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Noncommunicable diseases in the Western Pacific Region : a profile

December 31, 2012 World Health Organization

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Noncommunicable Diseases in the Western Pacific Region A Profile

WHO Library Cataloguing in Publication Data Noncommunicable diseases in the Western Pacific Region: a profile 1. Chronic diseases – prevention and control. 2. Data collection. 3. Registries. I. World Health Organization Regional Office for the Western Pacific. ISBN 978 92 9061 563 7 (NLM Classification: WT 500)

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Noncommunicable Diseases in the Western Pacific Region: A Profile

Table of Contents Preface Summary 1. Introduction 2. Burden of noncommunicable diseases 3. Risk factors for noncommunicable diseases 4. NCD country capacity 5. NCD country profiles 6. Key findings and recommendations Annexes Annex 1 - Regional Commitments on NCD Annex 2 - Exploratory Notes on Country Estimates Annex 3 - 2008 Comparable Estimates of NCD Mortality Annex 4 - WHO STEPwise Surveillance for NCD Risk Factors

5 7 9 10 17 23 29 57 59 59 63 68 69

Noncommunicable Diseases in the Western Pacific Region: A Profile

Acknowledgements This profile was prepared with input from Dr Annette David, Dr Cherian Varghese, Dr Hai-Rim Shin, Ms Marie Clem Carlos, Dr Han Tieru, Ms Leanne Riley, Ms Regina Guthold, Ms Melanie Cowen, Dr Ashley Bloomfield, Ms Anjana Bhushan, Dr Manju Rani, and Professor Donald Matheson. It was reviewed by Professor Ruth Bonita and Dr Kyungwon Oh.

Noncommunicable Diseases in the Western Pacific Region: A Profile

Preface Prevention and control of noncommunicable diseases (NCDs) are national, regional and global priorities. Despite progress, more needs to be done to address the burden and socioeconomic consequences of NCDs. Regional and global declarations in 2011 have reiterated the commitment of Member States to NCD prevention and control. While efforts are ongoing to address the challenges of NCD prevention and control, a forceful response is required at the national and regional levels. Reliable and timely data are mandatory for the planning and evaluation of NCD programmes. However, setting up and maintaining surveillance systems can be difficult for low- and middle-income countries. Regardless, the NCD burden, in terms of mortality and risk factors, have to be kept under regular surveillance. Information on health system indicators and capacity are also critical for introducing and evaluating interventions. Policies in related domains such as trade, agriculture and marketing also need monitoring as they impact NCDs. The political declaration of the United Nations High-level Meeting on Noncommunicable Diseases in September 2011 is a clear indication of the high level of commitment for NCD prevention and control worldwide. At the sixty-second session of the WHO Regional Committee for the Western Pacific, Member States discussed options for expanding and intensifying NCD prevention and control in the Region. Given the huge burden and unacceptable rates of preventable premature morbidity and mortality from NCDs, we have to move towards time-bound targets with indicators and an accountability framework. This regional profile, based on the WHO Global status report on noncommunicable diseases, will serve as a baseline for measuring the impact of our efforts in NCD prevention and control in the Western Pacific Region. Let us continue to work together to prevent NCDs and promote health and development for all people of the Region.

Shin Young-soo, MD, Ph.D. Regional Director

Noncommunicable Diseases in the Western Pacific Region: A Profile

Summary This profile of noncommunicable diseases (NCDs) in the Western Pacific Region is based largely on the WHO Global status report on noncommunicable diseases published in 2011. Country-specific data are classified by income category to reflect the variations among countries in the Region and to serve as a baseline for further monitoring. Mortality from NCDs is higher in low- and middle-income countries (LMIC) than in high-income countries (HIC). The gap between the two income groups is even more pronounced for NCD deaths below the age of 70 years. Efforts are also needed to strengthen mortality registration and certification systems in LMIC. Disease registries are not widely available in the Region, making it difficult to assess morbidity. National-level data on cancer burden are available from GLOBOCAN 2008, and are presented in terms of incidence and mortality. Variations in the rate of breast and uterine cervical cancer in women are also highlighted. Diabetes prevalence is more than 10% in almost all the Pacific island countries. Prevalence of risk factors is a pointer to the burden of NCDs. The wide variation in tobacco prevalence in the Region indicates that there is potential to reduce tobacco use in many countries. Obesity and lack of physical activity are serious issues in most countries and indicate a need for the promotion of healthy diets and physical activity through multisectoral actions. Alcohol consumption also shows wide variation. Raised blood pressure and blood cholesterol levels are uniformly high in the region. Population trends help to estimate the future burden of NCDs. National capacity for assessment of NCD prevention and control were undertaken by WHO in 2004 and 2010. NCD country profiles, which include mortality, risk factors, and capacity to prevent and control NCDs, are presented for all Member States in the Region. Periodic evaluation can help countries to scale up NCD prevention and control. This regional profile presents a situational analysis and can serve as a baseline for Member States to move towards time-bound targets.

Noncommunicable Diseases in the Western Pacific Region: A Profile

1. Introduction Noncommunicable diseases (NCDs), principally cardiovascular diseases, cancer, diabetes and chronic respiratory diseases, impose a major and growing burden on health and development in the Western Pacific Region. NCDs are the leading causes of death and disability in the Region, responsible for 80% of all deaths in a region that is home to more than one quarter of the world’s population. Of particular concern is the high level of premature mortality from NCDs (deaths before 70 years of age) in several low- and middle-income countries (LMIC). There are indications that NCD-related morbidity and mortality will continue to rise if urgent measures are not taken. The High-level Meeting of the General Assembly on the prevention and control of NCDs in September 2011 firmly placed NCD prevention and control as a global priority. Efforts are also ongoing at the regional and national levels to scale up NCD prevention and control. Regional commitments, particularly the Seoul Declaration and the Honiara Communiqué on the Pacific NCD Crisis (Annex 1), reflect the collective will to expand and intensify efforts for NCD prevention and control in the Region. One of the key ingredients for advancing the NCD agenda is to have an overview of the current NCD situation—mortality, morbidity, risk factors and country capacity. The data and findings presented in the profile are mainly from the WHO Global status report on noncommunicable diseases released in 2011.1 The profile has four major sections: burden, risk factors, country capacity for NCD prevention and control, and NCD country profiles. All estimates were prepared by WHO, using multiple data sources and analytical methods (Annex 2). The data are presented by country groupings—high-income countries (HIC) and low- and middleincome countries (LMIC)—as per the World Bank income categories as of July 2011.2 The NCD country profiles in Section 5, however, use the 2008 World Bank income categories. There are many challenges in data collection and analysis in LMIC. Mortality registration is often weak, disease registries are suboptimal, and risk factor surveys are sporadic. National governments are responsible for leading and facilitating the collection of data and processing of information for action. Other groups such as academia and civil society are well positioned to support these efforts and use the data in innovative ways. The WHO STEPwise approach to surveillance of NCD risk factors (STEPS) has been adopted in some LMIC of the Region to measure trends, either as a stand alone format or incorporated into national health surveys. WHO has been undertaking a major exercise in passive epidemiological surveillance, gathering published and unpublished data and information about key aspects of NCD globally. The findings in this profile are limited to the global comparisons. There is also a need to have better indicators to demonstrate the full information on the actual implementation of interventions. This brief profile provides a baseline for measuring our efforts and encourages scaling up national surveillance frameworks for NCD prevention and control, especially in LMIC. 1 2

Global status report on noncommunicable diseases. Geneva, WHO, 2011. Available online at http://www.who.int/chp/ncd_global_status_report/en/ World Bank List of Economies. Washington, DC, The World Bank, 2011. Available online at http://siteresources.worldbank.org/DATASTATISTICS/ Resources/CLASS.XLS

Noncommunicable Diseases in the Western Pacific Region: A Profile

2. Burden of noncommunicable diseases Mortality In 2008, more than a quarter of the 36 million deaths from NCDs worldwide were from the Western Pacific Region. Globally, NCD deaths are projected to increase by 15% between 2010 and 2020 (to 44 million deaths), with the highest numbers predicted in the Western Pacific (12.3 million deaths) and South-East Asia (10.4 million deaths) Regions. Comparable estimates of NCD mortality for 2008—total NCD deaths, percentage of NCD deaths occurring under the age of 70, and age-standardized death rates per 100 000—are presented for each Member State of the Region in Annex 3.

Overall mortality from noncommunicable diseases Figure 1 presents the age-standardized death rate from NCDs in the Region. The data are presented in ascending order of mortality rates in HIC and LMIC. There is a two- to three-fold difference in male NCD mortality rates between HIC and LMIC. Figure 1. Age-standardized death rate (per 100 000) from NCD, Western Pacific Region, 2008 1400 Men 1200 Women

Age-standardized death rate per 100,000

1000

800

600

400

200

0 m era Mic ted ron Sta esia tes , of* Va nu atu * nd Re p Ko ublic rea of , th e Da Br rus une sal i am ina s* s Fiji ga Tu val u ll Is lan ds, the * Ma rsh a alia sia es po re lau * ti ew Gu ine cra a * tic Lao P Re pu eople blic ’s , th e* Mo ng olia * Isla nd ea la Jap Ton lay Ch pin mo od ia Niu Na nd iba Pa Vie t Isla ga Kir mb ilip Sa Na str uru a* e an *

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High Income

Low- and middle-income

*Countries have a high degree of uncertainty because they are not based on national NCD mortality data. The estimates for these countries 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). Source: Global status report on noncommunicable diseases. Geneva, WHO, 2011.

Noncommunicable Diseases in the Western Pacific Region: A Profile

Premature mortality from noncommunicable diseases Premature deaths from NCDs result in loss of productivity and have an impact on the economy. Figure 2 presents the proportion of all NCD deaths occurring under the age 70 in the Western Pacific Region, highlighting the greater burden borne by LMIC. Figure 2. Percentage of all NCD deaths under age 70, Western Pacific Region, 2008 100 Men Women

% of all NCD deaths

0 an a* rat Micr ed on Sta esia tes , of* Ma lay sia Va De nu mo atu cra * tic Lao P Re e pu ople blic ’s , th e* Co ok Isla So nd s lom on Isla nd s* d Re p Ko ublic rea of , th e Sin ga po re Da Br rus une sal i am alia Fiji lu uru e ti iba Kir Ma rsh all Isla * ga * ina lau ia* m es a* Tu va Na mo Niu olia lan Jap Ton pin ine Ch Na od ea Pa ng Vie t mb Gu Sa ilip s, t nd str he *

High Income

the

Low- and middle-income

Noncommunicable Diseases in the Western Pacific Region: A Profile

Cardiovascular disease and diabetes mellitus Age-standardized death rates from cardiovascular disease and diabetes mellitus are provided in Figure 3. Substantial differences in mortality rates are seen between HIC and LMIC. Figure 3. Age-standardized death rate (per 100 000) from cardiovascular disease and diabetes, Western Pacific Region, 2008 1000 Men Women

Age-standardized death rate per 100,000

750

500

250

0 * rat Micr ed on Sta esia tes , aN of* ew Gu ine a* Va De nu mo a cra t u* tic Lao P Re pu eople blic ’s , th e* Pa lau * Re p Ko ublic rea of , th Ne e wZ ea lan d Sin ga po re Da Br rus une sal i am alia olia iba nd Niu Tu va nd Jap pin Na Ton mo Ch lay od he s, t nd Isla Kir Isla ng mb ilip Sa Na str uru a* ti ina Fiji lu Ma rsh all Isla e sia an s ga ia* m es s* *

Vie t

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High Income

* Country data not available. Estimate 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 (not including chronic diseases). Source: Global status report on noncommunicable diseases. Geneva, WHO, 2011.

the

Low- and middle-income

Noncommunicable Diseases in the Western Pacific Region: A Profile

Cancer Within the Region, cancer deaths make up one quarter of all NCD deaths. Variation in death rates across countries is presented in Figure 4. Figure 4. Age-standardized death rate (per 100 000) from cancer, Western Pacific Region, 2008 300 Men Women

Age-standardized death rate per 100,000

200

100

0 Jap an Re p Ko ublic rea of , th e Fiji uru lu * m Ca mb od i a L * tic ao P Re pu eople Pa blic ’s pu , th aN e* ew Gu ine a* ti e B rus rune sal i am Au str alia Sin ga po re Ne wZ ea lan d Sa mo a* rat Micr ed on Sta esia tes , of* * tu* ga he ina Ch s sia es s* Niu Tu va Ton pin ua Isla Kir Pa s, t Na lay Na nd Isla Va n Vie t ilip Ma nd ng Mo olia iba lau nd *

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cra

Noncommunicable Diseases in the Western Pacific Region: A Profile

Morbidity Morbidity data on the four principal NCDs are not uniformly available. Only cancer and diabetes mellitus are addressed in this profile. Population-based disease registries are essential to generate incidence data on NCDs.

Cancer Morbidity data on cancer come from GLOBOCAN 2008,3 which provides comparable estimates on incidence and mortality of cancers worldwide in 2008. Figure 5 presents age-standardized cancer incidence in men and women and demonstrates the wide variation across countries. Figure 5. Age-standardized incidence rate of cancer (all sites except non-melanoma skin cancer), Western Pacific Region, 2008 400 Men Women

Age-standardized rate per 100,000

300

200

100

0 ga po re B rus rune sal i am a m Jap an Re pu b Ko lic rea of , th e Ne wZ ea lan d alia nd s mb od ia de Mic rat ed rone Sta sia tes , De mo of cra La o tic Re Peo pu ple blic ’s , th e ina Ch tu a mo ysi ilip pin str Na ua ine sla Ma la Va n Vie t Gu Sa ng Mo olia Fiji es a aN Pa pu ew

on I

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High Income Source: IARC Globocan 2008

Low- and middle-income

GLOBOCAN 2008. Lyons, International Agency for Research on Cancer, 2008 (http://globocan.iarc.fr/)

the

Noncommunicable Diseases in the Western Pacific Region: A Profile

In women, breast and cervical cancer are among the leading causes of cancer deaths. The variation in incidence among countries is in large part a reflection of heterogeneous screening and early detection programmes throughout the Region in addition to the underlying differences in occurence (Figure 6). Figure 6. Age-standardized incidence rate of breast and cervix uteri cancer, Western Pacific Region, 2008 100 Breast Cervix

Age-standardized rate per 100,000

0 Na m L tic ao P Re eo pu ple blic ’s , th Pa e pu aN ew Gu ine a So lom on Isla nd s alia an B rus rune sal i am Re pu Ko blic rea of , th e ina a tu Fiji olia lan mo od po ua Jap pin str ng mb Ch Sa Va n ga ea lay Ma sia ia es Ph ilip re d

Sin

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High Income Source: IARC Globocan 2008

cra

Low- and middle-income

Noncommunicable Diseases in the Western Pacific Region: A Profile

Diabetes mellitus Diabetes mellitus4 is an important marker of the burden of NCD in a population. It is the leading cause of renal failure in many populations. Figure 7 shows a marked variation in prevalence rates of diabetes in the Region, and very little difference in prevalence among men and women in most countries. Figure 7. Age-standardized prevalence of diabetes mellitus in adults aged 25+ years, comparable estimates, Western Pacific Region, 2008 40 Men Women

Prevalence %

0 Fiji M rat icro ed ne Sta sia Pa tes , pu of aN ew Gu ine a tu m alia ina re sia an s ga Re p Ko ublic rea of , th e es a s uru ti iba Kir Ma rsh all Isla olia nd nd Na po Jap pin ua Ton mo od Ch lay Na str ng mb Isla Isla Vie t Va n ilip Sa ga Mo Ma Au nd s, t he ia Ca

Sin

on So lom

High Income

Low- and middle-income

Source: Global status report on noncommunicable diseases. Geneva, WHO, 2011.

