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Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities

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Monitoring noncommunicable diseases and injuries Pilot assessment in 20 cities

Monitoring noncommunicable diseases and injuries Pilot assessment in 20 cities Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities ISBN 978-92-4-010149-4 (electronic version) ISBN 978-92-4-010150-0 (print version) © World Health Organization 2024 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. 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To submit requests for commercial use and queries on rights and licensing, see https://www.who.int/copyright. Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user. General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. iii Contents Acknowledgements �� iv Abbreviations �� v 1 Introduction �� 1 2 Methods �� 3 2.1 City selection ................................................................................................................. 3 2.2 Data collection, review and verification ...................................................................... 4 2.3 Analysis ......................................................................................................................... 6 3 Results and discussion �� 7 3.1 Summary ....................................................................................................................... 7 3.1.1 Air pollution reduction .................................................................................... 11 3.1.2 Alcohol control ................................................................................................. 15 3.1.3 Overdose prevention ........................................................................................ 19 3.1.4 Promoting healthy diets ................................................................................... 23 3.1.5 Road safety ....................................................................................................... 27 3.1.6 Safe walking and cycling .................................................................................. 31 3.1.7 Tobacco control ................................................................................................ 35 3.1.8 NCD and injury surveillance ............................................................................. 39 3.2 City profiles .................................................................................................................. 43 4 Conclusion �� 84 References �� 85 Annex �� 87 iv Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities Acknowledgements The World Health Organization would like to thank all individuals who contributed to the pilot-testing of indicators intended for assessing the status and progress of the city in the prevention and control of noncommunicable diseases. Special thanks are due to all staff from participating cities, who volunteered their time and expertise to support the development of a baseline assessment of their city’s achievement level in tackling NCDs and injuries. Whilst many individuals contributed to this process, focal points who coordinated this work include: Amman – Mervat Al-Mherat Bangkok – Kunthida Jainaknaen, Nateetip Jungsomprasong, Charoen Khongchada, Tanaporn Sawakewang Barcelona – Montse Bartrolli, Laia Font, Maribel Pasarín, Katherine Pérez Bogotá – Adriana Ardila, Diane Moyano y Sofía Ríos Bursa – Nalan Fidan Cape Town – Natacha Berkowitz, Letitia Bosch, Albert Ferreira, Ian Gildenhuys, Solomzi Mdlangaso, Ferial Soeker Doha – Hanan Alburno, Zeina Jamal, Rayan Sheik, Mounir Soussi (Ministry of Public Health, Qatar) Goiânia – Ana Lúcia Carneiro Greater Geelong – Hanna Goorden, Kylie Riley Harare – Louis Mukumba, Innocent Mukuredzi Helsinki – Ari Jaakola , Tommi Sulander, Stina Högnabba Lalitpur – Sarita Maharjan London – Gwen Doran, Taryn Ferguson, Barry Fong, Bianca D’Souza, Lucy Sutton Maio – Zuleica Soares Pires Manama – Safa Isa Obu – Mihoko Kubota Parañaque – Ruber Ver D Bombeta, Marc Jerard S Juane, Olga Z Virtusio Quezon City – Olive Bueno Esquivias, Laarni Malapit, Jean Pauline Tee Vancouver – Peter Marriott Utrecht – Miriam Weber, Ilse Swinkels WHO would also like to thank all of its staff involved from the following country offices: Bahrain, Brazil, Cabo Verde, Colombia, Jordan, Nepal, Philippines, Qatar, South Africa, Thailand, Türkiye and Zimbabwe, in addition to colleagues from the WHO regional offices and headquarters. WHO is also grateful to staff from the Partnership for Healthy Cities and the Alliance for Healthy Cities for their support with city coordination. Production of the report was coordinated by Belinda Chihota, Arlene Quiambao, Leanne Riley and Susannah Robinson from the WHO headquarters. Production of this WHO document has been supported by a grant from Bloomberg Philanthropies. v Abbreviations NO2 nitrogen dioxide O3 ozone PM2.5 particulate matter ≤2.5μm diameter PM10 particulate matter ≤10μm diameter NCDs noncommunicable diseases SDGs Sustainable Development Goals WHO World Health Organization Indicator groups AP1, AP2 etc. air pollution reduction AC1, AC2 etc. alcohol control OP1, OP2 etc. overdose prevention HD1, HD2 etc. promoting healthy diets RS1, RS2 etc. road safety WC1, WC2 etc. safe walking and cycling TC1, TC2 etc. tobacco control S1, S2 etc. NCD and injury surveillance

Introduction 1 1 Introduction By 2050, approximately 68% of the world’s population will be living in urban areas (1). Cities already play a fundamental role in protecting and promoting people’s health, and increasing rates of urbanization make their contribution even more essential. Cities are integral to achieving the Sustainable Development Goals (SDGs), including health-related goals that require strong and coordinated local implementation of national and sub-national policies (2). When managed effectively, rapid urbanization can create positive impacts on the environment, economy and society for sustainable futures (1,2). On the other hand, if not managed properly, it can jeopardize health and wellbeing. Unplanned built environments, poorly designed transportation systems, inequitable access to health services, poor air quality and unhealthy food systems can all impede health and sustainable development. These issues particularly expose urban residents to a higher risk of noncommunicable diseases (NCDs) and injuries, two major public health concerns both globally and in urban areas (2,3,4). Yet the association between these risks and urban environments is not inevitable. City leadership can introduce and implement effective interventions to reduce risk factors for NCDs and injuries. They can enact and enforce policies on road design and infrastructure that promote safe walking and cycling, adopt programmes that promote a healthy food environment, or monitor implementation of smoke-free policies and tobacco advertising bans (5). To support city-level action on mitigating NCDs and injuries, the World Health Organization (WHO) has developed indicators that can be used by cities to monitor progress and actions across these issues. In 2019, experts proposed a number of city-level qualitative and quantitative indicators across eight policy intervention areas: ● Air pollution reduction. ● Alcohol control. ● Overdose prevention. ● Promoting healthy diets. ● Road safety. ● Safe walking and cycling. ● Tobacco control. ● NCD and injury surveillance. Between 2021 and 2023 the indicators were piloted in 20 cities from a range of settings. The aim of the pilot was to carry out a baseline assessment of indicator availability across different cities, 2 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities to understand their feasibility in different contexts, and to ensure that the data collection tool was fit for purpose. This report presents the results of the pilot assessment. It represents the first application of the guidance in cities from a range of geographical regions and income levels. The results provide a snapshot of the implementation status of key NCD and injury prevention and control interventions at a municipal level. They also serve as a baseline against which the participating cities can, if they wish, monitor changes over time for topics of particular interest, and as a model for other cities to replicate to support their own work. The final set of indicators is available in the WHO City-level monitoring guidance for the prevention and control of noncommunicable diseases and injuries (6). The guidance contains a minimum set of core and optional indicators that city-level authorities can use to track their progress in implementing evidence-based policies for preventing and controlling NCDs and certain types of injuries. The indicators are intended as a technical resource for cities around the world, enabling them to conduct an initial self-assessment of work on one or more of the eight topics, to identify areas for improvement and which policies could support this, and to monitor progress against internal or external targets. Methods 3 2 Methods 2.1 City selection 1 Small cities have populations of fewer than 250 000 inhabitants, medium-sized cities range from 250 000 to 1 million, large cities have populations between 1 million and 5 million, and very large cities have at least 5 million inhabitants. 2 Population estimates of cities for the latest available year between 2003 and 2023. All city population estimates are taken from the United Nations Department of Economic and Social Affairs Demographic Yearbook 73rd issue 2022, unless the city was not listed, or in cases where a city specifically requested an alternative source. There is some variation in reference years based on data availability. Data reported by local authorities may not accurately reflect WHO official statistics. Cities were invited to participate in the project at different times over a two-year period, between 2021 and 2023. They were selected through consultation with WHO technical departments, regional and country offices, and through existing WHO collaborations such as the Partnership for Healthy Cities, a global network of cities working to promote NCD and injury prevention (7). To ensure balanced representation, a maximum number of cities from each WHO region was set and cities were included from a range of World Bank Group country classifications by income. A total of 20 cities were included in the final pilot, representing a mix of cities with varying urban population sizes, ranging from around 7000 to over 8 million inhabitants (Table 1). These cities represent a wide range of geographies (Fig. 1), with two to five participating cities in each of the six WHO regions. Just over half of the cities were from middle-income countries, and the remainder were from high-income settings (Table 2). TABLE 1. National capital classification, city size type and estimated population of participating cities City National capital classification (8) City size type1 (2) Estimated population2 (8) Amman Yes Large 3 999 008 Bangkok Yes Very large 8 421 212 Barcelona No Large 1 627 559 Bogotá Yes Very large 7 901 653 Bursa No Large 3 147 818 Cape Town Yes Large 4 772 846 (9) Doha Yes Large 1 186 023 Goiânia No Large 1 437 366 (10) Greater Geelong No Medium 271 057 (11) Harare Yes Large 1 698 122 Helsinki Yes Medium 656 920 Lalitpur No Small 133 305 London Yes Very large 8 945 309 (12) Maio No Small 6980 (13) Manama Yes Small 176 909 Obu No Small 93 123 (14) Parañaque No Medium 689 992 Quezon City No Large 2 960 048 Utrecht No Medium 367 984 (15) Vancouver No Medium 725 778 (16) 4 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities FIG. 1. Geographic spread of participating cities The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not be full agreement. © WHO 2024. All rights reserved. Amman Bangkok Barcelona Bogotá Bursa Cape Town Doha Goiânia Greater Geelong Harare Helsinki Lalitpur London Maio Manama Obu Parañaque Quezon City Utrecht Vancouver Data not available Not applicable 2000 km TABLE 2. Number of participating cities by WHO region and World Bank Group country classifications by income level (17) WHO region Lower-middle-income Upper-middle- income High-income Total African Region 2 1 3 Region of the Americas 2 1 3 South-east Asia Region 2 2 European Region 1 4 5 Eastern Mediterranean Region 1 2 3 Western Pacific Region 2 2 4 Total 7 4 9 20 2.2 Data collection, review and verification Four cities were involved in a preliminary first-stage assessment to assess the availability and relevance of an initial set of 63 draft indicators identified by WHO. Cities were asked to identify sources for indicators that they collected and to provide additional feedback on the indicators such as their relevance for their work, monitoring responsibility and any other aspect of the indicators. Methods 5 Based on feedback, the following adjustments were made: ● Indicators with low availability were either removed, classified as optional or consolidated with other indicators. ● Indicators with issues on actionability at city level or applicability in all cities were either removed, classified as optional, or redefined to improve their responsiveness to city-level action. ● Some of the quantitative/prevalence indicators were either classified as optional or consolidated with other indicators. ● Some indicators were reclassified as optional to achieve balance across policy areas. ● All indicators were simplified where possible to improve ease of collection and use. This first-stage assessment reduced the number of indicators from 63 to 56, and defined 34 as core and 22 as optional. A second round of assessment was then conducted to identify the baseline status of those 56 indicators in a wider range of pilot cities. A further 16 cities were selected and invited to participate in the process. The review process was consistent for both the first-stage assessment and the broader baseline assessment. At least one focal point was designated for each participating city to coordinate city indicators review, collection of data sources and submission. Cities were asked to respond to simple questions about indicators and to provide existing data sources to support their response. Responses were submitted via an online survey platform or by email. In some cases, ministries of health and WHO country offices supported city compilation of data sources and data entry. A desk review was then conducted by two members of the project team focused on sources identified by the cities. This was supplemented with additional search of online databases such as the WHO Global Health Observatory (18) and websites containing national, sub-national or city-level legislations or city-specific policies, plans, strategies, reports and surveys. The desk review was used to verify city responses and to complete the assessment instrument (Annex 1) using an internal web-based platform. The instrument contained all the necessary components for assessing the status of each indicator. To ensure that assessment was consistent between the two reviewers, a review of indicator ratings and related items was conducted by topic. Technical experts were consulted to clarify assessment of items that were vague or ambiguous. For some indicators related to established national-level indicators, availability was checked at national or other sub-national levels. Applying a tripartite scoring framework, preliminary city profiles were generated with the achievement level for each indicator presented as ‘nascent’ (score = 1), ‘developing’ (score = 2) or ‘advanced’ (score = 3). These profiles were subsequently shared with city focal points and technical experts of individual policy areas so they could verify the results and provide additional or updated information as needed. Desk review and data verification were performed iteratively with the cities, as necessary to ensure that city profiles accurately reflected the status of each city. 6 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities 2.3 Analysis Desk review data from the platform were exported to an Excel-readable file. Data cleaning and calculation of scores of each indicator by city was done using STATA 17 software (Stata Corporation, 2021). City profiles providing the baseline status were generated using a simple listing of indicators with corresponding status icon. Bar charts depicting counts of cities by achievement level were generated to identify indicators depicting high or low levels of activity. To compare results within and across policy areas, the tripartite classification was converted into a numeric range, with 1 corresponding to nascent, 2 to developing, and 3 to advanced. The mean scores of core indicators were plotted by World Bank Group country classifications by income level of the corresponding countries (i.e. high-income countries; upper-middle-income countries; lower-middle-income countries). Frequencies of components of indicators were assessed to determine the most prevalent actions being undertaken in cities. Results and discussion 7 3 Results and discussion 3.1 Summary 3 Data reported by local authorities that are presented in the case studies may not accurately reflect WHO official statistics. The outputs of the baseline assessment include: ● A summary of core indicators by topic, showing their availability based on the aggregate results from all pilot cities. ● Individual profiles reporting the status of core indicators for each city. ● City case studies3 highlighting good practices and examples for each topic. In addition to the core indicators, cities provided feedback for a selection of optional indicators also included in the WHO guidance. These were not included in the city profiles or main analysis, but have served to provide additional insights into indicator availability and relevance. Some of the feedback is included in the general commentary. The results should not be used out of the context of the pilot project, and cannot be extrapolated into broader generalizations about cities from different countries, regions or income groups. They are intended to provide a snapshot of indicator status within a range of cities at a specific moment in time. City feedback collected during the pilot was also instrumental in highlighting additional factors to consider for indicator definitions, assessment scoring and use. The baseline assessment reflects the status of the following 34 core indicators (Fig. 2) for prevention and control of noncommunicable diseases and injuries in 20 cities: ● 4 indicators connected to air pollution reduction. ● 5 indicators connected to alcohol control. ● 4 indicators connected to overdose prevention. ● 5 indicators connected to promoting healthy diets. ● 4 indicators connected to road safety. ● 4 indicators connected to safe walking and cycling. ● 4 indicators connected to tobacco control. ● 4 indicators connected to NCD and injury surveillance. 8 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities FIG. 2. Core indicator distribution and status across the eight policy areas, 20 cities, 2023 Policy area Indicator Air pollution reduction 1. Air pollution measurement capacity 7 8 5 2. Availability of air quality information and trends 7 6 7 3. Availability of emission estimates 8 4 8 4. Existence and enforcement of air quality standards 4 12 4 Alcohol control 1. Existence of comprehensive strategy, plan of action and activities to reduce harmful use of alcohol 1 9 10 2. Existence of policy to restrict commercial and public availability of alcohol 1 17 2 3. Existence of bans or comprehensive restrictions on alcohol advertising, sponsorship and promotion 1 12 7 4. Existence and enforcement of drink-driving legislation 6 8 6 5. Availability of brief intervention and treatment for problematic alcohol use 4 7 9 Overdose prevention 1. Availability of key medications for opioid dependence treatment 5 7 8 2. Existence of service governance mechanisms for drug use disorder treatment 10 6 4 3. Availability of non-structured harm reduction services for people with drug use disorders 7 5 8 4. Availability of take-home naloxone at city level 2 2 16 Promoting healthy diets 1. Existence and enforcement of policies to restrict marketing of unhealthy foods and non-alcoholic beverages 12 8 2. Existence and enforcement of nutrition standards for foods and beverages served and/or sold in public settings 3 14 3 3. Existence and enforcement of policies and programmes to improve healthy eating in restaurants, food outlets or vending machines 2 4 14 4. Existence and enforcement of urban planning/zoning policies to increase healthier food options 3 17 5. Existence and enforcement of policies to ensure free safely managed drinking water is available in all public settings 9 11 Road safety 1. Existence and enforcement of speed limit legislation for private passenger vehicles 1 19 2. Existence and implementation of road design standards that include speed management and safe infrastructure for pedestrians and cyclists 5 13 2 3. Existence and enforcement of legislation on helmet use for two- and three-wheeled motor vehicles including helmet use standards and wearing requirements 6 14 4. Existence and enforcement of legislation for seat-belt use 7 13 Safe walking and cycling 1. Existence of city policy promoting walking 5 11 4 2. Existence of city policy promoting cycling 10 55 3. Existence of city policy on access to public open space 5 8 7 4. Existence of city urban planning policy to encourage compact urban design and mixed land use 12 5 3 Tobacco control 1. Existence and compliance measurement of smoke free legislation 8 12 2. Existence and compliance measurement of bans on advertising, promotion and sponsorship 5 15 3. Existence of anti-tobacco mass media campaigns 1 12 7 4. Availability of tobacco cessation services 3 12 5 NCD and injury surveillance 1. Adult NCD risk factor surveillance capacity 8 12 2. Adult injury risk factor surveillance capacity 3 17 3. Access to and use of routine health facility data on alcohol and substance use disorders and tobacco dependencies 3 7 10 4. Access to and use of cause-of-death death data on NCDs and injuries 6 9 5 Status:  advanced  developing  nascent Results and discussion 9 Overall, there was considerable variation in core indicator status across the 20 participating cities. All indicators were at a ‘developing’ level in at least two cities, and 29 indicators were at ‘advanced’ level in at least one city. There were eight indicators that appeared to have low availability across all cities, meaning at least 50% of cities only rated them as ‘nascent’ level. Common reasons for not reaching an advanced rating included a lack of evidence of policy enforcement, the absence of: data for specific indicator criteria; data that met the criteria for either methodology or definitions of key parameters; or data that had been collected within a sufficiently recent period (typically between two to five years). In some cases, gathering the requisite information to complete the assessment was a lengthy process, particularly if the topic was led by a different level of government or another non-municipal authority. The desk review conducted by WHO provided the following insights: ● City-level data on indicators that were reported as not collected by cities were at times available from other sources. These were collected by other government institutions or at other national/regional/provincial levels. Their absence from city survey responses may indicate that that data is not used by the cities in their programmatic work, or that they are unaware of its collection. ● Some of the proposed policy indicators needed to be assessed by reviewing national, regional or provincial sources, in cases where cities did not have the authority to independently introduce legislation. ● Although quantitative or prevalence indicators were available, there were differences in definitions, recency, target age groups/populations. Some data could not be verified as age-standardized. These inconsistencies presented a challenge for comparability. Aggregated summaries of indicator ratings for each topic are provided in Sections 3.1.1 to 3.1.8, with more detail on trends and insights from all 20 cities. The final core indicator profiles for each city are available in Section 3.2. In addition to providing a self-assessed rating of indicator status, cities also shared qualitative feedback connected to the indicator definitions, scoring criteria or perceived utility to their work. A key issue raised was around legislative authority. Even within the relatively small cohort of the pilot, cities had significantly varying levels of legislative authority over individual policy areas that affected their ability to effect change. This meant that some cities faced greater barriers to certain kinds of actions, such as introducing a new policy if a national one did not exist. Perspectives were also shared around the question of prioritization. Each indicator is composed of various sub-criteria, which together create the composite score of nascent, developing or advanced. In some cases, cities noted that meeting all of the sub-criteria required to mark an indicator as ‘advanced’ would entail allocating significant amounts of time and resources to areas that could have been used to support another area of work in greater need. In real-world usage, cities would 10 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities likely also conduct the assessment for only the topic/s which they were most interested in advancing, or where they were concerned about progress. Finally, an important factor flagged by many cities was the role of context. The profiles do not capture the hugely varying legislative, socioeconomic and historical contexts underpinning each city’s work, and consequently affecting the status of each indicator. While the standards for achieving specific ratings are a consistent global standard, the reasons behind the gaps and barriers to action vary hugely. The primary aim of the indicator guidance is to support individual cities to assess and monitor their own progress over time, against a common global standard for surveillance, policy development or enforcement. Comparisons in levels of advancement between different cities should not be made without understanding and acknowledging the factors affecting their operational context. The case studies for each topic area demonstrate the breadth of contextual variation, whilst also showing how cities have successfully managed to advance work in specific indicator areas. Results and discussion 11 3.1.1 Air pollution reduction Core indicators: 4 Key observations ☼ The indicator that was most frequently scored as developing or advanced was the existence and enforcement of air quality standards (Fig. 3). At the same time, comparatively few cities achieved an advanced score for this indicator. This was most commonly due to: the absence of quality norms around the use of solid fuels by households; a lack of emission controls during periods of poor air quality; and the absence of environmental impact assessments in construction projects. ☼ Of all indicators, availability of emission estimates had the highest number of cities with advanced levels compared to other indicators. However, it was also the indicator with the highest number of nascent cities. ☼ When classified by income (Fig. 4), the indicator with the strongest average assessment level for pilot cities was different for each group: ☐ Lower-middle-income settings: existence and enforcement of air quality standards. ☐ Upper-middle-income settings: availability of air quality information and trends. ☐ High-income settings: air pollution measurement capacity. ☼ Common barriers that were reported as preventing cities from achieving an advanced indicator level included: a lack of evidence of enforcement; a lack of recent information or data (within the past three to five years); and the absence of data on specific emissions or pollutants. 