать участие всех заинтересованных сторон. Они должны подходить для различных условий и включать использование всех имеющихся инструментов, в том числе маркировку, нормотворчество, изменение состава продуктов, налоговые льготы, стимулирующие производство и потребление продуктов питания с пониженным содержанием натрия, а также информационную работу с населением, направленную на эффективную реализацию стратегий. В некоторых странах был достигнут значительный прогресс на этом направлении.

Меры по снижению употребления табака включают: защиту населения от пассивного курения на основе национального законодательства, обеспечивающего «полное отсутствие дыма»; консультации по отказу от курения и работу по информированию населения об опасностях, связанных с употреблением табака; обеспечение исполнения запрета на рекламу, стимулирование продажи и спонсорство табака; а также повышение налогов на табак до уровня, при котором они составят не менее 70% от конечной розничной цены любого табачного изделия. В борьбе против табака в мировом масштабе за последние годы удалось достичь заметного прогресса: выросло как число стран, защищающих свое население от табака, так и число людей по всему миру, охваченных эффективными мерами борьбы против табака. В 2013 г. 95 стран полностью реализовали по меньшей мере одну из мер борьбы против табака, получивших название «лучшая покупка» (крайне затратоэффективные меры), а две страны полностью реализовали все четыре «лучшие покупки». Многие страны, успешно внедряющие «лучшие покупки», относятся к числу стран с низким или средним уровнем доходов. Как утверждают авторы доклада в Главе 5, во многих странах необходимы дополнительные усилия для принятия эффективных мер борьбы против табака. В частности, необходимо вывести меры по снижению спроса из категории «лучшая покупка» на качественно новый уровень, на котором деятельность еще не велась; поддерживать и активизировать осуществление существующих программ, включив в них полный спектр мер; и осуществлять в полной мере РКБТ ВОЗ. Достижения большинства стран в осуществлении мер по снижению спроса на табак говорят о том, что любая страна независимо от ее размера и уровня развития может успешно бороться против табачной эпидемии.

Глобальная цель 5: Относительное сокращение на 30% показателя распространенности употребления табака среди лиц в возрасте от 15 лет к 2025 г. По оценкам, около 6 миллионов человек в год умирают по причинам, связанным с употреблением табака, причем 600 000 человек погибают от пассивного курения (из них 170 000 детей).

Глобальная цель 6: Сокращение на 25% распространенности случаев повышенного кровяного давления или сдерживание распространенности случаев повышенного кровяного давления, в соответствии с национальными условиями, к 2025 г. В 2010 г., по оценкам, повышенное кровяное давление стало причиной смерти 9,4 миллиона человек и 7% бремени болезней (в ГЖПИ). Без лечения повышенное кровяное давление приводит к инсульту, инфаркту миокарда, сердечной недостаточности, деменции, почечной недостаточности и слепоте.

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Существуют убедительные научные данные в пользу того, что снижение кровяного давления посредством как мер, ориентированных на население в целом, так и индивидуальных мер (поведенческого и фармакологического характера) полезно для здоровья. Общемировой показатель распространенности случаев повышенного кровяного давления (систолическое и/или диастолическое кровяное давление составляет или превышает 140/90 мм рт. ст.) среди лиц 18 лет и старше в 2014 г. составил 22%. Высокая распространенность случаев повышенного кровяного давления обусловлена многочисленными факторами, поддающимися изменению. К ним относятся употребление в пищу продуктов, содержащих слишком много соли и жира, недостаток в рационе фруктов и овощей, избыточный вес и ожирение, вредное употребление алкоголя, недостаточная физическая активность, психологический стресс, социально-экономические детерминанты и недостаточный доступ к медико-санитарным услугам. Выявление, лечение и контроль по всему миру оставляют желать лучшего из-за несовершенства систем здравоохранения, особенно на уровне первичной медико-санитарной помощи. Для достижения этой цели необходимо проводить стратегии и принимать меры, ориентированные на население в целом и воздействующие на поддающиеся изменению факторы риска. Кроме того, необходимо разрабатывать и внедрять комплексные программы в сфере первичной медико-санитарной помощи для повышения эффективности выявления и лечения гипертензии и других сердечно-сосудистых факторов риска на основе принципов учета всех факторов риска, как рекомендует ВОЗ.

формированию среды, способствующей поддержанию должного уровня физической активности. Лица, находящиеся в группе высокого риска по диабету, могут снизить его за счет умеренного похудения и ежедневной умеренной физической активности. В небольшом числе стран с высоким уровнем доходов соответствующими мерами удалось охватить все население. Однако в странах с низким и средним уровнем доходов масштабное принятие таких мер осложнено, частично потому, что современные методы выявления лиц, подвергающихся высокому риску, неудобны и весьма дорогостоящи. Существует острая необходимость в проведении оценки эффективности мер профилактики ожирения и диабета.

Глобальная цель 8: Получение к 2025 г. по крайней мере 50% людей, которым это необходимо, лекарственной терапии и консультирования (включая гликемический контроль) для предотвращения инфаркта и инсульта В 2012 г. сердечно-сосудистые заболевания стали наиболее распространенной причиной смертности от НИЗ: на их долю пришлось 17,5 миллиона смертей (46% от всех смертей, вызванных НИЗ). Из них около 7,4 миллиона смертей были вызваны инфарктом (ишемической болезнью сердца), а 6,7 миллиона — инсультом. Цель по снижению распространенности инфаркта и инсульта подразумевает расширение охвата лекарственной терапии и консультирования населения с повышенным риском развития сердечно-сосудистых заболеваний и с диагностированными заболеваниями. Это доступные по стоимости мероприятия, которые можно проводить в рамках первичной медико-санитарной помощи даже в условиях дефицита ресурсов. Охват населения мероприятиями по профилактике инфаркта и инсульта крайне неравномерен, особенно в странах с низким и средним уровнем доходов. Основные причины этого следующие: затрудненный доступ к базовым услугам первичной медико-санитарной помощи, нехватка лекарственных средств и лабораторных исследований, ненадлежащие методы клинической практики и несоблюдение пациентами рекомендаций по лечению. В целях продвижения к всеобщему охвату услугами здравоохранения мероприятия по профилактике инфаркта и инсульта необходимо включать в базовый пакет медицинских услуг. Кроме того, следует с учетом конкретного контекста разработать стратегии устранения многочисленных пробелов в

Глобальная цель 7: Прекращение роста числа случаев диабета и ожирения к 2025 г. Ожирение повышает вероятность развития диабета, гипертензии, ишемической болезни сердца, инсульта и некоторых видов рака. В мировом масштабе распространенность ожирения выросла почте в два раза. В 2014 г. 10% мужчин и 14% женщин в возрасте 18 лет и старше страдали ожирением. В 2013 г. более 42 миллиона детей младше 5 лет имели лишний вес. Глобальная распространенность диабета в 2014 г. оценивается в 10%. Ожирение и диабет поддаются профилактике на основе многосекторальных усилий, нацеленных одновременно на различные сектора, участвующие в производстве, сбыте и маркетинге продуктов питания. Параллельно необходимо вести работу по

Доклад о ситуации в области неинфекционных заболеваний в мире 2014 г.

системах здравоохранения, связанных с доступом к базовым технологиям и лекарственным средствам, медицинскими кадрами, оказанием услуг, информированием и направлением пациентов, обращая при этом особое внимание на первичную медико-санитарную помощь.

Глобальная цель 9: Достижение к 2025 г. как в частных, так и в государственных учреждениях здравоохранения 80% уровня наличия базовых технологий и основных лекарственных средств (включая препараты-генерики), необходимых для лечения основных неинфекционных заболеваний Данная цель связана с наличием определенного уровня технологий и лекарственных средств для осуществления затратоэффективных мероприятий первичной медико-санитарной помощи по борьбе против сердечно-сосудистых заболеваний, диабета и астмы. Перечень основных лекарственных средств включает аспирин, статин, ингибитор ангиотензинпревращающего фермента, тиазидный диуретик, блокатор кальциевых каналов пролонгированного действия, метформин, инсулин, бронходилататор и стероидный ингаляционный препарат. В перечень базовых технологий входят, как минимум, прибор для измерения кровяного давления, весы, средства для измерения уровня сахара и холестерина в крови (тест-полоски) и анализ альбумина в моче с помощью полосок. Без выполнения этих минимальных требований невозможно осуществление даже базовых мероприятий по НИЗ на уровне первичной медико-санитарной помощи. В настоящее время сохраняется множество проблем, связанных с доступностью и наличием базовых технологий и основных лекарственных средств, особенно в странах с низким и средним уровнем доходов. Из-за ограниченного доступа пациенты поздно обращаются за лечением, что может приводить как к появлению осложнений, которых можно было бы избежать, так и к необходимости оплачивать дорогостоящие медицинские услуги из своего кармана, что может разорить домохозяйство. Необходимо устойчивое финансирование здравоохранения, которое позволило бы наладить эффективные и надежные системы закупок и сбыта, гарантирующие поставки технологий и основных лекарственных средств от НИЗ на всех уровнях здравоохранения, включая первичную медико-санитарную помощь. Соответственно, национальная политика, направленная на обеспечение доступности базовых медицинских технологий и лекарственных

средств, должна играть центральную роль в усилиях по достижению всеобщего охвата услугами здравоохранения. Лекарственные средства должны использоваться надлежащим образом, поэтому необходимо обеспечить соответствие основанным на фактических данных руководящим принципам и вести работу по разъяснению принципов их рационального применения как медикам, так и пациентам. Стратегии и мероприятия, направленные на достижение этих девяти целей (главы 1–9), должны получить высокий приоритет и финансироваться из бюджетов национальных многосекторальных планов действий по НИЗ. В Главе 10, посвященной разработке национального многосекторального плана по НИЗ, перечислены ключевые аспекты НИЗ, которые необходимо учесть: руководство, профилактика, здравоохранение, эпиднадзор и мониторинг. Для повышения вероятности успешной реализации процесс разработки плана должен в обязательном порядке охватывать все заинтересованные стороны как в секторах, связанных со здравоохранением, так и в других секторах, включая гражданское общество и частный сектор. В последней главе предлагаются пути достижения девяти добровольных глобальных целей к 2025 г. и подчеркиваются основные выводы доклада.

Вывод 1. НИЗ являются ключевой движущей силой устойчивого развития Данные доклада свидетельствуют о том, что НИЗ присутствуют во всех странах и что наиболее тяжелым бременем смертности и заболеваемости они ложатся на страны с низким и средним уровнем доходов. Потери производительности, связанные с преждевременной смертностью, и личные и национальные расходы на борьбу против НИЗ являются серьезными препятствиями для сокращения масштабов нищеты и устойчивого развития. Таким образом, прогресс в достижении целей по НИЗ имеет ключевое значение для достижения целей в области устойчивого развития.

Вывод 2. Некоторые страны идут правильным путем к достижению глобальных целей по НИЗ, но большинство сбились с курса Как свидетельствуют многие обнадеживающие тематические исследования, страны, политические лидеры которых продемонстрировали твердую

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приверженность решению проблемы НИЗ, уже добились значительных успехов в этой области. Однако прогресс остается неравномерным и недостаточным. В докладе говорится о многочисленных упущенных возможностях по укреплению руководства, профилактики, здравоохранения, а также эпиднадзора и мониторинга, особенно в странах с низким и средним уровнем доходов.