Diabetes is defined as having a fasting plasma glucose value ≥ 7.0 mmol/L (126 mg/dl) or being on medication for raised blood glucose.

the

Noncommunicable Diseases in the Western Pacific Region: A Profile

3. Risk factors for noncommunicable diseases The levels of NCD risk factors in the population are important indicators of future disease burden. Four modifiable risk factors are responsible for two thirds of NCDs in the Region: tobacco use, unhealthy diets, physical inactivity and harmful use of alcohol. Significant gains can be made in the Region by addressing all of these risk factors as well as the metabolic and physiologic changes: obesity, raised blood pressure, raised blood glucose, and unhealthy lipid profiles.

Behavioural risk factors Tobacco use Tobacco use is the leading cause of preventable deaths globally and within the Region. The percentage of men and women who smoke daily varies considerable by country, with rates ranging from less than 15% to 74% in men, and from under 2% to 62% in women (Figure 8). The variation in rates of tobacco use prevalence is a reflection of tobacco control efforts and indicates the huge potential for reducing rates further in countries. Figure 8. Age-standardized prevalence of daily tobacco smoking in adults aged 15+ years, comparable country estimates, Western Pacific Region, 2008 75 Men Women

Prevalence % 25 0 Re p Ko ublic rea of , th e Fiji lau u olia Na mo uru cra La tic o P Re eo pu ple blic ’s , th e Ca mb od ia ua tu de Mic rat ed rone Ma Sta sia rsh tes , all of Isla nd s, t he Sa mo a Ton ga m Jap an alia ina es sia ds d re a s Tu val ea lan pin lan lay Pa Na po Mo ng str sla Ch ine Sin ga Va n Gu Kir iba nd ti

ok Is

on I

Vie t

ilip

So lom

the

High Income

Low- and middle-income

Source: Global status report on noncommunicable diseases. Geneva, WHO, 2011.

Noncommunicable Diseases in the Western Pacific Region: A Profile

Unhealthy diet Unhealthy diet is composed of multiple elements. Comparable data on the prevalence of this parameter across countries were not available. Metabolic and physiologic risk factors such as obesity, diabetes and high blood cholesterol are indirect indicators of the prevalence of unhealthy diets in the population.

Physical inactivity Physical inactivity5 is variable across the Region, with prevalence rates ranging from 10% to 70% in men and women. Women tend to report more physical inactivity than men, especially in PIC (Figure 9). Figure 9. Age-standardized prevalence of insufficient physical activity in adults aged 15+ years, comparable country estimates, Western Pacific Region, 2008 75 Men Women

Prevalence % 25 0 mo a lay sia Fe de Mic rat ed rone Sta sia tes , of Co ok Isla nd s the Na m La tic o P Re eo pu ple blic ’s , th Pa e pu aN ew Gu ine a Ca mb od ia Ton ga Isla nd s iba ti an olia uru Na nd Jap pin es alia ina ea la str ng Ch Vie t ilip Sa Kir nd all Isla s, t he Mo Au Ma

So lom

High Income

De mo

Low- and middle-income

Source: Global status report on noncommunicable diseases. Geneva, WHO, 2011.

Insufficient physical activity is defined as less than 30 minutes of moderate activity five times per week, or less than 20 minutes of vigorous activity three times per week, or equivalent.

Ma rsh

cra

Noncommunicable Diseases in the Western Pacific Region: A Profile

Harmful use of alcohol There is a high level of variation in alcohol consumption. Total adult per capita consumption of pure alcohol (litres) for both sexes is presented in Figure 10. Figure 10. Total adult (15+ years of age) per capita consumption of pure alcohol (litres) for both sexes, Western Pacific Region, 2008 20

Adult capita consumption of pure alcohol (litres)

0 Re p Ko ublic rea of , th e Fiji lu Na uru M rat icro ed ne Sta sia tes , of Ch ina Ph De ilip pin mo es cra La tic o P Re eo pu ple blic ’s , th e olia ia ti B rus rune sal i am alia iba nd nd ine mo Tu va Na Jap Ton lay Niu lan po ua od str Isla Isla Kir ng Va n Vie t Ma Mo Au mb Gu ea Sa ga Pa lau a m a sia an ga tu d re e s s

Sin

lom

High Income Source: Global status report on noncommunicable diseases. Geneva, WHO, 2011.

Low- and middle-income

the

Noncommunicable Diseases in the Western Pacific Region: A Profile

Metabolic/physiologic risk factors Behavioural risk factors lead to metabolic/physiologic risk factors such as overweight and obesity, raised blood pressure, raised blood glucose, and unhealthy lipid profiles. These risk factors operate on a risk continuum and population-based approaches are needed to reduce the mean levels in the population. Mean levels of systolic blood pressure, body mass index (BMI), blood glucose, and total cholesterol are incorporated in the NCD country profiles in Section 5. This section presents the prevalence of risk factors using the cut-off levels used in the WHO Global status report on noncommunicable diseases 2010.

Overweight and obesity Overweight and obesity6 lead to adverse effects on blood pressure, cholesterol, triglycerides and insulin resistance. The risks of coronary heart disease, ischaemic stroke and type 2 diabetes mellitus increase steadily with increasing BMI. Raised BMI also increases the risk of cancer of the breast, colon/rectum, endometrium, kidney, oesophagus (adenocarcinoma) and pancreas.7,8 The prevalence of obesity among adults in the Region varies from under 5% to 75%. Women are more likely to be obese than men, especially in many PIC (Figure 11). Figure 11. Age-standardized prevalence of obesity in adults aged 20+ years, comparable country estimates, Western Pacific Region, 2008 75 Men Women

Prevalence % 25 0 ore Re p Ko ublic rea of , th e Au str alia Ne wZ ea lan d an sia sla nd s era Micr ted one Sta sia tes , of m ina dia L tic ao P Re eo pu ple blic ’s , th e Ph ilip pin es atu Fiji lia a a ti s ok Isla nd mb o Va nu ga p Gu Kir ds, t Vie t Mo n Ma Sa Na uru ine a iba he Ton g Na Jap Ch lay go mo

on I

ll Is lan

Sin

So lom

De mo

High Income Source: Global status report on noncommunicable diseases. Geneva, WHO, 2011.

Low- and middle-income

Overweight is defined as body mass index (BMI) ≥25 kg/m2 , while obesity as BMI ≥30 kg/m2. The World health report 2002: Reducing risks, promoting healthy life. Geneva, World Health Organization, 2002. 8 Policy and action for cancer prevention. Food, nutrition, and physical activity: a global perspective. Washington, DC, World Cancer Research Fund/ American Institute for Cancer Research, 2009. 6 7

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Noncommunicable Diseases in the Western Pacific Region: A Profile

Raised blood pressure Raised blood pressure9 has been shown to be positively linked to stroke and coronary heart disease and to multiple end-organ complications. All countries in the Region have prevalence rates of raised blood pressure over 20%, with country-specific rates ranging from 25% to 50%. Rates among women are almost as high as men in all the countries. Prevalence of raised blood pressure does not show a marked difference between HIC and LMIC (Figure 12). Figure 12. Age-standardized prevalence of raised blood pressure in adults aged 25+ years, comparable country estimates, Western Pacific Region, 2008 75 Men Women

Prevalence % 25 0 nd s atic Lao Re Peo pu ple blic ’s , th e Ph ilip pin es Re p Ko ublic rea of , th e Au str alia Ne wZ ea lan d Sin ga po re m Fiji an Ton ga Fe de Mic rat ed rone Sta sia tes , of Sa mo a Co ok Isla nd s uru ina tu ua Va n od Jap wG uin Na Ch iba ysi Na Ca mb Vie t Mo ng Isla Ma la nd s, Kir olia the ea ia a ti

So lom

pu a

mo cr

rsh

all

Isla

High Income

Low- and middle-income

Source: Global status report on noncommunicable diseases. Geneva, WHO, 2011.

Raised blood pressure is defined as systolic blood pressure of ≥140 mmHg and/or diastolic blood pressure of ≥90 mmHg, or using medication to lower blood pressure.

the

Noncommunicable Diseases in the Western Pacific Region: A Profile

Raised cholesterol Raised cholesterol10 increases the risk of heart disease and stroke. The prevalence of raised cholesterol is higher in HIC than LMIC. Uniformly high rates are observed in both men and women (Figure 13). Figure 13. Age-standardized prevalence of raised total cholesterol11 in adults aged 25 years, comparable country estimates, Western Pacific Region, 2008 75 Men Women

Prevalence % 25 0 Re p Ko ublic rea of , th e an a olia alia M rat icro ed ne Sta sia tes , of uru Fiji ga ia ti ina iba he d es s re a nd mo lan po ine od Jap pin Ton Ch Na ng str s, t Isla mb Gu ga ilip Au Mo nd Isla Co ok Sa Kir ea nd s

Sin

lom

rsh

all

Isla Ma

High Income Source: Global status report on noncommunicable diseases. Geneva, WHO, 2011.

Low- and middle-income

10 11

Ezzati M et al. Selected major risk factors and global and regional burden of disease. The Lancet, 2002, 360:1347–1360. Raised cholesterol was defined, in these estimates, as 5.0 mmol/L or 190 mg/dl or higher.

the

Noncommunicable Diseases in the Western Pacific Region: A Profile

4. NCD country capacity NCD country capacity surveys (CCS) were undertaken by WHO in 2004 and 2010 to update information on individual country capacity to address NCD prevention and control. Collated information from countries is available in the Global Health Observatory Data Repository (http://apps.who.int/ ghodata/).

Country capacity surveys: 2004 and 2010 In the Region, twenty-seven countries and areas responded to the survey in 2004 and 35 responded in 2010. Table 1 shows the status of selected parameters in both years. Table 1. Comparison of country capacity indicators, Western Pacific Region, 2004 and 2010 Indicator NCD POLICY AND PROGRAMME INFRASTRUCTURE Number of countries with national NCD entity (focal point, unit or department) Number of countries with an allocated budget for NCD prevention and control Number of countries with an integrated NCD policy, strategy and/or action plan Number of countries with legislation (acts, laws, regulations, ministerial decrees, policies, plans, procedures, etc.) on: Tobacco Control Nutrition Physical Activity Alcohol Consumption Diabetes Number of countries completing at least one round of WHO STEPS survey Number of countries with surveillance system that covers the following risk factors: Tobacco Control Alcohol Consumption Unhealthy Diet Physical Inactivity Diabetes/Raised Blood Glucose Hypertension/Raised Blood Pressure Overweight and Obesity Dyslipidaemia Number of countries with clinical protocols, guidelines, standards for the treatment/management of the following: Hypertension Diabetes Mellitus Source: NCD country capacity survey data, WHO Western Pacific Regional Office, 2004 and 2010.

2004 (n=27) 14 24 15

2010 (n=35) 32 30 28

22 17 9 12 15 10 17 13 12 12 18 17 15 10

29 23 21 19 25 22 31 29 30 27 28 29 30 25

16 18

32 33

Noncommunicable Diseases in the Western Pacific Region: A Profile

Country capacity 2010 NCD unit and policies Thirty-two of the 35 countries and areas that responded to the 2010 survey have a unit, branch or department in the Ministry of Health (or its equivalent) designated for NCD prevention and control. Twenty-eight have an integrated NCD policy, strategy and/or action plan and specific policies that address risk factors, most notably tobacco use. Though structures and mechanisms vary, most countries and areas have a designated NCD unit and policies for NCD risk factor reduction (Table 2). Table 2. Dedicated NCD unit, integrated NCD policy, and policies on risk factors, Western Pacific Region, 2010 Dedicated NCD office in Ministry of Health Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Policy addressing specific risk factors Integrated NCD Policy No Yes No Yes No Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes No Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Alcohol No Yes Yes Yes No No* Yes Yes Yes Yes Yes No* No No Yes Yes Yes No* Yes Yes Yes Yes No* No* No* Yes No* Yes No* Yes No* No* Yes No Unhealthy diet No Yes Yes No* Yes No* Yes Yes Yes Yes Yes No* Yes Yes No* Yes Yes Yes Yes Yes Yes Yes Yes No* No* Yes Yes Yes No* Yes Yes No* Yes No Physical inactivity No Yes Yes No* No No* Yes Yes Yes Yes Yes No* Yes Yes No* Yes Yes Yes Yes Yes Yes Yes No* No* No* Yes Yes Yes No* Yes No* No* Yes No Tobacco Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No* No* Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No* Yes Yes Yes

Country

American Samoa Australia Brunei Darussalam Cambodia China Cook Islands Fiji French Polynesia Guam Hong Kong (China) Japan Kiribati Lao People’s Democratic Republic, the Macao (China) Malaysia Marshall Islands, the Micronesia, the Federated States of Mongolia Nauru New Caledonia New Zealand Niue Northern Mariana Islands, the Commonwealth of the Palau Papua New Guinea Philippines Republic of Korea, the Samoa Singapore Solomon Islands Tokelau Tonga Tuvalu Vanuatu Viet Nam

Note: *Not a standalone policy but was reported as part of the integrated national policy

Noncommunicable Diseases in the Western Pacific Region: A Profile

Health reporting, information systems, monitoring and surveillance Twelve of the 35 countries and areas have incorporated population-based, cause-specific mortality data into their national health reporting systems. While many countries and areas in the Region have a cancer registry, only 10 countries maintain a population-based cancer registry. Twenty-six countries and areas reported having risk factor surveys, and of which, 23 are based on populations (Table 3). The WHO STEPwise approach to surveillance of NCD risk factors (STEPS) has been used in 22 countries and areas of the Region either in a “stand alone” format or incorporated into national health surveys (Annex 4). Repeated surveys at regular intervals are essential to measure trends.

Table 3. Surveillance data in national health reporting systems, Western Pacific Region, 2010 Country American Samoa Australia Brunei Darussalam Cambodia China Cook Islands Fiji French Polynesia Guam Hong Kong (China) Japan Kiribati Lao People’s Democratic Republic, the Macao (China) Malaysia Marshall Islands, the Micronesia, the Federated States of Mongolia Nauru New Caledonia New Zealand Niue Northern Mariana Islands, the Commonwealth of the Palau Papua New Guinea Philippines Republic of Korea, the Samoa Singapore Solomon Islands Tokelau Tonga Tuvalu Vanuatu Viet Nam *Population-based data

Mortality No Yes* Yes* Yes Yes* Yes Yes Yes Yes Yes* Yes* Yes No Yes Yes Yes Yes Yes Yes Yes* Yes* Yes Yes Yes* Yes* Yes Yes* Yes Yes* No Yes* Yes Yes Yes Yes

Cancer Registry Yes Yes* Yes Yes Yes* Yes* Yes* Yes Yes* Yes* Yes* Yes* Yes* Yes Yes* Yes Yes* Yes* Yes* Yes* Yes* Yes* Yes Yes Yes* Yes* Yes* No Yes* Yes Yes* Yes* No Yes* Yes

Risk Factors Yes* Yes* Yes* No Yes Yes Yes No Yes Yes* Yes Yes Yes Yes Yes* Yes Yes Yes Yes Yes Yes* Yes Yes No Yes Yes* Yes* No Yes* No Yes Yes No Yes* No

Noncommunicable Diseases in the Western Pacific Region: A Profile

Health system capacity for NCD prevention, early detection, treatment and care within the primary health care system A majority of the respondent countries and areas have evidence-based national guidelines, protocols and/or standards for diabetes (94%) and hypertension (91%) (Table 4). Nearly half of the 35 countries and areas have insurance coverage for NCDs (46%), while 29 countries and areas have a list of essential NCD-related medicines. Accessibility to community or home care for people with advanced or end-stage NCDs was reported by 14 countries and areas.