12 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities FIG. 3. Status of air pollution reduction indicators across 20 cities, 2023 AdvancedStatus: Nu m be r o f c iti es 14 7 7 8 5 4 4 4 8 8 7 6 12 12 10 8 6 2 4 0 Developing Nascent 1. Air pollution measurement capacity 2. Availability of air quality information and trends 3. Availability of emission estimates 4. Existence and enforcement of air quality standards FIG. 4. Mean scores of air pollution indicators by World Bank Group country classifications by income level, 20 cities, 2023 Indicator 1.6 All indicators Average score 1.3 1.4 1.7 1.5 Lower-middle-income (n=7) Upper-middle-income (n=4) 1 2 3 2.0 Average score 2.3 2.0 1.8 2.0 1 2 3 2.6 Average score 2.4 2.4 2.3 2.4 1 2 3 High-income (n=9) 1. Air pollution measurement capacity 2. Availability of air quality information and trends 3. Availability of emission estimates 4. Existence and enforcement of air quality standards Results and discussion 13 Case study Breathing life into the city: Monitoring information on air quality London, United Kingdom of Great Britain and Northern Ireland © Breathe London All Breathe London Reference PM2.5 particulates Nitrogen dioxide NONE LOW MODERATE HIGH V. HIGH Reference : Fri 20th October 2023 – 7:00:00 BL : Fri 20th October 2023 – 8:00:00 Last Updated A map of air quality index based on PM2.5 in air quality monitoring sites in London Almost the entire global population (99%) breathes air that exceeds WHO air quality guidelines and threatens their health.a Air quality is a particular concern in cities, and its importance is reflected in at least two global Sustainable Development Goal targets. Air quality monitoring in cities is essential to understand emission sources, target policy responses, and measure progress. In the United Kingdom, London is considered a leading example of how this can be achieved. London’s boroughs have been funding automatic air quality monitoring since the early 1990s. This reference-quality monitoring network now includes approximately 150 monitors across the city. The measurement data is used to assess and officially report on pollution levels in different areas of the city, track trends over time, and model or evaluate how different local policies affect air pollution.b The data is publicly available and helps to inform public alerts from the Mayor on days when air quality reaches dangerous levels, including notifications at underground stations, bus stops, and via direct messages to schools.c The Mayor is also working in partnership with the London Air Quality and Health Programme Office to develop air quality alerts to health professionals which are due to be launched in February 2024.d Great Ormond Street Hospital for Children now also includes annual average levels Artwork by a primary school pupil from Latchmere School in Kingston upon Thames, Greater London. One of the winning artworks from the Mayor of London’s Clean Air Day 2023 schools’ competition, responding to ‘what does clean air mean to me?’. © Greater London Authority 14 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities of PM2.5 (particulate matter ≤2.5μm diameter) and NO2 (nitrogen dioxide) for home addresses in their electronic patient records. This highlights to hospital staff those patients who are living in postcodes where levels are above the WHO air quality guidelines, and provides additional materials for education and action.e In addition to the reference-grade monitoring, the London Mayor’s Office has installed a community sensor network: Breathe London. This uses smaller but more affordable air quality sensors to measure pollution in real time in specific local areas and empowers citizens to choose the location of these monitoring sites and use this data to manage exposure and advocate for change.f There are now around 450 Breathe London sensors across London, monitoring both NO2 and particulate matter. These monitors, plus the extensive network of NO2 diffusion tube monitors across the city, shows that London leverages diverse monitoring systems to obtain a very comprehensive picture of air quality. The combination of reference-grade and community-led monitoring, along with the active use of data in policy and communications, makes the London system a highly robust model for monitoring and modelling air quality. Sources: a Billions of people still breathe unhealthy air: new WHO data. Geneva: World Health Organization; 2022 (https://www.who. int/news/item/04–04-2022-billions-of-people-still-breathe-unhealthy-air-new-who-data, accessed 1 April 2024). b London air [website]. London: Imperial College London; 2024 (https://www.londonair.org.uk/LondonAir/nowcast.aspx, accessed 1 April 2024). c Monitoring and predicting air pollution [website]. London@ Greater London Authority; 2024 (https://www.london.gov.uk/ programmes-and-strategies/environment-and-climate-change/pollution-and-air-quality/monitoring-and-predicting-air- pollution, accessed 1 April 2024). d London Air Quality and Health Programme Office (https://www.gov.uk/government/groups/london-air-quality-and-health- programme-office, accessed 19 August 2024) e Air pollution levels added to patient's postcodes. London: Great Ormond Street Hospital for Children; 2023 (https://www. gosh.nhs.uk/news/air-pollution-levels-added-to-patients-postcodes/, accessed 1 April 2024) f Breathe London. London: Imperial College London; 2024 (https://www.breathelondon.org/about, accessed 1 April 2024). [case study ends] Results and discussion 15 3.1.2 Alcohol control Core indicators: 5 Key observations ☼ From the core indicators, the indicator that was most commonly available at developing level was the existence of a policy to restrict the commercial and public availability of alcohol (Fig. 5). With only one city achieving an advanced score, most had gaps in legislation that would undermine its overall effectiveness. These gaps included a lack of regulations on informally produced alcohol and regulations on combatting illicit alcohol. ☼ Existence of bans or comprehensive restrictions on alcohol advertising, sponsorship and promotion was the second most commonly observed indicator as developing in cities. However, most cities reported a lack of bans on sponsorship activities for alcohol, or around relatively new marketing channels such as social media. ☼ Existence and enforcement of drink-driving legislation had the highest number of cities with advanced levels compared to other indicators. ☼ The indicator with the most limited availability was existence of comprehensive strategy plan of action and activities to reduce harmful use of alcohol. Half of the pilot cities had only a nascent score for this indicator. Its availability was much more limited in the cities from lower income settings. ☼ When classified by income (Fig. 6), the indicator with the strongest average availability for pilot cities was different for each group: ☐ Lower-middle-income settings: existence of a policy to restrict the commercial and public availability of alcohol. ☐ Upper-middle income settings: availability of brief intervention and treatment for problematic alcohol use. ☐ High-income settings: Existence and enforcement of drink-driving legislation. ☼ Common barriers that were reported as preventing cities from achieving an advanced indicator level included the absence of monitoring or evaluation frameworks for activities, a lack of restrictions on the consumption of alcohol in specific public spaces; gaps in existing marketing regulations; and limited options for brief interventions and treatment. 16 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities FIG� 5� Status of alcohol control indicators across 20 cities, 2023 AdvancedStatus: Nu m be r o f c iti es 1 1 9 10 12 6 6 1 7 2 17 8 15 10 5 0 Developing Nascent 1. Existence of comprehensive strategy, plan of action and activities to reduce harmful use of alcohol 2. Existence of policy to restrict commercial and public availability of alcohol 3. Existence of bans or comprehensive restrictions on alcohol advertising, sponsorship and promotion 4. Existence and enforcement of drink-driving legislation 4 9 7 5. Availability of brief intervention and treatment for problematic alcohol use FIG� 6� Average scores of alcohol control indicators by World Bank Group country classifications by income level, 20 cities, 2023 Average score 1 2 3 Average score 1 2 3 Average score 1 2 3 Indicator 1.1 1.9 1.4 1.6 1.1 Lower-middle-income (n=7) Upper-middle-income (n=4) 1.5 1.8 1.8 1.8 2.0 1.9 2.1 1.9 2.4 2.1 All indicators 1.4 1.8 2.1 High-income (n=9) 1. Existence of comprehensive strategy, plan of action and activities to reduce harmful use of alcohol 2. Existence of policy to restrict commercial and public availability of alcohol 3. Existence of bans or comprehensive restrictions on alcohol advertising, sponsorship and promotion 4. Existence and enforcement of drink-driving legislation 5. Availability of brief intervention and treatment for problematic alcohol use Results and discussion 17 Case study Creating comprehensive policy to reduce the harmful use of alcohol Cape Town, South Africa Worldwide, around 2.6 million deaths every year result from the consumption of alcohol. It is a causal factor in more than 200 diseases, injuries and other health conditions.a In addition to health consequences, it also brings significant social and economic losses to individuals and society at large. In South Africa, around 7.3% of all deaths in 2019 can be attributed to alcohol consumption.b The City of Cape Town is committed to minimizing and mitigating harmful use of alcohol through a multi-faceted approach. Since 2008, Cape Town has had a mandate to respond to substance abuse by devising and implementing local strategies, working in tandem with other levels of government. In 2011, an initial city-wide strategy on alcohol control was published under the Policy position on alcohol and drugs and alcohol and other drug harm minimization and mitigation strategy 2011–2014.c This aimed to promote greater access to treatment and services for alcohol use disorders, while also reducing the unlicensed sale of alcohol products. An accompanying document was developed in 2013 which focused specifically on prevention and early intervention as ways to reduce harms from alcohol (and other substances) in the city.d Building on learnings from the first strategy, the city released an updated version in 2014: the Alcohol and other drug strategy 2014–2017.e This focused on strengthening the delivery of policies by focusing on four core areas: prevention, intervention, suppression and coordination. It is also explicitly aligned with other municipal, regional and national policies and strategies to ensure integration and coordinated action. To ensure its policies deliver outcomes, Cape Town works to translate these strategies into action. For example, the city offers a Matrix® program, meaning free treatment for alcohol and drug use is offered at eight community-based alcohol and drug treatment sites. By providing services that are free, local and delivered for outpatients, the aim is to improve access to evidence-based treatment for citizens, and particularly for economically or socially vulnerable groups. Front cover of City of Cape Town's Alcohol and other drug strategy 2014-2017 Entrance to Town II Community Day Centre, Khayelitsha, Cape Town © City of Cape Town 18 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities The 2014–17 strategy document continues to guide the city’s alcohol control efforts to this day. The emphasis on evidence-based interventions and a comprehensive, inclusive approach reflects the city’s ongoing approach. This gives the document continuing relevance as a guide for preventing the harmful use of alcohol in Cape Town. Sources: a Global status report on alcohol and health and treatment of substance use disorders.l. Geneva: World Health Organization; 2024 (https://iris.who.int/handle/10665/377960, accessed 23 September 2024). b Alcohol-attributable fractions, all-cause deaths (%) [website]. Geneva: Global Health Observatory, World Health Organization; 2019 (https://www.who.int/data/gho/data/indicators/indicator-details/GHO/alcohol-attributable-fractions-all-cause-deaths-(-), accessed 23 September 2024). c Policy position on alcohol and drugs and alcohol and other drug harm minimization and mitigation strategy, 2011–2014. Cape Town: City of Cape Town; 2011 (https://alcoholsouthafrica.files.wordpress.com/2012/04/cape-town-policy-position- on-alcohol-and-drugs-2011–2014.pdf, accessed 1 April 2024). d Prevention and early intervention of alcohol and other drug use policy. Cape Town: City of Cape Town; 2013 (https:// resource.capetown.gov.za/documentcentre/Documents/Bylaws%20and%20policies/Prevention%20and%20Early%20 Intervention%20of%20Alcohol%20-%20(Policy%20number%2012399B)%20approved%20on%2004%20December%20 2013.pdf, accessed 1 April 2024). e Alcohol and other drug strategy 2014–2017. Cape Town: City of Cape Town; 2014 (https://resource.capetown.gov.za/ documentcentre/Documents/City%20strategies,%20plans%20and%20frameworks/Annexure%20H%20-t%20Alcohol%20 and%20Other%20Drugs%20Strategy%202014_2017.pdf, accessed 1 April 2024). Results and discussion 19 3.1.3 Overdose prevention Core indicators: 4 Key observations ☼ From the core indicators, the indicator that was most frequently scored as advanced was the existence of service governance mechanisms for the treatment of drug use disorders (Fig. 7). It was also the indicator with the highest average availability for each income group (Fig. 8). The vast majority of the cities reported having a designated focal point for the prevention and treatment of drug use and most of these cities had a policy and action plan for service development. However, only half of the cities had legal provisions in place for protecting people undergoing treatment for substance use disorders, the absence of which may hinder service uptake. ☼ The indicator with the highest number of nascent cities was the availability of take- home naloxone at the city level. This was likely to be connected to national regulation around access to naloxone as either a supervised or take-home medication. For cities that did provide take-home naloxone, it was not always recorded as available in all settings regardless of insurance or residence status, which might further restrict access for individual users. ☼ Over half of the cities reported having some form of non-structured harm reduction services available. However, there tended to be limited support beyond medication. Only a few cities reported having formal interventions that included broader rehabilitation assistance such as employment assistance, special housing services or welfare assistance. ☼ Common barriers that were reported as preventing cities from achieving an advanced indicator level included a lack of legislative authority over the provision of specific medications for treating opioid dependence, or for certain non-structured harm reduction services such as safe injection sites. This tended to be related to the existence (or absence) of national policies around these issues, which would supersede city-level policies. 20 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities FIG� 7� Status of overdose prevention indicators across 20 cities, 2023 AdvancedStatus: Nu m be r o f c iti es 5 10 7 8 5 2 16 7 8 4 6 2 15 10 5 0 Developing Nascent 1. Availability of key medications for opioid dependence treatment 2. Existence of service governance mechanisms for drug use disorder treatment 3. Availability of non-structured harm reduction services for people with drug use disorders 4. Availability of take-home naloxone at city level FIG� 8� Average scores of overdose prevention indicators by World Bank Group country classifications by income level, 20 cities, 2023 1. Availability of key medications for opioid dependence treatment 2. Existence of service governance mechanisms for drug use disorder treatment 3. Availability of non-structured harm reduction services for people with drug use disorders 4. Availability of take-home naloxone at city level Indicator 1.4 All indicators Average score 2.0 1.4 1.0 1.5 Lower-middle-income (n=7) Upper-middle-income (n=4) 1 2 3 1.8 Average score 2.3 2.0 1.0 1.8 1 2 3 2.2 Average score 2.6 2.3 1.7 2.2 1 2 3 High-income (n=9) . Results and discussion 21 Case study A concerted effort to reduce deaths from opioid overdoses Vancouver, Canada Opioids are commonly used for the treatment of pain. However, their non-medical use, prolonged use, misuse or use without medical supervision can lead to opioid dependence, and other health problems. Due to their pharmacological effects opioids can cause breathing difficulties, and opioid overdose can lead to death. Of the estimated 177 000 global deaths due to drug use disorders in 2021, about 130 000 were caused by opioid overdose.a There are effective treatment inter ventions for opioid dependence that can decrease the risk of overdose, yet as low as 0.3% to a maximum of 35% of people who need such treatment are receiving it.b The medication naloxone can prevent deaths from opioid overdose if administered in time, but not everyone who could benefit from the drug is able to access it in time.c In Canada, more than 30 000 people have died from opioid overdoses since 2016. Over two-thirds of these deaths have been in the province of British Colombia (BC), which declared the issue a public health emergency in April 2016.d,e Its largest city, Vancouver, is estimated to have seen more than 3300 deaths due to drug overdose.f In response, the city has also been at the forefront of efforts to reduce deaths and harm attributable to non-medical opioid use. One way the city has done this is by working with provincial, regional and local partners to support the availability of take-home naloxone. In partnership with the B.C. Take Home Naloxone programme, take-home naloxone kits are available at over 568 local pharmacies and dedicated Take Home Naloxone (THN) sites around Vancouver.g Naloxone is available without a prescription and the kits are given to both individuals at risk of an overdose, and to those likely to witness and respond to an overdose such as family or friends of someone at risk. The city also makes training freely available on preventing and responding to overdose.h A map of Take Home Naloxone sites in Vancouver © www.towardtheheart.com 22 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities The availability of naloxone is led by the provincial authority, as part of their mandate for health service provision.i While COVID-19 exacerbated the overdose crisis nationally, both the city and provincial authorities remain committed to supporting access to treatment for people living with opioid dependence.e Alcohol-attributable fractions, all-cause deaths (%) [website]. Geneva: Global Health Observatory, World Health Organization; 2019 Sources: a Global Health Estimates: Life expectancy and leading causes of death and disability. Geneva: Global Health Observatory, World Health Organization;2021 (https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates, accessed 23 September 2024). b Global status report on alcohol and health and treatment of substance use disorders.l. Geneva: World Health Organization; 2024 (https://iris.who.int/handle/10665/377960, accessed 23 September 2024). c Opioid overdose. Geneva: World Health Organization; 2023 (https://www.who.int/news-room/fact-sheets/detail/opioid- overdose, accessed 1 April 2024). d Fischer B. The continuous opioid death crisis in Canada: changing characteristics and implications for path options forward. The Lancet Regional Health – Americas. 