Follow-up on selected resolutions/decisions of the last three years: update on scaling up prevention and control of chronic noncommunicable diseases and alcohol consumption control.

1 Agenda item 5.5 SEA/ACM/Meet.1/5.55 10 June 2008 Follow-up on Selected Resolutions/ Decisions of the Last Three Years: Update on Scaling up Prevention and Control of Chronic Noncommunicable Diseases and Alcohol Consumption Control Part A The WHO Regional Committee for South-East Asia (SEA) through resolution SEA/RC60/R4 on scaling up prevention and control of chronic noncommunicable diseases (NCDs) (Annex 1) endorsed the Regional Framework for Prevention and Control of NCDs and urged Member States to initiate appropriate steps to formulate, update and strengthen national policies, strategies and programmes and to establish suitable infrastructure and appropriate funding mechanisms for integrated prevention and control of NCDs. The resolution also requested the Regional Director to provide technical assistance to Member countries, and to mobilize necessary resources for developing the capacity to implement national policies, strategies and programmes for integrated prevention and control of NCDs, and to facilitate and coordinate international support of development partners. In addition, in May 2008, the Sixty-first World Health Assembly endorsed the Action Plan for the Global Strategy for the Prevention and Control of NCDs that set up six objectives and corresponding actions to be taken by Member States, the WHO Secretariat and international partners, for the period 2008-2013. The resolution SEA/RC60/R4 also requested the Regional Director to report to the Sixty-third session of the Regional Committee in 2010 on the progress achieved in implementing the Regional Framework. This document reports on the initial action undertaken by Member States and WHO, on implementation of the resolution and considers regional implications of the global NCD action plan 2008-2013. Meeting of the Advisory Committee (ACM) to review technical matters to be discussed at the Sixty-first Session of the Regional Committee WHO/SEARO, New Delhi, 30 June – 3 July 2008 Part B The WHO Regional Committee for South-East Asia through its resolution - SEA/RC59/R8 - on alcohol consumption control policy options (Annex 2), endorsed the policy options for South-East Asia (Document SEA/RC59/15), for reducing public health problems caused by alcohol use; and urged Member States to establish/strengthen institutional capacity, through multisectoral partnership, in order to generate information on consumption of alcohol and related problems based on socioeconomic strata, alcohol marketing strategies, commercial aspects and revenue generated from alcohol, to be used for policy, planning, monitoring and evaluation; and to establish/strengthen appropriate mechanism(s) for effective planning, implementation, monitoring and evaluation of national programmes, with adequate institutional capacity and funding. The resolution also requested the Regional Director to support Member States in building and strengthening institutional capacities for developing: information systems, policies, action plans, programmes, guidelines and monitoring/evaluation of programmes on prevention of harm from alcohol use; to hold a biennial regional forum of key partners from Members States and other international partners to share progress, experiences and lessons on alcohol control programmes, and to report on the progress on the implementation of the policy options for alcohol consumption control, to the Sixty-first session of the Regional Committee in 2008. This document reports on the action taken on implementation of the resolution. The views and recommendations of the Meeting of the Advisory Committee (ACM) on this agenda item will be submitted to the Sixty-first Session of the Regional Committee for its consideration.. SEA/ACM/Meet.1/5.5 Page 1 PART A: SCALING UP PREVENTION AND CONTROL OF CHRONIC NONCOMMUNICABLE DISEASES IN THE SOUTH-EAST ASIA REGION (SEA/RC60/R4) 1. The Sixtieth session of the WHO Regional Committee for South-East Asia (SEA) through its resolution SEA/RC60/R4 (Annex 1), on scaling up prevention and control of chronic noncommunicable diseases (NCDs), endorsed the Regional Framework for Prevention and Control of Noncommunicable Diseases (NCDs) and urged Member States to initiate appropriate steps to formulate, update and strengthen national policies, strategies and programmes and to establish suitable infrastructure and appropriate funding mechanisms for integrated prevention and control of NCDs. The resolution also requested the Regional Director to provide technical assistance to Member countries, and to mobilize necessary resources for developing their capacity to implement national policies, strategies and programmes for integrated prevention and control of NCDs, and to facilitate and coordinate international support of development partners. The resolution requested the Regional Director to report to the Sixty-third session of the Regional Committee in 2010 on the progress achieved in implementing the Regional Framework. An update of action undertaken till date on implementation of the resolution and the framework is presented herewith. Progress in formulating NCD policies, strategies and programmes 2. Several Member countries of the SEA Region