Вывод 5. Необходимо сформировать структуры и процессы для многосекторального и межсекторального взаимодействия Взаимодействие между секторами помимо здравоохранения (многосекторальное взаимодействие) и между государственными и негосударственными структурами (межсекторальное взаимодействие) имеет ключевое значение как для профилактики НИЗ и борьбы с ними при соблюдении принципов справедливости, так и для достижения национальных целей. Механизмы и процессы содействия многосекторальному и межсекторальному взаимодействию должны быть предусмотрены на этапе планирования программ по НИЗ, при этом они должны функционировать на этапах осуществления, проведения государственной политики, мониторинга и оценки.

Вывод 3. Страны могут переходить от политических обязательств к практической работе путем приоритизации высокоэффективных и доступных по стоимости мероприятий Очевидно, что главным препятствием, обусловившим недостаточный прогресс в деле профилактики НИЗ и борьбы с ними, является вовсе не недостаточное число проводимых мероприятий. Высокие показатели смертности и заболеваемости, особенно в странах с низким и средним уровнем доходов, отражают недостаточный уровень инвестиций в затратоэффективные мероприятия по НИЗ. Для улучшения результатов работы по НИЗ необходимо расходовать ресурсы стратегически. Все страны могут переходить от политических обязательств к практической работе путем приоритизации высокоэффективных и доступных по стоимости стратегий и мероприятий («лучшие покупки»).

Вывод 6. Инвестиции в системы здравоохранения имеют принципиальное значение для улучшения результатов по НИЗ Анализ систем здравоохранения говорит о том, что пробелы в ключевых элементах системы здравоохранения затрудняют справедливое предоставление услуг здравоохранения людям с НИЗ. Укрепление систем здравоохранения, в том числе таких аспектов, как финансирование здравоохранения, руководство, медицинские кадры, медико-санитарная информация, медицинские товары и технологии и оказание медико-санитарной помощи, должно осуществляться на приоритетной основе в рамках активизации работы по профилактике НИЗ и борьбе с ними. Глобальный переход к всеобщему охвату услугами здравоохранения дает возможность явным образом приоритизировать затратоэффективные мероприятия по НИЗ в базовых пакетах медико-санитарных услуг.

Вывод 4. Все страны должны установить национальные цели по НИЗ и нести ответственность за их достижение Девять добровольных глобальных целей дают хорошее представление о том, как к 2025 г. может измениться положение в мире в том, что касается НИЗ. Все страны должны поставить себе национальные цели и наладить систему мониторинга для отслеживания прогресса в достижении этих целей. Учитывая, что глобальные цели ориентированы на ограниченный перечень ключевых конечных результатов по НИЗ, постановка национальных целей и реализация соответствующих стратегий и мероприятий позволит странам использовать ресурсы максимально эффективно. Для достижения наилучших результатов уроки, извлеченные из осуществления, следует оперативно использовать при принятии решений на основе оперативных исследований.

Вывод 7. Необходимо укреплять институциональный и человеческий потенциал в области профилактики НИЗ и борьбы с ними Достижение национальных целей требует наличия институционального и кадрового потенциала,

Доклад о ситуации в области неинфекционных заболеваний в мире 2014 г.

достаточного для решения сложных проблем, связанных с профилактикой НИЗ и борьбой с ними, таких как взаимосвязь между продовольственными и сельскохозяйственными системами, нормативно-правовой базой, торговлей, транспортом и городским планированием. Компетентность и потенциал кадров здравоохранения в области НИЗ необходимо будет усилить, в том числе путем включения аспектов общественного здравоохранения, связанных с профилактикой НИЗ и борьбой с ними, в учебные планы медико-санитарного и сестринского персонала, а также проведения специализированной подготовки на местах. Несомненно, правительства стран должны признавать, что на них лежит основная ответственность по реагированию на проблему НИЗ, устанавливать национальные цели и разрабатывать национальные планы действий, но достижение глобальных целей потребует усилий и участия всех секторов общества на национальном, региональном и глобальном уровнях. Появились новые глобальные механизмы, призванные ускорить осуществление национальных мер по НИЗ. Межучрежденческая целевая группа Организации Объединенных Наций по профилактике НИЗ и борьбе с ними, которую Генеральный секретарь учредил в июне 2013 г. и поместил под управление ВОЗ, координирует деятельность соответствующих учреждений Организации Объединенных Наций и других межправительственных организаций, содействуя выполнению обязательств, принятых мировыми лидерами в Политической декларации по вопросу о НИЗ 2011 г., в частности, посредством осуществления Глобального плана действий ВОЗ по НИЗ на 2013-2020 годы. Круг ведения Целевой группы был принят Экономическим и Социальным Советом Организации Объединенных Наций в июле 2014 года. В сентябре 2014 г. ВОЗ учредила Глобальный координационный механизм ВОЗ по профилактике НИЗ и борьбе с ними, призванный обеспечивать и совершенствовать координацию действий различных государств-членов, учреждений системы Организации Объединенных Наций и негосударственных структур в интересах осуществления Глобального плана действий ВОЗ по НИЗ на 2013–2020 годы. ВОЗ играет руководящую и координирующую роль, содействуя деятельности по решению проблемы НИЗ и контролируя ее эффективность. Как основное специализированное учреждение Организации Объединенных Наций по охране здоровья, ВОЗ продолжит поддерживать принимаемые странами меры по НИЗ в целях осуществления Глобального плана действий ВОЗ по НИЗ на

2013–2020 годы. В 2015 г. и далее ключевыми направлениями работы будут следующие: предоставление государствам-членам технической помощи в постановке национальных целей, разработка и осуществление национальных стратегий и планов по НИЗ в целях достижения поставленных целей, отслеживание тенденций и оценка прогресса. В 2015 г. ВОЗ планирует завершить работу над платформой, призванной помогать странам вести деятельность, охватывающую различные сектора (не только сектор здравоохранения), а также над подходом, позволяющим вести учет и публиковать информацию о вкладе негосударственных структур в достижение девяти добровольных глобальных целей. Глобальная архитектура и приверженность стран действенной борьбе против эпидемии НИЗ создали крайне благоприятные условия для решения этой проблемы. Достижение девяти глобальных целей по НИЗ к 2025 г. позволит приостановить стремительный рост эпидемии НИЗ и смягчить ее разрушительные последствия для здоровья населения, экономики и жизни общества. Это масштабная задача, и решить ее будет непросто. Однако будущие поколения не простят нам бездействия. Если мы упустим эту возможность изменить историю, у наших потомков будет право спросить, почему мы не приняли решительные меры, когда могли это сделать.

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Относительное сокращение на 25% общей смертности от сердечно-сосудистых заболеваний, онкологических заболеваний, диабета и хронических респираторных болезней Относительное сокращение вредного употребления алкоголя, по меньшей мере, на 10%, в соответствующих случаях, с учетом национальных условий

Относительное сокращение на 10% распространенности недостаточной физической активности

Относительное сокращение на 30% среднего потребления соли/натрия среди населения

Относительное сокращение на 30% текущей распространенности употребления табака Относительное сокращение на 25% распространенности повышенного кровяного давления или сдерживание распространенности повышенного кровяного давления в соответствии с национальными обстоятельствами

Прекращение роста числа случаев диабета и ожирения Обеспечение, по меньшей мере, для 50% людей, имеющих соответствующие показатели, лекарственной терапии и консультирования (включая гликемический контроль) для профилактики инфаркта и инсульта Достижение как в государственных, так и в частных учреждениях здравоохранения 80% уровня наличия базисных технологий и основных лекарственных средств, включая лекарства-генерики, необходимых для лечения основных инфекционных заболеваний

www.who.int/ncd

‫‪WHO/NMH/NVI/15.1‬‬

‫عن الأمرا�ض غير ال�سارية ‪2014‬‬ ‫بلوغ الغايات العالمية الت�سع المتعلقة بالأمرا�ض غير ال�سارية م�س�ؤولية م�شتركة‬

‫تقريرالحالةالعالمي‬

‫�شكر وتقدير‬ ‫قام األشخاص التالية أسماؤهم بإعداد هذا التقرير وانتاجه تحت رعاية مساعد المدير العام‪ ،‬أوليغ شستنوف‪.‬‬ ‫مكتب المديرة العامة (النصح واإلرشاد) أنارفي أساموا‪-‬باه‪ ،‬نائب المدير العام‪ ،‬كريس داي‪ ،‬إيان سميث‬ ‫كبير المؤلفين شانتي منديس‪ .‬المسؤول عن تقسيم الفصول تيم أرمسترونغ‪ ،‬دوغالس بيتشر‪ ،‬فرانشيسكو برانكا‪ ،‬جيريمي لوير‪ ،‬سيسيل ماس‪ ،‬شانتي منديس‪،‬‬ ‫فالديمير بوزيناك‪ ،‬ليان رايلي‪ ،‬فيرا دا كوستا إي سيلفا ‪ ،‬جريتشين ستيفنز‪.‬‬ ‫مدير المشروع كوك تشو تانغ‬ ‫موظفو المنظمة في جنيف وليون‪ :‬جوليا بوكونينه‪ ،‬فريدي براي‪ ،‬نيك بنتفاال‪ ،‬ميالني بيرترام‪ ،‬بيتر باير‪ ،‬مونيكا بلوسنر‪ ،‬أليسون ألشا كومار‪ ،‬إدوارد تورسام‬ ‫ديسبانت‪ ،‬مرسيدس دي اونيس‪ ،‬الكسندرا فليشمان‪ ،‬سيلفيا فرانشيسكي‪ ،‬إتيان كروغ‪ ،‬شيزورو نيشيدا‪ ،‬كولن ماذرز‪ ،‬بنتي ميكلسن‪ ،‬أرماندو بروغا‪ ،‬داغ ركفي‪،‬‬ ‫جين روبرتسن‪ ،‬جوشكا روغلك‪ ،‬ياسويوكي سحارى‪ ،‬رويتاني شاو‪ ،‬أندرياس أولريش‪ ،‬ميندرت فان هيلتن‪ ،‬تيمو واكينافالو‪ ،‬كريستوفر بي وايلد ‪.‬‬ ‫موظفو المنظمة في المكاتب اإلقليمية والقطرية‬ ‫المديرون اإلقليميون‪ :‬اإلقليم األفريقي ‪ -‬لويس سامبو ‪ ،‬وإقليم األمريكتين‪ -‬كاريسا فاوستينا إتيين ‪ ،‬وإقليم شرق المتوسط عالء علوان‪ ،‬واإلقليم األوروبي ‪ -‬سوزانا‬ ‫جاكاب ‪ ،‬وإقليم جنوب شرق آسيا‪ -‬بونام سينغ‪ ،‬وإقليم غرب المحيط الهادي ‪-‬يونغ سو شين ‪.‬‬ ‫موظفون آخرون‪ :‬ابتهال فاضل‪ ،‬رينو جارج‪ ،‬غاودن غاليا‪ ،‬أنسلم هنيس‪ ،‬برانكا لجتيك‪ ،‬سامر جبور‪ ،‬فردريك هانتينغ‪ ،‬هاي‪-‬ريم شين‪ ،‬سوزان ميركادو‪ ،‬ستيفن‬ ‫شونغوي‪ ،‬سليم سالمه‪ ،‬ايلينا تسويي‪ ،‬شيريان فارغيز‬ ‫المراجعون الخارجيون وأخرون‬ ‫جورج آلن‪ ،‬روبرت بيغليغول‪ ،‬ديفيد براملي‪ ،‬جوي كارينغتون‪ ،‬راجيف تشودري‪ ،‬مايكل إنجلجاو‪ ،‬ماجد عزتي‪ ،‬تشارلي فوستر‪ ،‬أوسكار فرانكو‪ ،‬فالنتين فوستر‪،‬‬ ‫جيرالد جارتلنهر‪ ،‬دانيال جودارز‪ ،‬فليوس غرابسكس‪ ،‬ايان غراهام‪ ،‬مراد حسن‪ ،‬جون هارولد‪ ،‬كورينا هوكس كارل هنجهام‪ ،‬كونستانتين كونتنكو‪ ،‬ليمينغ لي‪ ،‬أالن‬ ‫لوبيز‪ ،‬غابرييل ماسيه‪ ،‬جان كلود مبنيه‪ ،‬جورج منساه‪ ،‬روب مودي‪ ،‬فينكات نارايان‪ ،‬سانيا نيشتار‪ ،‬سريناث ريدي‪ ،‬يورغن دايان ريم‪ ،‬مايك راينر‪ ،‬بيتر سكاربورو‪،‬‬ ‫يعقوب سيدات ‪ ،‬سوريندرا شاستري‪ ،‬بريا شيتي‪ ،‬سيدني سميث‪ ،‬إيزولده سومر‪ ،‬لورانس سبيرلينغ‪ ،‬ديفيد ستاكلر‪ ،‬دوغ ويب‪ ،‬الكرملين ويكراماسنجي‪ ،‬ديفيد‬ ‫وود‪ ،‬تشياو يولين‪ ،‬سالم يوسف‪.‬‬ ‫الدعم اإلداري فابيان بيسون‪ ،‬ماريتا أوسكري أميه ‪ ،‬جويل تارل‪ ،‬رويلوف يوتي‬ ‫تمت طباعة هذا المنشور بفضل ما قدمته حكومة النرويج وحكومة االتحاد الروسي من دعم مالي سخي‪.‬‬