2023;19:100437 (https://www.thelancet.com/journals/lanam/article/PIIS2667– 193X(23)00011-X/fulltext, accessed 1 April 2024). e Vancouver’s approach to the overdose crisis. Vancouver: City of Vancouver; 2016 (https://vancouver.ca/people-programs/ drugs.aspx, accessed 1 April 2024). f For more information on drug overdose mortality, please see the City of Vancouver data portal: (https://opendata.vancouver. ca/pages/indicator/?q=cardid%3D100, accessed 1 April 2024). g Toward the heart [website]. Vancouver: British Columbia Centre for Disease Control; 2024 (https://towardtheheart.com/ site-finder, accessed 1 April 2024). h Overdose response, naloxone & training [website]. Vancouver: Vancouver Coastal Health; 2024 (https://www.vch.ca/en/ overdose-response-naloxone-training, accessed 1 April 2024). i Four Pillars drug strategy [website]. Vancouver: City of Vancouver; (https://vancouver.ca/people-programs/four-pillars-drug- strategy.aspx, accessed 1 April 2024). A view of buildings along Hastings Street in the Downtown Eastside of Vancouver, a neighbourhood at the epicentre of the toxic drug emergency © Peter Marriott Results and discussion 23 3.1.4 Promoting healthy diets Core indicators: 5 Key observations ☼ The indicator that was most frequently scored as developing or advanced was the existence and enforcement of nutrition standards for foods and beverages served and/or sold in public institutions (Fig. 9). It was the indicator with the highest average rating for each income group (Fig. 10). However, a lack of enforcement meant that only three cities rated it as advanced. ☼ The indicator with the most limited availability was existence and enforcement of urban planning/zoning policies to increase healthier food options. Only three cities reached a developing level with this indicator, and none reached the advanced level due to a lack of monitoring and enforcement. ☼ Over half of cities reported having a policy to restrict exposure to food and beverage marketing. However, only three cities reported conducting monitoring or enforcement activities and none registered data on compliance rates with the policy, which is likely to undermine the health impact of those existing policies. ☼ In general, a major barrier that was reported as preventing cities from achieving higher availability levels across indicators was the absence of monitoring and enforcement mechanisms for their policies. This is likely to limit the effectiveness of policies in place, and could be an area for cities to consider strengthening if resources allow. For policies aligned with national or regional legislation, authorities from other levels of government may be able to provide additional resourcing support. 24 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities FIG� 9� Status of promoting healthy diet indicators across 20 cities, 2023 AdvancedStatus: Nu m be r o f c iti es 12 3 8 4 17 2 14 3 14 3 15 20 10 5 0 Developing Nascent 1. Existence and enforcement of policies to restrict marketing of unhealthy foods and non-alcoholic beverages 2. Existence and enforcement of nutrition standards for foods and beverages served and/or sold in public settings 3. Existence and enforcement of policies and programmes to improve healthy eating in restaurants, food outlets or vending machines 4. Existence and enforcement of urban planning/zoning policies to increase healthier food options 11 9 5. Existence and enforcement of policies to ensure free safely managed drinking water is available in all public settings FIG� 10� Average scores of promoting healthy diets indicators by World Bank Group country classifications by income level, 20 cities, 2023 Average score 1 2 3 Average score 1 2 3 Average score 1 2 3 1. Existence and enforcement of policies to restrict marketing of unhealthy foods and non-alcoholic beverages 2. Existence and enforcement of nutrition standards for foods and beverages served and/or sold in public settings 3. Existence and enforcement of policies and programmes to improve healthy eating in restaurants, food outlets or vending machines 4. Existence and enforcement of urban planning/zoning policies to increase healthier food options 5. Existence and enforcement of policies to ensure free safely managed drinking water is available in all public settings Indicator 1.3 1.7 1.0 1.0 1.3 Lower-middle-income (n=7) Upper-middle-income (n=4) 1.8 2.3 1.3 1.0 1.5 1.8 2.1 1.8 1.3 1.6 All indicators 1.3 1.6 1.7 High-income (n=9) Results and discussion 25 Case study Harmonized implementation of central and local regulation to ensure healthy food in schools Quezon City, Philippines A healthy diet helps to protect against malnutrition in all its forms, including noncommunicable diseases.a It is especially important for children and young people to be guaranteed a healthy food environment, in order to protect them from immediate health problems as well as an increased risk of adult obesity and NCD-related issues later in life. To promote healthy eating among students in public elementary and secondary schools, the National Department of Education (DepEd) in the Philippines established the Policy and guidelines on healthy food and beverage choices in schools and in DepEd offices in 2017.b The policy established food guidelines and prohibited the sale and marketing of foods and beverages rich in saturated fat, sugar, and/or sodium, as well as trans fats. A food colour-coding system based on nutritional composition was also introduced to classify foods that should not be consumed, sold or offered on school grounds, such as soft drinks, strongly salted snacks, chocolates and ice cream. Students are also not permitted to bring certain foods to school (whether prepared at home or purchased elsewhere). To support implementation of the DepEd policy, the Quezon City administration passed its own ordinance prohibiting and penalizing the sale and marketing of ‘junk’ foods and sugary drinks among preparatory, elementary and high school children on school campus, and within one hundred metres of the perimeter of private and public schools.c After broad consultation on ordinance implementation, the 2019 Quezon City Healthy Diet in Schools Ordinance was enacted, replacing the previous ordinance. A school health council was created to support proper implementation of the ordinance, including an information, education and communication campaign, and trainings IMPLEMENTING RULES AND REGULATIONS Pursuant to Ordinance No. SP 2579, Series of 2017 SECTION 1. TITLE - These Rules shall be known and cited as the Implementing Rules and Regulations of Ordinance No. SP 2579, S. - 2017. otherwise known as An Ordinance Prohibiting the Selling and Promotion of Junk Food and Sugary Drinks to Preparatory, Elementary and High School Students Inside and Within One Hundred (100) Meters Perimeter In Public and Private Schools in Quezon City and Providing Penalties for Violations Thereof; also known as the "Quezon City Anti-Junk Food and Sugary Drinks Ordinance of 2017”. SECTION 2. PURPOSE - These Rules and Regulations are promulgated to prescribe the procedures and guidelines for the implementation of Quezon City Ordinance No. SP 2579. S- 2017 in order to achieve its objectives and facilitate compliance therewith. SECTION 3. CONSTRUCTION - These Rules and Regulations shall be construed and applied in accordance with and in furtherance of the policies and objectives of the Ordinance. Any item not specified in the provisions will be construed in accordance with the prefatory clauses of the Ordinance. SECTION 4. SCOPE - This Ordinance shall cover all Private and Public Preparatory, Elementary and High Schools in Quezon City, including school administrators, canteen owners, registered / unregistered vendors, business enterprisers, retailers/ wholesalers, suppliers, concessionaires and the like, inside the school and within the 100 meters perimeter premises. 3. Government to recognize the promotion of health and welfare of our children. OBJECTIVES - It is the objective of this Ordinance to implement measures to achieve the following: 4.1 Limit the intake of free sugars by children and adolescents to less than ten percent (10%) of total energy intake, with further reduction to less than five percent (5%) of total energy intake to achieve additional health benefits as recommended by the World Health Organization; 4.2 Prohibit the selling, marketing, advertising, sponsorship and promotion of junk food and sugary drinks inside school premises and within 100 meters perimeter of the school premises; 4.3. Impose penalties for offenders. 20 l7-ocm/MEG Pursuant to Ordinance No. SP 2579, Series of 2017 First page of the "Implementing Rules and Regulations" of the ordinance for prohibiting the selling and promotion of junk food and sugary drinks in schools in Quezon City. 26 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities for evaluation of foods and drinks in school canteens, and a specific budget was allocated for implementation.d The work is part of Quezon City’s broader commitment to ensuring a healthy food environment for its citizens. In 2021, they were the first local government unit in the country to establish a healthy food procurement policy, and the city has also announced plans to promote healthier restaurant environments through a local calorie labelling policy.e Sources: a Healthy diet. Geneva: World Health Organization; 2022 (https://www.who.int/en/news-room/fact-sheets/detail/healthy-diet, accessed 1 April 2024). b Policy and guidelines on healthy food and beverage choices in schools and in DepEd offices. Manila: Philippines Department of Education, 2017 ( https://www.deped.gov.ph/2017/03/14/do-13-s-2017-policy-and-guidelines-on-healthy-food-and- beverage-choices-in-schools-and-in-deped-offices/, accessed 22 August 2024). c Ordinance enacting the “Quezon City Health Diet in Schools Ordinance”. Quezon City: Quezon City Council; 2019 (https:// quezoncitycouncil.ph/ordinance/SP/SP-2846,%20S-2019.pdf, accessed 1 April 2024). d QC first LGU to implement healthy food procurement policy. Quezon City: Quezon City Council; 2021 (https://quezoncity. gov.ph/qc-first-lgu-to-implement-healthy-food-procurement-policy/, accessed 1 April 2024). e Calorie labelling policy agreement. Quezon City: Quezon City Council; 2023 (https://quezoncity.gov.ph/calorie-labelling- policy-agreement/, accessed 1 April 2024). A school canteen in Quezon city with posters about the healthy food guidelines © Jirah Asa Sideco Results and discussion 27 3.1.5 Road safety Core indicators: 4 Key observations ☼ From the core indicators, all cities received a rating of developing or advanced for three of the four core indicators: namely the existence and enforcement of legislation for speed limits, helmet use for two- and three-wheeler vehicles, and seat-belt use (Fig. 11). National laws exist for all of these topics, but the presence of enforcement activities at the city level is encouraging, given their important role as implementors for national legislation. ☼ The indicator with comparatively limited availability was the existence and implementation of road design standards that include speed management and safe infrastructure for pedestrians and cyclists. However, most cities reported some level of technical design standards required for all new roads which were intended to promote safety for all road users. Design standards in the majority of the cities included evidence-based elements such as safe crossings for pedestrians and cyclists, or their safe separation from vehicles on roads. ☼ When classified by income (Fig. 12), the indicator with the strongest average availability for pilot cities was different for each group: ☐ Lower-middle-income settings: existence and enforcement of legislation for seat-belt use. ☐ Upper-middle-income settings: existence and implementation of road design standards, and existence and enforcement of legislation on helmet use for two- and three-wheeled vehicles. ☐ High-income settings: existence and enforcement of legislation for seat-belt use. ☼ Limitations that were reported as preventing cities from achieving higher availability of road safety indicators included the absence of particular types of implementation evidence, and a lack of enforcement evidence for regulation on helmet or seat-belt use. 28 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities FIG� 11� Status of road safety indicators across 20 cities, 2023 AdvancedStatus: Nu m be r o f c iti es 1 5 19 6 7 14 2 13 13 20 15 10 5 0 Developing Nascent 1. Existence and enforcement of speed limit legislation for private passenger vehicles 2. Existence and implementation of road design standards that include speed management and safe infrastructure for pedestrians and cyclists 3. Existence and enforcement of legislation on helmet use for two- and three-wheeled motor vehicles including helmet use standards and wearing requirements 4. Existence and enforcement of legislation for seat-belt use FIG� 12� Average scores of road safety indicators by World Bank Group country classifications by income level, 20 cities, 2023 1. Existence and enforcement of speed limit legislation for private passenger vehicles 2. Existence and implementation of road design standards that include speed management and safe infrastructure for pedestrians and cyclists 3. Existence and enforcement of legislation on helmet use for two- and three-wheeled motor vehicles including helmet use standards and wearing requirements 4. Existence and enforcement of legislation for seat-belt use Indicator 2.0 All indicators Average score 1.7 2.0 2.1 2.0 Lower-middle-income (n=7) Upper-middle-income (n=4) 1 2 3 2.0 Average score 2.3 2.3 2.0 2.1 1 2 3 2.1 Average score 2.4 2.6 2.7 2.4 1 2 3 High-income (n=9) Results and discussion 29 Case study Not taking a back seat: strengthening national policy through local enforcement Bangkok, Thailand In 2021, there were over 117 000 road traffic crashes reported in Bangkok, leading to 614 deaths and over 70 000 injuries.a Improving road safety is a long- standing priority for the city. To achieve it , the Bangkok Metropolitan Administration (BMA) use a dual approach of both enforcing national regulations and developing new municipal- level policies. An example of their key role in enforcement can be seen in seat-belt use. Seat-belts have saved more lives than any other road safety intervention in histor y, reducing deaths among vehicle occupants in crashes by up to 50%.b In Thailand, seat-belts were previously only required for front- seat passengers. But in April 2017 a national law was passed also mandating their use by rear-seat passengers.c With support from partners, the BMA supported the law’s enforcement by working with local police to check seat- belt usage and issue warnings to those found to be non-compliant. The city also promoted messages on seat-belt use in local and national campaign materials, including at key times such as around Songkran (Thai New Year) when roads around Bangkok are especially busy. Cover of "Road Safety Master Plan and Road Safety Action Plan: Bangkok 2021-2025" 30 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities Data from a third-party survey conducted between 2015–2019 showed that higher rates of rear seat-belt use were observed in Bangkok after the passing of the new law, with a high of 38.5% of rear-seat occupants using seat-belts, compared to the previous high of 21.7% before the law. However, this was not an automatic gain since at times rates were lower.c These results highlighted the important role that subnational actors can hold in enforcing national laws and ensuring they deliver their intended outcomes. Sources: a Data source: Accident Data Center of Thailand (http://www.thairsc.com/eng/). Summary graphic provided by Bangkok Post Graphics (https://www.bangkokpost.com/thailand/general/2259819/its-not-just-motorists-at-fault, accessed 1 April 2024). b New global guidelines to boost the use of life-saving safety restraints in vehicles. Geneva: World Health Organization; 2023 (https://www.who.int/news/item/06–03-2023-new-global-guidelines-to-boost-the-use-of-life-saving-safety-restraints-in- vehicles23, accessed 1 April 2024). c Sutanto E, Zia N, Taber N, Rinawan FR, Amelia I, Jiwattanakulpaisarn et al. Rear-seat seatbelt use in urban Southeast Asia: results from Bandung and Bangkok. International Journal of Injury Control and Safety Promotion. 2021;29(2):247–255. doi :10.1080/17457300.2021.1998135. © Vital Strategies A busy road in Bangkok Results and discussion 31 3.1.6 Safe walking and cycling Core indicators: 4 Key observations ☼ In general, the pilot results indicated reasonably good availability of the existence of city policies to promote safe active mobility. ☼ In this policy area, the indicator with the highest number of cities reporting developing and advanced levels was the existence of city urban planning policy to encourage compact design and mixed land use (Fig. 13). Availability was reported as good across different income settings, with over half of the cities recording an advanced rating for this indicator (Fig. 14). ☼ Two other indicators that showed good availability were the existence of city policy promoting walking and existence of city policy promoting cycling, which were reported as either ‘developing’ or ‘advanced’ by at least three-quarters of the cities. ☼ The indicator that averaged the lowest rating was existence of city policy on access to public open space. Seven cities rated this as only being at the nascent level. ☼ Limitations reported as preventing cities from achieving higher availability levels included the absence of monitoring frameworks to assess progress and implementation of key policies. In almost three-fifths of the cities there was no set target for increasing areas of and access to open public spaces. Limited use of public engagement around active mobility was also an issue. In the past two years less than half of the cities had run a city-wide mass media and participation campaign, and only four cities had conducted any survey to assess community perceptions of walking and cycling. 32 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities FIG� 13� Status of safe walking and cycling indicators across 20 cities, 2023 AdvancedStatus: Nu m be r o f c iti es 5 5 10 5 4 11 5 7 8 12 3 5 10 5 0 Developing Nascent 1. Existence of city policy promoting walking 2. Existence of city policy promoting cycling 3. Existence of city policy on access to public open space 4. Existence of city urban planning policy to encourage compact urban design and mixed land use FIG� 14� Average scores of safe walking and cycling indicators by World Bank Group country classifications by income level, 20 cities, 2023 Indicator 1.7 All indicators Average score 1.6 1.6 1.9 1.7 Lower-middle-income (n=7) Upper-middle-income (n=4) 1 2 3 2.3 Average score 1.8 1.3 2.5 1.9 1 2 3 2.2 Average score 2.4 2.4 2.9 2.5 1 2 3 High-income (n=9) 1. Existence of city policy promoting walking 2. Existence of city policy promoting cycling 3. Existence of city policy on access to public open space 4. Existence of city urban planning policy to encourage compact urban design and mixed land use Results and discussion 33 Case study Ensuring access to safe public space for staying active Doha, Qatar Within urban environments, public open spaces – such as parks, recreational spaces and sports amenities – are an important way to ensure all residents have safe spaces for being physically active. Improving access to public open spaces is a core action recommended by the WHO ACTIVE technical package to promote safe, equitable access to places for walking, cycling and other kinds of physical activity.a In a 2021 global NCD survey, less than 50% of countries in the WHO Eastern Mediterranean Region reported implementing national policies to promote public open spaces.b However, for Qatar promoting physical activity has been a priority in recent years. This is partly due to relatively high rates of physical inactivity – in 2022 over half of all Qatari adults did not do enough physical activity, and nearly half of all adult women.c It has also received special attention due to the country’s hosting of the 2022 FIFA World Cup, which galvanized interest in sports and physical activity. The country’s capital city of Doha is supporting this commitment through its own urban design policies. In 2022 the Ministry of Municipalities published a National Plan on Centre Plans and Zoning Regulations, which outlined how land should be used to promote sustainable development and accessible walking and living environments.d The plan includes a section on how different districts within the Municipality of Doha plan to manage future urban development, using a range of approaches based on local needs and existing spaces. Policies include using public–private partnerships to provide open spaces for communities, the development of parks near schools and other community facilities, and the provision of ‘pocket parks’ to enhance access to open spaces. Cover of Volume 4 of "Centre Plans and Zoning Regulations" by Ministry of Municipality Qatar Centre Plans and Zoning Regulations Volume - 4 Ministry of Municipality Version V – 2023/03/23 34 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities By using a range of policies, local districts can target actions to specific issues for their communities, whilst also integrating into a broader strategy of sustainable urban development and active transport for the municipality – and country – as a whole. Sources: a ACTIVE: a technical package for increasing physical activity. Geneva: World Health Organization; 2018 (https://iris.who.int/ bitstream/handle/10665/275415/9789241514804-eng.pdf, accessed 1 April 2024). b Assessing national capacity for the prevention and control of noncommunicable diseases: report of the 2021 global survey. Geneva: World Health Organization; 2023 (https://iris.who.int/handle/10665/370423, accessed 1 April 2024). c Prevalence of insufficient physical activity among adults. Data by country. Geneva: Global Health Observatory; 2022 https:// www.who.int/data/gho/data/indicators/indicator-details/GHO/prevalence-of-insufficient-physical-activity-among-adults- aged-18-years-(crude-estimate)-(-), accessed 23 September 2024). d Centre Plans and Zoning Regulations, Volume IV. Ministry of Municipality, 29/05/2022 Families enjoying one of Doha’s open green spaces, which offer a safe environment for recreation and social interaction © Ministry of Public Health Qatar Results and discussion 35 3.1.7 Tobacco control Core indicators: 4 Key observations ☼ All cities were assessed as having ‘developing’ or ‘advanced’ levels for the indicators for existence and compliance measurement of smoke free legislation and existence and compliance measurement of bans on advertising, promotion and sponsorship (Fig. 15). A common reason for cities not reaching advanced level on either of these was a lack of compliance measurements. ☼ The indicator on existence and compliance measurement of smoke-free legislation had the highest average rating in all income settings (Fig. 16). ☼ Existence of anti-tobacco mass media campaigns was assessed as nascent in seven cities. Anti-tobacco mass media campaigns had been conducted in two of the seven cities in the past, but not within the time period required by the indicator definition (within the previous three years). ☼ A quarter of the cities did not have any policy to promote cessation of tobacco use nor provide treatment for tobacco cessation. However, the three cities that scored advanced for this indicator showed evidence of comprehensive cessation services, such as tobacco cessation advice in primary care services, free and easily accessible telephone, and free low-cost cessation medicines. 