Health promotion, partnerships and collaboration Thirty-two of the 35 countries and areas reported engaging in partnerships to implement NCD activities (Table 5). Key stakeholders are nongovernmental organizations, the private sector, and non-health government ministries or departments. A majority of countries and areas reported implementing fiscal interventions for NCD prevention and control (86%). About one third reported having established earmarking of taxes on substances such as tobacco and alcohol. Fifteen have regulations on the marketing of food to children, while nine have enforcement mechanisms.

Table 4. Health system capacity for NCD prevention, early detection, treatment and care within the primary health care system, Western Pacific Region, 2010 Guidelines/protocols/standards for the mgmt of conditions for NCDs Health care system factors affecting NCD management Physical activity counseling Essential list of medicine Health insurance coverage

Country / Area Hypertension Overweight and obesity Blood lipids Alcohol dependence Tobacco dependence Dietary counseling

Diabetes

Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No Yes Yes No Yes No No No Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes No No Yes Yes No Yes Yes No Yes Yes Yes No Yes Yes Yes Yes No Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No Yes Yes No Yes Yes No No Yes No No Yes Yes No Yes Yes No

Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

Yes Yes No No Yes Yes Yes Yes No Yes Yes No Yes Yes Yes Yes No No Yes Yes Yes

Yes Yes Yes No Yes No Yes Yes Yes Yes Yes No Yes Yes Yes Yes No Yes

Yes Yes No No Yes No No

Yes Yes Yes No Yes No No

Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes

Yes Yes No Yes Yes Yes Yes No Yes Yes Yes

Yes No Yes Yes Yes Yes Yes No

Yes Yes No No No No No Yes Yes Yes No Yes No Yes No Yes Yes No Yes Yes No Yes No Yes No Yes No No Yes No No Yes No Yes Yes Yes No Yes Yes No Yes Yes Yes No No Yes Yes Yes No Yes Yes No Yes Yes Yes No

Noncommunicable Diseases in the Western Pacific Region: A Profile

Table 5. Health promotion, partnerships, and collaboration, Western Pacific Region, 2010 Key stakeholders Other Government Ministries (Non-health) Other international institutions Private Sector Fiscal interventions Earmarking of taxes Academia and research centres NGOs / communitybased organizations / civil society Initiatives to regulate food marketing to children Enforcement of food marketing regulations

Health promotion initiatives

Country / Area Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No Yes Yes No Yes No Yes Yes No No No No Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes No No Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No Yes No Yes No Yes Yes Yes No No Yes No No Yes No Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes No No Yes Yes Yes Yes No Yes No Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No Yes No Yes No No Yes No Yes Yes No No No No Yes No Yes No Yes No No Yes No No No No Yes No Yes Yes Yes No No No Yes Yes No Yes No Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes No Yes No Yes Yes Yes Yes No Yes No Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes No No No No Yes Yes Yes No Yes No Yes No No No No Yes No Yes No Yes Yes No Yes No No No No Yes No No No Yes Yes Yes* No Yes* No Yes No No Yes* No No No No Yes No Yes Yes Yes* No No No Yes Yes* No

With partnerships / collaborations

Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes

Yes Yes Yes

Noncommunicable Diseases in the Western Pacific Region: A Profile

Yes

Yes Yes Yes Yes Yes

Yes

Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes

Notes: *Yes=Food marketing regulation to children is self-regulated

Noncommunicable Diseases in the Western Pacific Region: A Profile

5. NCD country profiles The NCD country profiles in this section present data of each country related to their NCD mortality, risk factors and capacity to prevent and control NCDs.12 The data presented in each of the country profiles were derived from several sources, as detailed in Annex 2.

Noncommunicable diseases country profiles. Geneva , WHO, 2011. Available online at http://www.who.int/nmh/countries/en/index.html.

Noncommunicable Diseases in the Western Pacific Region: A Profile

Australia 2010 total population: 22 268 384 Income group: High NCD mortality 2008 estimates

Proportional mortality (% of total deaths, all ages) males females 63.4 63.2 13.4 9.2 Communicable, maternal, perinatal and Injuries nutritional 6% conditions 4%

Total NCD deaths (000s) NCD deaths under age 60 (percent of all NCD deaths)

Age-standardized death rate per 100 000 All NCDs Cancers Chronic respiratory diseases Cardiovascular diseases and diabetes Behavioural risk factors 2008 estimated prevalence (%)

364.8 140.8 25.6 136.3

246.3 92.9 15.5 88.6

Other NCDs 17%

CVD 35%

Current daily tobacco smoking Physical inactivity Metabolic risk factors 2008 estimated prevalence (%)

males females 18.3 15.4 38.0 42.5

total 16.8 40.3

Diabetes 3% Respiratory diseases 6%

Raised blood pressure Raised blood glucose Overweight Obesity Raised cholesterol Metabolic risk factor trends 136 133

males females 41.1 32.0 10.8 8.0 68.2 59.3 26.4 27.1 55.9 58.9

total 36.4 9.4 63.7 26.8 57.4

Cancers 29%

NCDs are estimated to account for 90% of all deaths.

Mean systolic blood pressure kg/m2

30 28 26 24 22 20

Mean body mass index

mmHg

130 127 124 121 118

1980

1984

1988

1992

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

5.8 mmol/l 5.6 5.4 5.2 5.0 4.8 1980 1984

Mean fasting blood glucose mmol/l

6.0 5.8 5.6 5.4 5.2 5.0 Males Females

Mean total cholesterol

1988

1992

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

Country capacity to address and respond to NCDs Has a Unit / Branch / Dept in MOH with responsibility for NCDs Yes There is funding available for: NCD treatment and control NCD prevention and health promotion NCD surveillance, monitoring and evaluation National health reporting system includes: NCD cause-specific mortality NCD morbidity NCD risk factors Has a national, population-based cancer registry Has an integrated or topic-specific policy / programme / action plan which is currently operational for: Cardiovascular diseases No Cancer Yes Chronic respiratory diseases No Diabetes No Alcohol Yes Unhealthy diet / Overweight / Obesity Yes Physical inactivity Yes Tobacco Yes Number of tobacco (m)POWER measures implemented at the highest level of achievement 3/5

Yes Yes Yes

Yes Yes Yes Yes

World Health Organization - NCD Country Profiles , 2011.

Noncommunicable Diseases in the Western Pacific Region: A Profile

Brunei Darussalam 2010 total population: 398 920 Income group: High NCD mortality 2008 estimates

Proportional mortality (% of total deaths, all ages) males females 0.5 0.5 41.4 30.0 Communicable, maternal, perinatal and nutritional conditions 10% Injuries 8%

Total NCD deaths (000s) NCD deaths under age 60 (percent of all NCD deaths)

Age-standardized death rate per 100 000 All NCDs Cancers Chronic respiratory diseases Cardiovascular diseases and diabetes Behavioural risk factors 2008 estimated prevalence (%)

534.3 97.0 69.0 292.7

488.7 98.1 44.0 275.4

CVD 33%

Current daily tobacco smoking Physical inactivity Metabolic risk factors 2008 estimated prevalence (%)

males females … … ... ...

total … ...

Other NCDs 14%

Raised blood pressure Raised blood glucose Overweight Obesity Raised cholesterol Metabolic risk factor trends 136 132

males females ... ... ... ... ... ... ... ... … …

total ... ... ... ... …

Diabetes 11% Respiratory diseases 8%

Cancers 16%

NCDs are estimated to account for 82% of all deaths.

Mean systolic blood pressure kg/m2

28 26 24 22 20 18

Mean body mass index

mmHg

128 124 120 116

1980

1984

1988

1992

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

5.6 mmol/l 5.4 5.2 5.0 4.8 4.6 1980 1984

Mean fasting blood glucose mmol/l

5.6 5.4 5.2 5.0 4.8 4.6 Males Females

Mean total cholesterol

1988

1992

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

Country capacity to address and respond to NCDs Has a Unit / Branch / Dept in MOH with responsibility for NCDs There is funding available for: NCD treatment and control NCD prevention and health promotion NCD surveillance, monitoring and evaluation National health reporting system includes: NCD cause-specific mortality NCD morbidity NCD risk factors Has a national, population-based cancer registry … = no data available

Yes Yes Yes

Yes Yes No Yes

Has an integrated or topic-specific policy / programme / action plan which is currently operational for: Cardiovascular diseases No Cancer No Chronic respiratory diseases No Diabetes Yes Alcohol Yes Unhealthy diet / Overweight / Obesity Yes Physical inactivity No Tobacco Yes Number of tobacco (m)POWER measures implemented at the highest level of achievement 1/5

World Health Organization - NCD Country Profiles , 2011.

Noncommunicable Diseases in the Western Pacific Region: A Profile

Cambodia 2010 total population: 14 138 255 Income group: Low NCD mortality* 2008 estimates

Proportional mortality (% of total deaths, all ages)* males females 31.1 25.5 56.2 34.8 Injuries 7%

Total NCD deaths (000s) NCD deaths under age 60 (percent of all NCD deaths)

Age-standardized death rate per 100 000 All NCDs Cancers Chronic respiratory diseases Cardiovascular diseases and diabetes Behavioural risk factors 2008 estimated prevalence (%)

957.9 144.9 129.0 480.4

592.2 90.0 60.4 338.7

CVD 21%

Current daily tobacco smoking Physical inactivity Metabolic risk factors 2008 estimated prevalence (%)

males females 45.6 3.7 10.8 10.9

total 23.7 10.9

Cancers 7% Communicable, maternal, perinatal and nutritional conditions 46%

Respiratory diseases 5% Diabetes 3% Other NCDs 11%

Raised blood pressure Raised blood glucose Overweight Obesity Raised cholesterol Metabolic risk factor trends 124 122 120 118 116 114 112 110 1980 1984

males females 30.5 25.1 3.9 4.5 10.8 13.2 1.5 2.7 26.4 31.1

total 27.6 4.2 12.1 2.1 29.0

NCDs are estimated to account for 46% of all deaths.

Mean systolic blood pressure kg/m2

26 24 22 20 18 16

Mean body mass index

mmHg

1988

1992

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

5.4 mmol/l 5.2 5.0 4.8 4.6 4.4 1980 1984

Mean fasting blood glucose mmol/l

4.8 4.6 4.4 4.2 4.0 3.8 Males Females

Mean total cholesterol

1988

1992

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

Country capacity to address and respond to NCDs Has a Unit / Branch / Dept in MOH with responsibility for NCDs Yes There is funding available for: NCD treatment and control NCD prevention and health promotion NCD surveillance, monitoring and evaluation National health reporting system includes: NCD cause-specific mortality NCD morbidity NCD risk factors Has a national, population-based cancer registry * The mortality estimates for this country have a high degree of uncertainty because they are not based on any national NCD mortality data. The estimates are based on a combination of country life tables, cause of death models, regional cause of death patterns, and WHO and UNAIDS program estimates for some major causes of death (not including NCDs).

Yes Yes Yes

Yes Yes No No

Has an integrated or topic-specific policy / programme / action plan which is currently operational for: Cardiovascular diseases Yes** Cancer Yes** Chronic respiratory diseases No Diabetes Yes** Alcohol Yes** Unhealthy diet / Overweight / Obesity Yes** Physical inactivity Yes** Tobacco Yes** Number of tobacco (m)POWER measures implemented at the highest level of achievement 0/5

** = covered by integrated policy/programme/action plan

World Health Organization - NCD Country Profiles , 2011.

Noncommunicable Diseases in the Western Pacific Region: A Profile

China 2010 total population: 1 341 335 152 Income group: Lower middle NCD mortality 2008 estimates

Proportional mortality (% of total deaths, all ages) males females 4323.3 3675.5 22.8 17.4 Communicable, maternal, perinatal and nutritional conditions 7% Injuries 10%

Total NCD deaths (000s) NCD deaths under age 60 (percent of all NCD deaths)

Age-standardized death rate per 100 000 All NCDs Cancers Chronic respiratory diseases Cardiovascular diseases and diabetes Behavioural risk factors 2008 estimated prevalence (%)

665.2 182.3 118.4 311.5

495.2 105.0 88.7 259.6

Other NCDs 7% Diabetes 2%

CVD 38%

Current daily tobacco smoking Physical inactivity Metabolic risk factors 2008 estimated prevalence (%)

males females 49.3 2.1 29.3 32.0

total 26.3 30.6

Raised blood pressure Raised blood glucose Overweight Obesity Raised cholesterol Metabolic risk factor trends 129 127 mmHg 125 123 121 119 1980 1984 1988 1992

males females 40.1 36.2 9.5 9.3 25.5 25.4 4.7 6.7 31.8 35.3

total 38.2 9.4 25.4 5.7 33.5

Respiratory diseases 15%

Cancers 21%

NCDs are estimated to account for 83% of all deaths.

Mean systolic blood pressure kg/m2

28 26 24 22 20 18

Mean body mass index

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

5.8 mmol/l 5.6 5.4 5.2 5.0 4.8 1980 1984

Mean fasting blood glucose mmol/l

5.0 4.8 4.6 4.4 4.2 4.0 Males Females

Mean total cholesterol

1988

1992

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

Country capacity to address and respond to NCDs Has a Unit / Branch / Dept in MOH with responsibility for NCDs Yes There is funding available for: NCD treatment and control NCD prevention and health promotion NCD surveillance, monitoring and evaluation National health reporting system includes: NCD cause-specific mortality NCD morbidity NCD risk factors Has a national, population-based cancer registry Has an integrated or topic-specific policy / programme / action plan which is currently operational for: Cardiovascular diseases No Cancer Yes Chronic respiratory diseases No Diabetes No Alcohol No Unhealthy diet / Overweight / Obesity Yes Physical inactivity No Tobacco No Number of tobacco (m)POWER measures implemented at the highest level of achievement 0/5

Yes Yes Yes

Yes Yes Yes Yes

World Health Organization - NCD Country Profiles , 2011.

Noncommunicable Diseases in the Western Pacific Region: A Profile

Cook Islands 2010 total population: 20 288 Income group: Upper middle NCD mortality 2008 estimates

Proportional mortality (% of total deaths, all ages) males females 0.0 0.0 39.4 30.6 Communicable, maternal, perinatal and nutritional conditions 19% Injuries 7%

Total NCD deaths (000s) NCD deaths under age 60 (percent of all NCD deaths)

Age-standardized death rate per 100 000 All NCDs Cancers Chronic respiratory diseases Cardiovascular diseases and diabetes Behavioural risk factors 2008 estimated prevalence (%)

592.0 58.6 61.3 350.7

326.3 57.4 26.3 180.0

CVD 37%

Current daily tobacco smoking Physical inactivity Metabolic risk factors 2008 estimated prevalence (%)

males females 38.9 29.7 71.6 73.0

total 34.4 72.3 Other NCDs 15%

Raised blood pressure Raised blood glucose Overweight Obesity Raised cholesterol Metabolic risk factor trends

males females 46.0 36.8 19.5 20.5 91.0 89.9 59.7 67.9 58.8 57.3

total 41.5 20.0 90.5 63.7 58.1

Diabetes 5%

Respiratory diseases 7%

Cancers 10%

NCDs are estimated to account for 74% of all deaths.

Mean systolic blood pressure

Mean body mass index

No Data Available

1980

1984

1988

1992

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

Mean fasting blood glucose

Mean total cholesterol

No Data Available

1980

1984

1988

1992

1996

2000

2004

2008

Males Females

1980

1984

1988

1992

1996

2000

2004

2008

Yes Yes Yes

Yes Yes Yes No

World Health Organization - NCD Country Profiles , 2011.