‫‪WHO/NMH/NVI/15.1‬‬

‫© منظمة الصحة العالمية ‪2014‬‬ ‫جميع الحقوق محفوظة‪ .‬يمكن الحصول على مطبوعات منظمة الصحة العالمية من على موقع المنظمة اإللكتروني (‪ )www.who.int‬أو شراءها من‬ ‫قسم الطباعة والنشر‪ ،‬منظمة الصحة العالمية ‪( 20 Avenue Appia, 1211 Geneva 27, Switzerland‬هاتف رقم‪+41 22 791 3264 :‬؛‬ ‫فاكس رقم‪+41 22 791 4857 :‬؛ عنوان البريد اإللكتروني‪ .)bookorders@who.int :‬وينبغي توجيه طلبات الحصول على اإلذن باستنساخ أو‬ ‫ترجمة منشورات منظمة الصحة العالمية ‪ -‬سواء كان ذلك لبيعها أو لتوزيعها توزيعاً غير تجاري ‪ -‬إلى قسم الطباعة والنشر عبر موقع المنظمة اإللكتروني‬ ‫(‪.)http://www.who.int/about/licensing/copyright_form/en/index.html‬‬ ‫والتسميات المستخدمة في هذا المطبوع‪ ،‬وطريقة عرض المواد الواردة فيه‪ ،‬ال تعبر إطالقاً عن رأي منظمة الصحة العالمية بشأن الوضع القانوني ألي بلد‪ ،‬أو‬ ‫إقليم‪ ،‬أو مدينة‪ ،‬أو منطقة‪ ،‬أو لسلطات أي منها‪ ،‬أو بشأن تحديد حدودها أو تخومها‪ .‬وتشكل الخطوط المنقوطة على الخرائط خطوطاً حدودية تقريبية قد ال‬ ‫يوجد بعد اتفاق كامل عليها‪.‬‬ ‫وذكر شركات بعينها أو منتجات جهات صانعة معينة ال يعني أن هذه الشركات والمنتجات معتمدة‪ ،‬أو موصى بها من قبل منظمة الصحة العالمية‪ ،‬تفضيالً لها‬ ‫على سواها مما يماثلها ولم يرد ذكره‪ .‬وفيما عدا الخطأ والسهو‪ ،‬تميز أسماء المنتجات المسجلة الملكية بوضع خط تحتها‪.‬‬ ‫ن المواد المنشورة توزع‬ ‫وقد اتخذت منظمة الصحة العالمية كل االحتياطات المعقولة للتحقق من صحة المعلومات الواردة في هذا المطبوع‪ .‬ومع ذلك فإ ّ‬ ‫دون أي ضمان من أي نوع صريحاً كان أو ضمنياً‪ .‬والقارئ هو المسؤول عن تفسير واستعمال المواد المنشورة‪ .‬والمنظمة ليست مسؤولة بأي حال عن األضرار‬ ‫التي تترتب على استعمال هذه المواد‪.‬‬

‫ر�سالة موجهة من المديرة العامة‬ ‫الدكتورة مارغريت تشان‬ ‫المديرة العامة‬ ‫منظمة الصحة العالمية‬ ‫الحكومة ووضع سياسات تشارك فيها جميع الدوائر الحكومية‬ ‫وإحراز تقدم صوب بلوغ التغطية الصحية الشاملة‪.‬‬ ‫ووزراء الصحة هم الجمهور الذي يستهدفه أساساً هذا التقرير‬ ‫الذي يورد معلومات عن الغايات العالمية االختيارية وعن كيفية‬ ‫توسيع نطاق الجهود الوطنية الرامية إلى بلوغ تلك الغايات بطريقة‬ ‫مستدامة‪ .‬وترد ههنا التقديرات األساسية لعام ‪ 2010‬بشأن الوفيات‬ ‫الناجمة عن األمراض غير السارية وعوامل خطر تلك األمراض كيما‬ ‫يتسنى للبلدان أن تبدأ في تزويد المنظمة بتقارير عن التقدم المحرز‬ ‫ء من عام ‪ .2015‬وبإمكان الجهات‬ ‫في بلوغ الغايات المذكورة ابتدا ً‬ ‫األخرى التي تواجه تحديات مماثلة أن تستفيد من دراسات الحالة‬ ‫القطرية التي يبرزها التقرير فيما يتعلق بالجهود الناجحة للوقاية‬ ‫من األمراض غير السارية ومكافحتها‪.‬‬ ‫ويناقش هذه التقرير مجموعة متفق عليها من التدخالت العالية‬ ‫المردودية للغاية والمطبقة على الصعيد العالمي بشأن األمراض‬ ‫غير السارية من أجل بلوغ الغايات العالمية التسع بحلول عام ‪،2025‬‬ ‫التي يلزم أن يطبقها كل بلد ضمن نطاق الظروف والسياقات المحلية‬ ‫ينات المتاحة‪ .‬واتفق‬ ‫السائدة فيه تحديدا ً وباالستناد إلى أفضل الب ّ‬ ‫الوزراء الذين اجتمعوا في الجمعية العامة لألمم المتحدة في شهر‬ ‫تموز‪ /‬يوليو ‪ 2014‬على أنهم ال يرون أية أسباب تبرر تأخر أي بلد‬ ‫ سواء كان دخله منخفضاً أم متوسطاً أم مرتفعاً – عن المضي قدماً‬‫في التنفيذ‪ ،‬فالتأخير في اتخاذ اإلجراءات يسفر عن تفاقم عبء‬ ‫األمراض غير السارية وزيادة تكاليف الرعاية الصحية‪.‬‬ ‫ويوجه التقرير العالمي الثاني عن األمراض غير السارية رسالة هامة‬ ‫للغاية مؤداها أن المجتمع العالمي أمامه اليوم فرصة لتغيير مسار‬ ‫وباء األمراض المذكورة‪ ،‬وأن العالم لديه اآلن جدول أعمال عالمي‬ ‫فعلي بشأن الوقاية من تلك األمراض ومكافحتها بالتالزم مع تقاسم‬ ‫البلدان كافة لمسؤولياتها في هذا المضمار باالستناد إلى غايات‬ ‫وتها لعالج‬ ‫ملموسة‪ ،‬فهذه فرصة تاريخية ال يمكن ألي بلد أن يف ّ‬ ‫وباء األمراض غير السارية‪.‬‬ ‫لقد وصل العالم إلى نقطة حاسمة في‬ ‫تاريخ األمراض غير السارية‪ ،‬وأمامه‬ ‫فرصة غير مسبوقة لتغيير مساره‪ .‬واتفقت الدول األعضاء في‬ ‫منظمة الصحة العالمية (المنظمة) على مجموعة محددة بإطار‬ ‫رر بلوغها بحلول‬ ‫زمني مكونة من تسع غايات عالمية اختيارية تق ّ‬ ‫عام ‪ .2025‬وثمة غايات أخرى بشأن الحد من تعاطي الكحول على‬ ‫نحو ضار‪ ،‬وقلّة النشاط البدني‪ ،‬والمدخول من الملح‪ /‬الصوديوم‪،‬‬ ‫وتعاطي التبغ وارتفاع ضغط الدم‪ ،‬ووقف الزيادة في معدالت داء‬ ‫السكري والسمنة‪ ،‬وتحسين التغطية بالعالج للوقاية من النوبات‬ ‫القلبية والسكتات الدماغية‪ .‬ويوجد أيضاً غاية بشأن تحسين توافر‬ ‫التكنولوجيات واألدوية األساسية بأسعار معقولة لعالج األمراض‬ ‫غير السارية‪ .‬ويلزم أن تحرز البلدان تقدماً فيما يخص جميع هذه‬ ‫الغايات لبلوغ الغاية الشاملة بشأن تقليص معدل الوفيات المبكرة‬ ‫من جراء األمراض غير السارية األربعة األساسية بنسبة ‪ ٪25‬بحلول‬ ‫عام ‪.2025‬‬ ‫ومن بين الوفيات الناجمة عن األمراض غير السارية التي بلغ عددها‬ ‫‪ 38‬مليون وفاة في عام ‪ ،2012‬كان نصفها تقريباً من الوفيات المبكرة‬ ‫مني بها أفراد تتراوح أعمارهم بين ‪ 30‬و‪ 70‬عاماً‪ ،‬ومعظمها‬ ‫التي ُ‬ ‫جعة تثبت فعالً أنه‬ ‫يمكن الوقاية منه‪ .‬ويورد هذا التقرير بيّنات مش ّ‬ ‫يمكن تقليل الوفيات المبكرة بشكل كبير في جميع أنحاء العالم‪ ،‬إذ‬ ‫جرى تخفيض الوفيات الناجمة عن أمراض القلب واألوعية الدموية‬ ‫تخفيضاً كبيرا ً في العديد من البلدان المرتفعة الدخل بفضل سياسات‬ ‫الحكومات التي تسهل اعتماد أنماط حياة صحية وتوفير رعاية‬ ‫صحية منصفة‪ .‬وال بد من إدامة هذا التحول المالئم وتعجيله‪ ،‬إن‬ ‫أمكن‪ ،‬في البلدان المتقدمة وتكراره في البلدان المنخفضة الدخل‬ ‫وتلك المتوسطة الدخل‪.‬‬ ‫واألمراض غير السارية مدفوعة بآثار العولمة على التسويق والتجارة‬ ‫والتوسع الحضري السريع وشيخوخة السكان – وهي عوامل تكاد‬ ‫ّ‬ ‫تخرج عن سيطرة الفرد وتضعف إزاءها أيضاً حيلة القطاع الصحي‬ ‫التقليدي‪ .‬ومع أن تغيير سلوكيات الفرد ضروري فإن عالج األمراض‬ ‫غير السارية نهائياً يستدعي توفير قيادة على أعلى مستويات‬