36 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities FIG� 15� Status of tobacco control indicators across 20 cities, 2023 AdvancedStatus: Nu m be r o f c iti es 5 15 8 12 1 7 12 3 5 12 15 10 5 0 Developing Nascent 1. Existence and compliance measurement of smoke free legislation 2. Existence and compliance measurement of bans on advertising, promotion and sponsorship 3. Existence of anti-tobacco mass media campaigns 4. Availability of tobacco cessation services FIG� 16� Average scores of tobacco control by World Bank Group country classifications by income level, 20 cities, 2023 Indicator 2.0 All indicators Average score 2.0 1.3 1.4 1.7 Lower-middle-income (n=7) Upper-middle-income (n=4) 1 2 3 2.8 Average score 2.8 2.0 1.8 2.3 1 2 3 2.6 Average score 2.2 1.9 2.3 2.3 1 2 3 High-income (n=9) 1. Existence and compliance measurement of smoke free legislation 2. Existence and compliance measurement of bans on advertising, promotion and sponsorship 3. Existence of anti-tobacco mass media campaigns 4. Availability of tobacco cessation services Results and discussion 37 Case study Bringing smoke-free legislation to life Geelong, Australia No smoking sign © WHO / Uka Borregaard Second-hand smoke kills over 1 million non-smokers every year, and causes heart disease, cancer and many other diseases.a There is no safe level of exposure, so by creating smoke-free spaces people can be protected from its harmful effects. As a result, smoke-free spaces are considered a key component of effective tobacco control.b Local authorities play a key role in ensuring enforcement of relevant smoke-free laws. The City of Greater Geelong, Australia has demonstrated this in the way it has supported implementation of state- level tobacco legislation. Under the state of Victoria’s Tobacco Act Legislation, smoking is prohibited in all enclosed workplaces and many public spaces including outdoor dining and recreational areas, the grounds of primary and secondary schools, sporting venues during underage sporting events and public transport.c The city’s official website explicitly acknowledges the council’s role in enforcing the Tobacco Act 1987 and provides information on the restrictions that apply to different spaces. It also offers links to signs and factsheets for business owners and managers, as practical 38 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities tools to help inform staff and customers about these rules within their establishments.d The council’s responsibility to enforce smoke-free spaces is also included within their Neighbourhood Amenity Local Law 2014, which clearly lays out the council’s legal rights to enforce smoke-free spaces, along with the accompanying penalty for infringements based on nationally set rates.e In addition to enforcement, many cities also have the legislative authority to pass their own local smoke-free laws for areas such as municipal buildings, public transport, local parks and other public spaces.f The Neighbourhood Amenity Local Law outlines Geelong’s legal right to declare specific municipal places as smoke-free, providing that they follow the guidelines of a Local Laws Procedures Manual. Other cities in the state of Victoria, such as Melbourne, have already used similar powers to create their own local smoke-free spaces – ensuring their citizens can breathe cleaner air and enjoy a healthier environment. Sources: a Protecting people from tobacco smoke. Geneva: World Health Organization (https://www.who.int/activities/protecting- people-from-tobacco-smoke, accessed 1 April 2024). b MPOWER. Geneva: World Health Organization (https://www.who.int/initiatives/mpower, accessed 1 April 2024). c Smoke-free and vape-free areas. Melbourne: Victoria Department of Health; 2024 (https://www.health.vic.gov.au/tobacco- reform/smoke-free-and-vape-free-areas, accessed 1 April 2024). d Tobacco laws. Geelong: City of Greater Geelong; 2023 (https://www.geelongaustralia.com.au/safety/article/ item/8d0600e8c48116a.aspx, accessed 1 April 2024). e Neighbourhood Amenity Local Law 2014. Geelong: City of Greater Geelong; 2023 (https://www.geelongaustralia.com.au/ locallaws/documents/item/8cb952796cb30ae.aspx, accessed 1 April 2024). f Making cities smoke-free. Geneva: World Health Organization; 2011 (https://iris.who.int/handle/10665/44773, accessed 1 April 2024). Results and discussion 39 3.1.8 NCD and injury surveillance Core indicators: 4 Key observations ☼ Three-quarters of the cities reported having access to and use of cause-of-death data on NCDs and injuries, and half of the cities had access to and use of routine health facility data (Fig. 17). These two indicators were observed to have the best performance across all income settings (Fig. 18). ☼ No other indicators were assessed as advanced in any of the cities. The primary reason for this was a lack of available data within the time parameters required (typically, collected within the past two or five years). ☼ The indicator for assessing adult injury risk factor surveillance capacities saw the lowest performance: just three cities rated this as developing, and none as advanced. Reasons for this were connected to a lack of recent data, and gaps in data for key risk factors. ☼ In general, the results indicated limited city capacity to conduct regular surveys on NCD or injury prevention. Reasons for this may include the cost of data collection, or that data collection is carried out by national authorities, reducing city agency over frequency or the inclusion of specific topics. 40 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities FIG� 17� Status of NCD and injury surveillance indicators across 20 cities, 2023 AdvancedStatus: Nu m be r o f c iti es 3 17 8 12 3 10 7 6 5 9 15 20 10 5 0 Developing Nascent 1. Adult NCD risk factor surveillance capacity 2. Adult injury risk factor surveillance capacity 3. Access to and use of routine health facility data on alcohol and substance use disorders and tobacco dependencies 4. Access to and use of cause-of-death death data on NCDs and injuries FIG� 18� Average scores of NCD and injury surveillance indicators by World Bank Group country classifications by income level, 20 cities, 2023 Indicator 1.1 All indicators Average score 1.0 1.4 1.4 1.3 Lower-middle-income (n=7) Upper-middle-income (n=4) 1 2 3 1.0 Average score 1.0 1.3 2.0 1.3 1 2 3 1.8 Average score 1.3 2.0 2.6 1.9 1 2 3 High-income (n=9) 1. Adult NCD risk factor surveillance capacity 2. Adult injury risk factor surveillance capacity 3. Access to and use of routine health facility data on alcohol and substance use disorders and tobacco dependencies 4. Access to and use of cause-of-death death data on NCDs and injuries Results and discussion 41 Case study Promoting a culture of accessible, action-oriented data to improve health and reduce health inequalities Barcelona, Spain Since 1983, the Barcelona Public Health Agency (ASPB) has generated an annual analytical report on health status and determinants across the city.a,b The report is an essential tool for monitoring and prioritizing policies aimed at improving the health of the population. It provides an analysis of the health status and its determinants in the city of Barcelona, with a special focus on social inequalities in health. Each report reveals the situation and key city health trends, covering a wide range of topics linked to determinants, health and well-being. In addition to the full report, there is also an ‘easy read’ edition which presents the results in a simple, accessible manner to promote wider readership. One of the report’s major strengths is the integration of multiple data types into a single unified document, drawing from a variety of sources. It is structured according to the conceptual framework for social determinants for health and health inequalities for cities.c Headline categories include: ● Environmental data – such as air and noise pollution, climate conditions, and transport. ● Socioeconomic data – such as incomes, employment rates and sociodemographic trends. ● Core health data – such as survey data on health status or risk factors, data from primary care information systems, and mortality trends. Under each category, the report offers succinct summaries of relevant data, providing key messages and data products such as charts, tables and infographics. The aim of this comprehensive but centralized data summary is to provide the city council and others with the right information for planning policies and actions linked to priority health issues and reduction of health inequalities. The report’s approach is indicative of Barcelona’s efforts to ensure data is both usable and accessible. There are a number of dashboards that shows the environment, socioeconomic, and health data by inequality axes such age, gender, socioeconomic status and territorial, when available. These include data by district, from an adult household health survey, from a secondary school health survey, and from health inequalities surveillance. Cover of the 2022 edition of "Health in Barcelona" 42 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities In addition, the Health and Policy Impact Observatory (OBSIP) is a tool that allows the monitoring of health status in the city as a whole, and the existing inequalities between neighbourhoods and social groups. It also provides a repository of health impact evaluations of policies developed in Barcelona.d The work is aligned with the city’s broader commitment to open, accessible data. Since 2011 the city has hosted a platform, Open Data BCN, which optimizes access to all information collected or managed by public bodies to make it usable and relevant for citizens. To reflect its commitment to global issues, the platform even includes a section on the 2030 Agenda, where the city’s data sources are catalogued against the 17 Sustainable Development Goals, highlighting the city’s potential contribution to each topic.e For health alone, the city reports 56 datasets relevant to SDG 3, demonstrating the breadth of its contribution to this goal.f Sources: a Borrell C, Bartoll X, García-Altés A, Pasarín MI, Piñeiro M, Villalbí JR. Veinticinco años de informes de salud en Barcelona: una apuesta por la transparencia y un instrumento para la acción. Revista Española de Salud Pública. 2011;85:449–458. b La salut a Barcelona. Barcelona: l’Agència de Salut Pública de Barcelona; 2022 (https://www.aspb.cat/wp-content/ uploads/2023/12/ASPB-salutbarcelona2022-breu-231211.pdf, accessed 1 April 2024). c Borrell C, Pons-Vigués M, Morrison J, Díez È. Factors and processes influencing health inequalities in urban areas. J Epidemiol Community Health. 2013;67(5):389–391. d (https://dades.aspb.cat/obsip/, accessed 1 April 2024). e The 2030 Agenda for Sustainable Development and Open Data BCN [website]. Barcelona: Barcelona City Council (https:// opendata-ajuntament.barcelona.cat/en/ods-agenda2030, accessed 1 April 2024). f Open Data BCN Datasets [website]. Barcelona: Barcelona City Council (https://opendata-ajuntament.barcelona.cat/data/ en/dataset?ODS_Principal_agenda_2030=ODS+3%3A+Salut+i+benestar, accessed 1 April 2024). The Observatori Fabra in Barcelona © Vicente Zambrano González Results and discussion 43 © WHO/Diego Rodriguez 3.2 City profiles The following profiles were produced by WHO using information submitted by cities as part of the pilot testing of the indicators. All information was collected between 2021–2023. 44 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities Amman, Jordan City Population: 3 999 008 (8) Air pollution reduction 1. Air pollution measurement capacity 2. Availability of air quality information and trends 3. Availability of emission estimates 4. Existence and enforcement of air quality standards Alcohol control 1. Existence of comprehensive strategy, plan of action and activities to reduce harmful use of alcohol 2. Existence of policy to restrict commercial and public availability of alcohol 3. Existence of bans or comprehensive restrictions on alcohol advertising, sponsorship and promotion 4. Existence and enforcement of drink-driving legislation 5. Availability of brief intervention and treatment for problematic alcohol use Overdose prevention 1. Availability of key medications for opioid dependence treatment 2. Existence of service governance mechanisms for drug use disorder treatment 3. Availability of non-structured harm reduction services for people with drug use disorders 4. Availability of take-home naloxone at city level Promoting healthy diets 1. Existence and enforcement of policies to restrict marketing of unhealthy foods and non-alcoholic beverages 2. Existence and enforcement of nutrition standards for foods and beverages served and/or sold in public settings 3. Existence and enforcement of policies and programmes to improve healthy eating in restaurants, food outlets or vending machines 4. Existence and enforcement of urban planning/zoning policies to increase healthier food options 5. Existence and enforcement of policies to ensure free safely managed drinking water is available in all public settings Results and discussion 45 Road safety 1. Existence and enforcement of speed limit legislation for private passenger vehicles 2. Existence and implementation of road design standards that include speed management and safe infrastructure for pedestrians and cyclists 3. Existence and enforcement of legislation on helmet use for two- and three-wheeled motor vehicles including helmet use standards and wearing requirements 4. Existence and enforcement of legislation for seat-belt use Safe walking and cycling 1. Existence of city policy promoting walking 2. Existence of city policy promoting cycling 3. Existence of city policy on access to public open space 4. Existence of city urban planning policy to encourage compact urban design and mixed land use Tobacco control 1. Existence and compliance measurement of smoke free legislation 2. Existence and compliance measurement of bans on advertising, promotion and sponsorship 3. Existence of anti-tobacco mass media campaigns 4. Availability of tobacco cessation services NCD and injury surveillance 1. Adult NCD risk factor surveillance capacity 2. Adult injury risk factor surveillance capacity 3. Access to and use of routine health facility data on alcohol and substance use disorders and tobacco dependencies 4. Access to and use of cause-of-death death data on NCDs and injuries Nascent Developing Advanced 46 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities Bangkok, Thailand City Population: 8 421 212 (8) Air pollution reduction 1. Air pollution measurement capacity 2. Availability of air quality information and trends 3. Availability of emission estimates 4. Existence and enforcement of air quality standards Alcohol control 1. Existence of comprehensive strategy, plan of action and activities to reduce harmful use of alcohol 2. Existence of policy to restrict commercial and public availability of alcohol 3. Existence of bans or comprehensive restrictions on alcohol advertising, sponsorship and promotion 4. Existence and enforcement of drink-driving legislation 5. Availability of brief intervention and treatment for problematic alcohol use Overdose prevention 1. Availability of key medications for opioid dependence treatment 2. Existence of service governance mechanisms for drug use disorder treatment 3. Availability of non-structured harm reduction services for people with drug use disorders 4. Availability of take-home naloxone at city level Promoting healthy diets 1. Existence and enforcement of policies to restrict marketing of unhealthy foods and non-alcoholic beverages 2. Existence and enforcement of nutrition standards for foods and beverages served and/or sold in public settings 3. Existence and enforcement of policies and programmes to improve healthy eating in restaurants, food outlets or vending machines 4. Existence and enforcement of urban planning/zoning policies to increase healthier food options 5. Existence and enforcement of policies to ensure free safely managed drinking water is available in all public settings Results and discussion 47 Road safety 1. Existence and enforcement of speed limit legislation for private passenger vehicles 2. Existence and implementation of road design standards that include speed management and safe infrastructure for pedestrians and cyclists 3. Existence and enforcement of legislation on helmet use for two- and three-wheeled motor vehicles including helmet use standards and wearing requirements 4. Existence and enforcement of legislation for seat-belt use Safe walking and cycling 1. Existence of city policy promoting walking 2. Existence of city policy promoting cycling 3. Existence of city policy on access to public open space 4. Existence of city urban planning policy to encourage compact urban design and mixed land use Tobacco control 1. Existence and compliance measurement of smoke free legislation 2. Existence and compliance measurement of bans on advertising, promotion and sponsorship 3. Existence of anti-tobacco mass media campaigns 4. Availability of tobacco cessation services NCD and injury surveillance 1. Adult NCD risk factor surveillance capacity 2. Adult injury risk factor surveillance capacity 3. Access to and use of routine health facility data on alcohol and substance use disorders and tobacco dependencies 4. Access to and use of cause-of-death death data on NCDs and injuries Nascent Developing Advanced 48 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities Barcelona, Spain City Population: 1 627 559 (8) Air pollution reduction 1. Air pollution measurement capacity 2. Availability of air quality information and trends 3. Availability of emission estimates 4. Existence and enforcement of air quality standards Alcohol control 1. Existence of comprehensive strategy, plan of action and activities to reduce harmful use of alcohol 2. Existence of policy to restrict commercial and public availability of alcohol 3. Existence of bans or comprehensive restrictions on alcohol advertising, sponsorship and promotion 4. Existence and enforcement of drink-driving legislation 5. Availability of brief intervention and treatment for problematic alcohol use Overdose prevention 1. Availability of key medications for opioid dependence treatment 2. Existence of service governance mechanisms for drug use disorder treatment 3. Availability of non-structured harm reduction services for people with drug use disorders 4. Availability of take-home naloxone at city level Promoting healthy diets 1. Existence and enforcement of policies to restrict marketing of unhealthy foods and non-alcoholic beverages 2. Existence and enforcement of nutrition standards for foods and beverages served and/or sold in public settings 3. Existence and enforcement of policies and programmes to improve healthy eating in restaurants, food outlets or vending machines 4. Existence and enforcement of urban planning/zoning policies to increase healthier food options 5. Existence and enforcement of policies to ensure free safely managed drinking water is available in all public settings Results and discussion 49 Road safety 1. Existence and enforcement of speed limit legislation for private passenger vehicles 2. Existence and implementation of road design standards that include speed management and safe infrastructure for pedestrians and cyclists 3. Existence and enforcement of legislation on helmet use for two- and three-wheeled motor vehicles including helmet use standards and wearing requirements 4. Existence and enforcement of legislation for seat-belt use Safe walking and cycling 1. Existence of city policy promoting walking 2. Existence of city policy promoting cycling 3. Existence of city policy on access to public open space 4. Existence of city urban planning policy to encourage compact urban design and mixed land use Tobacco control 1. Existence and compliance measurement of smoke free legislation 2. Existence and compliance measurement of bans on advertising, promotion and sponsorship 3. Existence of anti-tobacco mass media campaigns 4. Availability of tobacco cessation services NCD and injury surveillance 1. Adult NCD risk factor surveillance capacity 2. Adult injury risk factor surveillance capacity 3. Access to and use of routine health facility data on alcohol and substance use disorders and tobacco dependencies 4. Access to and use of cause-of-death death data on NCDs and injuries Nascent Developing Advanced 50 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities Bogotá, Colombia City Population: 7 901 653 (8) Air pollution reduction 1. Air pollution measurement capacity 2. Availability of air quality information and trends 3. Availability of emission estimates 4. Existence and enforcement of air quality standards Alcohol control 1. Existence of comprehensive strategy, plan of action and activities to reduce harmful use of alcohol 2. Existence of policy to restrict commercial and public availability of alcohol 3. Existence of bans or comprehensive restrictions on alcohol advertising, sponsorship and promotion 4. Existence and enforcement of drink-driving legislation 5. Availability of brief intervention and treatment for problematic alcohol use Overdose prevention 1. Availability of key medications for opioid dependence treatment 2. Existence of service governance mechanisms for drug use disorder treatment 3. Availability of non-structured harm reduction services for people with drug use disorders 4. Availability of take-home naloxone at city level Promoting healthy diets 1. Existence and enforcement of policies to restrict marketing of unhealthy foods and non-alcoholic beverages 2. Existence and enforcement of nutrition standards for foods and beverages served and/or sold in public settings 3. Existence and enforcement of policies and programmes to improve healthy eating in restaurants, food outlets or vending machines 4. Existence and enforcement of urban planning/zoning policies to increase healthier food options 5. Existence and enforcement of policies to ensure free safely managed drinking water is available in all public settings Results and discussion 51 Road safety 1. Existence and enforcement of speed limit legislation for private passenger vehicles 2. Existence and implementation of road design standards that include speed management and safe infrastructure for pedestrians and cyclists 3. Existence and enforcement of legislation on helmet use for two- and three-wheeled motor vehicles including helmet use standards and wearing requirements 4. Existence and enforcement of legislation for seat-belt use Safe walking and cycling 1. Existence of city policy promoting walking 2. Existence of city policy promoting cycling 3. Existence of city policy on access to public open space 4. Existence of city urban planning policy to encourage compact urban design and mixed land use Tobacco control 1. Existence and compliance measurement of smoke free legislation 2. Existence and compliance measurement of bans on advertising, promotion and sponsorship 3. Existence of anti-tobacco mass media campaigns 4. Availability of tobacco cessation services NCD and injury surveillance 1. Adult NCD risk factor surveillance capacity 2. Adult injury risk factor surveillance capacity 3. Access to and use of routine health facility data on alcohol and substance use disorders and tobacco dependencies 4. Access to and use of cause-of-death death data on NCDs and injuries Nascent Developing Advanced 52 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities Bursa, Türkiye City Population: 3 147 818 (8) Air pollution reduction 1. Air pollution measurement capacity 2. Availability of air quality information and trends 3. Availability of emission estimates 4. Existence and enforcement of air quality standards Alcohol control 1. Existence of comprehensive strategy, plan of action and activities to reduce harmful use of alcohol 2. Existence of policy to restrict commercial and public availability of alcohol 3. Existence of bans or comprehensive restrictions on alcohol advertising, sponsorship and promotion 4. Existence and enforcement of drink-driving legislation 5. Availability of brief intervention and treatment for problematic alcohol use Overdose prevention 1. Availability of key medications for opioid dependence treatment 2. Existence of service governance mechanisms for drug use disorder treatment 3. Availability of non-structured harm reduction services for people with drug use disorders 4. Availability of take-home naloxone at city level Promoting healthy diets 1. Existence and enforcement of policies to restrict marketing of unhealthy foods and non-alcoholic beverages 2. Existence and enforcement of nutrition standards for foods and beverages served and/or sold in public settings 3. Existence and enforcement of policies and programmes to improve healthy eating in restaurants, food outlets or vending machines 4. Existence and enforcement of urban planning/zoning policies to increase healthier food options 5. Existence and enforcement of policies to ensure free safely managed drinking water is available in all public settings Results and discussion 53 Road safety 1. Existence and enforcement of speed limit legislation for private passenger vehicles 2. Existence and implementation of road design standards that include speed management and safe infrastructure for pedestrians and cyclists 3. Existence and enforcement of legislation on helmet use for two- and three-wheeled motor vehicles including helmet use standards and wearing requirements 4. Existence and enforcement of legislation for seat-belt use Safe walking and cycling 1. Existence of city policy promoting walking 2. Existence of city policy promoting cycling 3. Existence of city policy on access to public open space 4. Existence of city urban planning policy to encourage compact urban design and mixed land use Tobacco control 1. Existence and compliance measurement of smoke free legislation 2. Existence and compliance measurement of bans on advertising, promotion and sponsorship 3. Existence of anti-tobacco mass media campaigns 4. Availability of tobacco cessation services NCD and injury surveillance 1. Adult NCD risk factor surveillance capacity 2. Adult injury risk factor surveillance capacity 3. Access to and use of routine health facility data on alcohol and substance use