Noncommunicable Diseases in the Western Pacific Region: A Profile

Fiji 2010 total population: 860 623 Income group: Upper middle NCD mortality 2008 estimates

Proportional mortality (% of total deaths, all ages) males females 2.4 1.8 45.6 38.0 Communicable, maternal, perinatal and nutritional conditions 18% Injuries 5%

Total NCD deaths (000s) NCD deaths under age 60 (percent of all NCD deaths)

Age-standardized death rate per 100 000 All NCDs Cancers Chronic respiratory diseases Cardiovascular diseases and diabetes Behavioural risk factors 2008 estimated prevalence (%)

928.4 106.2 91.1 579.9

590.9 121.6 44.2 328.2

CVD 42%

Current daily tobacco smoking Physical inactivity Metabolic risk factors 2008 estimated prevalence (%)

males females 15.0 1.7 ... ...

total 8.4 ...

Other NCDs 13%

Raised blood pressure Raised blood glucose Overweight Obesity Raised cholesterol Metabolic risk factor trends 130 128 mmHg 126 124 122 120 1980 1984 1988 1992

males females 40.1 37.5 12.0 15.6 58.3 71.7 20.3 41.1 56.1 48.9

total 38.8 13.8 65.0 30.6 52.5

Diabetes 4% Respiratory diseases 6% Cancers 12%

NCDs are estimated to account for 77% of all deaths.

Mean systolic blood pressure kg/m2

31 29 27 25 23 21

Mean body mass index

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

6.1 mmol/l 5.9 5.7 5.5 5.3 5.1 1980 1984

Mean fasting blood glucose mmol/l

5.4 5.2 5.0 4.8 4.6 4.4 Males Females

Mean total cholesterol

1988

1992

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

Yes Yes Yes

Yes Yes Yes No

World Health Organization - NCD Country Profiles , 2011.

Noncommunicable Diseases in the Western Pacific Region: A Profile

Japan 2010 total population: 126 535 920 Income group: High NCD mortality 2008 estimates

Proportional mortality (% of total deaths, all ages) males females 473.2 435.5 11.6 7.0 Communicable, maternal, perinatal and nutritional conditions 14% Injuries 6%

Total NCD deaths (000s) NCD deaths under age 60 (percent of all NCD deaths)

Age-standardized death rate per 100 000 All NCDs Cancers Chronic respiratory diseases Cardiovascular diseases and diabetes Behavioural risk factors 2008 estimated prevalence (%)

336.7 150.5 22.5 118.1

178.1 76.6 8.0 65.0

CVD 32%

Current daily tobacco smoking Physical inactivity Metabolic risk factors 2008 estimated prevalence (%)

males females 36.6 8.7 64.4 66.1

total 22.2 65.3

Other NCDs 11% Diabetes 1% Respiratory diseases 5% Cancers 31%

Raised blood pressure Raised blood glucose Overweight Obesity Raised cholesterol Metabolic risk factor trends 138 136 134 132 130 128 126 124 1980 1984

males females 47.1 41.0 8.9 6.7 30.1 19.2 5.8 4.4 57.0 58.5

total 43.9 7.7 24.4 5.0 57.8

NCDs are estimated to account for 80% of all deaths.

Mean systolic blood pressure kg/m2

28 26 24 22 20 18

Mean body mass index

mmHg

1988

1992

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

5.7 mmol/l 5.5 5.3 5.1 4.9 4.7 1980 1984

Mean fasting blood glucose mmol/l

5.4 5.2 5.0 4.8 4.6 4.4 Males Females

Mean total cholesterol

1988

1992

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

Yes Yes Yes

Yes Yes Yes Yes

World Health Organization - NCD Country Profiles , 2011.

Noncommunicable Diseases in the Western Pacific Region: A Profile

Kiribati 2010 total population: 99 546 Income group: Lower middle NCD mortality 2008 estimates

Proportional mortality (% of total deaths, all ages) males females 0.3 0.2 66.5 47.6 Communicable, maternal, perinatal and nutritional conditions 29% Injuries 3% CVD 23%

Total NCD deaths (000s) NCD deaths under age 60 (percent of all NCD deaths)

Age-standardized death rate per 100 000 All NCDs Cancers Chronic respiratory diseases Cardiovascular diseases and diabetes Behavioural risk factors 2008 estimated prevalence (%)

832.4 39.0 61.8 425.9

548.3 64.2 19.1 223.8

Current daily tobacco smoking Physical inactivity Metabolic risk factors 2008 estimated prevalence (%)

males females 73.3 61.7 42.4 57.1

total 67.4 49.8

Cancers 5% Respiratory diseases 4% Diabetes 8%

Raised blood pressure Raised blood glucose Overweight Obesity Raised cholesterol Metabolic risk factor trends

males females 39.1 28.7 22.0 22.8 78.4 82.8 37.7 53.8 32.8 36.6

total 33.7 22.4 80.7 46.0 34.8

Other NCDs 28%

NCDs are estimated to account for 69% of all deaths.

Mean systolic blood pressure

Mean body mass index

No Data Available

1980

1984

1988

1992

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

Mean fasting blood glucose

Mean total cholesterol

No Data Available

1980

1984

1988

1992

1996

2000

2004

2008

Males Females

1980

1984

1988

1992

1996

2000

2004

2008

No Yes Yes

Yes Yes Yes No

Has an integrated or topic-specific policy / programme / action plan which is currently operational for: Cardiovascular diseases Yes** Cancer Yes** Chronic respiratory diseases Yes** Diabetes Yes** Alcohol Yes** Unhealthy diet / Overweight / Obesity Yes** Physical inactivity Yes** Tobacco Yes** Number of tobacco (m)POWER measures implemented at the highest level of achievement 0/5

World Health Organization - NCD Country Profiles , 2011.

Noncommunicable Diseases in the Western Pacific Region: A Profile

Lao People's Democratic Republic 2010 total population: 6 200 894 Income group: Low NCD mortality* 2008 estimates

Proportional mortality (% of total deaths, all ages)* males females 12.1 11.7 38.6 32.6 Injuries 10%

Total NCD deaths (000s) NCD deaths under age 60 (percent of all NCD deaths)

Age-standardized death rate per 100 000 All NCDs Cancers Chronic respiratory diseases Cardiovascular diseases and diabetes Behavioural risk factors 2008 estimated prevalence (%)

CVD 24%

849.4 145.4 122.8 467.9

689.0 111.1 103.4 392.8

Current daily tobacco smoking Physical inactivity Metabolic risk factors 2008 estimated prevalence (%)

males females 41.4 2.5 15.6 19.5

total 21.6 17.6

Raised blood pressure Raised blood glucose Overweight Obesity Raised cholesterol Metabolic risk factor trends 126 124 mmHg 122 120 118 116 1980 1984 1988 1992

males females 34.4 30.0 ... ... 10.0 16.4 1.4 3.7 … …

total 32.1 ... 13.3 2.6 …

Communicable, maternal, perinatal and nutritional conditions 41%

Cancers 9%

Respiratory diseases 7%

Other NCDs 8%

Diabetes 1%

NCDs are estimated to account for 48% of all deaths.

Mean systolic blood pressure kg/m2

26 24 22 20 18 16

Mean body mass index

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

5.6 mmol/l 5.4 5.2 5.0 4.8 4.6 1980 1984

Mean fasting blood glucose mmol/l

5.0 4.8 4.6 4.4 4.2 4.0 Males Females

Mean total cholesterol

1988

1992

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

Country capacity to address and respond to NCDs Has a Unit / Branch / Dept in MOH with responsibility for NCDs Yes There is funding available for: NCD treatment and control NCD prevention and health promotion NCD surveillance, monitoring and evaluation National health reporting system includes: NCD cause-specific mortality NCD morbidity NCD risk factors Has a national, population-based cancer registry * The mortality estimates for this country have a high degree of uncertainty because they are not based on any national NCD mortality data. The estimates are based on a combination of country life tables, cause of death models, regional cause of death patterns, and WHO and UNAIDS program estimates for some major causes of death (not including NCDs).

Yes Yes Yes

No No Yes No

Has an integrated or topic-specific policy / programme / action plan which is currently operational for: Cardiovascular diseases DK Cancer DK Chronic respiratory diseases DK Diabetes DK Alcohol DK Unhealthy diet / Overweight / Obesity DK Physical inactivity DK Tobacco No Number of tobacco (m)POWER measures implemented at the highest level of achievement 0/5

… = no data available DK = Country responded "don't know"

World Health Organization - NCD Country Profiles , 2011.

Noncommunicable Diseases in the Western Pacific Region: A Profile

Malaysia 2010 total population: 28 401 017 Income group: Upper middle NCD mortality 2008 estimates

Proportional mortality (% of total deaths, all ages) males females 50.4 39.1 33.7 26.3 Injuries 9% Communicable, maternal, perinatal and nutritional conditions 24%

Total NCD deaths (000s) NCD deaths under age 60 (percent of all NCD deaths)

Age-standardized death rate per 100 000 All NCDs Cancers Chronic respiratory diseases Cardiovascular diseases and diabetes Behavioural risk factors 2008 estimated prevalence (%)

605.7 118.8 74.7 318.7

436.5 89.9 42.1 236.5

CVD 32%

Current daily tobacco smoking Physical inactivity Metabolic risk factors 2008 estimated prevalence (%)

males females 40.9 1.6 56.0 65.0

total 21.5 60.5

Raised blood pressure Raised blood glucose Overweight Obesity Raised cholesterol Metabolic risk factor trends 130 128 mmHg 126 124 122 120 1980 1984 1988 1992

males females 36.9 32.4 10.6 10.3 42.1 46.3 10.4 17.6 … …

total 34.7 10.5 44.2 14.0 …

Other NCDs 11% Diabetes 2% Respiratory diseases 7%

Cancers 15%

NCDs are estimated to account for 67% of all deaths.

Mean systolic blood pressure kg/m2

28 26 24 22 20 18

Mean body mass index

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

6.0 mmol/l 5.8 5.6 5.4 5.2 5.0 1980 1984

Mean fasting blood glucose mmol/l

5.4 5.2 5.0 4.8 4.6 4.4 Males Females

Mean total cholesterol

1988

1992

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

Yes Yes Yes

Yes Yes Yes Yes

Has an integrated or topic-specific policy / programme / action plan which is currently operational for: Cardiovascular diseases Yes** Cancer Yes Chronic respiratory diseases No Diabetes Yes** Alcohol No Unhealthy diet / Overweight / Obesity Yes** Physical inactivity Yes** Tobacco Yes Number of tobacco (m)POWER measures implemented at the highest level of achievement 1/5

World Health Organization - NCD Country Profiles , 2011.

Noncommunicable Diseases in the Western Pacific Region: A Profile

Marshall Islands 2010 total population: 54 038 Income group: Lower middle NCD mortality* 2008 estimates

Proportional mortality (% of total deaths, all ages)* males females 0.3 0.3 52.2 42.8 Communicable, maternal, perinatal and nutritional conditions 22% Injuries 5%

Total NCD deaths (000s) NCD deaths under age 60 (percent of all NCD deaths)

Age-standardized death rate per 100 000 All NCDs Cancers Chronic respiratory diseases Cardiovascular diseases and diabetes Behavioural risk factors 2008 estimated prevalence (%)

1280.1 100.7 135.1 818.5

1316.0 129.0 107.1 831.4

CVD 40%

Current daily tobacco smoking Physical inactivity Metabolic risk factors 2008 estimated prevalence (%)

males females 31.6 3.8 46.3 57.1

total 17.3 51.7 Other NCDs 14%

Raised blood pressure Raised blood glucose Overweight Obesity Raised cholesterol Metabolic risk factor trends

males females 37.4 28.4 23.8 29.0 77.4 81.0 37.9 52.4 42.8 45.9

total 32.7 26.5 79.2 45.4 44.4

Diabetes 5%

Respiratory diseases 7%

Cancers 7%

NCDs are estimated to account for 73% of all deaths.

Mean systolic blood pressure

Mean body mass index

No Data Available

1980

1984

1988

1992

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

Mean fasting blood glucose

Mean total cholesterol

No Data Available

1980

1984

1988

1992

1996

2000

2004

2008

Males Females

1980

1984

1988

1992

1996

2000

2004

2008

Country capacity to address and respond to NCDs Has a Unit / Branch / Dept in MOH with responsibility for NCDs Yes There is funding available for: NCD treatment and control NCD prevention and health promotion NCD surveillance, monitoring and evaluation National health reporting system includes: NCD cause-specific mortality NCD morbidity NCD risk factors Has a national, population-based cancer registry * The mortality estimates for this country have a high degree of uncertainty because they are not based on any national NCD mortality data. The estimates are based on a combination of country life tables, cause of death models, regional cause of death patterns, and WHO and UNAIDS program estimates for some major causes of death (not including NCDs).

No Yes No

Yes Yes Yes No

Has an integrated or topic-specific policy / programme / action plan which is currently operational for: Cardiovascular diseases No Cancer Yes** Chronic respiratory diseases No Diabetes Yes Alcohol Yes** Unhealthy diet / Overweight / Obesity Yes** Physical inactivity Yes** Tobacco Yes** Number of tobacco (m)POWER measures implemented at the highest level of achievement 1/5

** = covered by integrated policy/programme/action plan

World Health Organization - NCD Country Profiles , 2011.

Noncommunicable Diseases in the Western Pacific Region: A Profile

Micronesia (Federated States of) 2010 total population: 111 064 Income group: Lower middle NCD mortality* 2008 estimates

Proportional mortality (% of total deaths, all ages)* males females 0.2 0.2 38.8 37.0 Injuries 5%

Total NCD deaths (000s) NCD deaths under age 60 (percent of all NCD deaths)

Age-standardized death rate per 100 000 All NCDs Cancers Chronic respiratory diseases Cardiovascular diseases and diabetes Behavioural risk factors 2008 estimated prevalence (%)

753.7 79.3 80.2 459.4

622.8 90.1 50.8 363.1

Communicable, maternal, perinatal and nutritional conditions 28%

CVD 35%

Current daily tobacco smoking Physical inactivity Metabolic risk factors 2008 estimated prevalence (%)

males females 22.4 12.4 56.4 74.3

total 17.5 65.2

Raised blood pressure Raised blood glucose Overweight Obesity Raised cholesterol Metabolic risk factor trends 132 130 128 126 124 122 120 118 1980 1984

males females 42.7 34.1 12.8 18.3 67.9 82.5 28.1 53.2 47.1 45.4

total 38.3 15.6 75.2 40.6 46.2

Other NCDs 14% Diabetes 4% Respiratory diseases 6%

Cancers 8%

NCDs are estimated to account for 67% of all deaths.

Mean systolic blood pressure kg/m2

32 30 28 26 24 22

Mean body mass index

mmHg

1988

1992

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

6.4 6.2 mmol/l 6.0 5.8 5.6 5.4 5.2 1980 1984

Mean fasting blood glucose mmol/l

5.2 5.0 4.8 4.6 4.4 4.2 Males Females

Mean total cholesterol

1988

1992

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

Country capacity to address and respond to NCDs Has a Unit / Branch / Dept in MOH with responsibility for NCDs Yes There is funding available for: NCD treatment and control NCD prevention and health promotion NCD surveillance, monitoring and evaluation National health reporting system includes: NCD cause-specific mortality NCD morbidity NCD risk factors Has a national, population-based cancer registry * The mortality estimates for this country have a high degree of uncertainty because they are not based on any national NCD mortality data. The estimates are based on a combination of country life tables, cause of death models, regional cause of death patterns, and WHO and UNAIDS program estimates for some major causes of death (not including NCDs).

No Yes Yes

Yes Yes Yes No

Has an integrated or topic-specific policy / programme / action plan which is currently operational for: Cardiovascular diseases No Cancer Yes** Chronic respiratory diseases No Diabetes Yes** Alcohol Yes** Unhealthy diet / Overweight / Obesity Yes** Physical inactivity Yes** Tobacco Yes** Number of tobacco (m)POWER measures implemented at the highest level of achievement 0/5

** = covered by integrated policy/programme/action plan

World Health Organization - NCD Country Profiles , 2011.