‫‪iii‬‬

‫تمهيد‬ ‫الدكتور أوليغ تشيسنوف‬ ‫المدير العام المساعد‬ ‫دائرة األمراض غير السارية والصحة النفسية‬ ‫منظمة الصحة العالمية‬ ‫والعمل عبر مختلف القطاعات‪ .‬وستحظى خطة العمل المذكورة‬ ‫بمزيد من الدعم من فرقة عمل األمم المتحدة المشتركة بين‬ ‫الوكاالت والمعنية بالوقاية من األمراض غير السارية (المعدية)‬ ‫ومكافحتها‪ ،‬التي أنشأها األمين العام لتنسيق عمل المؤسسات‬ ‫المعنية التابعة لألمم المتحدة وسائر المنظمات الحكومية الدولية‪.‬‬ ‫ويأتي تقرير الحالة العالمي الثاني هذا في وقت لم يبق فيه أمامنا‬ ‫سوى عقد واحد من الزمن لبلوغ الغايات العالمية االختيارية المتفق‬ ‫عليها دولياً‪ ،‬وهو وقت يمكن أن نشعر فيه أيضاً بتفاؤل ربما يفوق‬ ‫تفاؤلنا في أي مرحلة أخرى من التاريخ الحديث حيال مستقبل‬ ‫الوقاية من األمراض غير السارية ومكافحتها‪ .‬وسيلزم لبلوغ الغايات‬ ‫العالمية المتعلقة باألمراض المذكورة أن تعمل الحكومات والجهات‬ ‫ينات والمعلومات‬ ‫الشريكة الدولية والمنظمة يدا ً بيد وتتقاسم الب ّ‬ ‫وتتبادلها وتتخذ ما يلزم من خطوات لتضييق الفجوات التي تتخلل‬ ‫القدرات والموارد‪.‬‬ ‫وينبغي أال يُهمل أي بلد في إطار مضي العالم قدماً بخطى حاسمة‬ ‫في المستقبل صوب التصدي لواحد من أكبر التحديات التي تواجهها‬ ‫الصحة العمومية في القرن الحادي والعشرين‪.‬‬ ‫األمراض غير السارية واحدة من التحديات الصحية واإلنمائية‬ ‫الرئيسية في القرن الحادي والعشرين‪ ،‬سواء من حيث المعاناة‬ ‫اإلنسانية التي تسببها أم األضرار التي تلحقها بالنسيج االجتماعي‬ ‫واالقتصادي للبلدان‪ ،‬وخاص ً‬ ‫ة البلدان المنخفضة الدخل وتلك‬ ‫المتوسطة الدخل‪ ،‬وليس بوسع أي حكومة أن تتجاهل العبء‬ ‫ينات‬ ‫المتزايد لتلك األمراض‪ .‬ونظرا ً لعدم اتخاذ إجراءات مسندة بالب ّ‬ ‫بشأن األمراض المذكورة فإن تكاليفها اإلنسانية واالجتماعية‬ ‫واالقتصادية ستستمر في الزيادة وتتجاوز قدرة البلدان على التصدي‬ ‫لها‪.‬‬ ‫وتسليماً من زعماء العالم في أيلول‪ /‬سبتمبر ‪ 2011‬باآلثار المدمرة‬ ‫التي تخلّفها األمراض غير السارية على المجتمع واالقتصاد والصحة‬ ‫العمومية‪ ،‬فقد اعتمدوا إعالناً سياسياً يتضمن التزامات قوية بشأن‬ ‫التصدي للعبء العالمي لتلك األمراض وكلّفوا المنظمة بعدة مهام‬ ‫لكي تساعد في دعم الجهود التي تبذلها البلدان‪ .‬ومن بين تلك‬ ‫المهام إعداد خطة العمل العالمية للمنظمة والخاصة بالوقاية من‬ ‫األمراض غير السارية ومكافحتها ‪( 2020-2013‬المعروفة باسم خطة‬ ‫العمل العالمية الخاصة باألمراض غير السارية)‪ ،‬بما فيها الغايات‬ ‫العالمية االختيارية التسع وإطار الرصد العالمي‪ .‬وقد اعتمدت‬ ‫جمعية الصحة العالمية خطة العمل العالمية الخاصة باألمراض‬ ‫غير السارية والغايات العالمية االختيارية في عام ‪.2013‬‬ ‫وتؤكد الغايات العالمية االختيارية التسع المتعلقة باألمراض‬ ‫غير السارية على أهمية إعطاء األولوية لعمل البلدان على الحد‬ ‫من تعاطي الكحول على نحو ضار‪ ،‬وانتشار قلّة النشاط البدني‪،‬‬ ‫والمدخول من الملح‪ /‬الصوديوم‪ ،‬وتعاطي التبغ وارتفاع ضغط‬ ‫الدم‪ ،‬ووقف الزيادة في معدالت داء السكري والسمنة‪ ،‬وتحسين‬ ‫التغطية بالعالج للوقاية من النوبات القلبية والسكتات الدماغية‬ ‫وإتاحة التكنولوجيات واألدوية األساسية‪.‬‬ ‫ودعماً لتنفيذ خطة العمل العالمية الخاصة باألمراض غير السارية‪،‬‬ ‫زز تنسيق األنشطة المتعلقة‬ ‫أنشأت المنظمة آلية تنسيق عالمية ستع ّ‬ ‫بتلك األمراض وتوث ّق عرى مشاركة أصحاب المصلحة المتعددين‬

‫‪v‬‬

‫تقرير احلالة العاملي عن الأمرا�ض غري ال�سارية ‪2014‬‬

‫ملخ�ص‬ ‫من جانب الدول األعضاء والجهات الشريكة الدولية والمنظمة‪.‬‬ ‫ويرتكز تنظيم مجموعة اإلجراءات على ستة أغراض ترمي إلى‬ ‫تعزيز القدرات الوطنية وتوطيد التعاون الدولي للحد من التعرض‬ ‫لعوامل الخطر وتدعيم النظم الصحية ورصد التقدم المحرز في‬ ‫بلوغ الغايات العالمية المتعلقة باألمراض غير السارية‪.‬‬ ‫وفي تموز‪/‬يوليو ‪ ،2014‬أجرت الجمعية العامة لألمم المتحدة‬ ‫استعراضاً لتقييم التقدم المحرز في تنفيذ اإلعالن السياسي لعام‬ ‫‪ 2011‬واعترفت بالتقدم المحرز على الصعيد الوطني منذ أيلول‪/‬‬ ‫سبتمبر ‪ .2011‬وإذ اعترفت الدول األعضاء في األمم المتحدة أيضاً‬ ‫بالتقدم غير الكافي والشديد التفاوت المحرز في تنفيذ خريطة‬ ‫الطريق الخاصة بااللتزامات الواردة في اإلعالن السياسي لعام ‪2011‬‬ ‫وبضرورة مواصلة الجهود وتكثيفها‪ ،‬التزمت باتخاذ مجموعة من‬ ‫التدابير في إطار أربعة مجاالت ذات أولوية هي تصريف الشؤون‬ ‫والوقاية من عوامل الخطر والحد منها والرعاية الصحية والترصد‪.‬‬ ‫وتشمل هذه التدابير المحددة المدة تحديد غايات وطنية متصلة‬ ‫باألمراض غير السارية ومتسقة مع الغايات العالمية ووضع خطط‬ ‫وطنية ومتعددة القطاعات بشأن األمراض غير السارية بحلول عام‬ ‫‪ 2015‬وبدء تنفيذ هذه الخطط بحلول عام ‪ 2016‬بغية تحقيق‬ ‫الغايات الوطنية‪.‬‬ ‫وهذا التقرير العالمي الثاني عن وضع الوقاية من األمراض غير‬ ‫السارية ومكافحتها معد على أساس الغايات العالمية االختيارية‬ ‫التسع‪ .‬ويتضمن التقرير بيانات عن الوضع الحالي بتحديد‬ ‫العقبات المواجهة إضافة إلى الفرص المتاحة واإلجراءات ذات‬ ‫األولوية المتخذة لبلوغ الغايات‪ .‬وعالوة على ذلك‪ ،‬ترد اإلشارة‬ ‫إلى التقديرات األساسية لعام ‪ 2010‬بشأن الوفيات وعوامل الخطر‬ ‫المرتبطة باألمراض غير السارية بحيث يتسنى للبلدان التبليغ عن‬ ‫ء من عام‪.2015 ‬‬ ‫التقدم المحرز ابتدا ً‬ ‫هذا التقرير العالمي عن وضع الوقاية من األمراض غير السارية‬ ‫ومكافحتها هو التقرير الثاني من سلسلة التقارير التي تصدر كل‬ ‫ثالث سنوات لتتبع التقدم المحرز على الصعيد العالمي في مجال‬ ‫الوقاية من األمراض غير السارية ومكافحتها‪.‬‬ ‫وتتأثر كل البلدان بعواقب األمراض غير السارية من النواحي‬ ‫اإلنسانية واالجتماعية واالقتصادية غير أن هذه العواقب تدمر بوجه‬ ‫خاص الفئات السكانية الفقيرة والضعيفة‪ .‬ويعتبر تخفيف العبء‬ ‫العالمي لألمراض غير السارية أولوية قصوى وشرطاً الزماً لتحقيق‬ ‫التنمية المستدامة‪ .‬وقد سببت األمراض غير السارية بوصفها السبب‬ ‫الرئيسي للوفاة على الصعيد العالمي ‪ 38‬مليون حالة وفاة (‪)٪68‬‬ ‫من أصل ‪ 56‬مليون حالة وفاة مسجلة في العالم خالل عام ‪.2012‬‬ ‫وكان أكثر من ‪ ٪40‬من هذه الحاالت (‪ 16‬مليون حالة) عبارة عن‬ ‫وفيات مبكرة لدى األشخاص دون سن ‪ 70‬سنة‪ .‬ويسجل حوالي‬ ‫ثالثة أرباع جميع حاالت الوفاة الناجمة عن األمراض غير السارية‬ ‫(‪ 28‬مليون حالة) وأغلب الوفيات المبكرة (‪ )٪82‬في البلدان ذات‬ ‫الدخل المنخفض والمتوسط‪.‬‬ ‫وتبلغ القيمة المقدرة للخسائر االقتصادية التراكمية الناجمة عن‬ ‫األمراض غير السارية في إطار الحال «المألوف» في البلدان ذات‬ ‫الدخل المنخفض والمتوسط ‪ 7‬ترليونات دوالر أمريكي خالل‬ ‫الفترة ‪ .2025-2011‬وتفوق هذه التكاليف الهائلة الناجمة عن عدم‬ ‫اتخاذ اإلجراءات إلى حد بعيد التكاليف السنوية الناتجة عن تنفيذ‬ ‫مجموعة من التدخالت الشديدة التأثير لتخفيف عبء األمراض غير‬ ‫السارية (أي ‪ 11.2‬مليار دوالر أمريكي في السنة)‪.‬‬ ‫وقد اتفق قادة العالم في أيلول‪/‬سبتمبر ‪ 2011‬على خريطة طريق‬ ‫خاصة بالتزامات ملموسة تستهدف التصدي للعبء العالمي‬ ‫لألمراض غير السارية وتشمل االلتزام بوضع خطط عمل وسياسات‬ ‫متعددة القطاعات للوقاية من األمراض غير السارية ومكافحتها‬ ‫بحلول عام ‪.2013‬‬ ‫وسعياً إلى تسريع وتيرة الجهود الوطنية المبذولة للتصدي لألمراض‬ ‫غير السارية‪ ،‬اعتمدت جمعية الصحة العالمية في عام ‪ 2013‬تسع‬ ‫غايات عالمية اختيارية ملموسة يتوخى تحقيقها بحلول عام ‪2025‬‬ ‫ومجموعة من اإلجراءات المنظمة بناء على خطة العمل العالمية‬ ‫لمنظمة الصحة العالمية الخاصة باألمراض غير السارية للفترة‬ ‫‪ 2020-2013‬التي ستساعد على تحقيق التزامات قادة العالم‬ ‫المقطوعة في أيلول‪/‬سبتمبر ‪ 2011‬في حال تنفيذها الجماعي‬ ‫‪vi‬‬