disorders and tobacco dependencies 4. Access to and use of cause-of-death death data on NCDs and injuries Nascent Developing Advanced 54 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities Cape Town, South Africa City Population: 4 772 846 (9) Air pollution reduction 1. Air pollution measurement capacity 2. Availability of air quality information and trends 3. Availability of emission estimates 4. Existence and enforcement of air quality standards Alcohol control 1. Existence of comprehensive strategy, plan of action and activities to reduce harmful use of alcohol 2. Existence of policy to restrict commercial and public availability of alcohol 3. Existence of bans or comprehensive restrictions on alcohol advertising, sponsorship and promotion 4. Existence and enforcement of drink-driving legislation 5. Availability of brief intervention and treatment for problematic alcohol use Overdose prevention 1. Availability of key medications for opioid dependence treatment 2. Existence of service governance mechanisms for drug use disorder treatment 3. Availability of non-structured harm reduction services for people with drug use disorders 4. Availability of take-home naloxone at city level Promoting healthy diets 1. Existence and enforcement of policies to restrict marketing of unhealthy foods and non-alcoholic beverages 2. Existence and enforcement of nutrition standards for foods and beverages served and/or sold in public settings 3. Existence and enforcement of policies and programmes to improve healthy eating in restaurants, food outlets or vending machines 4. Existence and enforcement of urban planning/zoning policies to increase healthier food options 5. Existence and enforcement of policies to ensure free safely managed drinking water is available in all public settings Results and discussion 55 Road safety 1. Existence and enforcement of speed limit legislation for private passenger vehicles 2. Existence and implementation of road design standards that include speed management and safe infrastructure for pedestrians and cyclists 3. Existence and enforcement of legislation on helmet use for two- and three-wheeled motor vehicles including helmet use standards and wearing requirements 4. Existence and enforcement of legislation for seat-belt use Safe walking and cycling 1. Existence of city policy promoting walking 2. Existence of city policy promoting cycling 3. Existence of city policy on access to public open space 4. Existence of city urban planning policy to encourage compact urban design and mixed land use Tobacco control 1. Existence and compliance measurement of smoke free legislation 2. Existence and compliance measurement of bans on advertising, promotion and sponsorship 3. Existence of anti-tobacco mass media campaigns 4. Availability of tobacco cessation services NCD and injury surveillance 1. Adult NCD risk factor surveillance capacity 2. Adult injury risk factor surveillance capacity 3. Access to and use of routine health facility data on alcohol and substance use disorders and tobacco dependencies 4. Access to and use of cause-of-death death data on NCDs and injuries Nascent Developing Advanced 56 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities Doha, Qatar City Population: 1 186 023 (8) Air pollution reduction 1. Air pollution measurement capacity 2. Availability of air quality information and trends 3. Availability of emission estimates 4. Existence and enforcement of air quality standards Alcohol control 1. Existence of comprehensive strategy, plan of action and activities to reduce harmful use of alcohol 2. Existence of policy to restrict commercial and public availability of alcohol 3. Existence of bans or comprehensive restrictions on alcohol advertising, sponsorship and promotion 4. Existence and enforcement of drink-driving legislation 5. Availability of brief intervention and treatment for problematic alcohol use Overdose prevention 1. Availability of key medications for opioid dependence treatment 2. Existence of service governance mechanisms for drug use disorder treatment 3. Availability of non-structured harm reduction services for people with drug use disorders 4. Availability of take-home naloxone at city level Promoting healthy diets 1. Existence and enforcement of policies to restrict marketing of unhealthy foods and non-alcoholic beverages 2. Existence and enforcement of nutrition standards for foods and beverages served and/or sold in public settings 3. Existence and enforcement of policies and programmes to improve healthy eating in restaurants, food outlets or vending machines 4. Existence and enforcement of urban planning/zoning policies to increase healthier food options 5. Existence and enforcement of policies to ensure free safely managed drinking water is available in all public settings Results and discussion 57 Road safety 1. Existence and enforcement of speed limit legislation for private passenger vehicles 2. Existence and implementation of road design standards that include speed management and safe infrastructure for pedestrians and cyclists 3. Existence and enforcement of legislation on helmet use for two- and three-wheeled motor vehicles including helmet use standards and wearing requirements 4. Existence and enforcement of legislation for seat-belt use Safe walking and cycling 1. Existence of city policy promoting walking 2. Existence of city policy promoting cycling 3. Existence of city policy on access to public open space 4. Existence of city urban planning policy to encourage compact urban design and mixed land use Tobacco control 1. Existence and compliance measurement of smoke free legislation 2. Existence and compliance measurement of bans on advertising, promotion and sponsorship 3. Existence of anti-tobacco mass media campaigns 4. Availability of tobacco cessation services NCD and injury surveillance 1. Adult NCD risk factor surveillance capacity 2. Adult injury risk factor surveillance capacity 3. Access to and use of routine health facility data on alcohol and substance use disorders and tobacco dependencies 4. Access to and use of cause-of-death death data on NCDs and injuries Nascent Developing Advanced 58 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities Goiânia, Brazil City Population: 1 437 366 (10) Air pollution reduction 1. Air pollution measurement capacity 2. Availability of air quality information and trends 3. Availability of emission estimates 4. Existence and enforcement of air quality standards Alcohol control 1. Existence of comprehensive strategy, plan of action and activities to reduce harmful use of alcohol 2. Existence of policy to restrict commercial and public availability of alcohol 3. Existence of bans or comprehensive restrictions on alcohol advertising, sponsorship and promotion 4. Existence and enforcement of drink-driving legislation 5. Availability of brief intervention and treatment for problematic alcohol use Overdose prevention 1. Availability of key medications for opioid dependence treatment 2. Existence of service governance mechanisms for drug use disorder treatment 3. Availability of non-structured harm reduction services for people with drug use disorders 4. Availability of take-home naloxone at city level Promoting healthy diets 1. Existence and enforcement of policies to restrict marketing of unhealthy foods and non-alcoholic beverages 2. Existence and enforcement of nutrition standards for foods and beverages served and/or sold in public settings 3. Existence and enforcement of policies and programmes to improve healthy eating in restaurants, food outlets or vending machines 4. Existence and enforcement of urban planning/zoning policies to increase healthier food options 5. Existence and enforcement of policies to ensure free safely managed drinking water is available in all public settings Results and discussion 59 Road safety 1. Existence and enforcement of speed limit legislation for private passenger vehicles 2. Existence and implementation of road design standards that include speed management and safe infrastructure for pedestrians and cyclists 3. Existence and enforcement of legislation on helmet use for two- and three-wheeled motor vehicles including helmet use standards and wearing requirements 4. Existence and enforcement of legislation for seat-belt use Safe walking and cycling 1. Existence of city policy promoting walking 2. Existence of city policy promoting cycling 3. Existence of city policy on access to public open space 4. Existence of city urban planning policy to encourage compact urban design and mixed land use Tobacco control 1. Existence and compliance measurement of smoke free legislation 2. Existence and compliance measurement of bans on advertising, promotion and sponsorship 3. Existence of anti-tobacco mass media campaigns 4. Availability of tobacco cessation services NCD and injury surveillance 1. Adult NCD risk factor surveillance capacity 2. Adult injury risk factor surveillance capacity 3. Access to and use of routine health facility data on alcohol and substance use disorders and tobacco dependencies 4. Access to and use of cause-of-death death data on NCDs and injuries Nascent Developing Advanced 60 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities Greater Geelong, Australia City Population: 271 057 (11) Air pollution reduction 1. Air pollution measurement capacity 2. Availability of air quality information and trends 3. Availability of emission estimates 4. Existence and enforcement of air quality standards Alcohol control 1. Existence of comprehensive strategy, plan of action and activities to reduce harmful use of alcohol 2. Existence of policy to restrict commercial and public availability of alcohol 3. Existence of bans or comprehensive restrictions on alcohol advertising, sponsorship and promotion 4. Existence and enforcement of drink-driving legislation 5. Availability of brief intervention and treatment for problematic alcohol use Overdose prevention 1. Availability of key medications for opioid dependence treatment 2. Existence of service governance mechanisms for drug use disorder treatment 3. Availability of non-structured harm reduction services for people with drug use disorders 4. Availability of take-home naloxone at city level Promoting healthy diets 1. Existence and enforcement of policies to restrict marketing of unhealthy foods and non-alcoholic beverages 2. Existence and enforcement of nutrition standards for foods and beverages served and/or sold in public settings 3. Existence and enforcement of policies and programmes to improve healthy eating in restaurants, food outlets or vending machines 4. Existence and enforcement of urban planning/zoning policies to increase healthier food options 5. Existence and enforcement of policies to ensure free safely managed drinking water is available in all public settings Results and discussion 61 Road safety 1. Existence and enforcement of speed limit legislation for private passenger vehicles 2. Existence and implementation of road design standards that include speed management and safe infrastructure for pedestrians and cyclists 3. Existence and enforcement of legislation on helmet use for two- and three-wheeled motor vehicles including helmet use standards and wearing requirements 4. Existence and enforcement of legislation for seat-belt use Safe walking and cycling 1. Existence of city policy promoting walking 2. Existence of city policy promoting cycling 3. Existence of city policy on access to public open space 4. Existence of city urban planning policy to encourage compact urban design and mixed land use Tobacco control 1. Existence and compliance measurement of smoke free legislation 2. Existence and compliance measurement of bans on advertising, promotion and sponsorship 3. Existence of anti-tobacco mass media campaigns 4. Availability of tobacco cessation services NCD and injury surveillance 1. Adult NCD risk factor surveillance capacity 2. Adult injury risk factor surveillance capacity 3. Access to and use of routine health facility data on alcohol and substance use disorders and tobacco dependencies 4. Access to and use of cause-of-death death data on NCDs and injuries Nascent Developing Advanced 62 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities Harare, Zimbabwe City Population: 1 698 122 (8) Air pollution reduction 1. Air pollution measurement capacity 2. Availability of air quality information and trends 3. Availability of emission estimates 4. Existence and enforcement of air quality standards Alcohol control 1. Existence of comprehensive strategy, plan of action and activities to reduce harmful use of alcohol 2. Existence of policy to restrict commercial and public availability of alcohol 3. Existence of bans or comprehensive restrictions on alcohol advertising, sponsorship and promotion 4. Existence and enforcement of drink-driving legislation 5. Availability of brief intervention and treatment for problematic alcohol use Overdose prevention 1. Availability of key medications for opioid dependence treatment 2. Existence of service governance mechanisms for drug use disorder treatment 3. Availability of non-structured harm reduction services for people with drug use disorders 4. Availability of take-home naloxone at city level Promoting healthy diets 1. Existence and enforcement of policies to restrict marketing of unhealthy foods and non-alcoholic beverages 2. Existence and enforcement of nutrition standards for foods and beverages served and/or sold in public settings 3. Existence and enforcement of policies and programmes to improve healthy eating in restaurants, food outlets or vending machines 4. Existence and enforcement of urban planning/zoning policies to increase healthier food options 5. Existence and enforcement of policies to ensure free safely managed drinking water is available in all public settings Results and discussion 63 Road safety 1. Existence and enforcement of speed limit legislation for private passenger vehicles 2. Existence and implementation of road design standards that include speed management and safe infrastructure for pedestrians and cyclists 3. Existence and enforcement of legislation on helmet use for two- and three-wheeled motor vehicles including helmet use standards and wearing requirements 4. Existence and enforcement of legislation for seat-belt use Safe walking and cycling 1. Existence of city policy promoting walking 2. Existence of city policy promoting cycling 3. Existence of city policy on access to public open space 4. Existence of city urban planning policy to encourage compact urban design and mixed land use Tobacco control 1. Existence and compliance measurement of smoke free legislation 2. Existence and compliance measurement of bans on advertising, promotion and sponsorship 3. Existence of anti-tobacco mass media campaigns 4. Availability of tobacco cessation services NCD and injury surveillance 1. Adult NCD risk factor surveillance capacity 2. Adult injury risk factor surveillance capacity 3. Access to and use of routine health facility data on alcohol and substance use disorders and tobacco dependencies 4. Access to and use of cause-of-death death data on NCDs and injuries Nascent Developing Advanced 64 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities Helsinki, Finland City Population: 656 920 (8) Air pollution reduction 1. Air pollution measurement capacity 2. Availability of air quality information and trends 3. Availability of emission estimates 4. Existence and enforcement of air quality standards Alcohol control 1. Existence of comprehensive strategy, plan of action and activities to reduce harmful use of alcohol 2. Existence of policy to restrict commercial and public availability of alcohol 3. Existence of bans or comprehensive restrictions on alcohol advertising, sponsorship and promotion 4. Existence and enforcement of drink-driving legislation 5. Availability of brief intervention and treatment for problematic alcohol use Overdose prevention 1. Availability of key medications for opioid dependence treatment 2. Existence of service governance mechanisms for drug use disorder treatment 3. Availability of non-structured harm reduction services for people with drug use disorders 4. Availability of take-home naloxone at city level Promoting healthy diets 1. Existence and enforcement of policies to restrict marketing of unhealthy foods and non-alcoholic beverages 2. Existence and enforcement of nutrition standards for foods and beverages served and/or sold in public settings 3. Existence and enforcement of policies and programmes to improve healthy eating in restaurants, food outlets or vending machines 4. Existence and enforcement of urban planning/zoning policies to increase healthier food options 5. Existence and enforcement of policies to ensure free safely managed drinking water is available in all public settings Results and discussion 65 Road safety 1. Existence and enforcement of speed limit legislation for private passenger vehicles 2. Existence and implementation of road design standards that include speed management and safe infrastructure for pedestrians and cyclists 3. Existence and enforcement of legislation on helmet use for two- and three-wheeled motor vehicles including helmet use standards and wearing requirements 4. Existence and enforcement of legislation for seat-belt use Safe walking and cycling 1. Existence of city policy promoting walking 2. Existence of city policy promoting cycling 3. Existence of city policy on access to public open space 4. Existence of city urban planning policy to encourage compact urban design and mixed land use Tobacco control 1. Existence and compliance measurement of smoke free legislation 2. Existence and compliance measurement of bans on advertising, promotion and sponsorship 3. Existence of anti-tobacco mass media campaigns 4. Availability of tobacco cessation services NCD and injury surveillance 1. Adult NCD risk factor surveillance capacity 2. Adult injury risk factor surveillance capacity 3. Access to and use of routine health facility data on alcohol and substance use disorders and tobacco dependencies 4. Access to and use of cause-of-death death data on NCDs and injuries Nascent Developing Advanced 66 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities Lalitpur, Nepal City Population: 133 305 (8) Air pollution reduction 1. Air pollution measurement capacity 2. Availability of air quality information and trends 3. Availability of emission estimates 4. Existence and enforcement of air quality standards Alcohol control 1. Existence of comprehensive strategy, plan of action and activities to reduce harmful use of alcohol 2. Existence of policy to restrict commercial and public availability of alcohol 3. Existence of bans or comprehensive restrictions on alcohol advertising, sponsorship and promotion 4. Existence and enforcement of drink-driving legislation 5. Availability of brief intervention and treatment for problematic alcohol use Overdose prevention 1. Availability of key medications for opioid dependence treatment 2. Existence of service governance mechanisms for drug use disorder treatment 3. Availability of non-structured harm reduction services for people with drug use disorders 4. Availability of take-home naloxone at city level Promoting healthy diets 1. Existence and enforcement of policies to restrict marketing of unhealthy foods and non-alcoholic beverages 2. Existence and enforcement of nutrition standards for foods and beverages served and/or sold in public settings 3. Existence and enforcement of policies and programmes to improve healthy eating in restaurants, food outlets or vending machines 4. Existence and enforcement of urban planning/zoning policies to increase healthier food options 5. Existence and enforcement of policies to ensure free safely managed drinking water is available in all public settings Results and discussion 67 Road safety 1. Existence and enforcement of speed limit legislation for private passenger vehicles 2. Existence and implementation of road design standards that include speed management and safe infrastructure for pedestrians and cyclists 3. Existence and enforcement of legislation on helmet use for two- and three-wheeled motor vehicles including helmet use standards and wearing requirements 4. Existence and enforcement of legislation for seat-belt use Safe walking and cycling 1. Existence of city policy promoting walking 2. Existence of city policy promoting cycling 3. Existence of city policy on access to public open space 4. Existence of city urban planning policy to encourage compact urban design and mixed land use Tobacco control 1. Existence and compliance measurement of smoke free legislation 2. Existence and compliance measurement of bans on advertising, promotion and sponsorship 3. Existence of anti-tobacco mass media campaigns 4. Availability of tobacco cessation services NCD and injury surveillance 1. Adult NCD risk factor surveillance capacity 2. Adult injury risk factor surveillance capacity 3. Access to and use of routine health facility data on alcohol and substance use disorders and tobacco dependencies 4. Access to and use of cause-of-death death data on NCDs and injuries Nascent Developing Advanced 68 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities London, United Kingdom of Great Britain and Northern Ireland City Population: 8 945 309 (12) Air pollution reduction 1. Air pollution measurement capacity 2. Availability of air quality information and trends 3. Availability of emission estimates 4. Existence and enforcement of air quality standards Alcohol control 1. Existence of comprehensive strategy, plan of action and activities to reduce harmful use of alcohol 2. Existence of policy to restrict commercial and public availability of alcohol 3. Existence of bans or comprehensive restrictions on alcohol advertising, sponsorship and promotion 4. Existence and enforcement of drink-driving legislation 5. Availability of brief intervention and treatment for problematic alcohol use Overdose prevention 1. Availability of key medications for opioid dependence treatment 2. Existence of service governance mechanisms for drug use disorder treatment 3. Availability of non-structured harm reduction services for people with drug use disorders 4. Availability of take-home naloxone at city level Promoting healthy diets 1. Existence and enforcement of policies to restrict marketing of unhealthy foods and non-alcoholic beverages 2. Existence and enforcement of nutrition standards for foods and beverages served and/or sold in public settings 3. Existence and enforcement of policies and programmes to improve healthy eating in restaurants, food outlets or vending machines 4. Existence and enforcement of urban planning/zoning policies to increase healthier food options 5. Existence and enforcement of policies to ensure free safely managed drinking water is available in all public settings Results and discussion 69 Road safety 1. Existence and enforcement of speed limit legislation for private passenger vehicles 2. Existence and implementation of road design standards that include speed management and safe infrastructure for pedestrians and cyclists 3. Existence and enforcement of legislation on helmet use for two- and three-wheeled motor vehicles including helmet use standards and wearing requirements 4. Existence and enforcement of legislation for seat-belt use Safe walking and cycling 1. Existence of city policy promoting walking 2. Existence of city policy promoting cycling 3. Existence of city policy on access to public open space 4. Existence of city urban planning policy to encourage compact urban design and mixed land use Tobacco control 1. Existence and compliance measurement of smoke free legislation 2. Existence and compliance measurement of bans on advertising, promotion and sponsorship 3. Existence of anti-tobacco mass media campaigns 4. Availability of tobacco cessation services NCD and injury surveillance 1. Adult NCD risk factor surveillance capacity 2. Adult injury risk factor surveillance capacity 3. Access to and use of routine health facility data on alcohol and substance use disorders and tobacco dependencies 4. Access to and use of cause-of-death death data on NCDs and injuries Nascent Developing Advanced 70 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities Maio, Cabo Verde City Population: 6980 (13) Air pollution reduction 1. Air pollution measurement capacity 2. Availability of air quality