Noncommunicable Diseases in the Western Pacific Region: A Profile

Mongolia 2010 total population: 2 756 001 Income group: Lower middle NCD mortality* 2008 estimates

Proportional mortality (% of total deaths, all ages)* males females 6.1 4.8 48.0 35.4 Injuries 13%

Total NCD deaths (000s) NCD deaths under age 60 (percent of all NCD deaths)

Age-standardized death rate per 100 000 All NCDs Cancers Chronic respiratory diseases Cardiovascular diseases and diabetes Behavioural risk factors 2008 estimated prevalence (%)

867.7 259.5 33.6 456.4

569.0 166.4 22.7 303.6

Communicable, maternal, perinatal and nutritional conditions 14%

CVD 37%

Current daily tobacco smoking Physical inactivity Metabolic risk factors 2008 estimated prevalence (%)

males females 43.0 5.2 7.9 8.4

total 23.7 8.2

Other NCDs 12% Diabetes 0% Respiratory diseases 3% Cancers 21%

Raised blood pressure Raised blood glucose Overweight Obesity Raised cholesterol Metabolic risk factor trends 134 132 mmHg 130 128 126 124 1980 1984 1988 1992

males females 44.6 36.4 9.7 7.8 40.7 45.7 10.4 18.3 36.4 36.2

total 40.4 8.7 43.2 14.4 36.3

NCDs are estimated to account for 72% of all deaths.

Mean systolic blood pressure kg/m2

30 28 26 24 22 20

Mean body mass index

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

5.8 mmol/l 5.6 5.4 5.2 5.0 4.8 1980 1984

Mean fasting blood glucose mmol/l

5.4 5.2 5.0 4.8 4.6 4.4 Males Females

Mean total cholesterol

1988

1992

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

Country capacity to address and respond to NCDs Has a Unit / Branch / Dept in MOH with responsibility for NCDs Yes There is funding available for: NCD treatment and control NCD prevention and health promotion NCD surveillance, monitoring and evaluation National health reporting system includes: NCD cause-specific mortality NCD morbidity NCD risk factors Has a national, population-based cancer registry * The mortality estimates for this country have a high degree of uncertainty because they are not based on any national NCD mortality data. The estimates are based on a combination of country life tables, cause of death models, regional cause of death patterns, and WHO and UNAIDS program estimates for some major causes of death (not including NCDs).

Yes Yes Yes

Yes Yes Yes No

** = covered by integrated policy/programme/action plan

World Health Organization - NCD Country Profiles , 2011.

Noncommunicable Diseases in the Western Pacific Region: A Profile

Nauru 2010 total population: 10 255 Income group: Upper middle NCD mortality 2008 estimates

Proportional mortality (% of total deaths, all ages) males females 0.0 0.0 54.0 48.5 Communicable, maternal, perinatal and nutritional conditions 19% Injuries 11%

Total NCD deaths (000s) NCD deaths under age 60 (percent of all NCD deaths)

Age-standardized death rate per 100 000 All NCDs Cancers Chronic respiratory diseases Cardiovascular diseases and diabetes Behavioural risk factors 2008 estimated prevalence (%)

1367.4 114.7 86.3 922.3

845.5 190.6 72.3 473.0

CVD 40%

Current daily tobacco smoking Physical inactivity Metabolic risk factors 2008 estimated prevalence (%)

males females 44.3 50.5 47.7 51.2

total 47.5 49.4 Other NCDs 12%

Raised blood pressure Raised blood glucose Overweight Obesity Raised cholesterol Metabolic risk factor trends

males females 45.0 34.6 11.6 13.3 93.5 92.3 67.7 74.4 41.2 48.1

total 39.6 12.5 92.9 71.1 44.7

Diabetes 4%

Respiratory diseases 5%

Cancers 9%

NCDs are estimated to account for 70% of all deaths.

Mean systolic blood pressure

Mean body mass index

No Data Available

1980

1984

1988

1992

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

Mean fasting blood glucose

Mean total cholesterol

No Data Available

1980

1984

1988

1992

1996

2000

2004

2008

Males Females

1980

1984

1988

1992

1996

2000

2004

2008

Yes Yes Yes

Yes Yes Yes No

Has an integrated or topic-specific policy / programme / action plan which is currently operational for: Cardiovascular diseases No Cancer No Chronic respiratory diseases No Diabetes Yes** Alcohol Yes** Unhealthy diet / Overweight / Obesity Yes** Physical inactivity Yes** Tobacco Yes** Number of tobacco (m)POWER measures implemented at the highest level of achievement 1/5

World Health Organization - NCD Country Profiles , 2011.

Noncommunicable Diseases in the Western Pacific Region: A Profile

New Zealand 2010 total population: 4 368 136 Income group: High NCD mortality 2008 estimates

Proportional mortality (% of total deaths, all ages) males females 13.1 12.8 14.1 11.1 Communicable, maternal, perinatal and nutritional Injuries conditions 6% 3%

Total NCD deaths (000s) NCD deaths under age 60 (percent of all NCD deaths)

Age-standardized death rate per 100 000 All NCDs Cancers Chronic respiratory diseases Cardiovascular diseases and diabetes Behavioural risk factors 2008 estimated prevalence (%)

410.7 149.1 30.1 171.2

285.1 110.8 20.5 106.1

Other NCDs 15%

CVD 37%

Current daily tobacco smoking Physical inactivity Metabolic risk factors 2008 estimated prevalence (%)

males females 21.4 20.1 45.9 50.2

total 20.7 48.1

Diabetes 3% Respiratory diseases 7%

Raised blood pressure Raised blood glucose Overweight Obesity Raised cholesterol Metabolic risk factor trends 136 mmHg 132 128 124 120 1980 1984 1988 1992

males females 40.8 33.0 ... ... 69.2 62.6 27.3 29.3 57.5 57.9

total 36.8 ... 65.8 28.3 57.7

Cancers 29%

NCDs are estimated to account for 91% of all deaths.

Mean systolic blood pressure kg/m2

32 30 28 26 24 22

Mean body mass index

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

5.9 mmol/l 5.7 5.5 5.3 5.1 4.9 1980 1984

Mean fasting blood glucose mmol/l

6.2 6.0 5.8 5.6 5.4 5.2 5.0

Mean total cholesterol

1988

1992

1996

2000

2004

2008

Males Females

1980

1984

1988

1992

1996

2000

2004

2008

Yes Yes Yes

Yes Yes Yes Yes

Has an integrated or topic-specific policy / programme / action plan which is currently operational for: Cardiovascular diseases Yes Cancer Yes Chronic respiratory diseases No Diabetes Yes Alcohol Yes Unhealthy diet / Overweight / Obesity Yes Physical inactivity Yes Tobacco Yes Number of tobacco (m)POWER measures implemented at the highest level of achievement 3/5

World Health Organization - NCD Country Profiles , 2011.

Noncommunicable Diseases in the Western Pacific Region: A Profile

Niue 2010 total population: 1 468 Income group: Upper middle NCD mortality 2008 estimates

Proportional mortality (% of total deaths, all ages) males females 0.0 0.0 45.6 21.3 Communicable, maternal, perinatal and nutritional conditions 21% Injuries 8%

Total NCD deaths (000s) NCD deaths under age 60 (percent of all NCD deaths)

Age-standardized death rate per 100 000 All NCDs Cancers Chronic respiratory diseases Cardiovascular diseases and diabetes Behavioural risk factors 2008 estimated prevalence (%)

790.3 79.7 81.1 486.3

314.6 80.5 24.2 160.4

CVD 36%

Current daily tobacco smoking Physical inactivity Metabolic risk factors 2008 estimated prevalence (%)

males females … … ... ...

total … ... Other NCDs 13% Diabetes Respiratory 4% diseases 7% Cancers 11%

Raised blood pressure Raised blood glucose Overweight Obesity Raised cholesterol Metabolic risk factor trends

males females ... ... ... ... … … … … … …

total ... ... … … …

NCDs are estimated to account for 72% of all deaths.

Mean systolic blood pressure

Mean body mass index

No Data Available

1980

1984

1988

1992

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

Mean fasting blood glucose

Mean total cholesterol

No Data Available

1980

1984

1988

1992

1996

2000

2004

2008

Males Females

1980

1984

1988

1992

1996

2000

2004

2008

No Yes No

Yes Yes Yes No

Has an integrated or topic-specific policy / programme / action plan which is currently operational for: Cardiovascular diseases Yes** Cancer DK Chronic respiratory diseases DK Diabetes Yes** Alcohol Yes** Unhealthy diet / Overweight / Obesity Yes** Physical inactivity Yes** Tobacco Yes** Number of tobacco (m)POWER measures implemented at the highest level of achievement 0/5

World Health Organization - NCD Country Profiles , 2011.

Noncommunicable Diseases in the Western Pacific Region: A Profile

Palau 2010 total population: 20 472 Income group: Upper middle NCD mortality* 2008 estimates

Proportional mortality (% of total deaths, all ages)* males females 0.0 0.0 43.6 38.1 Communicable, maternal, perinatal and nutritional conditions 20% Injuries 6%

Total NCD deaths (000s) NCD deaths under age 60 (percent of all NCD deaths)

Age-standardized death rate per 100 000 All NCDs Cancers Chronic respiratory diseases Cardiovascular diseases and diabetes Behavioural risk factors 2008 estimated prevalence (%)

777.3 91.4 78.7 469.6

413.7 105.3 27.9 214.8

CVD 38%

Current daily tobacco smoking Physical inactivity Metabolic risk factors 2008 estimated prevalence (%)

males females 33.0 7.1 … …

total 19.7 …

Other NCDs 13%

Raised blood pressure Raised blood glucose Overweight Obesity Raised cholesterol Metabolic risk factor trends

males females ... ... ... ... ... ... ... ... … …

total ... ... ... ... …

Diabetes 4%

Respiratory diseases 6%

Cancers 13%

NCDs are estimated to account for 74% of all deaths.

Mean systolic blood pressure

Mean body mass index

No Data Available

1980

1984

1988

1992

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

Mean fasting blood glucose

Mean total cholesterol

No Data Available

1980

1984

1988

1992

1996

2000

2004

2008

Males Females

1980

1984

1988

1992

1996

2000

2004

2008

Country capacity to address and respond to NCDs Has a Unit / Branch / Dept in MOH with responsibility for NCDs Yes There is funding available for: NCD treatment and control NCD prevention and health promotion NCD surveillance, monitoring and evaluation National health reporting system includes: NCD cause-specific mortality NCD morbidity NCD risk factors Has a national, population-based cancer registry * The mortality estimates for this country have a high degree of uncertainty because they are not based on any national NCD mortality data. The estimates are based on a combination of country life tables, cause of death models, regional cause of death patterns, and WHO and UNAIDS program estimates for some major causes of death (not including NCDs).

No Yes No

Yes No No No

Has an integrated or topic-specific policy / programme / action plan which is currently operational for: Cardiovascular diseases No Cancer Yes** Chronic respiratory diseases No Diabetes Yes** Alcohol Yes** Unhealthy diet / Overweight / Obesity Yes** Physical inactivity Yes** Tobacco Yes** Number of tobacco (m)POWER measures implemented at the highest level of achievement 0/5

… = no data available ** = covered by integrated policy/programme/action plan

World Health Organization - NCD Country Profiles , 2011.

Noncommunicable Diseases in the Western Pacific Region: A Profile

Papua New Guinea 2010 total population: 6 858 266 Income group: Lower middle NCD mortality* 2008 estimates

Proportional mortality (% of total deaths, all ages)* males females 11.1 9.1 49.1 48.4 Injuries 9%

Total NCD deaths (000s) NCD deaths under age 60 (percent of all NCD deaths)

Age-standardized death rate per 100 000 All NCDs Cancers Chronic respiratory diseases Cardiovascular diseases and diabetes Behavioural risk factors 2008 estimated prevalence (%)

CVD 21%

836.9 151.8 99.9 459.8

664.7 106.9 74.1 395.4 Cancers 8%

Current daily tobacco smoking Physical inactivity Metabolic risk factors 2008 estimated prevalence (%)

males females 56.9 24.8 14.1 18.1

total 40.9 16.1

Raised blood pressure Raised blood glucose Overweight Obesity Raised cholesterol Metabolic risk factor trends 122 120 118 116 114 112 110 108 1980 1984

males females 29.4 24.6 13.4 13.2 45.3 51.2 11.7 20.6 36.1 37.5

total 27.0 13.3 48.3 16.2 36.8

Communicable, maternal, perinatal and nutritional conditions 47%

Respiratory diseases 5% Diabetes 2%

Other NCDs 8%

NCDs are estimated to account for 44% of all deaths.

Mean systolic blood pressure kg/m2

28 26 24 22 20 18

Mean body mass index

mmHg

1988

1992

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

6.1 mmol/l 5.9 5.7 5.5 5.3 5.1 1980 1984

Mean fasting blood glucose mmol/l

5.0 4.8 4.6 4.4 4.2 4.0 Males Females

Mean total cholesterol

1988

1992

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

Country capacity to address and respond to NCDs Has a Unit / Branch / Dept in MOH with responsibility for NCDs Yes There is funding available for: NCD treatment and control NCD prevention and health promotion NCD surveillance, monitoring and evaluation National health reporting system includes: NCD cause-specific mortality NCD morbidity NCD risk factors Has a national, population-based cancer registry * The mortality estimates for this country have a high degree of uncertainty because they are not based on any national NCD mortality data. The estimates are based on a combination of country life tables, cause of death models, regional cause of death patterns, and WHO and UNAIDS program estimates for some major causes of death (not including NCDs).

Yes Yes Yes

Yes Yes Yes DK

** = covered by integrated policy/programme/action plan DK = Country responded "don't know"

World Health Organization - NCD Country Profiles , 2011.

Noncommunicable Diseases in the Western Pacific Region: A Profile

Philippines 2010 total population: 93 260 798 Income group: Lower middle NCD mortality 2008 estimates

Proportional mortality (% of total deaths, all ages) males females 175.7 133.9 44.4 35.6 Injuries 8% CVD 30%

Total NCD deaths (000s) NCD deaths under age 60 (percent of all NCD deaths)

Age-standardized death rate per 100 000 All NCDs Cancers Chronic respiratory diseases Cardiovascular diseases and diabetes Behavioural risk factors 2008 estimated prevalence (%)

711.6 98.6 80.7 394.8

482.8 74.6 32.5 295.3

Current daily tobacco smoking Physical inactivity Metabolic risk factors 2008 estimated prevalence (%)

males females 34.7 7.7 20.0 25.7

total 21.2 22.9

Communicable, maternal, perinatal and nutritional conditions 30%

Cancers 10% Respiratory diseases 5% Diabetes 4%

Raised blood pressure Raised blood glucose Overweight Obesity Raised cholesterol Metabolic risk factor trends 128 126 mmHg 124 122 120 118 1980 1984 1988 1992

males females 35.4 30.0 5.7 5.9 24.6 28.4 4.6 8.0 39.0 44.5

total 32.7 5.8 26.5 6.3 41.8

Other NCDs 13%

NCDs are estimated to account for 61% of all deaths.

Mean systolic blood pressure kg/m2

28 26 24 22 20 18

Mean body mass index

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

5.6 mmol/l 5.4 5.2 5.0 4.8 4.6 1980 1984

Mean fasting blood glucose mmol/l

5.2 5.0 4.8 4.6 4.4 4.2 Males Females

Mean total cholesterol

1988

1992

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

Yes Yes Yes

Yes Yes Yes Yes

Has an integrated or topic-specific policy / programme / action plan which is currently operational for: Cardiovascular diseases Yes** Cancer Yes** Chronic respiratory diseases Yes** Diabetes Yes** Alcohol Yes** Unhealthy diet / Overweight / Obesity Yes** Physical inactivity Yes** Tobacco Yes** Number of tobacco (m)POWER measures implemented at the highest level of achievement 0/5

World Health Organization - NCD Country Profiles , 2011.