made significant progress in formulating, revising and implementing their national NCD policies, plans and programmes. Ministries of Health of Bangladesh, Indonesia, India, Sri Lanka and Thailand made important investments in strengthening the public health infrastructure towards coordinating the integrated NCD programmes at national level. Other Member countries involved themselves in formulating national policies and strategies for NCD commitments. Bhutan developed its first-ever national policy and strategy on prevention and control of NCDs in 2008, while Maldives formulated a new Strategic Plan for Prevention and Control of NCDs for 2008–2010. Nepal and Sri Lanka also drafted their national policies on NCD prevention and control in 2007 for wider discussion among stakeholders and approval. In January 2008 the Ministry of Health, India launched a pilot programme for prevention and control of cardiovascular diseases, diabetes and stroke in six districts. Thailand’s Ministry of Public Health has drafted the Thailand Healthy Lifestyle Strategic Plan, 2007-2016, with focus on reduction of NCD risk factors. The draft is still under review by the stakeholders. 3. In collaboration with national oral health programme managers and experts on oral health, a regional strategy on oral health was formulated with the support of the regional network for NCD Prevention and Control (SEANET-NCD) and the WHO Collaborating Centre for Promoting Community-based Oral Health, situated in Chang Mai, Thailand. The objective of the regional strategy on oral health for the SEA Region was to facilitate SEA/ACM/Meet.1/5.5 Page 2 Member countries to develop or strengthen national oral health promotion and prevention programmes by restructuring/alignment of the health system for primary oral health care, and ensuring access to equitable, quality oral health care. The draft strategy will be further reviewed at the regional consultative meeting on oral health to be held by the third quarter of 2008. Promotion of collaboration and networking 4. A meeting of the regional NCD network (SEANET-NCD) held in October 2007, at Phuket, Thailand, was attended by representatives of national NCD networks and programmes from 10 countries of the Region, governmental and nongovernmental organizations, and WHO staff. The meeting discussed plans and programmes for scaling up the prevention and control of NCDs in line with the Regional Framework. At this SEANET-NCD meeting, five Member countries, namely Bangladesh, India, Indonesia, Nepal and Sri Lanka reported on the progress made by their national NCD networks. 5. The experience of national NCD networks (summarized in the document - SEA- NCD-79) highlights the progress in collaboration among stakeholders, and in particular the creation of forum(s) for sharing information, experience and expertise. Networking is often limited to professional associations and the public health sector. The involvement of the private sector and other sectors outside health is rather weak. Even within governments, health ministries have noted the limited progress made in assuming the leadership role by involving other ministries such as agriculture, food processing, trade and urban transport, etc., in coordinated fashion to address major determinants of NCDs. The schools and the media have, however, been involved most successfully. 6. Two national institutions had been designated during 2007 as WHO Collaborating Centres in the area related to NCD prevention and control. The newly-established WHO Collaborating Centre for NCD Prevention and Control in Chennai, India assumed important functions in facilitating risk factor surveillance activities, sustaining the Regional NCD Risk Factor InfoBase and supporting regional networking including developing and hosting the SEANET-NCD website. A new regional WHO collaborating centre on chronic respiratory diseases, in Chandigarh, India, to conduct collaborative research and strengthen the regional capacity for prevention and management of chronic obstructive pulmonary disease and asthma. Technical assistance in capacity building 7. In support of the national efforts to formulate comprehensive NCD policies, plans and programmes and to promote implementation of evidence-based and cost-effective interventions, a regional programme on capacity strengthening for policy makers and NCD programme managers was initiated in early 2006. A comprehensive training package consisting of ten basic modules for capacity-strengthening was developed, and pilot-tested in Nepal and subsequently finalized by end-2006. During 2007-08, national workshops on capacity strengthening were conducted in Bhutan, Indonesia, Myanmar, Maldives, Sri SEA/ACM/Meet.1/5.5 Page 3 Lanka and Thailand, using the package. These national capacity strengthening workshops made opportunities for national stakeholders and programme managers for reviewing and revising the existing policies or drafting new national NCD policies and plans. 