‫الغاية العالمية ‪ :1‬خف�ض ن�سبي قدره ‪٪25‬‬ ‫في المعدل الإجمالي للوفيات الناجمة‬ ‫عن �أمرا�ض القلب والأوعية الدموية �أو‬ ‫ال�سرطان �أو داء ال�سكري �أو �أمرا�ض الجهاز‬ ‫التنف�سي المزمنة بحلول عام ‪2025‬‬

‫��‬

‫الفردية مثل الفحص ألغراض تحري تعاطي الكحول الضار وعالج‬ ‫إدمان الكحول بفعاليتها على الرغم من أن تنفيذها هو أكثر كلفة‬ ‫من تنفيذ التدابير السكانية‪.‬‬ ‫وأحرز بعض التقدم في التصدي لتعاطي الكحول على نحو ضار منذ‬ ‫أن اعتمدت جمعية الصحة العالمية االستراتيجية العالمية بشأن‬ ‫الحد من تعاطي الكحول على نحو ضار في عام ‪ .2010‬ووضعت‬ ‫أعداد متزايدة من البلدان سياساتها وخطط عملها الوطنية بشأن‬ ‫الكحول أو أعادت صياغتها‪ .‬ومن بين ‪ 76‬بلدا ً لديه سياسة وطنية‬ ‫مدونة بشأن الكحول اتخذ ‪ 52‬بلدا ً الخطوات الالزمة لتنفيذها‪.‬‬ ‫وهناك حوالي ‪ 160‬دولة عضوا ً في المنظمة لديها لوائح بشأن‬ ‫حدود السن الدنيا لبيع المشروبات الكحولية‪.‬‬

‫الغاية العالمية ‪ :3‬خف�ض قدره‬ ‫‪ ٪10‬في معدل انت�شار قلة الن�شاط‬ ‫البدني بحلول عام ‪2025‬‬ ‫تسهم قلة النشاط البدني في ‪ 69.3‬مليون سنة من سنوات العمر‬ ‫المصححة باحتساب مدد العجز و‪ 3.2‬ماليين حالة وفاة كل سنة‪.‬‬ ‫والبالغون الذين قلما يمارسون النشاط البدني هم أكثر تعرضاً لخطر‬ ‫الوفاة الناجمة عن جميع األسباب مقارنة بالبالغين الذين يمارسون‬ ‫على األقل النشاط البدني المعتدل لمدة ‪ 150‬دقيقة في األسبوع‬ ‫أو ما يعادل ذلك وفقاً لتوصيات المنظمة‪ .‬فالنشاط البدني المنتظم‬ ‫يحد من خطر اإلصابة بمرض القلب اإلقفاري والسكتة الدماغية‬ ‫والسكري وسرطان الثدي والقولون‪.‬‬ ‫وكانت نسبة قليلي النشاط البدني من األشخاص البالغة أعمارهم‬ ‫‪ 18‬سنة وأكثر تساوي ‪ ٪23‬في عام ‪ .2014‬وكانت النساء أقل نشاطاً‬ ‫من الرجال وفئة المسنين أقل نشاطاً من فئة الشباب‪ .‬وبلغت‬ ‫نسبة قليلي النشاط البدني من المراهقين المتراوحة أعمارهم‬ ‫بين ‪ 11‬و‪ 17‬سنة ‪ ٪81‬في عام ‪ 2014‬على الصعيد العالمي‪ .‬وكانت‬ ‫المراهقات أقل نشاطاً من المراهقين الذكور باستجابة ‪ ٪84‬مقابل‬ ‫‪ ٪78‬لتوصيات المنظمة‪.‬‬ ‫وبلغت عدة بلدان متقدمة عن زيادة النشاط البدني خالل العقد‬ ‫الماضي نتيجة للسياسات والبرامج الوطنية الرامية إلى تحسين‬ ‫النشاط البدني‪ .‬وأعد عدد أكبر من البلدان ذات الدخل المنخفض‬ ‫والمتوسط أيضاً مبادرات للتصدي للخمول البدني في السنوات‬ ‫األخيرة‪ .‬ويتطلب بلوغ الغاية المتصلة بالنشاط البدني التعاون‬ ‫المتعدد القطاعات بين وزارات النقل والتخطيط الحضري والترفيه‬ ‫‪vii‬‬

‫إن التقدم المحرز في بلوغ جميع الغايات األخرى يسهم في تحقيق‬ ‫هذه الغاية الشاملة المتعلقة بالوفيات المبكرة‪ .‬ويعرض الفصل‬ ‫‪ 1‬البيانات عن الوفيات المسجلة في عام ‪ 2012‬التي تبرز ما يلي‪:‬‬ ‫(‪ )1‬تتأثر جميع البلدان باألمراض غير السارية‪ )2( ،‬ويكون أثر هذه‬ ‫األمراض بالغ الخطورة في البلدان ذات الدخل المنخفض والمتوسط‬ ‫بوجه خاص‪ )3( ،‬وتسجل أغلبية الوفيات المبكرة الناجمة عن هذه‬ ‫األمراض في البلدان ذات الدخل المنخفض والمتوسط‪.‬‬ ‫وتختلف القدرة على تحقيق هذه الغاية اختالفاً شديدا ً على نطاق‬ ‫العالم‪ .‬فبينما يمكن للبلدان ذات الدخل المنخفض والمتوسط أن‬ ‫تتوخى تحقيق غاية منطوية على خفض بنسبة ‪ ،٪25‬قد ترغب‬ ‫البلدان المرتفعة الدخل التي تبدي انخفاضاً في األمراض غير‬ ‫السارية الرئيسية في تحديد نسب تزيد على ‪ ٪25‬كغايات تتوخى‬ ‫تحقيقها‪.‬‬ ‫ويعرض الفصل ‪ 1‬بإيجاز اإلجراءات والتدخالت السياسية الشاملة‬ ‫والمتعددة القطاعات والقدرات القطرية‪ ،‬بما فيها نظم تسجيل‬ ‫األحوال المدنية‪/‬البيانات الحيوية والترصد‪ ،‬الالزمة لبلوغ هذه‬ ‫الغاية‪ .‬ويعني نقص الموارد في عدة بلدان أنه يجب منح األولوية‬ ‫القصوى لتنفيذ الخيارات والتدخالت السياسية العالية المردودية‬ ‫(أفضل الخيارات والتدخالت)‪.‬‬

‫الغاية العالمية ‪ :2‬خف�ض قدره ‪٪10‬‬ ‫على الأقل في م�ستوى تعاطي الكحول‬ ‫على نحو �ضار بحلول عام ‪2025‬‬ ‫عزي ما يساوي ‪ 3.3( ٪5.9‬ماليين حالة) من جميع حاالت الوفاة‬ ‫في العالم و‪ 5.1‬سنوات من سنوات العمر المصححة باحتساب مدد‬ ‫العجز حسب التقديرات إلى استهالك الكحول في عام ‪ .2012‬ونجم‬ ‫أكثر من نصف هذه الحاالت عن األمراض غير السارية‪.‬‬ ‫وبلغ مستوى استهالك الكحول في العالم ‪ 6.2‬لترات من الكحول‬ ‫الصافي لكل فرد عمره ‪ 15‬سنة وأكثر حسب التقديرات في عام‬ ‫‪( 2010‬ما يعادل ‪ 13.5‬غراماً من الكحول الصافي في اليوم)‪.‬‬ ‫ويرتبط معدل انتشار اإلفراط في تعاطي الكحول من حين إلى آخر‬ ‫بالمستويات اإلجمالية الستهالك الكحول ويسجل أعلى المستويات‬ ‫في اإلقليم األوروبي وإقليم األمريكتين‪.‬‬ ‫وهناك خيارات سياسية ذات مردودية للحد من تعاطي الكحول‬ ‫الضار تشمل سياسات التسعير وخيارات الحد من توافر الكحول‬ ‫وتسويقه وتحسين استجابة الخدمات الصحية والسياسات بشأن‬ ‫القيادة تحت تأثير الكحول وتدابير مكافحتها‪ .‬كما تتسم التدخالت‬

‫تقرير احلالة العاملي عن الأمرا�ض غري ال�سارية ‪2014‬‬

‫الغاية العالمية ‪ :5‬خف�ض ن�سبي قدره‬ ‫‪ ٪30‬في معدل انت�شار تعاطي التبغ‬ ‫الراهن لدى الأ�شخا�ص البالغة �أعمارهم‬ ‫‪� 15‬سنة و�أكثر بحلول عام ‪2025‬‬ ‫تشير التقديرات الحالية إلى وفاة حوالي ‪ 6‬ماليين شخص بسبب‬ ‫تعاطي التبغ بما في ذلك وفاة ما يزيد بقليل على ‪ 600 000‬شخص‬ ‫نتيجة للتعرض للدخان غير المباشر بتسجيل ‪ 170 000‬حالة وفاة‬ ‫من هذه الحاالت في صفوف األطفال‪.‬‬ ‫وتشمل التدابير الرامية إلى ضمان الحد من تعاطي التبغ ما يلي‪:‬‬ ‫حماية األشخاص من الدخان غير المباشر عبر التشريعات الوطنية‬ ‫بشأن «خلو األماكن التام من دخان التبغ» وتقديم المساعدة لإلقالع‬ ‫عن تعاطي التبغ وتحذير الناس من مخاطر تعاطي التبغ وإنفاذ‬ ‫تدابير الحظر المفروضة على أنشطة اإلعالن والترويج والرعاية‬ ‫المتعلقة بالتبغ ورفع الضرائب المفروضة على التبغ لتبلغ قيمتها‬ ‫على األقل ‪ ٪70‬من إجمالي سعر البيع بالتجزئة ألي منتج من‬ ‫منتجات التبغ‪.‬‬ ‫وقد أحرز تقدم ملحوظ في مكافحة التبغ على الصعيد العالمي‬ ‫في السنوات األخيرة في أعداد البلدان التي تحمي سكانها وأعداد‬ ‫األشخاص في العالم المستفيدين من الحماية عن طريق التدابير‬ ‫الفعالة لمكافحة التبغ‪ .‬وفي عام ‪ ،2013‬نفذ ‪ 95‬بلدا ً تدخالً واحدا ً‬ ‫على األقل من بين أفضل التدخالت األربعة لمكافحة التبغ (تدخالت‬ ‫عالية المردودية) على أرفع مستويات اإلنجاز بينما نفذ بلدان اثنان‬ ‫جميع هذه التدخالت األربعة على أرفع مستوى‪ .‬وكان الكثير من‬ ‫البلدان التي تحرز التقدم في تنفيذ أفضل التدابير في عداد البلدان‬ ‫ذات الدخل المنخفض أو المتوسط‪.‬‬ ‫وكما يرد بحثه في الفصل ‪ ،5‬ال بد من تكثيف العمل في عدة بلدان‬ ‫من أجل إقرار تدابير فعالة لمكافحة التبغ وإنفاذها مما يشمل‬ ‫توسيع نطاق األنشطة الرامية إلى تنفيذ أفضل التدابير للحد من‬ ‫الطلب على أرفع مستويات اإلنجاز حيثما لم‪ ‬تنفذ بعد وتدعيم‬ ‫البرامج الراهنة واستمرارها إلدماج مجموعة كاملة من التدابير‬ ‫إضافة إلى تنفيذ أحكام اتفاقية المنظمة اإلطارية بالكامل في نهاية‬ ‫المطاف‪ .‬وتبين إنجازات أغلبية البلدان المحققة في تطبيق تدابير‬ ‫الحد من الطلب على التبغ أنه من الممكن التصدي لوباء التبغ‬ ‫بصرف النظر عن حجم البلد أو عن مستوى تنميته‪.‬‬