Noncommunicable Diseases in the Western Pacific Region: A Profile

Republic of Korea 2010 total population: 48 183 584 Income group: High NCD mortality 2008 estimates

Proportional mortality (% of total deaths, all ages) males females 112.3 96.7 24.2 12.5 Communicable, maternal, perinatal and nutritional conditions 6% Injuries 12% CVD 29%

Total NCD deaths (000s) NCD deaths under age 60 (percent of all NCD deaths)

Age-standardized death rate per 100 000 All NCDs Cancers Chronic respiratory diseases Cardiovascular diseases and diabetes Behavioural risk factors 2008 estimated prevalence (%)

465.0 190.5 36.1 167.9

246.8 77.1 12.1 115.2

Other NCDs 13%

Current daily tobacco smoking Physical inactivity Metabolic risk factors 2008 estimated prevalence (%)

males females 50.4 4.9 … …

total 27.2 … Diabetes 5%

Raised blood pressure Raised blood glucose Overweight Obesity Raised cholesterol Metabolic risk factor trends 127 125 mmHg 123 121 119 117 1980 1984 1988 1992

males females 33.3 28.0 6.8 5.7 34.3 29.2 7.2 8.3 42.2 44.1

total 30.6 6.3 31.8 7.7 43.2

Respiratory diseases 5%

Cancers 30%

NCDs are estimated to account for 82% of all deaths.

Mean systolic blood pressure kg/m2

28 26 24 22 20 18

Mean body mass index

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

5.9 mmol/l 5.7 5.5 5.3 5.1 4.9 1980 1984

Mean fasting blood glucose mmol/l

5.2 5.0 4.8 4.6 4.4 4.2 Males Females

Mean total cholesterol

1988

1992

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

Yes Yes Yes

Yes Yes Yes Yes

Has an integrated or topic-specific policy / programme / action plan which is currently operational for: Cardiovascular diseases Yes** Cancer Yes** Chronic respiratory diseases Yes** Diabetes Yes** Alcohol Yes** Unhealthy diet / Overweight / Obesity Yes** Physical inactivity Yes** Tobacco Yes** Number of tobacco (m)POWER measures implemented at the highest level of achievement 1/5

World Health Organization - NCD Country Profiles , 2011.

Noncommunicable Diseases in the Western Pacific Region: A Profile

Samoa 2010 total population: 183 081 Income group: Lower middle NCD mortality* 2008 estimates

Proportional mortality (% of total deaths, all ages)* males females 0.4 0.4 36.1 27.7 Communicable, maternal, perinatal and nutritional conditions 25% Injuries 5%

Total NCD deaths (000s) NCD deaths under age 60 (percent of all NCD deaths)

Age-standardized death rate per 100 000 All NCDs Cancers Chronic respiratory diseases Cardiovascular diseases and diabetes Behavioural risk factors 2008 estimated prevalence (%)

772.1 68.5 83.3 477.4

583.2 40.2 50.2 373.6

CVD 37%

Current daily tobacco smoking Physical inactivity Metabolic risk factors 2008 estimated prevalence (%)

males females 53.6 17.1 35.1 65.6

total 36.2 49.7

Raised blood pressure Raised blood glucose Overweight Obesity Raised cholesterol Metabolic risk factor trends 132 130 128 126 124 122 120 118 1980 1984

males females 43.5 36.2 19.7 22.5 81.2 88.2 43.6 65.5 31.0 36.6

total 40.0 21.1 84.6 54.1 33.7

Other NCDs 15% Diabetes 5% Respiratory diseases 7%

Cancers 6%

NCDs are estimated to account for 70% of all deaths.

Mean systolic blood pressure kg/m2

34 32 30 28 26 24

Mean body mass index

mmHg

1988

1992

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

6.8 6.5 mmol/l 6.2 5.9 5.6 5.3 5.0 1980 1984

Mean fasting blood glucose mmol/l

5.0 4.8 4.6 4.4 4.2 4.0 Males Females

Mean total cholesterol

1988

1992

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

Country capacity to address and respond to NCDs Has a Unit / Branch / Dept in MOH with responsibility for NCDs Yes There is funding available for: NCD treatment and control NCD prevention and health promotion NCD surveillance, monitoring and evaluation National health reporting system includes: NCD cause-specific mortality NCD morbidity NCD risk factors Has a national, population-based cancer registry * The mortality estimates for this country have a high degree of uncertainty because they are not based on any national NCD mortality data. The estimates are based on a combination of country life tables, cause of death models, regional cause of death patterns, and WHO and UNAIDS program estimates for some major causes of death (not including NCDs).

Yes Yes Yes

Yes Yes No No

Has an integrated or topic-specific policy / programme / action plan which is currently operational for: Cardiovascular diseases No Cancer No Chronic respiratory diseases No Diabetes No Alcohol No Unhealthy diet / Overweight / Obesity Yes Physical inactivity Yes Tobacco No Number of tobacco (m)POWER measures implemented at the highest level of achievement 0/5

World Health Organization - NCD Country Profiles , 2011.

Noncommunicable Diseases in the Western Pacific Region: A Profile

Singapore 2010 total population: 5 086 418 Income group: High NCD mortality 2008 estimates

Proportional mortality (% of total deaths, all ages) males females 10.1 7.8 24.4 18.9 Communicable, maternal, perinatal and nutritional conditions 16% Injuries 5%

Total NCD deaths (000s) NCD deaths under age 60 (percent of all NCD deaths)

Age-standardized death rate per 100 000 All NCDs Cancers Chronic respiratory diseases Cardiovascular diseases and diabetes Behavioural risk factors 2008 estimated prevalence (%)

372.1 141.6 22.6 171.2

238.8 90.9 7.2 108.9

CVD 33%

Current daily tobacco smoking Physical inactivity Metabolic risk factors 2008 estimated prevalence (%)

males females 25.1 4.0 … …

total 14.5 …

Other NCDs 9%

Diabetes 3% Respiratory diseases 4% Cancers 30%

Raised blood pressure Raised blood glucose Overweight Obesity Raised cholesterol Metabolic risk factor trends 130 128 mmHg 126 124 122 120 1980 1984 1988 1992

males females 39.7 33.9 8.0 5.9 33.9 26.4 7.0 7.1 57.9 62.1

total 36.8 6.9 30.2 7.1 60.0

NCDs are estimated to account for 79% of all deaths.

Mean systolic blood pressure kg/m2

28 26 24 22 20 18

Mean body mass index

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

6.0 mmol/l 5.8 5.6 5.4 5.2 5.0 1980 1984

Mean fasting blood glucose mmol/l

5.8 5.6 5.4 5.2 5.0 4.8 4.6

Mean total cholesterol

1988

1992

1996

2000

2004

2008

Males Females

1980

1984

1988

1992

1996

2000

2004

2008

Yes Yes Yes

Yes Yes Yes Yes

Has an integrated or topic-specific policy / programme / action plan which is currently operational for: Cardiovascular diseases Yes** Cancer Yes** Chronic respiratory diseases Yes** Diabetes Yes** Alcohol Yes** Unhealthy diet / Overweight / Obesity Yes** Physical inactivity Yes** Tobacco Yes** Number of tobacco (m)POWER measures implemented at the highest level of achievement 2/5

World Health Organization - NCD Country Profiles , 2011.

Noncommunicable Diseases in the Western Pacific Region: A Profile

Solomon Islands 2010 total population: 538 148 Income group: Lower middle NCD mortality* 2008 estimates

Proportional mortality (% of total deaths, all ages)* males females 0.8 0.6 38.8 38.7 Injuries 5% CVD 29% Communicable, maternal, perinatal and nutritional conditions 35%

Total NCD deaths (000s) NCD deaths under age 60 (percent of all NCD deaths)

Age-standardized death rate per 100 000 All NCDs Cancers Chronic respiratory diseases Cardiovascular diseases and diabetes Behavioural risk factors 2008 estimated prevalence (%)

709.7 85.9 74.5 425.0

524.3 85.9 41.4 303.7

Current daily tobacco smoking Physical inactivity Metabolic risk factors 2008 estimated prevalence (%)

males females 42.4 14.4 36.8 48.6

total 28.8 42.6

Cancers 10%

Raised blood pressure Raised blood glucose Overweight Obesity Raised cholesterol Metabolic risk factor trends 125 123 mmHg 121 119 117 115 1980 1984 1988 1992

males females 32.7 28.9 14.3 15.4 61.0 69.6 22.6 37.7 29.5 35.4

total 30.8 14.9 65.2 30.0 32.4

Other NCDs 12%

Diabetes 4%

Respiratory diseases 5%

NCDs are estimated to account for 60% of all deaths.

Mean systolic blood pressure kg/m2

32 30 28 26 24 22

Mean body mass index

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

6.1 mmol/l 5.9 5.7 5.5 5.3 5.1 1980 1984

Mean fasting blood glucose mmol/l

5.0 4.8 4.6 4.4 4.2 4.0 Males Females

Mean total cholesterol

1988

1992

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

Country capacity to address and respond to NCDs Has a Unit / Branch / Dept in MOH with responsibility for NCDs Yes There is funding available for: NCD treatment and control NCD prevention and health promotion NCD surveillance, monitoring and evaluation National health reporting system includes: NCD cause-specific mortality NCD morbidity NCD risk factors Has a national, population-based cancer registry * The mortality estimates for this country have a high degree of uncertainty because they are not based on any national NCD mortality data. The estimates are based on a combination of country life tables, cause of death models, regional cause of death patterns, and WHO and UNAIDS program estimates for some major causes of death (not including NCDs).

Yes Yes No

No No No No

Has an integrated or topic-specific policy / programme / action plan which is currently operational for: Cardiovascular diseases No Cancer No Chronic respiratory diseases No Diabetes Yes Alcohol No Unhealthy diet / Overweight / Obesity No Physical inactivity No Tobacco No Number of tobacco (m)POWER measures implemented at the highest level of achievement 0/5

World Health Organization - NCD Country Profiles , 2011.

Noncommunicable Diseases in the Western Pacific Region: A Profile

Tonga 2010 total population: 104 058 Income group: Lower middle NCD mortality 2008 estimates

Proportional mortality (% of total deaths, all ages) males females 0.2 0.3 25.6 35.1 Communicable, maternal, perinatal and nutritional conditions 22% Injuries 4%

Total NCD deaths (000s) NCD deaths under age 60 (percent of all NCD deaths)

Age-standardized death rate per 100 000 All NCDs Cancers Chronic respiratory diseases Cardiovascular diseases and diabetes Behavioural risk factors 2008 estimated prevalence (%)

649.3 67.4 68.8 395.9

672.6 93.9 53.2 395.0

CVD 38%

Current daily tobacco smoking Physical inactivity Metabolic risk factors 2008 estimated prevalence (%)

males females 36.6 7.5 30.6 52.1

total 22.0 41.4 Other NCDs 15%

Raised blood pressure Raised blood glucose Overweight Obesity Raised cholesterol Metabolic risk factor trends 131 129 127 125 123 121 119 117 1980 1984

males females 42.1 38.0 15.8 19.1 84.2 89.9 46.6 68.5 52.5 44.9

total 40.1 17.5 87.0 57.6 48.7

Diabetes 5%

Respiratory diseases 7%

Cancers 9%

NCDs are estimated to account for 74% of all deaths.

Mean systolic blood pressure kg/m2

35 33 31 29 27 25

Mean body mass index

mmHg

1988

1992

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

6.3 mmol/l 6.1 5.9 5.7 5.5 5.3 1980 1984

Mean fasting blood glucose mmol/l

5.4 5.2 5.0 4.8 4.6 4.4 Males Females

Mean total cholesterol

1988

1992

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

Yes Yes Yes

Yes Yes Yes No

Has an integrated or topic-specific policy / programme / action plan which is currently operational for: Cardiovascular diseases Yes** Cancer No Chronic respiratory diseases Yes** Diabetes Yes** Alcohol Yes** Unhealthy diet / Overweight / Obesity Yes** Physical inactivity Yes** Tobacco Yes** Number of tobacco (m)POWER measures implemented at the highest level of achievement 0/5

World Health Organization - NCD Country Profiles , 2011.

Noncommunicable Diseases in the Western Pacific Region: A Profile

Tuvalu 2010 total population: 9 827 Income group: Lower middle NCD mortality 2008 estimates

Proportional mortality (% of total deaths, all ages) males females 0.0 0.0 36.6 37.0 Communicable, maternal, perinatal and nutritional conditions 21% Injuries 5%

Total NCD deaths (000s) NCD deaths under age 60 (percent of all NCD deaths)

Age-standardized death rate per 100 000 All NCDs Cancers Chronic respiratory diseases Cardiovascular diseases and diabetes Behavioural risk factors 2008 estimated prevalence (%)

992.3 106.9 98.4 605.8

991.9 153.8 77.3 568.0

CVD 38%

Current daily tobacco smoking Physical inactivity Metabolic risk factors 2008 estimated prevalence (%)

males females 47.8 15.5 … …

total 32.0 … Other NCDs 15%

Raised blood pressure Raised blood glucose Overweight Obesity Raised cholesterol Metabolic risk factor trends

males females ... ... ... ... … … … … … …

total ... ... … … …

Diabetes 5%

Respiratory diseases 6%

Cancers 10%

NCDs are estimated to account for 73% of all deaths.

Mean systolic blood pressure

Mean body mass index

No Data Available

1980

1984

1988

1992

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

Mean fasting blood glucose

Mean total cholesterol

No Data Available

1980

1984

1988

1992

1996

2000

2004

2008

Males Females

1980

1984

1988

1992

1996

2000

2004

2008

Yes Yes No

Yes Yes No No

Has an integrated or topic-specific policy / programme / action plan which is currently operational for: Cardiovascular diseases No Cancer Yes Chronic respiratory diseases No Diabetes Yes Alcohol No Unhealthy diet / Overweight / Obesity No Physical inactivity No Tobacco Yes Number of tobacco (m)POWER measures implemented at the highest level of achievement 0/5

World Health Organization - NCD Country Profiles , 2011.

Noncommunicable Diseases in the Western Pacific Region: A Profile

Vanuatu 2010 total population: 239 651 Income group: Lower middle NCD mortality* 2008 estimates

Proportional mortality (% of total deaths, all ages)* males females 0.5 0.3 37.9 42.0 Communicable, maternal, perinatal and nutritional conditions 24% Injuries 5%

Total NCD deaths (000s) NCD deaths under age 60 (percent of all NCD deaths)

Age-standardized death rate per 100 000 All NCDs Cancers Chronic respiratory diseases Cardiovascular diseases and diabetes Behavioural risk factors 2008 estimated prevalence (%)

767.8 94.7 79.5 462.4

576.8 94.3 44.8 333.4

CVD 36%

Current daily tobacco smoking Physical inactivity Metabolic risk factors 2008 estimated prevalence (%)

males females 21.3 3.1 … …

total 12.3 … Other NCDs 13% Diabetes 4% Respiratory diseases 6% Cancers 12%

Raised blood pressure Raised blood glucose Overweight Obesity Raised cholesterol Metabolic risk factor trends 134 132 mmHg 130 128 126 124 122 1980 1984 1988 1992

males females 44.5 39.1 8.1 8.0 59.2 65.7 21.0 34.2 … …

total 41.8 8.0 62.4 27.5 …

NCDs are estimated to account for 70% of all deaths.