information and trends 3. Availability of emission estimates 4. Existence and enforcement of air quality standards Alcohol control 1. Existence of comprehensive strategy, plan of action and activities to reduce harmful use of alcohol 2. Existence of policy to restrict commercial and public availability of alcohol 3. Existence of bans or comprehensive restrictions on alcohol advertising, sponsorship and promotion 4. Existence and enforcement of drink-driving legislation 5. Availability of brief intervention and treatment for problematic alcohol use Overdose prevention 1. Availability of key medications for opioid dependence treatment 2. Existence of service governance mechanisms for drug use disorder treatment 3. Availability of non-structured harm reduction services for people with drug use disorders 4. Availability of take-home naloxone at city level Promoting healthy diets 1. Existence and enforcement of policies to restrict marketing of unhealthy foods and non-alcoholic beverages 2. Existence and enforcement of nutrition standards for foods and beverages served and/or sold in public settings 3. Existence and enforcement of policies and programmes to improve healthy eating in restaurants, food outlets or vending machines 4. Existence and enforcement of urban planning/zoning policies to increase healthier food options 5. Existence and enforcement of policies to ensure free safely managed drinking water is available in all public settings Results and discussion 71 Road safety 1. Existence and enforcement of speed limit legislation for private passenger vehicles 2. Existence and implementation of road design standards that include speed management and safe infrastructure for pedestrians and cyclists 3. Existence and enforcement of legislation on helmet use for two- and three-wheeled motor vehicles including helmet use standards and wearing requirements 4. Existence and enforcement of legislation for seat-belt use Safe walking and cycling 1. Existence of city policy promoting walking 2. Existence of city policy promoting cycling 3. Existence of city policy on access to public open space 4. Existence of city urban planning policy to encourage compact urban design and mixed land use Tobacco control 1. Existence and compliance measurement of smoke free legislation 2. Existence and compliance measurement of bans on advertising, promotion and sponsorship 3. Existence of anti-tobacco mass media campaigns 4. Availability of tobacco cessation services NCD and injury surveillance 1. Adult NCD risk factor surveillance capacity 2. Adult injury risk factor surveillance capacity 3. Access to and use of routine health facility data on alcohol and substance use disorders and tobacco dependencies 4. Access to and use of cause-of-death death data on NCDs and injuries Nascent Developing Advanced 72 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities Manama, Bahrain City Population: 176 909 (8) Air pollution reduction 1. Air pollution measurement capacity 2. Availability of air quality information and trends 3. Availability of emission estimates 4. Existence and enforcement of air quality standards Alcohol control 1. Existence of comprehensive strategy, plan of action and activities to reduce harmful use of alcohol 2. Existence of policy to restrict commercial and public availability of alcohol 3. Existence of bans or comprehensive restrictions on alcohol advertising, sponsorship and promotion 4. Existence and enforcement of drink-driving legislation 5. Availability of brief intervention and treatment for problematic alcohol use Overdose prevention 1. Availability of key medications for opioid dependence treatment 2. Existence of service governance mechanisms for drug use disorder treatment 3. Availability of non-structured harm reduction services for people with drug use disorders 4. Availability of take-home naloxone at city level Promoting healthy diets 1. Existence and enforcement of policies to restrict marketing of unhealthy foods and non-alcoholic beverages 2. Existence and enforcement of nutrition standards for foods and beverages served and/or sold in public settings 3. Existence and enforcement of policies and programmes to improve healthy eating in restaurants, food outlets or vending machines 4. Existence and enforcement of urban planning/zoning policies to increase healthier food options 5. Existence and enforcement of policies to ensure free safely managed drinking water is available in all public settings Results and discussion 73 Road safety 1. Existence and enforcement of speed limit legislation for private passenger vehicles 2. Existence and implementation of road design standards that include speed management and safe infrastructure for pedestrians and cyclists 3. Existence and enforcement of legislation on helmet use for two- and three-wheeled motor vehicles including helmet use standards and wearing requirements 4. Existence and enforcement of legislation for seat-belt use Safe walking and cycling 1. Existence of city policy promoting walking 2. Existence of city policy promoting cycling 3. Existence of city policy on access to public open space 4. Existence of city urban planning policy to encourage compact urban design and mixed land use Tobacco control 1. Existence and compliance measurement of smoke free legislation 2. Existence and compliance measurement of bans on advertising, promotion and sponsorship 3. Existence of anti-tobacco mass media campaigns 4. Availability of tobacco cessation services NCD and injury surveillance 1. Adult NCD risk factor surveillance capacity 2. Adult injury risk factor surveillance capacity 3. Access to and use of routine health facility data on alcohol and substance use disorders and tobacco dependencies 4. Access to and use of cause-of-death death data on NCDs and injuries Nascent Developing Advanced 74 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities Obu, Japan City Population: 93 123 (14) Air pollution reduction 1. Air pollution measurement capacity 2. Availability of air quality information and trends 3. Availability of emission estimates 4. Existence and enforcement of air quality standards Alcohol control 1. Existence of comprehensive strategy, plan of action and activities to reduce harmful use of alcohol 2. Existence of policy to restrict commercial and public availability of alcohol 3. Existence of bans or comprehensive restrictions on alcohol advertising, sponsorship and promotion 4. Existence and enforcement of drink-driving legislation 5. Availability of brief intervention and treatment for problematic alcohol use Overdose prevention 1. Availability of key medications for opioid dependence treatment 2. Existence of service governance mechanisms for drug use disorder treatment 3. Availability of non-structured harm reduction services for people with drug use disorders 4. Availability of take-home naloxone at city level Promoting healthy diets 1. Existence and enforcement of policies to restrict marketing of unhealthy foods and non-alcoholic beverages 2. Existence and enforcement of nutrition standards for foods and beverages served and/or sold in public settings 3. Existence and enforcement of policies and programmes to improve healthy eating in restaurants, food outlets or vending machines 4. Existence and enforcement of urban planning/zoning policies to increase healthier food options 5. Existence and enforcement of policies to ensure free safely managed drinking water is available in all public settings Results and discussion 75 Road safety 1. Existence and enforcement of speed limit legislation for private passenger vehicles 2. Existence and implementation of road design standards that include speed management and safe infrastructure for pedestrians and cyclists 3. Existence and enforcement of legislation on helmet use for two- and three-wheeled motor vehicles including helmet use standards and wearing requirements 4. Existence and enforcement of legislation for seat-belt use Safe walking and cycling 1. Existence of city policy promoting walking 2. Existence of city policy promoting cycling 3. Existence of city policy on access to public open space 4. Existence of city urban planning policy to encourage compact urban design and mixed land use Tobacco control 1. Existence and compliance measurement of smoke free legislation 2. Existence and compliance measurement of bans on advertising, promotion and sponsorship 3. Existence of anti-tobacco mass media campaigns 4. Availability of tobacco cessation services NCD and injury surveillance 1. Adult NCD risk factor surveillance capacity 2. Adult injury risk factor surveillance capacity 3. Access to and use of routine health facility data on alcohol and substance use disorders and tobacco dependencies 4. Access to and use of cause-of-death death data on NCDs and injuries Nascent Developing Advanced 76 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities Parañaque, Philippines City Population: 689 992 (8) Air pollution reduction 1. Air pollution measurement capacity 2. Availability of air quality information and trends 3. Availability of emission estimates 4. Existence and enforcement of air quality standards Alcohol control 1. Existence of comprehensive strategy, plan of action and activities to reduce harmful use of alcohol 2. Existence of policy to restrict commercial and public availability of alcohol 3. Existence of bans or comprehensive restrictions on alcohol advertising, sponsorship and promotion 4. Existence and enforcement of drink-driving legislation 5. Availability of brief intervention and treatment for problematic alcohol use Overdose prevention 1. Availability of key medications for opioid dependence treatment 2. Existence of service governance mechanisms for drug use disorder treatment 3. Availability of non-structured harm reduction services for people with drug use disorders 4. Availability of take-home naloxone at city level Promoting healthy diets 1. Existence and enforcement of policies to restrict marketing of unhealthy foods and non-alcoholic beverages 2. Existence and enforcement of nutrition standards for foods and beverages served and/or sold in public settings 3. Existence and enforcement of policies and programmes to improve healthy eating in restaurants, food outlets or vending machines 4. Existence and enforcement of urban planning/zoning policies to increase healthier food options 5. Existence and enforcement of policies to ensure free safely managed drinking water is available in all public settings Results and discussion 77 Road safety 1. Existence and enforcement of speed limit legislation for private passenger vehicles 2. Existence and implementation of road design standards that include speed management and safe infrastructure for pedestrians and cyclists 3. Existence and enforcement of legislation on helmet use for two- and three-wheeled motor vehicles including helmet use standards and wearing requirements 4. Existence and enforcement of legislation for seat-belt use Safe walking and cycling 1. Existence of city policy promoting walking 2. Existence of city policy promoting cycling 3. Existence of city policy on access to public open space 4. Existence of city urban planning policy to encourage compact urban design and mixed land use Tobacco control 1. Existence and compliance measurement of smoke free legislation 2. Existence and compliance measurement of bans on advertising, promotion and sponsorship 3. Existence of anti-tobacco mass media campaigns 4. Availability of tobacco cessation services NCD and injury surveillance 1. Adult NCD risk factor surveillance capacity 2. Adult injury risk factor surveillance capacity 3. Access to and use of routine health facility data on alcohol and substance use disorders and tobacco dependencies 4. Access to and use of cause-of-death death data on NCDs and injuries Nascent Developing Advanced 78 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities Quezon City, Philippines City Population: 2 960 048 (8) Air pollution reduction 1. Air pollution measurement capacity 2. Availability of air quality information and trends 3. Availability of emission estimates 4. Existence and enforcement of air quality standards Alcohol control 1. Existence of comprehensive strategy, plan of action and activities to reduce harmful use of alcohol 2. Existence of policy to restrict commercial and public availability of alcohol 3. Existence of bans or comprehensive restrictions on alcohol advertising, sponsorship and promotion 4. Existence and enforcement of drink-driving legislation 5. Availability of brief intervention and treatment for problematic alcohol use Overdose prevention 1. Availability of key medications for opioid dependence treatment 2. Existence of service governance mechanisms for drug use disorder treatment 3. Availability of non-structured harm reduction services for people with drug use disorders 4. Availability of take-home naloxone at city level Promoting healthy diets 1. Existence and enforcement of policies to restrict marketing of unhealthy foods and non-alcoholic beverages 2. Existence and enforcement of nutrition standards for foods and beverages served and/or sold in public settings 3. Existence and enforcement of policies and programmes to improve healthy eating in restaurants, food outlets or vending machines 4. Existence and enforcement of urban planning/zoning policies to increase healthier food options 5. Existence and enforcement of policies to ensure free safely managed drinking water is available in all public settings Results and discussion 79 Road safety 1. Existence and enforcement of speed limit legislation for private passenger vehicles 2. Existence and implementation of road design standards that include speed management and safe infrastructure for pedestrians and cyclists 3. Existence and enforcement of legislation on helmet use for two- and three-wheeled motor vehicles including helmet use standards and wearing requirements 4. Existence and enforcement of legislation for seat-belt use Safe walking and cycling 1. Existence of city policy promoting walking 2. Existence of city policy promoting cycling 3. Existence of city policy on access to public open space 4. Existence of city urban planning policy to encourage compact urban design and mixed land use Tobacco control 1. Existence and compliance measurement of smoke free legislation 2. Existence and compliance measurement of bans on advertising, promotion and sponsorship 3. Existence of anti-tobacco mass media campaigns 4. Availability of tobacco cessation services NCD and injury surveillance 1. Adult NCD risk factor surveillance capacity 2. Adult injury risk factor surveillance capacity 3. Access to and use of routine health facility data on alcohol and substance use disorders and tobacco dependencies 4. Access to and use of cause-of-death death data on NCDs and injuries Nascent Developing Advanced 80 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities Utrecht, Netherlands (Kingdom of the) City Population: 367 984 (15) Air pollution reduction 1. Air pollution measurement capacity 2. Availability of air quality information and trends 3. Availability of emission estimates 4. Existence and enforcement of air quality standards Alcohol control 1. Existence of comprehensive strategy, plan of action and activities to reduce harmful use of alcohol 2. Existence of policy to restrict commercial and public availability of alcohol 3. Existence of bans or comprehensive restrictions on alcohol advertising, sponsorship and promotion 4. Existence and enforcement of drink-driving legislation 5. Availability of brief intervention and treatment for problematic alcohol use Overdose prevention 1. Availability of key medications for opioid dependence treatment 2. Existence of service governance mechanisms for drug use disorder treatment 3. Availability of non-structured harm reduction services for people with drug use disorders 4. Availability of take-home naloxone at city level Promoting healthy diets 1. Existence and enforcement of policies to restrict marketing of unhealthy foods and non-alcoholic beverages 2. Existence and enforcement of nutrition standards for foods and beverages served and/or sold in public settings 3. Existence and enforcement of policies and programmes to improve healthy eating in restaurants, food outlets or vending machines 4. Existence and enforcement of urban planning/zoning policies to increase healthier food options 5. Existence and enforcement of policies to ensure free safely managed drinking water is available in all public settings Results and discussion 81 Road safety 1. Existence and enforcement of speed limit legislation for private passenger vehicles 2. Existence and implementation of road design standards that include speed management and safe infrastructure for pedestrians and cyclists 3. Existence and enforcement of legislation on helmet use for two- and three-wheeled motor vehicles including helmet use standards and wearing requirements 4. Existence and enforcement of legislation for seat-belt use Safe walking and cycling 1. Existence of city policy promoting walking 2. Existence of city policy promoting cycling 3. Existence of city policy on access to public open space 4. Existence of city urban planning policy to encourage compact urban design and mixed land use Tobacco control 1. Existence and compliance measurement of smoke free legislation 2. Existence and compliance measurement of bans on advertising, promotion and sponsorship 3. Existence of anti-tobacco mass media campaigns 4. Availability of tobacco cessation services NCD and injury surveillance 1. Adult NCD risk factor surveillance capacity 2. Adult injury risk factor surveillance capacity 3. Access to and use of routine health facility data on alcohol and substance use disorders and tobacco dependencies 4. Access to and use of cause-of-death death data on NCDs and injuries Nascent Developing Advanced 82 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities Vancouver, Canada City Population: 725 778 (16) Air pollution reduction 1. Air pollution measurement capacity 2. Availability of air quality information and trends 3. Availability of emission estimates 4. Existence and enforcement of air quality standards Alcohol control 1. Existence of comprehensive strategy, plan of action and activities to reduce harmful use of alcohol 2. Existence of policy to restrict commercial and public availability of alcohol 3. Existence of bans or comprehensive restrictions on alcohol advertising, sponsorship and promotion 4. Existence and enforcement of drink-driving legislation 5. Availability of brief intervention and treatment for problematic alcohol use Overdose prevention 1. Availability of key medications for opioid dependence treatment 2. Existence of service governance mechanisms for drug use disorder treatment 3. Availability of non-structured harm reduction services for people with drug use disorders 4. Availability of take-home naloxone at city level Promoting healthy diets 1. Existence and enforcement of policies to restrict marketing of unhealthy foods and non-alcoholic beverages 2. Existence and enforcement of nutrition standards for foods and beverages served and/or sold in public settings 3. Existence and enforcement of policies and programmes to improve healthy eating in restaurants, food outlets or vending machines 4. Existence and enforcement of urban planning/zoning policies to increase healthier food options 5. Existence and enforcement of policies to ensure free safely managed drinking water is available in all public settings Results and discussion 83 Road safety 1. Existence and enforcement of speed limit legislation for private passenger vehicles 2. Existence and implementation of road design standards that include speed management and safe infrastructure for pedestrians and cyclists 3. Existence and enforcement of legislation on helmet use for two- and three-wheeled motor vehicles including helmet use standards and wearing requirements 4. Existence and enforcement of legislation for seat-belt use Safe walking and cycling 1. Existence of city policy promoting walking 2. Existence of city policy promoting cycling 3. Existence of city policy on access to public open space 4. Existence of city urban planning policy to encourage compact urban design and mixed land use Tobacco control 1. Existence and compliance measurement of smoke free legislation 2. Existence and compliance measurement of bans on advertising, promotion and sponsorship 3. Existence of anti-tobacco mass media campaigns 4. Availability of tobacco cessation services NCD and injury surveillance 1. Adult NCD risk factor surveillance capacity 2. Adult injury risk factor surveillance capacity 3. Access to and use of routine health facility data on alcohol and substance use disorders and tobacco dependencies 4. Access to and use of cause-of-death death data on NCDs and injuries Nascent Developing Advanced 84 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities 4 Conclusion The pilot assessment process was an instrumental step in the finalization and testing of the indicators. Participation from the cities was highly valued and appreciated by technical teams, and provided key insights into the practical application of the indicators, the data collection tool, and the rating criteria. Ultimately, the indicators are intended to facilitate an initial assessment of a city’s status of work on one or more of the eight topics covered. The results of this baseline assessment can also be used to identify areas of improvement, by advancing ratings for particular sub-components, and to monitor progress over time. With global rates of NCDs and injuries on the rise, action to address them is needed from all levels of government. The results of the pilot highlight how cities can play a key role in this by advancing policy development, implementation, enforcement and monitoring, and that many are already doing so. However, as the variation in ratings across the pilot cities demonstrates, these gains and capabilities are not automatic. Whilst the indicators are a starting point for action, cities must continue to be empowered with the political, financial and technical support they need to make positive changes and deliver public health impact. References 85 References 1. World urbanization prospects: The 2018 revision 2022: Summary of results. New York: United Nations, Department of Economic and Social Affairs; 2019 (https://population.un.org/wup/ Publications/Files/WUP2018-Report.pdf, accessed 1 April 2024). 2. World cities report 2022: Envisaging the future of cities. Nairobi: United Nations Human Settlements Programme (UN-Habitat); 2022 (https://unhabitat.org/sites/default/files/2022/06/ wcr_2022.pdf, accessed 1 April 2024). 3. Health topics: Urban health [website]. Geneva: World Health Organization; 2024 (https://www. who.int/health-topics/urban-health#tab=tab_3, accessed 1 April 2024). 4. Urban health: key facts [website]. Geneva: World Health Organization; 2021 (https://www.who. int/news-room/fact-sheets/detail/urban-health, accessed 1 April 2024). 5. The power of cities: tackling noncommunicable diseases and road traffic injuries. Geneva: World Health Organization; 2019 (https://iris.who.int/handle/10665/329429, accessed 1 April 2024). 6. City-level monitoring guidance for the prevention and control of noncommunicable diseases and injuries. Geneva: World Health Organization; 2024 (https://iris.who.int/handle/10665/374874, accessed 1 April 2024). 7. Partnership for Healthy Cities [website]. New York: Vital Strategies; 2024 (https://cities4health. org/, accessed 1 April 2024). 8. Demographic Yearbook 73rd Issue 2022. New York: United Nations Department of Economic and Social Affairs Population Division; 2023 (https://unstats.un.org/unsd/demographic-social/ products/dyb/dybsets/2022.pdf, accessed 22 August 2024). 9. 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Praia: Instituto Nacional de Estatistica; 2015 (https://ine. cv/wp-content/uploads/2017/02/statistical-yearbook-cv-2015_en.pdf, accessed 22 August 2024). 86 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities 14. 2020 Population Census: Basic Complete Tabulation of Population and Households. Tokyo: Ministry of Internal Affairs and Communications; 2021 (https://www.e-stat.go.jp/en/stat-search/files?page=1&layout=datalist&toukei=00200521 &tstat=000001136464&cycle=0&year=20200&month=24101210&tclass1=000001136466, accessed 22 August 2024). 