‫والرياضة والتعليم لتهيئة بيئات آمنة تساعد على ممارسة النشاط‬ ‫البدني لدى جميع الفئات العمرية‪.‬‬

‫الغاية العالمية ‪ :4‬خف�ض ن�سبي قدره‬ ‫‪ ٪30‬في متو�سط مدخول ال�سكان‬ ‫من الملح بحلول عام ‪2025‬‬ ‫يرتبط فرط استهالك الصوديوم الغذائي بزيادة خطر اإلصابة بفرط‬ ‫ضغط الدم وأمراض القلب واألوعية الدموية‪ .‬وقد عزيت ‪1.65‬‬ ‫مليون حالة وفاة سنوية ناجمة عن أمراض القلب واألوعية الدموية‬ ‫إلى فرط مدخول الصوديوم على الصعيد العالمي‪ .‬ويناهز متوسط‬ ‫المدخول العالمي من الملح حسب التقديرات الحالية ‪ 10‬غرامات‬ ‫من الملح في اليوم (‪ 3.95‬غرامات من الصوديوم في اليوم)‪ .‬وتوصي‬ ‫المنظمة بخفض مدخول الملح إلى أقل من ‪ 5‬غرامات في اليوم‬ ‫(غرامان من الصوديوم في اليوم) لتخفيض ضغط الدم والحد من‬ ‫خطر اإلصابة بأمراض القلب التاجية والسكتات الدماغية‪.‬‬ ‫ومصدر الملح الرئيسي في عدة بلدان هو األغذية المصنعة‬ ‫والوجبات المجهزة في حين أن كمية الملح المضافة أثناء تحضير‬ ‫األغذية في المنزل وعلى مائدة الطعام تعتبر كبيرة في بلدان‬ ‫أخرى‪ .‬وإذ يزداد توافر األغذية المصنعة في البلدان ذات الدخل‬ ‫ول سريع إلى هذه األغذية كمصادر‬ ‫المنخفض والمتوسط‪ ،‬يسجل تح ّ‬ ‫للصوديوم‪.‬‬ ‫وكما يرد بحثه في الفصل ‪ ،4‬يعتبر تحديد مدخول أساسي من الملح‬ ‫أمرا ً أساسياً لتحديد غايات وطنية وتصميم حمالت فعالة تستهدف‬ ‫المستهلكين‪ .‬وال بد من تحديد غايات تتصل بتخفيض الصوديوم‬ ‫بالنسبة إلى كل فئة من فئات األغذية بمنح األولوية لما يسهم منها‬ ‫أشد إسهام في المدخول السكاني‪.‬‬ ‫ومن الضروري أن تشرف جميع وزارات الصحة على وضع السياسات‬ ‫الرامية إلى الحد من استهالك الملح على مستوى السكان وتنفيذها‪.‬‬ ‫وينبغي أن تكون السياسات مشتركة بين القطاعات ومتعددة‬ ‫التخصصات وأن تنطوي على مشاركة جميع أصحاب المصلحة‬ ‫المعنيين وتنطبق على سياقات مختلفة وتستعين بجميع األدوات‬ ‫المتاحة بما فيها التوسيم والتشريع وتغيير تركيبة المنتجات وتوفير‬ ‫الحوافز المالية التي تشجع إنتاج األغذية ذات المحتوى المخفض‬ ‫من الصوديوم واستهالكها وتوعية المستهلكين لضمان فعالية تنفيذ‬ ‫السياسات‪ .‬وقد أحرز تقدم ملحوظ في تنفيذ هذه األنشطة في‬ ‫بعض البلدان‪.‬‬ ‫‪viii‬‬

‫��‬

‫تضاعف عدد حاالت البدانة على نطاق العالم منذ عام ‪.1980‬‬ ‫وبلغت نسبة األشخاص البالغة أعمارهم ‪ 18‬سنة وأكثر والمعانين‬ ‫من البدانة ‪ ٪10‬من الرجال و‪ ٪14‬من النساء في عام ‪ .2014‬وكان‬ ‫أكثر من ‪ 42‬مليون طفل دون سن الخامسة يعاني من فرط الوزن‬ ‫في عام ‪ .2013‬وبلغ معدل انتشار السكري على الصعيد العالمي‬ ‫‪ ٪10‬في عام‪ 2014 ‬حسب التقديرات‪.‬‬ ‫ويمكن الوقاية من البدانة والسكري عبر اتخاذ إجراءات متعددة‬ ‫القطاعات تستهدف في الوقت ذاته قطاعات مختلفة مساهمة في‬ ‫إنتاج األغذية وتوزيعها وتسويقها وتحديد بيئة ميسرة للنشاط‬ ‫البدني الكافي ومشجعة له في الوقت نفسه‪.‬‬ ‫ويمكن الحد من خطر اإلصابة بالسكري من خالل تخفيف الوزن‬ ‫المعتدل والنشاط البدني اليومي المعتدل لدى األشخاص الشديدي‬ ‫التعرض لخطر اإلصابة به‪ .‬وقد وسع نطاق هذا التدخل ليشمل‬ ‫جميع السكان في عدد صغير من البلدان المرتفعة الدخل إال‬ ‫أن تنفيذ هذا التدخل على نطاق واسع في البلدان ذات الدخل‬ ‫المنخفض والمتوسط أمر عسير مما يعزى جزئياً إلى األساليب‬ ‫الحالية لتحديد األشخاص الشديدي التعرض لخطر اإلصابة التي‬ ‫تتسم بتعقيدها وتعتبر مكلفة باألحرى‪.‬‬ ‫وهناك حاجة ملحة إلى إجراء المزيد من البحوث لتقييم فعالية‬ ‫التدخالت الرامية إلى الوقاية من البدانة والسكري‪.‬‬

‫الغاية العالمية ‪ :6‬خف�ض قدره ‪٪25‬‬ ‫في معدل انت�شار ارتفاع �ضغط الدم �أو‬ ‫احتواء انت�شار ارتفاع �ضغط الدم تبعا ً‬ ‫للظروف الوطنية بحلول عام ‪2025‬‬ ‫يقدر أن ارتفاع ضغط الدم قد سبب ‪ 9.4‬ماليين حالة وفاة و‪ ٪7‬من‬ ‫عبء المرض المحسوب وفقاً لسنوات العمر المصححة باحتساب مدد‬ ‫العجز في عام ‪ .2010‬ويسبب فرط ضغط الدم إن بقي غير مضبوط‬ ‫السكتة الدماغية واحتشاء عضل القلب وفشل القلب والخرف والفشل‬ ‫الكلوي والعمى‪ .‬وهناك بينات علمية راسخة تدل على الفوائد الصحية‬ ‫الناتجة عن تخفيض ضغط الدم عبر التدخالت السكانية والفردية‬ ‫(السلوكية والدوائية)‪ .‬وقد بلغ معدل انتشار ارتفاع ضغط الدم‬ ‫(المحدد حسب ضغط الدم االنقباضي و‪/‬أو االنبساطي الذي يساوي‬ ‫‪ 90/140‬مليمتر زئبق أو أكثر) لدى األشخاص البالغة أعمارهم ‪ 18‬سنة‬ ‫وأكثر على الصعيد العالمي ما يناهز ‪ ٪22‬في عام ‪.2014‬‬ ‫وتسهم عدة عوامل قابلة للتغيير في ارتفاع معدالت انتشار فرط‬ ‫ضغط الدم‪ .‬وتشمل تناول األغذية المحتوية على كمية كبيرة من‬ ‫الملح والدهون والمدخول غير الكافي من الفواكه والخضر وفرط‬ ‫الوزن والبدانة وتعاطي الكحول على نحو ضار والخمول البدني‬ ‫واإلجهاد النفسي والمحددات االجتماعية واالقتصادية والفرص غير‬ ‫الكافية إلتاحة الرعاية الصحية‪ .‬وليست خدمات الكشف والعالج‬ ‫والمكافحة على نطاق العالم كافية بسبب مواطن الضعف في النظم‬ ‫الصحية والسيما على مستوى الرعاية األولية‪.‬‬ ‫وسعياً إلى تحقيق هذه الغاية ال بد من تنفيذ سياسات وتدخالت‬ ‫سكانية من أجل التصدي لعوامل الخطر القابلة للتغيير المذكورة‪.‬‬ ‫وعالوة على ذلك‪ ،‬من الضروري وضع برامج متكاملة على مستوى‬ ‫الرعاية األولية لتحسين مستوى الفعالية والكفاءة في الكشف عن‬ ‫حاالت فرط ضغط الدم وسائر عوامل خطر اإلصابة بأمراض القلب‬ ‫واألوعية الدموية وتدبيرها العالجي باستخدام نهج المخاطر الشاملة‬ ‫وفقاً لتوصيات المنظمة‪.‬‬

‫الغاية العالمية ‪ :8‬ح�صول ‪ ٪50‬على الأقل‬ ‫من الأ�شخا�ص الم�ؤهلين على عالج بالأدوية‬ ‫وم�شورة (بما في ذلك �ضبط م�ستوى �سكر‬ ‫الدم) من �أجل الوقاية من النوبات القلبية‬ ‫وال�سكتات الدماغية بحلول عام ‪2025‬‬ ‫كانت أمراض القلب واألوعية الدموية السبب الرئيسي لحاالت‬ ‫الوفاة الناجمة عن األمراض غير السارية في عام ‪ 2012‬إذ سببت‬ ‫‪ 17.5‬مليون حالة وفاة أو ‪ ٪46‬من حاالت الوفاة الناجمة عن‬ ‫األمراض غير السارية‪ .‬ونجمت ‪ 7.4‬ماليين حالة وفاة عن النوبات‬ ‫القلبية (مرض القلب اإلقفاري) و‪ 6.2‬ماليين حالة وفاة عن السكتات‬ ‫الدماغية من بين تلك الحاالت‪.‬‬ ‫والغرض من هذه الغاية الرامية إلى الحد من النوبات القلبية‬ ‫والسكتات الدماغية هو تحسين تغطية العالج باألدوية والمشورة‬ ‫لدى األشخاص الذين يتعرضون لزيادة خطر اإلصابة بأمراض القلب‬ ‫واألوعية الدموية وتثبت إصابتهم بها‪ .‬وهذا تدخل ميسور الكلفة‬ ‫‪ix‬‬