Mean systolic blood pressure kg/m2

30 28 26 24 22 20

Mean body mass index

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

5.4 mmol/l 5.2 5.0 4.8 4.6 4.4 1980 1984

Mean fasting blood glucose mmol/l

5.2 5.0 4.8 4.6 4.4 4.2 Males Females

Mean total cholesterol

1988

1992

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

Country capacity to address and respond to NCDs Has a Unit / Branch / Dept in MOH with responsibility for NCDs Yes There is funding available for: NCD treatment and control NCD prevention and health promotion NCD surveillance, monitoring and evaluation National health reporting system includes: NCD cause-specific mortality NCD morbidity NCD risk factors Has a national, population-based cancer registry * The mortality estimates for this country have a high degree of uncertainty because they are not based on any national NCD mortality data. The estimates are based on a combination of country life tables, cause of death models, regional cause of death patterns, and WHO and UNAIDS program estimates for some major causes of death (not including NCDs).

Yes Yes Yes

Yes Yes Yes Yes

Has an integrated or topic-specific policy / programme / action plan which is currently operational for: Cardiovascular diseases Yes** Cancer Yes** Chronic respiratory diseases Yes** Diabetes Yes** Alcohol Yes** Unhealthy diet / Overweight / Obesity Yes** Physical inactivity Yes** Tobacco Yes** Number of tobacco (m)POWER measures implemented at the highest level of achievement 0/5

… = no data available ** = covered by integrated policy/programme/action plan

World Health Organization - NCD Country Profiles , 2011.

Noncommunicable Diseases in the Western Pacific Region: A Profile

Viet Nam 2010 total population: 87 848 445 Income group: Low NCD mortality 2008 estimates

Proportional mortality (% of total deaths, all ages) males females 208.0 222.0 26.4 19.4 Communicable, maternal, perinatal and nutritional conditions 16% Injuries 9%

Total NCD deaths (000s) NCD deaths under age 60 (percent of all NCD deaths)

Age-standardized death rate per 100 000 All NCDs Cancers Chronic respiratory diseases Cardiovascular diseases and diabetes Behavioural risk factors 2008 estimated prevalence (%)

687.2 137.3 76.6 381.5

508.2 94.3 45.5 298.2

CVD 40%

Current daily tobacco smoking Physical inactivity Metabolic risk factors 2008 estimated prevalence (%)

males females 40.4 1.0 14.2 15.6

total 20.1 14.9

Other NCDs 10%

Raised blood pressure Raised blood glucose Overweight Obesity Raised cholesterol Metabolic risk factor trends 126 124 mmHg 122 120 118 116 1980 1984 1988 1992

males females 36.0 30.0 6.6 7.2 9.5 10.9 1.2 2.1 … …

total 33.0 6.9 10.2 1.7 …

Diabetes 3% Respiratory diseases 8% Cancers 14%

NCDs are estimated to account for 75% of all deaths.

Mean systolic blood pressure kg/m2

26 24 22 20 18 16

Mean body mass index

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

5.6 mmol/l 5.4 5.2 5.0 4.8 4.6 1980 1984

Mean fasting blood glucose mmol/l

5.0 4.8 4.6 4.4 4.2 4.0 Males Females

Mean total cholesterol

1988

1992

1996

2000

2004

2008

1980

1984

1988

1992

1996

2000

2004

2008

Yes Yes Yes

Yes Yes No No

Has an integrated or topic-specific policy / programme / action plan which is currently operational for: Cardiovascular diseases Yes** Cancer Yes** Chronic respiratory diseases Yes Diabetes Yes** Alcohol No Unhealthy diet / Overweight / Obesity No Physical inactivity No Tobacco Yes Number of tobacco (m)POWER measures implemented at the highest level of achievement 0/5

World Health Organization - NCD Country Profiles , 2011.

Noncommunicable Diseases in the Western Pacific Region: A Profile

6. Key findings and recommendations NCDs are a major public health problem in all countries of the Region. Age-standardized death rates show a wide variation among countries, indicating a large potential for reducing NCD mortality. The high proportion of NCD deaths among people under 70 years in LMIC is of concern. Cause-specific mortality data, with International Classification of Diseases (ICD) coding, are required for monitoring NCD mortality and serve as unbiased indicators of the effectiveness of the overall NCD prevention and control programme. Mortality registration and certification should be strengthened, especially in LMIC, as it is an important basis for implementing and monitoring NCD programmes, as well as for assessing other health programmes. There is a two- to three-fold variation in cancer incidence in the Region. HIC have managed to reduce the incidence of cervical cancer through screening, early detection and prompt management. Population-based disease registries are available for cancer in many HIC. However, there are many challenges in establishing population-based disease registries in LMIC; hospital-based registries offer an entry point prior to coverage of a defined catchment population. Trends in NCD risk factors serve as indicators of the effectiveness of risk reduction programmes. Collection of comparable data in a periodic manner is essential for measuring trends between and within countries. WHO STEPS offers a standardized approach that can be adopted by countries. WHO has proposed a framework for a national NCD surveillance scheme with three major components as given in Box 1. Box 1. Framework for national NCD surveillance

Exposures Behavioural risk factors: tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diet. Physiological and metabolic risk factors: raised blood pressure, overweight/obesity, raised blood glucose, and raised cholesterol. Social determinants: educational level, household income, and access to health care.

Outcomes Mortality: NCD-specific mortality. Morbidity: Cancer incidence and type (as core).

Health system capacity and response Interventions and health system capacity: infrastructure, policies and plans, access to key health-care interventions and treatments, and partnerships.

Noncommunicable Diseases in the Western Pacific Region: A Profile

There has been substantial progress in the overall country capacity for NCD prevention and management in the Region. The profile has not gone into an analytical approach as the data on country capacity were limited to availability of policies and programmes and did not include detailed information on implementation. Interventions to prevent NCDs on a population-wide basis are not only feasible but also costeffective. Low-cost solutions can work anywhere to reduce the major risk factors for NCDs. While many interventions may be cost-effective, some are considered “best buys”—actions that should be undertaken immediately to produce accelerated results in terms of lives saved, diseases prevented and heavy costs avoided. A set of best buys and cost-effective interventions from the Global status report on noncommunicable diseases 2010, as listed below, can be considered as priority interventions. Best buys include: • protecting people from tobacco smoke and banning smoking in public places; • warning about the dangers of tobacco use; • enforcing bans on tobacco advertising, promotion and sponsorship; • raising taxes on tobacco; • restricting access to retailed alcohol; • enforcing bans on alcohol advertising; • raising taxes on alcohol; • reducing salt intake and salt content of food; • replacing trans-fat in food with polyunsaturated fat; and • promoting public awareness about diet and physical activity, including through mass media. Cost-effective approaches in individual health care interventions include: • counselling and multidrug therapy, including glycaemic control for diabetes for people older than 30 years with a 10-year risk of fatal or nonfatal cardiovascular events; • aspirin therapy for acute myocardial infarction; • screening for cervical cancer, once at age 40, followed by removal of any discovered cancerous lesion; • early case finding for breast cancer through biennial screening with mammography (for women aged 50–70 years) and treatment of all stages; • early detection of colorectal and oral cancer; and • treatment of persistent asthma with inhaled corticosteroids and beta-2 agonists. Given the health and economic burden caused by NCDs and the urgent need to scale up action and monitor progress, countries should move towards time-bound targets and improved monitoring frameworks for NCD prevention and control.

Noncommunicable Diseases in the Western Pacific Region: A Profile

Annexes Annex 1 - Regional Commitments on NCD SEOUL DECLARATION ON NONCOMMUNICABLE DISEASE PREVENTION AND CONTROL IN THE WESTERN PACIFIC REGION 18 March 2011 Recognizing the serious and rapidly increasing adverse impact of noncommunicable diseases (NCD), including cardiovascular diseases, cancers, diabetes and chronic respiratory diseases, on individuals, families, communities, health systems and national economies, and the high prevalence of the major risk factors, the countries and areas of the WHO Western Pacific Region participating at the Regional High-level Meeting on Scaling Up Multisectoral Action for Noncommunicable Disease Prevention and Control, declare their commitment to: (1) provide strong and sustained high-level political support for NCD prevention and control to reduce premature NCD death and disability and health inequalities; (2) ensure a supportive multisectoral whole-of-government policy environment across all levels of government and a coordinating mechanism to mainstream the response to NCD involving all stakeholders, including civil society and, where appropriate, the private sector to protect health over commercial and other vested interests and to ensure that healthy choices are the easiest choices; (3) reduce the common modifiable NCD risk factors (tobacco use; diets high in saturated fats and trans-fats, salt and sugar; the harmful use of alcohol; and physical inactivity); and • in line with the WHO global and regional action plans and using the full range of mechanisms including legislation, regulation, fiscal measures and healthy public policies and, in particular, accelerate the full implementation of the WHO Framework Convention on Tobacco Control; and • by addressing the social determinants of health and by leveraging the power of local governments and civil society actions; (4) strengthen and integrate health systems, based on primary health care to ensure that NCD prevention and control is part of a funded coherent, balanced, realistic and comprehensive health planning process that is financially feasible and to: • deliver services for NCD and their risk factors utilizing team-based care and the most appropriate professional health care for the patient’s needs, including affordable and cost-effective drugs and technologies to support evidence-based priority interventions; and • work towards continuity of quality care from prevention to palliation across all components of health systems and promote a people-centred approach; (5) prioritize human and financial resources and infrastructure to ensure equitable coverage of complementary priority evidence-based NCD prevention and control interventions, including resource mobilization through innovative financing mechanisms; and (6) provide integrated but practical monitoring and accountability systems based on strengthened health information systems and a small number of quantified and timed targets and indicators to assess progress nationally to be reported publicly and to the United Nations General Assembly and other appropriate forums.

Noncommunicable Diseases in the Western Pacific Region: A Profile

In support of these commitments, participating countries and areas request the global community, through the UN High-level Meeting on the Prevention and Control of Noncommunicable Diseases, to act in a coordinated way to facilitate global and national multisectoral actions by: (1) raising the priority of NCD on their agendas; (2) strengthening synergies between NCD programmes and other development priorities, including the Millennium Development Goals and the future global development agenda; and (3) mobilizing additional resources and supporting innovative approaches to financing NCD prevention and control.

Noncommunicable Diseases in the Western Pacific Region: A Profile

HONIARA COMMUNIQUÉ ON THE PACIFIC NONCOMMUNICABLE DISEASE CRISIS 9th Meeting of Ministers of Health for the Pacific Island Countries 30 June 2011 Ministers of Health for the Pacific island countries are gravely concerned that the rapid increase in the incidence and prevalence of noncommunicable disease (NCD) in the Pacific island countries and areas over the past decade is responsible for up to 75% of all deaths and a similar percentage of long-term illness and disability, and declared at their 9th Meeting in Honiara, Solomon Islands, on 28–30 June 2011 that the Pacific island countries and areas are in an NCD crisis requiring urgent attention. Pacific island countries and areas are in crisis due to an epidemic of noncommunicable disease (NCD) such as heart disease, cancer and diabetes. The burden of NCD in the region is already extremely high, causing up to 75% of deaths and much long-term illness and disability. Our prevalence of NCD risk factors are among the highest in the world—up to three of every four adults are obese and up to four of every five adults smoke—meaning that without real action things will only get worse. The Pacific NCD crisis is not just a concern for the health of our people. It drains limited national budgets, reduces worker productivity, separates families, and robs communities of leadership and wisdom, as adults suffer long-term illness and die early. While adult NCD rates continue to rise, the next generation—more overweight and less active than any other Pacific generation in history—is the tsunami of the future. High childhood obesity rates in the Pacific, if left unchecked, suggest that a true health catastrophe is just a generation away. There is hope, however. There has been some early progress in the fight against NCD, and effective actions are available across a spectrum ranging from prevention to early detection and treatment. But what is missing is a sense of urgency in the region, and the recognition among Pacific island countries and areas that a whole-of-government and whole-of-society approach is needed to tackle this health and development crisis. There is a great opportunity this year with the United Nations General Assembly holding a High-level Meeting on the Prevention and Control of Noncommunicable Diseases from 19–20 September 2011 in New York. In the lead-up to this meeting, there have already been a number of key regional and global meetings that have considered the NCD crisis. The resulting Nadi Statement and Moscow Declaration made important recommendations on ways forward and this communiqué builds on those important initiatives. We have an opportunity to address this crisis if we act now. Recognizing the fundamental importance of the upcoming United Nations High-level Meeting in tackling this crisis at the global level, and the need for the outcomes of this meeting to reflect Pacific realities, we call on the outcome document of the High-level Meeting to include the following: • recognize NCD as a crisis in the Pacific to be addressed with the utmost urgency; • address the need for better information and guidance on cost-effective interventions in resource-limited settings; • initiate and sustain effective action across the life-course; • ensure sustainable resourcing for NCD prevention, treatment and control;

Noncommunicable Diseases in the Western Pacific Region: A Profile

• adopt a small number of global and publicly reported targets for NCD that can be adapted to national context; and • initiate multisectoral action at the international level to complement national level action, and make an explicit expectation that international organizations will work together in a coordinated way to tackle NCD. And in support of these recommendations, consistent with the Pacific Plan endorsed by the leaders of the Pacific Islands Forum at their October 2005 meeting and in support of our goal of Healthy Islands, we, the Ministers of Health for the Pacific island countries and areas, declare our commitment to the following critical actions: (1) provide strong and sustained leadership and support for NCD prevention and control; (2) lead the advocacy for a whole-of-government and whole-of-society response and a coordinating mechanism to mainstream the response to NCD; (3) ensure implementation of evidence-based initiatives to reduce the common modifiable NCD risk factors across the life-course, and address the social determinants of health, including leveraging the power of local government and civil society, with a focus on interventions across the lifecourse; (4) strengthen health systems, based on primary health care, to ensure that effective NCD prevention and control is funded and part of a coherent, balanced, realistic and comprehensive programme of health services as reflected in a costed national health plan; (5) ensure monitoring and accountability systems are in place, along with a small number of quantified and timed national targets, with progress to be reported publicly; and (6) fully implement the WHO Framework Convention on Tobacco Control as a critical step in reducing the impact of tobacco use on the prevalence of NCD. Recognizing that many of the factors underlying this pandemic are outside the control of the health sector, and that as a result a whole-of-government, whole-of-society and whole-of- region response is needed, we also call on the Pacific Forum Leaders to give the highest priority to NCD, and to lead and champion tackling the crisis in the Pacific by:

(1) declaring NCD as a health and development crisis; (2) driving a whole-of-government and whole-of-society response involving all sectors; (3) integrating NCD prevention and control into national development agendas; (4) mobilizing additional resources locally and internationally to support the fight against NCD; (5) setting national targets for NCD and regularly and publicly reporting results; (6) calling on all Council of Regional Organizations in the Pacific (CROP) agencies and regional health agencies to play an active part in a coordinated regional response to the crisis, and to report back every two years to Pacific Islands Forum Leaders on actions and progress; (7) considering setting an ambitious regional tobacco elimination target, inspired by (8) New Zealand’s smoke-free by 2025 goal; and (9) championing the cause of prevention and control of this NCD epidemic.

Noncommunicable Diseases in the Western Pacific Region: A Profile

Annex 2 - Exploratory Notes on Country Estimates Mortality Age- and sex-specific all-cause mortality rates were estimated for the year 2008 for the 193 WHO Member States from revised life tables, published in World Health Statistics 2011. Total 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 2008 revision. To calculate causes of death for countries with complete or incomplete death registration data, vital registration data were used to estimate deaths by cause. Death registration data from 1980 up to 2008 (if available) were used to project recent trends for specific causes, and these trend estimates were used to estimate the cause distribution for 2008. Adjustments for deaths due to HIV, drug use disorders, war and natural disasters were based on other sources of information using similar data sources and methods as previous estimates. For countries without any nationally representative data, cause-specific estimates of deaths for children under age 5 were estimated as described by Black et al. For ages five years and over, previous estimated distributions of deaths by cause were projected forward from 2004 to 2008, excluding human immunodeficiency virus (HIV), war and natural disasters. Detailed proportional cause distributions within the three broad groups were based on death registration data from within each region. Further information on these methods is available from WHO. Specific causes were further adjusted on the basis of epidemiological evidence from registries, verbal autopsy studies, disease surveillance systems and analyses from WHO technical programmes. Cause-specific estimates for HIV, tuberculosis and malaria deaths for 2008 were derived from previously published WHO estimates. Country-specific estimates of maternal mortality and cause-specific maternal mortality were based on the recent estimates for 2008 together with an analysis of regional cause patterns.