8. To facilitate broader implementation of the capacity strengthening programme at sub-national level, WHO Regional Office in collaboration with SEANET-NCD, developed the detailed guidelines for coordinators and resource persons involved with sub-national NCD capacity strengthening workshops. The Global NCD Action Plan and its regional implications 9. On the advice of the 122 nd Session of the WHO Executive Board held at Geneva in January 2008, WHO has updated the Action Plan for the Global Strategy for the Prevention and Control of NCDs for 2008-2013, in wider consultation with Member States and other stakeholders. The Global Action Plan draws from and is in line with the SEA Regional Framework for NCD Prevention and Control and with similar documents from other WHO regions. The plan was extensively discussed with national counterparts and staff from WHO Country Offices in the SEA Region. The Regional Office staff contributed actively to its development at all stages. 10. The Sixty-first World Health Assembly held in May 2008 reviewed and, through its resolution WHA61.14, endorsed this Action Plan (Annex to Document A61/8), which sets out the priorities, actions and performance indicators for Member States, WHO and international partners, in order to map out emerging epidemics of NCDs, reduce the level of exposure to risk factors, and strengthen health care for people with NCDs. 11. The Regional NCD Action Plan 2008-2013, formulated and agreed at the SEANET- NCD meeting in October 2007, will be further updated, keeping in view the Global Action Plan, and used as background for preparing the workplans for Regional Office and Member States during Programme Budget of 2010-2011 and 2012-2013 respectively. The regional and national indicators, targets and timelines are to be set in line with the examples as contained in Global Action Plan. Mechanisms need to be established to collect appropriate information required for monitoring the implementation of the Action Plan according to the adopted indicators. 12. Full implementation of NCD action plan might be challenging without a major increase in administrative and financial commitments. A substantial strengthening of NCD programmes at regional and country levels in terms of human resources and funds is therefore required. SEA/ACM/Meet.1/5.5 Page 4 13. Action by Member States: (1) To develop and update national plans of action and allocate appropriate resources for prevention and control of NCDs in view of the Regional Framework for Prevention and Control of NCDs; and, (2) To contribute to implementation of the Action Plan for the Global Strategy for the Prevention and Control of NCDs endorsed by the Sixty-first World Health Assembly. 14. Action by WHO SEA Regional Office: (1) To provide technical support to Member countries in building their capacity for developing, implementing, monitoring and evaluating national multisectoral programmes for integrated prevention and control of NCDs. PART B: ALCOHOL CONSUMPTION CONTROL – Policy Options (SEA/RC59/R8) 15. The Fifty-ninth session of the WHO Regional Committee for South-East Asia, under its resolution on alcohol consumption control: policy options (Annex 2), requested the Regional Director: a) to support Member States in building and strengthening institutional capacities for developing: information systems, policies, action plans, programmes, guidelines and monitoring/evaluation of programmes on prevention of harm from alcohol use; b) to hold a biennial regional forum of key partners from Members States and other international partners to share progress, experiences and lessons on alcohol control programmes, and c) to report on the progress on the implementation of the Alcohol Consumption Control – Policy Options to the sixty-first session of the Regional Committee in 2008. Strengthening national capacity 16. WHO SEA Regional Office in collaboration with national experts and institutions has produced a series of publications during 2006 on reducing alcohol consumption. A sixth serial on the same series entitled “Current Information on Use and Harm from Alcohol in the South-East Asia Region” was published in early 2007. “Reducing harm from alcohol use: policy options” document was distributed as background paper at the Regional Conference on Health Promotion held at Bali, Indonesia in late 2007. All these have been distributed to the focal points in Member States. 17. The following activities are being undertaken to support Member States to build and strengthen their institutional capacities: SEA/ACM/Meet.1/5.5 Page 5 • National survey data from India (National Family Health Survey (NFHS 3 for 2005- 06, published in 2007) and Thailand (National Household Survey on Estimation of Population on Alcohol Abuse, 2007) are being analysed to determine the magnitude of use and harm from alcohol use. NCD Risk factor surveillance using WHO STEPS approach under Integrated Disease Surveillance Project in India launched in 2007 would help to provide population-based data on alcohol use on regular basis. • India has recently launched “Alcohol Atlas of India”, in collaboration with Indian Alcohol Policy Alliance, which will be used for policy advocacy and also for adopting interventions. • Community-based assessments of harm from alcohol use have been conducted in Myanmar and Sri Lanka. The information revealed from these assessment might be limited due to the conduct of studies in select communities, but these data are extremely useful to measure the magnitude of harm to the community and also in developing appropriate policy and programme interventions at the community level. • National data from Nepal on alcohol use are as part of the WHO STEPS survey of NCDs. • A Community-based assessment of harm from alcohol use will be conducted in three provinces, where alcohol use is high, in Indonesia. This assessment will be completed by the end of 2008, and will be in addition to the nation-wide household survey on health, being conducted by the National Institute of Health Research and Development, of which national representative data on alcohol use will be available by 2009. 