15. Personal records database: Personal data: Population 2023 (BRP). Den Haag: Ministry of the Interior and Kingdom Relations, Government of Netherlands; 2023 (https://www.government. nl/topics/personal-data/personal-records-database-brp, accessed 1 April 2024). 16. British Columbia population estimates: Municipal and subprovincial areas population 2011 to 2023. Victoria: Government of British Columbia; 2024 (https://www2.gov.bc.ca/gov/content/ data/statistics/people-population-community/population/population-estimates, accessed 13 March 2024). 17. World Bank country and lending groups. Washington, DC: The World Bank Group; 2024 (https:// datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending- groups, accessed 18 October 2024). 18. Global Health Observatory. Geneva: World Health Organization; 2024 (https://www.who.int/ data/gho, accessed 1 April 2024). Annex 87 Annex Annex 1. City indicators assessment instrument Modules I. Air pollution reduction II. Alcohol control III. Overdose prevention IV. Promoting healthy diets V. Road safety VI. Safe walking and cycling VII. Tobacco control VIII. Noncommunicable disease and injury surveillance I. Air pollution reduction AP1. Air pollution measurement capacity 1a) Is air pollution monitoring available in at least one populated urban background site in the city? ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, skip to question 2a) 1ai) Please specify which pollutants are monitored in the populated urban background site. Check all that apply. ☐ PM2.5 ☐ PM10 particulate matter ≤10 μm diameter ☐ NO2 ☐ O3 (ozone) ☐ Others, specify ______________________ 1b) Has the monitoring station in the populated urban background site been operational for at least one year? ☐ Yes ☐ No ☐ Don’t know 1c) Are there other air pollution monitoring stations located near industries or roadways? ☐ Yes ☐ No ☐ Don’t know 1d) Is a quality control procedure applied to data before it is finally released? ☐ Yes ☐ No ☐ Don’t know 88 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities 1e) Are the sites reviewed at least every five years to ensure they still meet the objectives of the network and hence are appropriate? ☐ Yes ☐ No ☐ Don’t know 1f) Is there city-level data on air pollution (PM2.5) that is weighted by population density? ☐ Yes ☐ No ☐ Don’t know AP2. Availability of air quality information and trends 2a) Is air quality information publicly available in public reports, on the internet or on information boards in the city centre? ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, skip to 2c) 2b) Is air quality information available as raw and/or aggregated data? ☐ Yes ☐ No ☐ Don’t know 2c) In the last three years, has there been any mass media education and awareness campaign on air pollution? ☐ Yes ☐ No ☐ Don’t know 2d) In the last five years, the city -level trend of air pollution for PM2.5 has been: ☐ Decreasing ☐ Stable ☐ Increasing 2e) Are warnings to the public issued during or before forecasted periods of poor air quality? ☐ Yes ☐ No ☐ Don’t know AP3. Availability of emissions estimates 3a) Have emission inventories for air pollution sources within the city been conducted in the past five years? ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, skip to 4a) 3b) Are there available emission estimates for the following emission sources: 3bi) Residential emissions ☐ Yes ☐ No ☐ Don’t know 3bii) Power-generating facility emissions ☐ Yes ☐ No ☐ Don’t know 3biii) Industrial emissions ☐ Yes ☐ No ☐ Don’t know 3biv) Traffic emissions ☐ Yes ☐ No ☐ Don’t know 3bv) Agricultural emissions ☐ Yes ☐ No ☐ Don’t know Annex 89 AP4. Existence and enforcement of air quality standards 4a) Is the city covered by air quality standards? ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, skip to 4e) 4ai) Please specify at which level the air quality standards are established. Check all that apply. ☐ National ☐ Regional (subnational) ☐ City 4b) Are ambient air quality standards such as limit values for acute effect (i.e. 24hr period) available? ☐ Yes ☐ No ☐ Don’t know 4bi) Please specify which pollutants have limit values for acute effect. Check all that apply. ☐ PM2.5 ☐ PM10 ☐ NO2 ☐ O3 ☐Others, specify _______________________ 4c) Does the city have ambient air quality standards such as limit values for chronic effect (monthly or yearly averaging time)? ☐ Yes ☐ No ☐ Don’t know 4ci) Please specify which pollutants have limit values for acute effect. Check all that apply. ☐ PM2.5 ☐ PM10 ☐ NO2 ☐ O3 ☐Others, specify _______________________ 4d) Are there enforced regulations to ensure compliance with air quality standards (if an area exceeds an air quality standard, are additional measures enforced to control emissions and ensure this is not repeated)? ☐ Yes ☐ No ☐ Don’t know 4e) Are environmental impact assessments conducted before the construction of major new projects such as roads or industrial facilities? ☐ Yes ☐ No ☐ Don’t know 4f) Are additional emission controls imposed on industry, or vehicle use restricted during episodes of particularly poor air quality? ☐ Yes ☐ No ☐ Don’t know 4g) Are there quality norms imposed on solid fuels to be used by households for: 4gi) coal ☐ Yes ☐ No ☐ Don’t know 4gii) wood/biomass ☐ Yes ☐ No ☐ Don’t know AP5. Proportion of population with primary reliance on clean fuels and technologies for cooking 5a) Proportion of people with access to clean fuels and technologies for cooking: _____% 90 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities II. Alcohol control AC1. Existence of a comprehensive strategy, plan of action and activities to reduce harmful use of alcohol 1a) Is there a city-level comprehensive strategy, plan of action and activities to reduce the harmful use of alcohol? ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, skip to 2a) 1b) Is there funding available to reduce the harmful use of alcohol? ☐ Yes ☐ No ☐ Don’t know 1c) Is/are there (a) designated institution(s) with responsibilities for coordinating and following up policies, strategies and plans? ☐ Yes ☐ No ☐ Don’t know 1d) Are there effective awareness programmes about the full range of alcohol-related harm, including harm to others? ☐ Yes ☐ No ☐ Don’t know 1e) Are there effective frameworks and responsible institutions for monitoring, surveillance and evaluation activities including periodic city surveys on alcohol consumption and alcohol-related harm and on an annual basis (at least) reporting back to a broad group of constituents on progress made? ☐ Yes ☐ No ☐ Don’t know AC2. Existence of policy to restrict commercial and public availability of alcohol 2a) Is there a policy/law to restrict commercial and public availability of alcohol? ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, skip to 3a) 2ai) Please specify at which levels the policies/laws are established. Check all that apply. ☐ National ☐ Regional (sub-national) ☐ City 2b) Are the following applicable: 2bi) Licensing of production of beer OR wines OR spirits ☐ Yes ☐ No ☐ Don’t know 2bii) Licensing of sales of beer OR wines OR spirits ☐ Yes ☐ No ☐ Don’t know 2c) Is there a monopoly on production and sale of beer, wines or spirits? ☐ Yes ☐ No ☐ Don’t know 2d) Are there restrictions for on-premises sales of beer or other alcoholic products? ☐ Yes ☐ No ☐ Don’t know Annex 91 2e) Are there restrictions for off-premises sales of beer or other alcoholic products? ☐ Yes ☐ No ☐ Don’t know 2f) Is there a legal minimum age restriction for sale of beer or other alcoholic products? ☐ Yes ☐ No ☐ Don’t know 2g) Are there restrictions on drinking in public places in the following places: 2gi) Healthcare ☐ Yes ☐ No ☐ Don’t know 2gii) Educational institutions ☐ Yes ☐ No ☐ Don’t know 2giii) Government offices ☐ Yes ☐ No ☐ Don’t know 2giv) Public transport ☐ Yes ☐ No ☐ Don’t know 2gv) Parks, streets, beaches etc. ☐ Yes ☐ No ☐ Don’t know 2gvi) Sporting events ☐ Yes ☐ No ☐ Don’t know 2gvii) Leisure events ☐ Yes ☐ No ☐ Don’t know 2gviii) Workplaces ☐ Yes ☐ No ☐ Don’t know 2gix) Religious places ☐ Yes ☐ No ☐ Don’t know 2h) Is there organized quality control on production and distribution of alcoholic beverages? ☐ Yes ☐ No ☐ Don’t know 2i) Are there regulations on informally produced alcohol and attempts to bring it into the taxation system, an efficient control and enforcement system, including tax stamps? ☐ Yes ☐ No ☐ Don’t know 2j) Do local and national authorities cooperate and exchange relevant information on combatting illicit alcohol? ☐ Yes ☐ No ☐ Don’t know AC3. Existence of bans on alcohol advertising, sponsorship, and promotion 3a) Is there a regulatory framework for alcohol marketing? ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, skip to 4a) 3ai) Please specify at which level the regulatory framework is established. Check all that apply. ☐ National ☐ Regional (sub-national) ☐ City 3b) Does it include regulation of content and the volume of marketing? ☐ Yes ☐ No ☐ Don’t know 3c) Does it include regulation of direct and indirect marketing in certain or all traditional media? ☐ Yes ☐ No ☐ Don’t know 3d) Does it include regulation of new forms of alcohol marketing techniques, for instance social media? ☐ Yes ☐ No ☐ Don’t know 3e) Does it include regulation of sponsorship activities that promote alcoholic beverages? ☐ Yes ☐ No ☐ Don’t know 92 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities 3f) Does it include restriction or ban of promotions in connection with activities targeting young people? ☐ Yes ☐ No ☐ Don’t know 3g) Are there public agencies or independent bodies or effective systems of surveillance of marketing of alcohol products? ☐ Yes ☐ No ☐ Don’t know AC4. Existence and enforcement of drink driving legislation 4a) Is there a drink–driving law? Ü If No or Don’t know, skip to 5a) 4ai) Please specify at which level the law is established. Check all that apply. ☐ National ☐ Regional (sub-national) ☐ City 4b) Is there a legal blood alcohol concentration (BAC) for the following: 4bi) General population ☐ Yes ☐ No ☐ Don’t know 4bii) Young/novice drivers ☐ Yes ☐ No ☐ Don’t know 4biii) Professional drivers ☐ Yes ☐ No ☐ Don’t know 4c) Is there breath-testing at specific locations or time? 4ci) Random breath testing ☐ Yes ☐ No ☐ Don’t know Random breath testing is defined as a test given by the police to drivers chosen by chance to measure the amount of alcohol the drivers have. It means that any driver can be stopped by the police at any time to test the breath for alcohol consumption. 4cii) Sobriety checkpoints ☐ Yes ☐ No ☐ Don’t know Sobriety checkpoints means checkpoints or roadblocks established by the police on public roadways to control for drink driving. 4d) Is there graduated licensing for novice drivers with zero tolerance for drink–driving? ☐ Yes ☐ No ☐ Don’t know 4e) Is the use of mandatory ignition interlock imposed by courts to reduce persons from driving intoxicated? ☐ Yes ☐ No ☐ Don’t know 4f) Is there mandatory driver education? ☐ Yes ☐ No ☐ Don’t know 4g) Is there counselling or, as appropriate, treatment programmes for persons found to have violated drink– driving regulations? ☐ Yes ☐ No ☐ Don’t know Annex 93 AC5. Availability of brief intervention and treatment for problematic alcohol use 5a) Are brief intervention and treatment for hazardous drinking and health conditions due to alcohol provided through any of the following facilities/services: 5ai) Antenatal services ☐ Yes ☐ No ☐ Don’t know 5aii) Primary health care services ☐ Yes ☐ No ☐ Don’t know 5aiii) Schools/ educational services ☐ Yes ☐ No ☐ Don’t know 5aiv) Telephone/e-Health services ☐ Yes ☐ No ☐ Don’t know 5av) Web-based services ☐ Yes ☐ No ☐ Don’t know AC6. Access to and use of price data on alcoholic beverages 6a) Does the city have access to and use price data on alcoholic beverages? ☐ Yes ☐ No ☐ Don’t know 6b) Does the city use historical price data on alcoholic beverages with latest estimates available within the past two years, to assess/monitor affordability of the most-sold alcoholic beverages? ☐ Yes ☐ No ☐ Don’t know AC7. Prevalence of heavy episodic drinking in drinkers aged 15 years and over 7a) Proportion of drinkers aged 15 years and over engaging in heavy episodic drinking, defined as having had at least 60 grams of pure alcohol on at least one occasion in the past 30 days: _____% (Drinkers are people who reported having consumed an alcoholic standard drink (10 grams) within the past 12 months). AC8. Age-standardized rates of liver cirrhosis, cancer and traffic crash mortality 8a) Age-standardized death rates for liver cirrhosis (per 100 000): ____ 8b) Age-standardized death rates for traffic crashes (per 100 000): ____ 8c) Age-standardized death rates for cancers likely to have alcohol-attributable fractions (per 100 000): ____ 94 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities III. Overdose prevention OP1. Availability of key medications for opioid dependence treatment 1a) Is there official registration of key medications for the treatment of opioid dependence that includes: 1ai) Methadone ☐ Yes ☐ No ☐ Don’t know 1aii) Buprenorphine (with or without naloxone) ☐ Yes ☐ No ☐ Don’t know 1aiii) Others (extended-release formulations of opioid agonists, oral and injectable opioid agonists, such as diacetylmorphine and hydromorphone) ☐ Yes ☐ No ☐ Don’t know 1aiv) Naltrexone ☐ Yes ☐ No ☐ Don’t know 1av) Alpha-2 adrenergic agonists for management of opioid withdrawal ☐ Yes ☐ No ☐ Don’t know 1b) Are the following available in health facilities in the city: 1bi) Methadone ☐ Yes ☐ No ☐ Don’t know 1bii) Buprenorphine (with or without naloxone) ☐ Yes ☐ No ☐ Don’t know 1biii) Others (extended-release formulations of opioid agonists, oral and injectable opioid agonists, such as diacetylmorphine and hydromorphone) ☐ Yes ☐ No ☐ Don’t know 1biv) Naltrexone ☐ Yes ☐ No ☐ Don’t know 1bv) Alpha-2 adrenergic agonists for management of opioid withdrawal ☐ Yes ☐ No ☐ Don’t know 1c) Are the following used for treatment of opioid use disorders in the city: 1ci) Methadone ☐ Yes ☐ No ☐ Don’t know 1cii) Buprenorphine (with or without naloxone) ☐ Yes ☐ No ☐ Don’t know 1ciii) Others (extended-release formulations of opioid agonists, oral and injectable opioid agonists, such as diacetylmorphine and hydromorphone) ☐ Yes ☐ No ☐ Don’t know 1civ) Naltrexone ☐ Yes ☐ No ☐ Don’t know 1cv) Alpha-2 adrenergic agonists for management of opioid withdrawal ☐ Yes ☐ No ☐ Don’t know OP2. Existence of service governance mechanisms for drug use disorders treatment 2a) Does a government unit or a government official exist that/ who is responsible for a policy regarding the prevention of drug use and the treatment of drug use disorders? ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, skip to 2b) Annex 95 2ai) Please specify at which level the government unit is established. Check all that apply. ☐ National ☐ Regional (sub-national) ☐ City 2b) Does a policy and action plan for service development exist? (Defined as an official statement by a government or health authority that provides the overall direction for health development by defining a vision, values, principles and objectives and by establishing a broad model for action to achieve that vision). ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, skip to 2c) 2bi) Please specify at which level policy and action plan for service development are established. Check all that apply. ☐ National ☐ Regional (sub-national) ☐ City 2c) Do laws or legal regulations that protect people in treatment for substance use disorder exist? (This can include voluntary treatment as an alternative or addition to criminal sanctions and laws/legal regulations that protect the confidentiality of people in treatment for drug use disorders). ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, skip to 3a) 2ci) Please specify at which level the laws or legal regulations are established. Check all that apply. ☐ National ☐ Regional (sub-national) ☐ City OP3. Availability of non-structured (harm reduction) services for people with drug use disorders 3a) Are non-structured harm reduction services for people with drug use and drug use disorders available in the city? ☐ Yes ☐ No ☐ Don’t know 3b) Are the following non-structured harm reduction services available: 3bi) Low-threshold community outreach services ☐ Yes ☐ No ☐ Don’t know 3bii) Drop-in services/centres ☐ Yes ☐ No ☐ Don’t know 3biii) Testing and counselling for infectious diseases (e.g. HIV, hepatitis, TB and STI) at low-threshold community programmes ☐ Yes ☐ No ☐ Don’t know 3biv) Mutual help/peer support groups for people with drug use disorders ☐ Yes ☐ No ☐ Don’t know 96 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities 3bv) Open-access interventions (e.g. telephone, helplines, web-based interventions, mobile phone-based interventions) ☐ Yes ☐ No ☐ Don’t know 3bvi) Supervised injection sites ☐ Yes ☐ No ☐ Don’t know 3bvii) Needle exchange programme for injecting drug users ☐ Yes ☐ No ☐ Don’t know OP4. Availability of naloxone 4a) Can take-home naloxone be obtained within the city? ☐ Yes ☐ No ☐ Don’t know 4b) Is it available at no cost regardless of insurance and residence status at: 4bi) Low-threshold/community outreach services ☐ Yes ☐ No ☐ Don’t know 4bii) Drop-in services/centres ☐ Yes ☐ No ☐ Don’t know 4biii) Opioid use disorders treatment facilities ☐ Yes ☐ No ☐ Don’t know 4biv) Pharmacies ☐ Yes ☐ No ☐ Don’t know 4bv) Medical facilities/emergency medical services/ primary health care providers ☐ Yes ☐ No ☐ Don’t know 4biv) Housing/shelters ☐ Yes ☐ No ☐ Don’t know 4bvii) Prisons ☐ Yes ☐ No ☐ Don’t know 4bviii) Supervised injection facilities ☐ Yes ☐ No ☐ Don’t know OP5. Availability of programmes on primary prevention of drug use 5a) Are there existing programmes for the primary prevention of drug use in the city? ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, skip to 6a) 5b) Are the following primary prevention activities included in the existing programmes: 5bi) Mass media campaigns ☐ Yes ☐ No ☐ Don’t know 5bii) School-based programmes ☐ Yes ☐ No ☐ Don’t know 5biii) Workplace programmes ☐ Yes ☐ No ☐ Don’t know 5biv) Parental programmes ☐ Yes ☐ No ☐ Don’t know 5bv) Community-based programmes ☐ Yes ☐ No ☐ Don’t know 5c) Is there an allocated budget for the existing programmes for primary prevention of drug use? ☐ Yes ☐ No ☐ Don’t know OP6. Service capacity for drug use disorders treatment 6a) Are there drug use disorder treatments provided within the city free of charge through public sector or through basic insurance package? ☐ Yes ☐ No ☐ Don’t know Ü If No or Don't know, skip to 7a) Annex 97 6b) Are the following key interventions included in the treatment of drug use disorder: 6bi) Screening, brief intervention, and referral to treatment ☐ Yes ☐ No ☐ Don’t know 6bii) Pharmacological treatment ☐ Yes ☐ No ☐ Don’t know 6biii) Psychosocial treatment ☐ Yes ☐ No ☐ Don’t know 6biv) Rehabilitation ☐ Yes ☐ No ☐ Don’t know Ü If 6bi is No or Don’t know, skip to 6d) 6c) Are the following components covered under screening, brief intervention, and referral to treatment interventions: 6ci) Substance use screening tools ☐ Yes ☐ No ☐ Don’t know 6cii) Screening in specialized services with expected high prevalence of substance use among patients and clients (e.g. mental health, infectious diseases) ☐ Yes ☐ No ☐ Don’t know 6ciii) Brief interventions to patients and clients screened positively ☐ Yes ☐ No ☐ Don’t know 6civ) Referral to other treatment modalities ☐ Yes ☐ No ☐ Don’t know 6cv) screening, brief intervention, and referral to treatment for special populations (such as emergency health services/trauma centres/ services for children and adolescents, in antenatal services, in employee assistance programmes) ☐ Yes ☐ No ☐ Don’t know Ü If 6bii is No or Don’t know, skip to 6e) 6d) Are the following components covered under pharmacological treatments: 6di) Pharmacological treatment of substance-related emergency conditions (excluding withdrawal syndrome) ☐ Yes ☐ No ☐ Don’t know 6dii) Pharmacological treatment of withdrawal syndrome ☐ Yes ☐ No ☐ Don’t know 6diii) Opioid agonist maintenance treatment for opioid dependence (with methadone and/or buprenorphine) ☐ Yes ☐ No ☐ Don’t know 6div) Pharmacological treatment other than opioid agonist maintenance treatment for substance dependence (naltrexone) ☐ Yes ☐ No ☐ Don’t know 6dv) Pharmacological treatment of co-morbid conditions (physical and mental health) ☐ Yes ☐ No ☐ Don’t know Ü If 6biii is No or Don’t know, skip to 6f) 6e) Are the following components covered under psychosocial treatment: 6ei) Psychoeducation for patients with substance use disorders ☐ Yes ☐ No ☐ Don’t know 98 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities 6eii) Cognitive behavioural therapy (CBT) for patients with substance use disorders ☐ Yes ☐ No ☐ Don’t know 6eiii) Motivational enhancement therapy/motivational interviewing for patients with substance use disorders ☐ Yes ☐ No ☐ Don’t know 6eiv) Family/couples therapy for patients with substance use disorders ☐ Yes ☐ No ☐ Don’t know 6ev) Contingency management (CM) approach for patients with substance use disorders ☐ Yes ☐ No ☐ Don’t know 6evi) Twelve-step approach ☐ Yes ☐ No ☐ Don’t know Ü If 6biv is No or Don’t know, skip to 7a) 6f) Are the following components covered under rehabilitation: 6fi) Rehabilitation in-patient programmes ☐ Yes ☐ No ☐ Don’t know 6fii) Rehabilitation out-patient programmes ☐ Yes ☐ No ☐ Don’t know 6fiii) Education programmes for people with substance use disorders ☐ Yes ☐ No ☐ Don’t know 6fiv) Employment assistance programmes for people with substance use disorders ☐ Yes ☐ No ☐ Don’t know 6fv) Special housing services for people with substance use disorders ☐ Yes ☐ No ☐ Don’t know 6fvi) Welfare assistance/benefits for people with substance use disorders ☐ Yes ☐ No ☐ Don’t know OP7. Availability of drug use disorder treatment in prisons 7a) Is opioid agonist maintenance treatment available in prison? ☐ Yes ☐ No ☐ Don’t know 7b) Is opioid agonist maintenance treatment available upon release from prison? ☐ Yes ☐ No ☐ Don’t know OP8. Coverage of drug use disorders treatment 8a) Coverage of drug use disorders treatment (the number of people who received treatment in a year divided by the total number of people with drug use disorders in the same year, multiplied by 100%): ______ OP9. Opioid overdose mortality rate 9a) Opioid overdose morality rate per 100 000: _______ Annex 99 IV. Promoting healthy diets HD1. Existence and enforcement of policies to restrict marketing of unhealthy foods and non-alcoholic beverages 1a) Is there an existing policy to restrict both exposure to and power of marketing of unhealthy foods and beverages? ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, skip to 2a) 1ai) Please specify at which level the policy is established. Check all that apply. ☐ National ☐ Regional (sub-national) ☐ City 1b) Does the policy cover food and non-alcoholic beverages that are high in these nutrients and/or energy: 1bi) Sugars ☐ Yes ☐ No ☐ Don’t know 1bii) Salt/sodium ☐ Yes ☐ No ☐ Don’t know 1biii) Total fat ☐ Yes ☐ No ☐ Don’t know 1biv) Saturated fats ☐ Yes ☐ No ☐ Don’t know 1bv) Trans fats ☐ Yes ☐ No ☐ Don’t know 1bvi) Energy ☐ Yes ☐ No ☐ Don’t know 1c) Does the policy protect children up to the age of 18 years? ☐ Yes ☐ No ☐ Don’t know 1d) Is it being monitored and enforced (i.e. through monitoring the marketing practices of foods and non-alcoholic beverages including used channels and techniques, and imposing sanctions in case of breaches)? ☐ Yes ☐ No ☐ Don’t know HD2. Existence and enforcement of nutrition standards for foods and beverages served and/or sold in public settings 2a) Are there existing nutrition standards for foods and beverages served and/or sold in public settings as well as in close proximity of where children gather? ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, skip to 3a) 2ai) Please specify at which level the nutrition standards are established. Check all that apply. ☐ National ☐ Regional (sub-national) ☐ City 100 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities 2b) Do these standards cover key nutrients of concern or food that is typically high in the following key nutrients: 2bi) Sugars ☐ Yes ☐ No ☐ Don’t know 2bii) Sodium ☐ Yes ☐ No ☐ Don’t know 2biii) Total fat ☐ Yes ☐ No ☐ Don’t know 2biv) Saturated fats ☐ Yes ☐ No ☐ Don’t know 2bv) Trans fats ☐ Yes ☐ No ☐ Don’t know 2bvi) Energy ☐ Yes ☐ No ☐ Don’t know 2c) Do these standards apply to all categories of foods and beverages? ☐ Yes ☐ No ☐ Don’t know 2d) Do the standards apply to following: 2di) Foods and beverages served/sold in school canteens ☐ Yes ☐ No ☐ Don’t know 2dii) Foods and beverages served/sold at events ☐ Yes ☐ No ☐ Don’t know 2diii) Foods and beverages served/sold at school kiosks ☐ Yes ☐ No ☐ Don’t know 2div) Foods and beverages brought from home to schools ☐ Yes ☐ No ☐ Don’t know 2e) Are there standards for foods served or sold in the following settings: 2ei) Childcare sites ☐ Yes ☐ No ☐ Don’t know 2eii) Hospitals and caring homes ☐ Yes ☐ No ☐ Don’t know 2eiii) Workplaces ☐ Yes ☐ No ☐ Don’t know 2eiv) Government workplaces ☐ Yes ☐ No ☐ Don’t know 2ev) Military bases ☐ Yes ☐ No ☐ Don’t know 2evi) Prisons ☐ Yes ☐ No ☐ Don’t know 2evii) Universities ☐ Yes ☐ No ☐ Don’t know 2eviii) Other, specify ____________ 2f) Is it being monitored and enforced (i.e. through related activities monitoring the types of foods and beverages served or sold in public settings and imposing sanctions in case of breaches)? ☐ Yes ☐ No ☐ Don’t know HD3. Existence and enforcement of policies or programmes to improve healthy eating in restaurants, food outlets or vending machines 3a) Are there existing policies and programmes to improve the healthiness of foods and beverages being sold and served at restaurants and other food outlets? ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, skip to 4a) Annex 101 3ai) Please specify at which level the policies and programmes are established. Check all that apply. ☐ National ☐ Regional (sub-national) ☐ City 3b) Does the policy cover specific measures including: 3bi) Menu labelling ☐ Yes ☐ No ☐ Don’t know 3bii) Product placement in the service area ☐ Yes ☐ No ☐ Don’t know 3biii) Reduced pricing of healthy food/increased pricing of unhealthy food ☐ Yes ☐ No ☐ Don’t know 3biv) Marketing restrictions in the restaurant (including promotions, give aways etc.) ☐ Yes ☐ No ☐ Don’t know 3bv) Ban on placing salt-shakers or sugar sachets in service areas or on tables ☐ Yes ☐ No ☐ Don’t know 3bvi) Controlling portion sizes ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know for 3bi), skip to 3d) 3c) Does the menu labelling target nutrients of concern or food that is typically high in these key nutrients of concern: 3ci) Sugars ☐ Yes ☐ No ☐ Don’t know 3cii) Sodium ☐ Yes ☐ No ☐ Don’t know 3ciii) Total fat ☐ Yes ☐ No ☐ Don’t know 3civ) Saturated fats ☐ Yes ☐ No ☐ Don’t know 3cv) Trans fats ☐ Yes ☐ No ☐ Don’t know 3cvi) Energy ☐ Yes ☐ No ☐ Don’t know 3d) Is the policy being monitored and enforced (i.e. through monitoring the types of foods and beverages being sold and served at restaurants and other food outlets, and imposing sanctions in case of breaches)? ☐ Yes ☐ No ☐ Don’t know HD4. Existence and enforcement of urban planning/zoning policies designed to increase the availability of healthier foods and beverages 4a) Are there existing policies designed to limit the density of food outlets selling predominantly unhealthy foods and beverages compared to outlets selling predominantly healthy foods and beverages? ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, skip to 5a) 4ai) Please specify at which level the policies are established. Check all that apply. ☐ National ☐ Regional (sub-national) ☐ City 102 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities 4b) Does the policy cover specific measures such as: 4bi) Restricting the density of outlets that sell unhealthy food and beverages ☐ Yes ☐ No ☐ Don’t know 4bii) Encouraging the establishment of outlets that sell fresh fruit and vegetables ☐ Yes ☐ No ☐ Don’t know 4c) Does the policy cover the following places where children gather: 4ci) Areas near childcare sites ☐ Yes ☐ No ☐ Don’t know 4cii) Areas near school ☐ Yes ☐ No ☐ Don’t know 4d) Does the policy cover low-income communities? ☐ Yes ☐ No ☐ Don’t know 4e) Is the policy being monitored and enforced (i.e. through monitoring the outlets selling predominantly healthy and unhealthy foods and beverages, and imposing sanctions in case of breaches)? ☐ Yes ☐ No ☐ Don’t know HD5. Existence and enforcement of policies that ensure free safely managed drinking-water is available in all public settings 5a) Is there existing policy or legislation that ensures free safely managed drinking-water is available in all public settings? Ü If No or Don’t know, skip to 6a) 5ai) Please specify at which level the policy or legislation is established. Check all that apply. ☐ National ☐ Regional (sub-national) ☐ City 5b) Does the policy provide access to free safely managed drinking-water in public settings? ☐ Yes ☐ No ☐ Don’t know 5c) Does the policy ensure availability of safely managed drinking-water in public settings all year round? ☐ Yes ☐ No ☐ Don’t know 5d) Does the policy apply to the following public settings: 5di) Childcare sites ☐ Yes ☐ No ☐ Don’t know 5dii) Schools ☐ Yes ☐ No ☐ Don’t know 5diii) Hospital ☐ Yes ☐ No ☐ Don’t know 5div) Workplaces ☐ Yes ☐ No ☐ Don’t know 5dv) Near childcare sites ☐ Yes ☐ No ☐ Don’t know 5dvi) Near schools ☐ Yes ☐ No ☐ Don’t know Annex 103 5e) Is the policy being monitored and enforced (i.e. through monitoring that safe drinking-water is freely available in public settings and adheres to nutrition criteria of the policy and imposing sanctions in case of breaches)? ☐ Yes ☐ No ☐ Don’t know HD6. Access to and use of sugar-sweetened beverages price data 6a) Does the city have access to and use price data on sugar- sweetened beverages? ☐ Yes ☐ No ☐ Don’t know 6b) Does the city use historical price data on sugar-sweetened beverages with latest estimates available within the past two years? 6c) Does the city use historical price data on sugar-sweetened beverages with latest estimates available within the past two years, to assess/monitor affordability of the following beverage product types: 6ci) Carbonated soft drinks ☐ Yes ☐ No ☐ Don’t know 6cii) Energy or sport drinks ☐ Yes ☐ No ☐ Don’t know 6ciii) 100% fruit or vegetable juices ☐ Yes ☐ No ☐ Don’t know 6civ) Fruit or vegetable drinks that are not 100% juice ☐ Yes ☐ No ☐ Don’t know 6cv) Syrups and concentrates containing sugars ☐ Yes ☐ No ☐ Don’t know 6cvi) Sugar-sweetened flavoured waters ☐ Yes ☐ No ☐ Don’t know 6cvii) Other, specify __________________ HD7. Mean population salt intake 7) Age-standardized mean population intake of salt (sodium chloride) per day in grams in persons aged 18+ years: _______ HD8. Prevalence of low fruit and vegetable intake 8) Age-standardized prevalence of persons consuming less than five total servings (400grams) of fruit and vegetables per day: ________ HD9. Prevalence of overweight and obesity in adolescents and adults 9a) Prevalence of overweight in adolescents (10–19 years of age %): _______ 9b) Prevalence of obesity in adolescents (10–19 years of age %):_______ 9c) Prevalence of overweight in adults (≥18 years of age %): _______ 9d) Prevalence of obesity in adults (≥18 years of age %): _______ 104 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities V. Road safety RS1. Existence of speed limit legislation enforcing speed limits for motorized passenger vehicles 1a) Is there existing legislation on speed limit for private motorized vehicles? ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, skip to 2a) 1ai) Please specify at which level the legislation is established. Check all that apply. ☐ National ☐ Regional (sub-national) ☐ City 1ai) Does it limit speeds to 30km/h (20 mph) in areas where vulnerable road users and vehicles mix in a frequent and planned manner? ☐ Yes ☐ No ☐ Don’t know 1aii) Does it limit speeds to 50km/h (30 mph) in urban areas? ☐ Yes ☐ No ☐ Don’t know 1b) Is the speed limit legislation enforced in the city? ☐ Yes ☐ No ☐ Don’t know 1c) Are the following enforcement mechanisms implemented: 1ci) Police officers carrying speedometers ☐ Yes ☐ No ☐ Don’t know 1cii) Automatic detection systems (e.g. cameras) ☐ Yes ☐ No ☐ Don’t know 1ciii) Speed limiters, at least in certain vehicles (e.g. trucks, buses) ☐ Yes ☐ No ☐ Don’t know 1civ) Infrastructure modifications (e.g. speed, roundabouts, cobble streets) ☐ Yes ☐ No ☐ Don’t know 1cv) Geofencing ☐ Yes ☐ No ☐ Don’t know 1cvi) New vehicles are required to have intelligent speed assistance systems to help drivers ☐ Yes ☐ No ☐ Don’t know 1cvii) Other, specify ___________ RS2. Existence and implementation of road design standards that include speed management and safe infrastructure for pedestrians and cyclists 2a) Does the city have technical design standards that are required to be met in the development of new roads that account for the safety of all road users? ☐ Yes ☐ No ☐ Don’t know 2b) On roads where pedestrians and cyclists are present, do design standards provide for: 2bi) Managing speed to safe system outcomes (e.g. 20 mph or 30 km/h) ☐ Yes ☐ No ☐ Don’t know 2bii) Safe crossings for pedestrians and cyclists ☐ Yes ☐ No ☐ Don’t know Annex 105 2biii) Separation of pedestrians and cyclists from vehicular traffic ☐ Yes ☐ No ☐ Don’t know 2c) Are road design standards/guidelines implemented in the city? ☐ Yes ☐ No ☐ Don’t know 2d) Which source types are evidence of implementation in the city? Check all that apply. ☐ Observational study ☐ Police report ☐ Research survey ☐ Population representative survey ☐ Other, specify _______ RS3. Existence of legislation on helmet use for two- and three-wheeled motor vehicles including helmet use standards and wearing requirements 3a) Is there existing legislation requiring helmet use among users of motorcycles? ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, skip to 4a) 3ai) Please specify at which level the legislation is established. Check all that apply. ☐ National ☐ Regional (sub-national) ☐ City 3b) Does the legislation meet international harmonized standards? (e.g. UN standard ECE 22.05) ☐ Yes ☐ No ☐ Don’t know 3c) Does the legislation cover the below components: 3ci) Requirement of drivers and passengers to wear a helmet on all roads ☐ Yes ☐ No ☐ Don’t know 3cii) Specification that helmets should be fastened ☐ Yes ☐ No ☐ Don’t know 3ciii) A reference to a helmet standard ☐ Yes ☐ No ☐ Don’t know 3d) Is helmet use legislation enforced in the city? ☐ Yes ☐ No ☐ Don’t know 3e) Which source types are evidence of enforcement in the city? Check all that apply. ☐ Observational study ☐ Police report ☐ Research survey ☐ Population representative survey ☐ Other, specify _______ 106 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities RS4. Existence and enforcement of legislation for seat-belt use 4a) Is there existing legislation requiring seat-belt use? ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, skip to 5a) 4ai) Please specify at which level the legislation is established. Check all that apply. ☐ National ☐ Regional (sub-national) ☐ City 4b) Is the legislation regarding seat-belts available in the following: ☐ Only driver’s seats ☐ Only front seats ☐ All seats in vehicle 4c) Does the legislation include seat-belt standards? ☐ Yes ☐ No ☐ Don’t know 4d) Is seat-belt legislation enforced in the city? ☐ Yes ☐ No ☐ Don’t know 4e) Which source types are evidence of enforcement in the city? Check all that apply. ☐ Observational study ☐ Police report ☐ Research survey ☐ Population representative survey ☐ Other, specify: _______ RS5. Prevalence of helmet use among all motorized vehicle users (i.e. drivers, passengers, motorbikes, bikes) 5) Prevalence of helmet use among all motorized vehicle users (%): ______ RS6. Prevalence of seat-belt use in all seating positions 6) Prevalence of seat-belt use in all seating positions (%): ______ RS7. Prevalence of road traffic deaths per 100 000 7) Prevalence of road traffic deaths per 100 000: _______ Annex 107 VI. Safe walking and cycling WC1. Existence of city policy promoting walking 1a) Is there a city policy/strategy/action plan that sets the agenda for promoting walking? ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, skip to 2a) 1b) Does it include actions to improve, extend and/or enhance provision of walking infrastructure (e.g. footpaths quality, quantity, pedestrian crossing, street furniture, other pedestrian safety measures)? ☐ Yes ☐ No ☐ Don’t know 1c) Is there a designated institution with responsibilities for coordinating and following up policies, strategies and plans? ☐ Yes ☐ No ☐ Don’t know 1d) Is there a dedicated budget line to support implementation? ☐ Yes ☐ No ☐ Don’t know 1e) Is there a monitoring framework to assess progress and implementation? ☐ Yes ☐ No ☐ Don’t know WC2. Existence of city policy promoting cycling 2a) Is there a policy/strategy/action plan that promotes cycling? Ü If No or Don’t know, skip to 3a) 2ai) IF YES to 1a) and 2a) items: Are there separate policy documents for walking and for cycling? ☐ Yes ☐ No ☐ Don’t know 2b) Does it include actions aimed at improving and/or extending provision of cycling infrastructure (e.g. cycle lanes, measures to improve cycle safety, provision of facilities such as bike storage)? ☐ Yes ☐ No ☐ Don’t know 2c) Is there a designated institution with responsibilities for coordinating and following up policies, strategies and plans? ☐ Yes ☐ No ☐ Don’t know 2d) Is there a dedicated budget line to support implementation? ☐ Yes ☐ No ☐ Don’t know 2e) Is there a monitoring framework to assess progress and implementation? ☐ Yes ☐ No ☐ Don’t know WC3. Existence of city policy on access to public open space 3a) Is there a policy/strategy/plan on the provision of public open space in the city boundary? ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, skip to 4a) 108 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities 3b) Is there a dedicated budget line to support policy implementation? ☐ Yes ☐ No ☐ Don’t know 3c) Does it include actions to enhance the provision of public open space (e.g. maintenance, improve park amenities and facilities, increase park safety)? ☐ Yes ☐ No ☐ Don’t know 3d) Is there a designated institution with responsibilities for coordinating and following up policies, strategies, and plans? ☐ Yes ☐ No ☐ Don’t know 3e) Is there a set target for increasing areas and access to public open space? ☐ Yes ☐ No ☐ Don’t know 3f) Is the city measuring the amount of, and access to, public open space? ☐ Yes ☐ No ☐ Don’t know WC4. Existence of city urban planning policy that encourages compact urban design and mixed land use 4a) Is there a policy/strategy/plan for urban development and/ or land use in the city? ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, skip to 5a 4b) Does it prioritize urban planning that aims to deliver compact mixed land use neighbourhoods? ☐ Yes ☐ No ☐ Don’t know WC5. Implementation of walking and cycling campaigns and promotion 5a) Has the city implemented any city-wide mass media public education campaign on walking or cycling within the past two years? (A campaign would include messages on walking and or cycling and use at least one mass media channels such as TV, Radio, newspapers, or digital such as websites or social media). ☐ Yes ☐ No ☐ Don’t know 5b) Has the city implemented any mass participation walking or cycling events to encourage participation by the general public within the past two years? (This refers to large community-based, events and are offered free. It can include, for example, celebration of international days of walking, cycling or physical activity, national care-free days, but does NOT include hosting of competitive walking, running or cycling events such as marathons unless there is clear provision of free access to participate in shorter distances and or provision of non-competitive activities). ☐ Yes ☐ No ☐ Don’t know Annex 109 WC6. Implementation of city surveys on knowledge and awareness on cycling and walking 6a) Has the city conducted any knowledge and awareness surveys which assesses the level of cycling and walking? ☐ Yes ☐ No ☐ Don’t know 6b) Has the city conducted any survey to assess community perceptions on walking and cycling (e.g. community perception of safety, amenities, etc.)? ☐ Yes ☐ No ☐ Don’t know 110 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities VII. Tobacco control TC1. Existence and compliance measurement of smoke-free legislation 1a) Is there legislation to eliminate exposure to second-hand tobacco smoke in all indoor workplaces, public places and public transport? ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, skip to 2a) 1ai) Please specify at which level the legislation is established. Check all that apply. ☐ National ☐ Regional (sub-national) ☐ City 1b) Does the city measure compliance of the legislation? ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, skip to 2a) 1bi) How often is compliance measured? ________ TC2. Existence and compliance measurement of bans on advertising, promotion and sponsorship 2a) Is there legislation that comprehensively bans tobacco advertising, promotion, and sponsorship? ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, skip to 3a) 2ai) Please specify at which level the legislation is established. Check all that apply. ☐ National ☐ Regional (sub-national) ☐ City 2b) Does the city routinely measure compliance of tobacco advertising, promotion and sponsorship? ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, skip to 3a) 2bi) How often is compliance measured? ________ TC3. Implementation of anti-tobacco mass media campaigns 3a) Has there been an anti-tobacco mass-media campaign implemented in the city? ☐ Yes ☐ No ☐ Don’t know 3b) Was a campaign conducted within the past three years with a duration of at least three weeks? ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, skip to 4a) Annex 111 3bi) Please specify at which level the was the campaign conducted. Check all that apply. ☐ National ☐ Regional (sub-national) ☐ City 3c) Did the campaign include the following characteristics: 3ci) The campaign was part of a comprehensive tobacco control programme ☐ Yes ☐ No ☐ Don’t know 3cii) Before the campaign, research was undertaken or reviewed to gain a thorough understanding of the target audience ☐ Yes ☐ No ☐ Don’t know 3ciii) Campaign communication materials were pre-tested with the target audience and refined in line with campaign objectives ☐ Yes ☐ No ☐ Don’t know 3civ) The implementing agency worked with journalists to gain publicity or news coverage for the campaign ☐ Yes ☐ No ☐ Don’t know 3cv) Process evaluation was undertaken to assess how effectively the campaign had been implemented ☐ Yes ☐ No ☐ Don’t know 3cvi) An outcome evaluation process was implemented to assess campaign impact ☐ Yes ☐ No ☐ Don’t know TC4. Availability of tobacco cessation services 4a) Is there a policy to promote cessation of tobacco use and provide treatment for tobacco cessation? ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, skip to 5a) 4ai) Please specify at which level the policy is established. Check all that apply. ☐ National ☐ Regional (sub-national) ☐ City 4b) Are the following programmes implemented and available: 4bi) Tobacco cessation advice incorporated into primary and routine health care services ☐ Yes ☐ No ☐ Don’t know 4bii) Easily accessible and free telephone help lines (known as ‘quit lines’) ☐ Yes ☐ No ☐ Don’t know 4biii) Free and low-cost cessation medicines including nicotine replacement therapy ☐ Yes ☐ No ☐ Don’t know 112 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities 4c) Are the following public places covered: 4ci) Health clinics or other primary care facilities ☐ Yes ☐ No ☐ Don’t know 4cii) Hospitals ☐ Yes ☐ No ☐ Don’t know 4ciii) Office of a health professional ☐ Yes ☐ No ☐ Don’t know 4civ) Community settings ☐ Yes ☐ No ☐ Don’t know 4d) Are availability and/or accessibility to these services in the city monitored? ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, skip to 5a) 4di) How often are availability and/or accessibility to these services monitored? ________ TC5. Access to and use of tobacco price data 5a) Does the city have access to and use tobacco price data? ☐ Yes ☐ No ☐ Don’t know 5b) Does the city use historical tobacco price data with latest estimates available within the past two years, to assess/ monitor affordability of the most-sold alcoholic beverages? ☐ Yes ☐ No ☐ Don’t know TC6. Prevalence of tobacco use in adults 6a) Population aged 18 years and over who currently use any tobacco product (smoked and/or smokeless tobacco) on a daily or non-daily basis (%): _____ Annex 113 VIII. Noncommunicable disease (NCD) and injury surveillance S1. Adult NCD risk factor surveillance capacity 1a) Was a comprehensive city level survey (or wider survey with usable city-level results) conducted on adult NCD risk factors? ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, skip to 2a) 1b) When was the survey conducted? ☐ Within the past five years ☐ Five to ten years ago ☐ More than ten years ago 1c) Did the survey capture data on the following risk factors: 1ci) Alcohol use ☐ Yes ☐ No ☐ Don’t know 1cii) Fruit and vegetable intake ☐ Yes ☐ No ☐ Don’t know 1ciii) Overweight and obesity ☐ Yes ☐ No ☐ Don’t know 1civ) Physical inactivity: walking and cycling ☐ Yes ☐ No ☐ Don’t know 1cv) Salt/sodium intake ☐ Yes ☐ No ☐ Don’t know 1cvi) Tobacco use ☐ Yes ☐ No ☐ Don’t know S2. Adult injury risk factor surveillance capacity 2a) Was a city-level survey (or wider survey with usable city- level results) conducted on adult injury risk factors? ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, skip to 3a) 2b) When was the survey conducted? ☐ Within the past five years ☐ Five to ten years ago ☐ More than ten years ago 2c) Did the survey capture data on the following injury risk factors: 2ci) Drink-driving ☐ Yes ☐ No ☐ Don’t know 2cii) Driving beyond the speed limit ☐ Yes ☐ No ☐ Don’t know 2ciii) Helmet use ☐ Yes ☐ No ☐ Don’t know 2civ) Seat-belt use ☐ Yes ☐ No ☐ Don’t know 114 Monitoring noncommunicable diseases and injuries: pilot assessment in 20 cities S3. Adolescent NCD risk factor surveillance capacity 3a) Was a city level survey (or wider survey with usable city- level results) conducted on adolescent NCD risk factors? ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, skip to 4a) 3b) When was the survey conducted? ☐ Within the past five years ☐ Five to ten years ago ☐ More than ten years ago 3c) Did the survey capture data on the following risk factors: 3ci) Alcohol use ☐ Yes ☐ No ☐ Don’t know 3cii) Fruit and vegetable intake ☐ Yes ☐ No ☐ Don’t know 3ciii) Overweight and obesity ☐ Yes ☐ No ☐ Don’t know 3civ) Physical inactivity: walking and cycling ☐ Yes ☐ No ☐ Don’t know 3cv) Tobacco use ☐ Yes ☐ No ☐ Don’t know S4. Child NCD risk factor surveillance capacity 4a) Was a city-level survey (or wider survey with usable city- level results) conducted on child NCD risk factors? ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, skip to 5a) 4b) When was the survey conducted? ☐ Within the past five years ☐ Five to ten years ago ☐ More than ten years ago 4c) Did the survey capture data on the following risk factors: 4ci) Overweight and obesity ☐ Yes ☐ No ☐ Don’t know 4cii) Physical inactivity: walking and cycling ☐ Yes ☐ No ☐ Don’t know S5. Access to and use of routine health facility data on alcohol and substance use disorders and tobacco dependencies 5a) Does the city have access to statistics from a routine health facility reporting system? ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, skip to 6a) Annex 115 5b) Does the city report/use health facility statistics on the following: 5bi) Alcohol use disorder treatment ☐ Yes ☐ No ☐ Don’t know 5bii) Drug use disorder treatment ☐ Yes ☐ No ☐ Don’t know 5biii) Tobacco dependence treatment ☐ Yes ☐ No ☐ Don’t know 5c) How recent are the statistics reported/used by the city? ☐ Within the past two years ☐ Two to five years ago ☐ More than five years ago S6. Cause-of-death certification and reporting system 6a) Does the city have access to data generated from police reports, coroner inquest reports or vital registration systems, with cause-of-death statistics? ☐ Yes ☐ No ☐ Don’t know Ü If No or Don’t know, end of questionnaire. 6b) Does the city use NCD and injury mortality statistics from vital registration systems with medical certification of cause- of-death that are compliant with International Classification of Diseases coding, to inform their progress on NCD and injury prevention work? ☐ Yes ☐ No ☐ Don’t know 6c) How recent are the mortality statistics used by the city? ☐ Within the past two years ☐ Two to five years ago ☐ More than five years ago

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Organisation Organisation mondiale de la santé (OMS)

Type de document Publications

Date October 28, 2024

Source who_document