‫الغاية العالمية ‪ :7‬وقف الزيادة‬ ‫في حاالت الإ�صابة بال�سكري‬ ‫والبدانة بحلول عام ‪2025‬‬ ‫تزيد البدانة احتمال اإلصابة بالسكري وفرط ضغط الدم وأمراض‬ ‫القلب التاجية والسكتة الدماغية وبعض أنماط السرطان‪ .‬وقد‬

‫تقرير احلالة العاملي عن الأمرا�ض غري ال�سارية ‪2014‬‬

‫األساسية وفي مدى توافر هذه التكنولوجيات واألدوية في الوقت‬ ‫الحالي وال‪ ‬سيما في البلدان ذات الدخل المنخفض والمتوسط‪.‬‬ ‫ويعني انعدام فرص إتاحتها تأخر المرضى في طلب الرعاية وإصابتهم‬ ‫بمضاعفات على نحو مفرط أو تكبدهم تكاليف باهظة بدفعها من‬ ‫جيبهم مما قد يدمر األسر من الناحية المالية‪ .‬ومن الضروري توفير‬ ‫التمويل الصحي المستدام لضمان نظم الشراء والتوزيع الكافية‬ ‫والموثوق بها التي تكفل اإلمداد بالتكنولوجيات واألدوية األساسية‬ ‫لمكافحة األمراض غير السارية على جميع مستويات الرعاية الصحية‬ ‫بما فيها الرعاية األولية‪ .‬ونتيجة لذلك‪ ،‬ينبغي أن تكتسي السياسات‬ ‫الوطنية التي تشجع توافر التكنولوجيات الصحية األساسية واألدوية‬ ‫األساسية أهمية محورية في إطار الجهود المركزة على تحقيق‬ ‫تغطية صحية شاملة‪ .‬كما يجب أن تستخدم األدوية استخداماً‬ ‫مناسباً ويجب بالتالي التقيد بالمبادئ التوجيهية المسندة بالبينات‬ ‫وتوعية العاملين المهنيين في مجال الرعاية الصحية والمرضى‬ ‫بشأن استخدامها الرشيد‪.‬‬ ‫وينبغي منح األولوية القصوى للسياسات والتدخالت الرامية إلى‬ ‫تحقيق الغايات التسع (الفصول من ‪ 1‬إلى ‪ )9‬ووضع الميزانيات‬ ‫الخاصة بها في خطط العمل الوطنية المتعددة القطاعات والمتصلة‬ ‫باألمراض غير السارية‪ .‬ويسلط الفصل ‪ 10‬المتعلق بوضع خطة‬ ‫وطنية متعددة القطاعات بشأن األمراض غير السارية األضواء على‬ ‫المجاالت الرئيسية المرتبطة باألمراض غير السارية التي ينبغي‬ ‫تغطيتها أي تصريف الشؤون والوقاية والرعاية الصحية والترصد‬ ‫والرصد‪ .‬وسعياً إلى تعزيز فرص التنفيذ الفعال إلى أقصى حد‪ ،‬يجب‬ ‫بالضرورة أن يشارك جميع أصحاب المصلحة من قطاع الصحة‬ ‫والقطاعات األخرى بما فيها المجتمع المدني والقطاع الخاص في‬ ‫عملية وضع الخطة‪.‬‬ ‫ويعرض الفصل األخير السبيل للمضي قدماً من أجل تحقيق الغايات‬ ‫العالمية االختيارية التسع بحلول عام ‪ 2025‬ويبرز رسائل هذا‬ ‫التقرير الرئيسية‪.‬‬

‫يمكن إتاحته عبر نهج الرعاية الصحية األولية حتى في السياقات‬ ‫المحدودة الموارد‪.‬‬ ‫وهناك ثغرات كبرى في تغطية هذا التدخل من أجل الوقاية من‬ ‫النوبات القلبية والسكتات الدماغية وخصوصاً في البلدان ذات‬ ‫الدخل المنخفض والمتوسط‪ .‬ويتمثل بعض األسباب الرئيسية لهذه‬ ‫الثغرات العالجية في قلة فرص الحصول على الخدمات األساسية في‬ ‫مجال الرعاية األولية وانعدام القدرة على تحمل تكاليف االختبارات‬ ‫المخبرية واألدوية واتباع أنماط الممارسة السريرية غير المالئمة‬ ‫وقلة التقيد بالعالج‪.‬‬ ‫ومن الضروري أن يندرج هذا التدخل الرامي إلى الوقاية من النوبات‬ ‫القلبية والسكتات الدماغية في مجموعة المزايا األساسية من أجل‬ ‫تحقيق التغطية الصحية الشاملة‪ .‬وفضالً عن ذلك‪ ،‬ال بد من وضع‬ ‫استراتيجيات خاصة بسياقات معينة بغرض سد الثغرات المتعددة‬ ‫في النظم الصحية والمتعلقة بإتاحة التكنولوجيات واألدوية‬ ‫األساسية والقوى العاملة الصحية وتوفير الخدمات والمعلومات‬ ‫الصحية واإلحالة بالتركيز الخاص على الرعاية األولية‪.‬‬

‫الغاية العالمية ‪ :9‬توافر التكنولوجيات‬ ‫الأ�سا�سية والأدوية الأ�سا�سية المي�سورة‬ ‫الكلفة بن�سبة ‪ ٪80‬بما في ذلك الأدوية‬ ‫الجني�سة الالزمة لعالج الأمرا�ض غير‬ ‫ال�سارية الرئي�سية في المرافق العامة‬ ‫والخا�صة على ال�سواء بحلول عام ‪2025‬‬ ‫تشمل هذه الغاية المتطلبات األساسية من التكنولوجيات واألدوية‬ ‫لتنفيذ تدخالت ذات مردودية في مجال الرعاية األولية من أجل‬ ‫التصدي ألمراض القلب واألوعية الدموية والسكري والربو‪.‬‬ ‫وتضم األدوية األساسية ما يلي‪ :‬األسبرين وستاتين وأحد مثبطات‬ ‫اإلنزيم المحول لألنجيوتنسين والثيازيد المدر للبول ومحصر‬ ‫قنوات الكالسيوم الممتد المفعول ومحصر بيتا الممتد المفعول‬ ‫والميتفورمين واإلنسولين وموسع قصبي وستيرويد مستنشق‪ .‬أما‬ ‫التكنولوجيات األساسية فتشمل على األقل جهازا ً لقياس ضغط الدم‬ ‫وميزاناً وأجهزة لقياس سكر الدم وكوليسترول الدم مزودة بأشرطة‬ ‫اختبار وأشرطة تحليل البول لمقايسة الزالل‪ .‬وهذه متطلبات دنيا‬ ‫ال يمكن دونها تنفيذ حتى التدخالت األساسية المرتبطة باألمراض‬ ‫غير السارية في مجال الرعاية األولية‪ .‬وتوجد ثغرات كبرى في‬ ‫القدرة على تحمل تكاليف التكنولوجيات الصحية األساسية واألدوية‬ ‫‪x‬‬

‫الر�سالة ‪ :1‬الأمرا�ض غير ال�سارية محرك‬ ‫رئي�سي للتنمية الم�ستدامة‬ ‫تظهر البيانات المعروضة في هذا التقرير أن األمراض غير السارية‬ ‫تؤثر في جميع البلدان وأن عبء الوفاة والمرض يتركز تركزا ً شديدا ً‬ ‫في البلدان ذات الدخل المنخفض والمتوسط‪ .‬وتعتبر الخسارة‬ ‫في اإلنتاجية بسبب الوفيات المبكرة والتكاليف الفردية والوطنية‬ ‫الناجمة عن التصدي لألمراض غير السارية عوائق كبيرة تعرقل‬

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‫وال بد لجميع البلدان من تحديد غايات وطنية ووضع إطار للرصد‬ ‫من أجل تتبع التقدم المحرز في بلوغ هذه الغايات‪ .‬وإذ تركز‬ ‫الغايات العالمية على مجموعة محدودة من الحصائل الرئيسية‬ ‫المتصلة باألمراض غير السارية‪ ،‬سيمكن تحديد غايات وطنية وتنفيذ‬ ‫سياسات وتدخالت لبلوغها البلدان من استخدام الموارد على أفضل‬ ‫وجه‪ .‬وتحقيقاً ألفضل النتائج‪ ،‬ينبغي أن تدمج الدروس المستخلصة‬ ‫من التنفيذ دمجاً سريعاً في عملية صنع القرارات عبر البحوث‬ ‫الميدانية‪.‬‬

‫مسار الحد من الفقر والتنمية المستدامة‪ .‬وعليه‪ ،‬يكتسي التقدم‬ ‫المحرز في بلوغ الغايات المرتبطة باألمراض غير السارية أهمية‬ ‫حيوية من أجل تحقيق أهداف التنمية المستدامة‪.‬‬

‫الر�سالة ‪ :5‬من ال�ضروري �إر�ساء الهياكل‬ ‫والعمليات للتعاون المتعدد القطاعات‬ ‫والم�شترك بين القطاعات‬ ‫يكتسي التعاون عبر القطاعات خارج قطاع الصحة (التعاون المتعدد‬ ‫القطاعات) وبين الجهات الفاعلة الحكومية وغير الحكومية (التعاون‬ ‫المشترك بين القطاعات) أهمية أساسية لضمان اإلنصاف في الوقاية‬ ‫من األمراض غير السارية ومكافحتها وبلوغ الغايات الوطنية‪ .‬ومن‬ ‫الضروري ترسيخ اآلليات والعمليات التي تيسر التعاون المتعدد‬ ‫القطاعات والمشترك بين القطاعات في مرحلة تخطيط البرامج‬ ‫المتعلقة باألمراض غير السارية وينبغي الحفاظ عليها عبر أنشطة‬ ‫التنفيذ ووضع السياسات العامة والرصد والتقييم‪.‬‬

‫الر�سالة ‪ :2‬يحرز بع�ض البلدان التقدم في‬ ‫حين �أن �أغلبية البلدان لي�ست في االتجاه‬ ‫ال�صحيح لتحقيق الغايات العالمية المت�صلة‬ ‫بالأمرا�ض غير ال�سارية‬ ‫إن البلدان التي أبدى زعماؤها السياسيون التزاماً راسخاً تحرز تقدماً‬ ‫ملحوظاً في التصدي لألمراض غير السارية كما يتضح من عدة‬ ‫دراسات حاالت تحفيزية غير أن التقدم المحرز ما زال غير متكافئ‬ ‫وكاف‪ .‬وتحدد البيانات المعروضة في هذا التقرير عدة فرص ضائعة‬ ‫لتعزيز تصريف الشؤون والوقاية والرعاية الصحية والترصد والرصد‬ ‫وال‪ ‬سيما في البلدان ذات الدخل المنخفض والمتوسط‪.‬‬