18. Reliable community-based data on the extent of use and harm from alcohol use will be available in almost all Member States, and these will be used to develop models of intervention strategies for prevention of harm from alcohol use. A regional workshop of all Principal Investigators of these national assessments will be held in late 2008 to discuss lessons learned from the community-based information and to develop possible intervention strategies for prevention of harm from alcohol use. 19. Member States of the WHO SEA Region are participating in the Global Survey on Alcohol and Health 2008, which would collect data in a structured format on alcohol use, harm from use, and alcohol control policies from all Member States. Regional and National Forums 20. Several regional workshops and forums have been held and planned: • A Regional Conference of Parliamentarians on the legislative and policy action for promoting health was organized at Bali, Indonesia, from 8-9 October 2007. Regional SEA/ACM/Meet.1/5.5 Page 6 and national policy options for reducing harm from alcohol use were discussed at this conference. The Parliamentarians adopted a call of action. • An intersectoral Symposium on Reducing Harm from Alcohol Use in the community, organized at Bali, Indonesia, from 4-6 October 2007. Stakeholders from diverse sectors who are concerned about harm from alcohol use participated at this Symposium. Several important recommendations for prevention of harm from alcohol use emerged from the discussions at this Symposium. • A meeting with alcohol producers to obtain their views on harm from alcohol use is planned for late 2008. This interaction will be held in collaboration with WHO Headquarters, and will essentially focus on obtaining the industry perspective on harm from alcohol use. • A bi-regional forum as recommended by the Regional Committee will be established once data from community assessment are ready. • Collaboration was forged with the regional alcohol control networks such as the ThaiHealth, Indian Alcohol Policy Alliance and Global Alcohol Policy Alliance. 21. Sri Lanka’s Parliament has adopted a new legislation on “National Alcohol and Tobacco Authority” in 2006, and national mechanism has been set up in 2007 to implement this legislation under the leadership of the Ministry of Health. Thailand has recently passed a new legislation – Alcohol Consumption Control Act 2008. Strategies to reduce the harmful use of alcohol 22. The Sixty-first World Health Assembly in May 2008 has reviewed the progress report on strategies to reduce the harmful use of alcohol (Document A61/13), which describes the discussions on the efforts of Member States and WHO on the reduction of harm from alcohol that have taken place since January 2007, and highlights the strategies and policy options to reduce the harmful use of alcohol in NINE broad areas: 1) Raising awareness and political commitment; 2) Health sector response; 3) Community action to reduce harmful use of alcohol; 4) Drink-driving policies and counter-measures; 5) Addressing availability of alcohol; 6) Addressing marketing of alcohol beverages; 7) Pricing policies; 8) Harm reduction; and 9) Reducing public impact of illegally and informally produced alcohol. SEA/ACM/Meet.1/5.5 Page 7 23. The report also deals with the way forward by Member States and WHO. The Health Assembly adopted a resolution - WHA61.4 that called for the development of a draft Global Strategy to reduce harmful use of alcohol based on all evidence and best practices, and submit it to the Sixty-third World Health Assembly in 2010, through wide consultation. 24. The Regional Committee is requested to take note of the progress. SEA/ACM/Meet.1/5.5 Page 8 Annex 1 SEA/RC60/R4 SCALING UP PREVENTION AND CONTROL OF CHRONIC NONCOMMUNICABLE DISEASES IN THE SOUTH-EAST ASIA REGION The Regional Committee, Recalling World Health Assembly resolutions WHA53.17, WHA56.1, WHA57.17 and WHA60.23, and its own resolutions SEA/RC52/R7 and SEA/RC53/R10 relating to the prevention and control of noncommunicable diseases (NCDs), Realizing that the countries in the WHO South-East Asia Region experience an increasing burden (in health, social and economic status) being imposed by major NCDs such as cardiovascular diseases, diabetes, cancers and chronic respiratory diseases, and concerned that noncommunicable diseases are increasingly becoming common among the poor and marginalized population groups, Aware of the rapidity of epidemiological transition and globalization which will escalate these burdens over the next decades if appropriate public health action is not taken, Acknowledging that effective, efficient and affordable interventions are available to modify the common risk factors of NCDs, such as unhealthy diet, physical inactivity, alcohol and tobacco consumption, and of their socioeconomic determinants that lie outside the domain of the health sector, Recognizing the role of a “life