Risk factors The crude adjusted estimates presented are based on aggregated data provided by countries to WHO or obtained through a review of published and unpublished literature. The inclusion criteria for estimation analysis stipulated that data had to come from a random sample of the general population, with clearly indicated survey methods (including sample sizes) and risk factor definition. Adjustments were made for the following factors so that the same indicator could be reported for a standard year (in this case 2008) in all countries: standard risk factor definition; standard set of age groups for reporting; standard reporting year, and representativeness of population. Using regression modelling techniques, crude adjusted rates were produced for each indicator. Additionally, means for each of the four metabolic indicators were also estimated for the years 1980-2009. These means are presented in the risk factor trend graphs. Uncertainty in the estimates was analysed by taking into account sampling error and uncertainty due to statistical modelling. Further detailed information on the methods and data sources used to produce these estimates is available from WHO.

Noncommunicable Diseases in the Western Pacific Region: A Profile

Prevalence estimates for the year 2008 are given for the following behavioural and metabolic risk factors: • Current daily tobacco smoking: the percentage of the population aged 15+ years who currently smoke tobacco on a daily basis. • Physical inactivity: the percentage of the population aged 15+ years engaging in less than 30 minutes of moderate activity per week or less than 3 times 20 minutes of vigorous activity per week, or the equivalent. • Raised blood pressure: the percentage of the population aged 25+ years having systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥90 mmHg or on medication to lower blood pressure. • Raised blood glucose: the percentage of the population aged 25+ years having a fasting plasma glucose value ≥ 7.0 mmol/L (126 mg/dl) or on medication for raised blood glucose. • Overweight: the percentage of the population aged 20+ years having a body mass index (BMI) ≥ 25 kg/m2. • Obesity: the percentage of the population aged 20+ years having a body mass index (BMI) ≥ 30 kg/m2. • Raised cholesterol: the percentage of the population aged 25+ years having a total cholesterol value ≥ 5.0 mmol/L (190 mg/dl).

Country Capacity Survey All information provided in this section of the profile, with the exception of the indicator on the highest level of implementation of the tobacco (m)POWER measures, were taken from country responses to the recent WHO NCD country capacity survey (CCS). Conducted in 2009-2010, the NCD CCS was undertaken by WHO to update the information about individual country capacity to respond to NCD prevention and control. An excel-based questionnaire was sent to the NCD focal points (i.e. the person responsible for the prevention and control of NCDs) or designated colleagues within the Ministry of Health or a national institute/agency in all 37 countries and areas in the Region. The questionnaire was sent in 2009 and the focal points were requested to respond by end of March 2010, but responses were accepted until June 2010. Thirty-five countries and areas responded to the survey, compared to 29 in 2004. The questionnaires used were not completely identical, but some questions on key indicators were unchanged. Just prior to this publication, countries were given the opportunity to update their profiles, with a closing date of July 2011. All countries and areas, except Pitcairn Islands and Wallis and Futuna, completed the questionnaire.

The questionnaire is composed of 5 domains and is discussed briefly below. Public Health Infrastructure This domain queried countries about having a designated NCD unit/branch/department within the Ministry of Health (or its equivalent), the designated unit’s responsibilities, and the existence of an established budget allocation to sustain this unit’s operations. Status of NCD Policies, Strategies and Action Plans This section queried countries about the existence of integrated NCD policies/strategies and action plans and the inclusion of key components in the policies/strategies/action plans as well as separate policies for individual risk factors. The questionnaire also asked about the availability of budgetary resources to implement the policies/strategies/action plans.

Noncommunicable Diseases in the Western Pacific Region: A Profile

Health Reporting/Information Systems, Monitoring and Surveillance This section of the assessment questionnaire queried countries about the inclusion of NCD-related data into national health reporting mechanisms, the existence of NCD registries, and the conduct of risk factor surveys. Health System Capacity for NCD Prevention, Early Detection, Treatment and Care within the Primary Health Care System This section queried countries on the integration of the various components of the spectrum of NCD-related health interventions into the primary health care system and factors within the health care system affecting the management of NCDs. Health Promotion, Partnerships, and Collaboration This section covers the health promotion initiatives, partnerships and collaboration related to NCDs. These include the mechanisms for partnership, the stakeholders, and the content areas of these collaborations.

Country Profiles The 2010 population estimates from the most recent United Nations Population Division World Population Prospects are reported in each profile. For income category, the 2008 World Bank income categories are reported. In addition to the methods as stated under Country Capacity Survey above, information about the MPOWER package of six evidence-based tobacco control measures was included in the country profiles. To help countries fulfil their WHO FCTC obligations, WHO, in 2008, introduced the MPOWER that are proven to reduce tobacco use. MPOWER refers to M: Monitoring tobacco use and prevention policies; P: Protecting people from tobacco smoke; O: Offering help to quit tobacco use; W: Warning about the dangers of tobacco; E: Enforcing bans on tobacco advertising, promotion and sponsorship; and R: Raising taxes on tobacco. Each measure reflects one or more provisions of the WHO FCTC, and the package of six measures is an important entry point for scaling up efforts to reduce the demand for tobacco. The NCD profile includes an assessment of progress in countries to implement only the POWER measures. (W focussed on Health Warnings only). Data for assessing the progress of Member States against the POWER measures were gathered by WHO from various country-level sources. These included original tobacco control legislation documents, detailed information on cessation services, mass media campaigns, cigarette prices and tobacco-related tax and revenues. The final data for each country were sent to the respective government for review and signoff. In cases where national authorities explicitly did not approve the data, this is noted in the WHO Report on the Global Tobacco Epidemic, 2011. Using these data, countries were then assessed at the highest level of achievement if they met the best-practice criteria for each POWER measure. A full description of these criteria can be found in the WHO Report on the Global Tobacco Epidemic, 2011 (13). For each of the POWER measures, countries were allocated a score of 1 if they were assessed by WHO as having attained the highest level of achievement, else a score of 0. This means that each individual country score is out of a total of 5 with a minimum of 0/5 to a maximum of 5/5.

Noncommunicable Diseases in the Western Pacific Region: A Profile

Cancer Method used to estimate incidence cases and deaths by country in GLOBOCAN Member States Australia Incidence National incidence rates (1986-2005) projected to 2008 and applied to 2008 population. The numbers were scaled to the estimated total number of new cancer cases by sex provided by the Australian Institute of Health and Welfare for 2008. Local incidence data and national mortality data: incidence was estimated from national mortality by modelling, using incidence mortality ratios derived from recorded data in local cancer registries in neighbouring countries Frequency data: age/sex specific incidence rates for all cancers were partitioned using data on relative frequency of different cancers (by age and sex) obtained from local source. Local incidence data and national mortality data: incidence was estimated from national mortality by modelling, using incidence mortality ratios derived from recorded data in country-specific cancer registries. National incidence rates observed in the Fiji Cancer Registry (1991-1999) were applied to the 2008 population Sample mortality data: estimated national mortality for 2008 for “all cancers” (WHO) was partitioned by site and age using the sample mortality data. National incidence rates (2000-2007) projected to 2008 (except for thyroid cancer for which incidence rates for 2007 were applied to 2008 population). Simple mean of rates observed in the cancer registries of Khon Kaen and Chiang Mai (Thailand). Mortality National mortality rates (1985-2004, source WHO) projected to 2008 and applied to 2008 population.

Brunei Darussalam

Local incidence data and national mortality data: incidence was estimated from national mortality by modelling, using incidence mortality ratios derived from recorded data in local cancer registries in neighbouring countries No data: the number of cancer deaths was estimated from incidence estimates and site specific survival, provided by neighbouring countries. Sample mortality data: estimated national mortality for 2008 for “all cancers” (WHO) was partitioned by site and age using the sample mortality data.

Cambodia

China

Fiji

The number of cancer deaths in 2008 was estimated from incidence estimates and site specific survival, estimated by the GDP method. National mortality data: recorded mortality in 2008.

Japan

Korea, Republic of

National mortality rates (2000-2007, source WHO) projected to 2008

Lao People’s Democratic Republic

Mortality was estimated from the 2008 national incidence estimate, using site specific relative survival from Thai and Chinese cancer registries. The number of cancer deaths (all ages) was partitioned by sex and age using proportions from Chinese cancer registries mortality files. The number of cancer deaths in 2008 was estimated from incidence estimates and site specific survival, estimated by the GDP method.

Malaysia

Simple mean of incidence rates recorded in peninsular Malaysia (2003), Penang (1998-2002) and Sarawak (1998-2002).

Noncommunicable Diseases in the Western Pacific Region: A Profile

Mongolia

National incidence data: reliable estimates of the national incidence in 2008. National incidence rates (1986-2005) projected to 2008 and applied to the 2008 population Frequency data: age/sex specific incidence rates for all cancers were partitioned using data on relative frequency of different cancers (by age and sex). Local incidence data and national mortality data: incidence was estimated from national mortality by modelling, using incidence mortality ratios derived from recorded data in local cancer registries in neighbouring countries. National incidence rates (1981-1987) applied to the population (2008).

National mortality data: recorded mortality in 2008. National mortality rates (1986-2005, source WHO) projected to 2008 and applied to the 2008 population. No data: the number of cancer deaths was estimated from incidence estimates and site specific survival, estimated by the GDP method.

New Zealand

Papua New Guinea

Philippines

Sample mortality data: estimated national mortality for 2008 for “all cancers” (WHO) was partitioned by site and age using the sample mortality data.

Samoa

Estimated incidence for 2008 was converted to mortality using mortality incidence ratios obtained by the aggregation of data from French Polynesia and Guam. National mortality data: mortality rates projected to 2008 No data: the number of cancer deaths was estimated from incidence estimates and site specific survival, estimated by the GDP method. The number of cancer deaths in 2008 was estimated from incidence estimates and site specific survival, estimated by the GDP method. Sample mortality data: estimated national mortality for 2008 for “all cancers” (WHO) was partitioned by site and age using the sample mortality data.

Singapore

National incidence data: incidence rates projected to 2008 No data: Incidence was estimated as the simple mean of the country-specific estimates for Fiji and Vanuatu. Mortality rates (1998-2002, provided by cancer registry) applied to the population (2008)

Solomon Islands

Vanuatu

Viet Nam

Annex 3 - 2008 Comparable Estimates of NCD Mortality Age-standardized death rate per 100,000 (Males) All NCDs Cancers CRD Cancers CRD CVD and diabetes All NCDs CVD and diabetes

Country Males Females

Total NCD deaths (‘000s) Latest Year of Data 2006 2008 no data 2007 2001 2000 2008 2002 103.4 89.9 129.0 622.8 569.0 845.5 285.1 314.6 413.7 664.7 482.8 246.8 583.2 238.8 524.3 672.6 991.9 576.8 508.2 90.1 166.4 190.6 110.8 80.5 105.3 106.9 74.6 77.1 40.2 90.9 85.9 93.9 153.8 94.3 94.3 42.1 107.1 50.8 22.7 72.3 20.5 24.2 27.9 74.1 32.5 12.1 50.2 7.2 41.4 53.2 77.3 44.8 45.5 392.8 236.5 831.4 363.1 303.6 473.0 106.1 160.4 214.8 395.4 295.3 115.2 373.6 108.9 303.7 395.0 568.0 333.4 298.2 no data 2006 no data no data no data 1996 2007 2000 no data no data 2003 2006 no data 2008 no data 1998 2000 no data 2008

NCD deaths under age 70 (percent of all NCD deaths) Age-standardized death rate per 100,000 (Females) 28.8 59.1 77.1 43.9 61.0 71.5 29.3 77.7 60.3 58.4 80.3 55.8 69.2 72.5 29.9 64.0 64.2 72.2 67.6 45.1 55.6 46.0 61.1 45.9 63.1 60.3 42.7 54.7 69.9 22.1 36.6 66.8 69.0 55.0 23.5 43.7 34.9 58.1 53.0 56.3 62.2 32.4 867.7 1367.4 410.7 790.3 777.3 836.9 711.6 465.0 772.1 372.1 709.7 649.3 992.3 767.8 687.2 259.5 114.7 149.1 79.7 91.4 151.8 98.6 190.5 68.5 141.6 85.9 67.4 106.9 94.7 137.3 33.6 86.3 30.1 81.1 78.7 99.9 80.7 36.1 83.3 22.6 74.5 68.8 98.4 79.5 76.6 456.4 922.3 171.2 486.3 469.6 459.8 394.8 167.9 477.4 171.2 425.0 395.9 605.8 462.4 381.5 51.2 753.7 79.3 80.2 459.4 46.0 70.6 605.7 1280.1 118.8 100.7 74.7 135.1 318.7 818.5 436.5 1316.0 53.0 849.4 145.4 122.8 467.9 689.0 111.1 18.6 46.4 56.6 32.0 52.5 61.1 15.7 66.5 364.8 534.3 957.9 665.2 592.0 928.4 336.7 832.4 140.8 97.0 144.9 182.3 58.6 106.2 150.5 39.0 25.6 69.0 129.0 118.4 61.3 91.1 22.5 61.8 136.3 292.7 480.4 311.5 350.7 579.9 118.1 425.9 246.3 488.7 592.2 495.2 326.3 590.9 178.1 548.3 92.9 98.1 90.0 105.0 57.4 121.6 76.6 64.2 15.5 44.0 60.4 88.7 26.3 44.2 8.0 19.1 88.6 275.4 338.7 259.6 180.0 328.2 65.0 223.8

Males

Females

63.4 0.5 31.1 4323.3 0.0 2.4 473.2 0.3 11.7 39.1 0.3 0.2 4.8 0.0 12.8 0.0 0.0 9.1 133.9 96.7 0.4 7.8 0.6 0.3 0.0 0.3 222.0

63.2 0.5 25.5 3675.5 0.0 1.8 435.5 0.2

12.1

50.4 0.3

Noncommunicable Diseases in the Western Pacific Region: A Profile

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

0.2

6.1 0.0 13.1 0.0 0.0 11.1 175.7 112.3 0.4 10.1 0.8 0.2 0.0 0.5 208.0

Note: Countries with asterisk have figures with a high degree of uncertainty because they are not based on any national NCD mortality data. The estimates for these countries 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).

Noncommunicable Diseases in the Western Pacific Region: A Profile

Annex 4 - WHO STEPwise Surveillance for NCD Risk Factors No. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Country American Samoa Cambodia China Cook Islands Fiji Kiribati Lao People’s Democratic Republic, the Malaysia Marshall Islands, the Micronesia, the Federated States of Mongolia Nauru Palau Papua New Guinea Philippines Samoa Solomon Islands Tokelau Tonga Tuvalu Vanuatu Viet Nam Coverage National National National National National National Subnational (Vientiane) National National Subnational (Pohnpei) National National National Subnational (Capital, Manus, Gulf, Madang, Simbu) National National Subnational National National National National Subnational (3 surveys) Survey period 2004 2010 2004, 2007, 2010 2004 2002 2004-06 2008 2005-06 2002 2002, 2006, 2008 2005 & 2009 2004 2011-12 (ongoing) 2007-08 2003-04, 2008 2002 2005-06 2005 2004 2006-07 2011 2005

WHO Western Pacific Region PUBLICATION

ISBN-13

978 92 9061 563 7

Key facts

Organisation World Health Organization (WHO)

Document type Publications

Adoption date December 31, 2012

Source World Health Organization