‫الر�سالة ‪ :3‬يمكن للبلدان االنتقال من‬ ‫االلتزام ال�سيا�سي �إلى العمل بمنح الأولوية‬ ‫للتدخالت ال�شديدة الت�أثير والمي�سورة الكلفة‬ ‫من البديهي أن االفتقار إلى التدخالت ال يمثل بوضوح العائق األولي‬ ‫للتقدم غير الكافي المحرز في الوقاية من األمراض غير السارية‬ ‫ومكافحتها‪ .‬فارتفاع معدالت الوفاة والمرض وخصوصاً في البلدان‬ ‫ذات الدخل المنخفض والمتوسط يجسد االستثمار غير الكافي في‬ ‫التدخالت ذات المردودية المتصلة باألمراض غير السارية‪ .‬وينبغي‬ ‫استخدام الموارد استخداماً استراتيجياً لتحسين حصائل األمراض‬ ‫غير السارية‪ .‬ويمكن لجميع البلدان االنتقال من االلتزام إلى العمل‬ ‫بمنح األولوية لتنفيذ سياسات وتدخالت عالية المردودية (أفضل‬ ‫السياسات والتدخالت)‪.‬‬

‫الر�سالة ‪ :6‬يكت�سي اال�ستثمار في النظم‬ ‫ال�صحية �أهمية حا�سمة لتح�سين ح�صائل‬ ‫الأمرا�ض غير ال�سارية‬ ‫يبين تحليل النظم الصحية أن الثغرات في العناصر الرئيسية للنظام‬ ‫الصحي تمثل عوائق تحول دون توفير الرعاية الصحية المنصفة‬ ‫لألشخاص المعانين من األمراض غير السارية‪ .‬وينبغي أن يكون‬ ‫تعزيز النظم الصحية‪ ،‬بما في ذلك التمويل الصحي وتصريف‬ ‫الشؤون والقوى العاملة الصحية والمعلومات الصحية والمنتجات‬ ‫والتكنولوجيات الطبية وتوفير الخدمات الصحية‪ ،‬بمثابة محور تركيز‬ ‫رئيسي في إطار تكثيف أنشطة الوقاية من األمراض غير السارية‬ ‫ومكافحتها‪ .‬وتتيح التدابير العالمية الرامية إلى تحقيق التغطية‬ ‫الصحية الشاملة فرصة لمنح األولوية بصراحة للتدخالت العالية‬ ‫المردودية المتصلة باألمراض غير السارية في مجموعة المزايا‬ ‫األساسية‪.‬‬ ‫‪xi‬‬

‫الر�سالة ‪ :4‬ال بد لجميع البلدان من تحديد‬ ‫غايات وطنية مت�صلة بالأمرا�ض غير‬ ‫ال�سارية وتحمل الم�س�ؤولية عن بلوغ هذه‬ ‫الغايات‬ ‫تشير الغايات العالمية االختيارية التسع إشارة واضحة إلى وضع‬ ‫العالم المحتمل فيما يتصل باألمراض غير السارية بحلول عام ‪.2025‬‬

‫تقرير احلالة العاملي عن الأمرا�ض غري ال�سارية ‪2014‬‬

‫الوكالة المتخصصة األولية المعنية بالصحة من بين وكاالت األمم‬ ‫المتحدة على دعم الجهود الوطنية المتصلة باألمراض غير السارية‬ ‫والرامية إلى تنفيذ خطة العمل العالمية الخاصة باألمراض غير‬ ‫السارية للفترة ‪ .2020-2013‬وتشمل المجاالت الرئيسية للعمل‬ ‫المتواصل خالل عام ‪ 2015‬وبعده تقديم المساعدة التقنية إلى‬ ‫الدول األعضاء لتحديد غايات وطنية ووضع سياسات وخطط وطنية‬ ‫بشأن األمراض غير السارية وتنفيذها من أجل بلوغ هذه الغايات‬ ‫الوطنية وتقييم االتجاهات ورصد التقدم المحرز‪ .‬وتعتزم المنظمة‬ ‫إنجاز العمل المتصل بإطار لتعزيز اتخاذ اإلجراءات القطرية على‬ ‫مستوى قطاع الصحة والقطاعات األخرى وبنهج لتسجيل مساهمات‬ ‫الجهات الفاعلة غير الدول في تحقيق الغايات العالمية االختيارية‬ ‫التسع ونشرها خالل عام ‪.2015‬‬ ‫وإن البنيان العالمي للتصدي الفعال لوباء األمراض غير السارية‬ ‫ومدى التزام البلدان بذلك في وضع جيد لم يسبق له مثيل‪.‬‬ ‫وسيساعد تحقيق الغايات العالمية التسع المتصلة باألمراض غير‬ ‫السارية بحلول عام ‪ 2025‬على كبح وباء األمراض غير السارية من‬ ‫حيث سرعة استفحاله وآثاره الصحية واالجتماعية واالقتصادية‬ ‫المدمرة‪ .‬وهذه مهمة عظيمة محفوفة بتحديات عديدة إال أن‬ ‫االمتناع عن العمل أمر لن تصفح عنه األجيال القادمة التي سيحق لها‬ ‫أن تستفسر عن سبب عدم اتخاذ إجراءات حاسمة إن سمحنا لهذه‬ ‫الفرصة المتاحة لتغيير مجرى التاريخ بأن تفلت من بين أيادينا‪.‬‬

‫الر�سالة ‪ :7‬من ال�ضروري تعزيز قدرات‬ ‫الم�ؤ�س�سات والموارد الب�شرية للوقاية من‬ ‫الأمرا�ض غير ال�سارية ومكافحتها‬ ‫يتطلب بلوغ الغايات الوطنية توفر قدرات المؤسسات والموارد‬ ‫البشرية لتناول المسائل المعقدة المتعلقة بالوقاية من األمراض‬ ‫غير السارية ومكافحتها مثل التفاعل بين النظم الغذائية والزراعية‬ ‫والقانون والتجارة والنقل والتخطيط الحضري‪ .‬ومن الضروري‬ ‫تعزيز كفاءات القوى العاملة الصحية وقدراتها من أجل التصدي‬ ‫لألمراض غير السارية‪ ،‬بما في ذلك عن طريق إدراج جوانب الصحة‬ ‫العمومية للوقاية من األمراض غير السارية ومكافحتها في مناهج‬ ‫تدريس العاملين الطبيين والعاملين في مجال التمريض والموظفين‬ ‫الصحيين المساعدين وتوفير التدريب أثناء العمل‪.‬‬ ‫وبينما يجب على الحكومات مواصلة االعتراف بمسؤوليتها‬ ‫األولية عن مواجهة التحدي الذي تطرحه األمراض غير السارية‬ ‫وتحديد غاياتها الوطنية ووضع خطط عملها الوطنية‪ ،‬سيقتضي‬ ‫تحقيق الغايات العالمية بذل الجهود والمشاركة على مستوى‬ ‫جميع قطاعات المجتمع على الصعيدين الوطني واإلقليمي وعلى‬ ‫الصعيد العالمي‪ .‬وتوجد آليات عالمية جديدة لتسريع وتيرة‬ ‫اإلجراءات الوطنية المتصلة باألمراض غير السارية‪ .‬وتتولى فرقة‬ ‫عمل األمم المتحدة المشتركة بين الوكاالت والمعنية بالوقاية من‬ ‫األمراض غير المعدية (غير السارية) ومكافحتها التي أنشأها األمين‬ ‫العام في حزيران‪/‬يونيو ‪ 2013‬وأسند قيادتها إلى منظمة الصحة‬ ‫العالمية تنسيق أنشطة منظمات األمم المتحدة المعنية والمنظمات‬ ‫الحكومية الدولية األخرى من أجل دعم تنفيذ االلتزامات التي‬ ‫قطعها قادة العالم ضمن اإلعالن السياسي لعام ‪ 2011‬بشأن األمراض‬ ‫غير السارية وال‪ ‬سيما من خالل تنفيذ خطة العمل العالمية لمنظمة‬ ‫الصحة العالمية الخاصة باألمراض غير السارية للفترة ‪.2020-2013‬‬ ‫وقد اعتمد المجلس االقتصادي واالجتماعي التابع لألمم المتحدة‬ ‫اختصاصات فرقة العمل في تموز‪/‬يوليو ‪ .2014‬وأنشأت منظمة‬ ‫الصحة العالمية آلية التنسيق العالمية التابعة لها والمعنية بالوقاية‬ ‫من األمراض غير السارية ومكافحتها في أيلول‪/‬سبتمبر ‪ 2014‬لتيسير‬ ‫تنسيق األنشطة وتعزيزه فيما بين الدول األعضاء ومنظمات األمم‬ ‫المتحدة والجهات الفاعلة غير الدول بهدف المساهمة في تنفيذ‬ ‫خطة العمل العالمية للمنظمة الخاصة باألمراض غير السارية للفترة‬ ‫‪.2020-2013‬‬ ‫وتضطلع المنظمة بدور القيادة والتنسيق في تعزيز إجراءات‬ ‫مكافحة األمراض غير السارية ورصدها‪ .‬وستثابر المنظمة بوصفها‬ ‫‪xii‬‬

‫خفض نسبي قدره ‪ ٪25‬في إجمالي معدل الوفيات الناجمة عن أمراض القلب‬ ‫واألوعية الدموية أو السرطان أو داء السكري أو أمراض الجهاز التنفسي المزمنة‬ ‫خفض نسبي قدره ‪ ٪10‬على األقل في تعاطي الكحول على نحو ضار‪ ،‬حسبما يكون‬ ‫مناسباً‪ ،‬في السياق الوطني‬ ‫خفض نسبي قدره ‪ ٪10‬في انتشار قلّة النشاط البدني‬ ‫خفض نسبي قدره ‪ ٪30‬في متوسط مدخول السكان من الملح‪ /‬الصوديوم‬ ‫خفض نسبي قدره ‪ ٪30‬في االنتشار الراهن لتعاطي التبغ بين األشخاص الذين‬ ‫يبلغون ‪ 15‬عاماً من العمر فأكثر‬ ‫خفض نسبي قدره ‪ ٪25‬في انتشار ارتفاع ضغط الدم أو احتواء انتشار ارتفاع ضغط‬ ‫الدم تبعاً للظروف الوطنية‬ ‫وقف الزيادة في داء السكري والبدانة‬ ‫تلقي ‪ ٪50‬على األقل من األشخاص المؤهلين عالجاً باألدوية ومشور ً‬ ‫ة (بما في‬ ‫ذلك السيطرة على سكر الدم) من أجل الوقاية من النوبات والسكتات القلبية‬ ‫توافر بنسبة ‪ ٪80‬للتكنولوجيات األساسية واألدوية األساسية بأسعار معقولة‪ ،‬بما‬ ‫في ذلك األدوية الجنيسة‪ ،‬الالزمة لعالج األمراض غير السارية الرئيسية في المرافق‬ ‫العامة والخاصة على السواء‬

‫‪ ‬‬

‫‪www.who.int/ncd‬‬

Key facts

Organisation World Health Organization (WHO)

Document type Publications

Adoption date December 31, 2014

Source World Health Organization