course” approach which emphasizes the need of utilizing available health promotion and disease prevention strategies to minimize the risk of NCDs at each stage of life and the complementarities of a “population-based” and “individual-centred” intervention in achieving this, Appreciating the growing commitment of Member States towards integrated prevention and control of NCDs and the considerable progress achieved in this regard, and Having considered the recommendations of the Joint Meeting of Health Secretaries and the Consultative Committee for Programme Development and Management (CCPDM), held in the Regional Office in New Delhi, 2–6 July 2007, 1. ENDORSES the Regional Framework for Prevention and Control of Noncommunicable Diseases; 2. URGES Member States: • to initiate appropriate steps based on the Regional Framework to formulate, update and strengthen national policies, strategies and programmes for integrated prevention and control of NCDs; • to establish suitable infrastructure and appropriate funding mechanisms for this purpose, and • to set up mechanisms to promote multilateral, multisectoral, multidisciplinary and multilevel collaboration for integrated prevention and control of NCDs and, in particular, to facilitate the establishment of national and regional networks for NCD prevention and control (SEANET-NCD), and 3. REQUESTS the Regional Director: • to provide technical assistance to Member States, and to mobilize necessary resources for developing the capacity to implement national policies, strategies and programmes for integrated prevention and control of NCDs, and to facilitate and coordinate international support of development partners, and • to report to the sixty-third session of the Regional Committee in 2010 on the progress achieved in implementing the Regional Framework. SEA/ACM/Meet.1/5.5 Page 9 Annex 2 SEA/RC59/R8 ALCOHOL CONSUMPTION CONTROL – POLICY OPTIONS The Regional Committee, Recalling World Health Assembly resolutions WHA32.40; WHA36.12, WHA42.20, WHA55.10, WHA57.10, WHA57.16, WHA58.26 and its own resolutions SEA/RC54/R2 on public health problems caused by alcohol use, Recognizing that the adult per capita alcohol consumption in the South-East Asia Region has almost doubled in the last decade and that the patterns, context and overall level of alcohol consumption has a negative impact on health and cause serious social and economic consequences to the population, especially the poor, Appreciating the continued efforts of Member States in adopting and implementing comprehensive national alcohol control policies and effective strategies for reducing public health problems caused by alcohol use, Having considered the document SEA/RC59/15 which highlights various policy options to reduce public health problems caused by alcohol use, through concerted efforts by the government, public agencies, civil society and the private sector having no conflict of interest, Noting the consequences of certain trade agreements that facilitate the free flow of and investment in alcohol, which boosts the consumption and negative impact of alcohol in the Region, and Noting the unique characteristics of regional/national alcohol consumption and related problems e.g. linkage of alcohol to poverty, payday drinking, indigenous alcoholic beverages, which require context- specific policy and interventions, (1) ENDORSES the document Alcohol Consumption Control – Policy Options in South-East Asia Region (SEA/RC59/15) along the lines and amendments made by Members, to help reduce public health problems caused by alcohol use as a minimum framework for alcohol control policy and providing strategic guidance to Member States; (2) URGES Member States: a) to establish/strengthen institutional capacity, through multi-sectoral partnership, in order to generate information on consumption of alcohol and related problems based on socioeconomic strata, alcohol marketing strategies, commercial aspects and revenue generated from alcohol, to be used for policy, planning, monitoring and evaluation; b) to encourage appropriate participation of stakeholders having no conflict of interest, to develop comprehensive national alcohol control policies, action plans and programmes for reducing public health problems caused by alcohol use, based on the Regional Policy Options as a minimum framework; c) to assess the potential impact of certain trade agreements on alcohol consumption and related problems so that effective policy interventions could be formulated, and d) to establish/strengthen appropriate mechanism(s) for effective planning, implementation, monitoring and evaluation of national programmes, with adequate institutional capacity and funding, and SEA/ACM/Meet.1/5.5 Page 10 (3) REQUESTS the Regional Director: d) to support Member States in building and strengthening institutional capacities for developing: information systems, policies, action plans, programmes, guidelines and monitoring/evaluation of programmes on prevention of harm from alcohol use; e) to hold a biennial regional forum of key partners from Members States and other international partners to share progress, experiences and lessons on alcohol control programmes, and f) to report on the progress on the implementation of the Alcohol Consumption Control – Policy Options to the sixty-first session of the Regional Committee in 2008.