© World Health Organization [2004] Cambridge International Health Leadership Programme; April, 25 th 2004 WHO long-term strategy for prevention and control

WHO long-term strategy for prevention and controlof leading chronic diseasesDerek Yach Representative of the Director-General World Health Organization

Scope and approachExclude mental health (except in relation to co-morbidity) and injuries

Include mainly 4 big killers-CVD, cancer, chronic respiratory disease and diabetes, and 3 major risks-tobacco, diet and physical activity

Current health impact...

Leading causes of mortalityfor adults, 2002 5823469223991398929754735606496478HIV/AIDS Ischaemic heart diseaseTuberculosisRoad traffic accidentsCerebrovascular diseaseSelf-inflicted injuriesViolenceCirrhosis of the liverLower respiratory infectionsChronic obstruc. pulmonary diseaseIschaemic heart diseaseCerebrovascular diseaseChronic obstruc. pulmonary diseaseLower respiratory infectionsTrachea, bronchus, lung cancersDiabetes mellitusHypertensive heart diseaseStomach cancerTuberculosisColon and rectal cancers1559 60 and overSource: WHO, WHR, 2003

Deaths due to Tuberculosis, Malaria and CVD in WHO Regions in 2002thousandsSource: WHR 2003

Cancers, age-specific death rates in China (urban & rural combined),1986 & 1999Source: Bumgarner, 2003

Chart4

90.764582559246.6650884633

269.4619253655133.420539572

542.5135927229373.3251611328

1241.7980548952736.6554695715

1999

1986

rate per 100,000

bumgarner cahrt for lts

bumgarner cahrt for lts

90.764582559246.6650884633

269.4619253655133.420539572

542.5135927229373.3251611328

1241.7980548952736.6554695715

1999

1986

rate per 100,000

chart 3 original

chart 3 original

90.764582559246.6650884633

269.4619253655133.420539572

542.5135927229373.3251611328

1241.7980548952736.6554695715

1999

1986

rate per 100,000

Cancers, age-specific death rates (urban & rural combined) 1986 & 1999

Sheet2

Sheet3

Deaths in South Africa, 2000: men

Risk factors are accumulating throughout the life course

A Life Course Approach to NCD PreventionDevelopment of NCD

Attributable Mortality (20 leading risk factors)

Trends in mean total cholesterol; Beijing China, 25-64Source: Subnational, Beijing, MONICAMean total cholesterol mmol/l

% of students aged 13-15who smoke cigarettesSource: Global Youth Tobacco SurveyOverall / Median AfricaBurkina FasoThe AmericasBoys currently smoke cigarettes15.0 10.428.616.6Girls currently smoke cigarettes6.64.69.612.2Boys/Girls ratio1.9:1.0 2.2:1.03.0:1.01.2:1.0South Africa21.010.62.0:1.0Columbia United StatesEastern MediterraneanEurope31.0 17.722.833.933.417.85.329.00.9:1.0 1.0:1.04.3:1.01.2:1.0Jordan22.09.92.2:1.0Bulgaria Czech RepublicSoutheast AsiaWestern Pacific26.0 34.013.519.039.435.13.23.20.7:1.0 1.0:1.04.2:1.05.9:1.0Indonesia38.94.78.3:1.0Myanmar11.06.41.7:1.0Palau20.023.30.9:1.0

Trends of overweight in childrenSource: de Onis and Blssner. Am. J. Clin. Nutr. 2000; 72: 1032-9Trends of overweight in children

World Health Organization

Trends of overweight in children

Mexico

Tunisia

Nigeria

India

Mali

Source: de Onis and Blssner. Am J Clin Nutr 2000;72:1032-9.

Chart3

0.71987198719871987

0.766666619883.719883.5

0.833333219893.845454545519893.6

0.899999819903.99090909091.53.7

0.966666419914.13636363642.13.8

1.0333331.64.28181818182.73.9

1.09999961.954.42727272733.34

1.16666622.34.572727272719944.1

1.23333282.654.718181818219954.2

1.334.863636363619964.3

199719975.009090909119974.5

199819985.319981998

Mali

India

Mexico

Nigeria

Tunisia

% >+2 SD

newOw_trends

Taken off markers as this looked like there are data points wheras this is a simple trend line

YearMaliIndiaMexicoNigeriaTunisia

19870.7Mali0.0666666

19880.83.73.5India0.35

19890.83.83.6Mexico0.1454545455

19900.94.01.53.7Nigeria0.6

19911.04.12.13.8Tunisia0.1

19921.01.64.32.73.9

19931.12.04.43.34.0

19941.22.34.64.1

19951.22.74.74.2

19961.33.04.94.3

19975.04.5

19985.3

newOw_trends

00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

Mali

India

Mexico

Nigeria

Tunisia

%+2 SD

YearMaliIndiaMexicoNigeriaTunisia

19870.73.7Mali0.0666666

19880.83.83.5India0.35

19890.84.03.6Mexico0.1454545455

19900.94.11.53.7Nigeria0.6

19911.04.32.13.8Tunisia0.1

19921.01.64.42.73.9

19931.12.04.63.34.0

19941.22.34.74.1

19951.22.74.94.2

19961.33.05.04.3

19975.24.4

19985.34.5

00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

Mali

India

Mexico

Nigeria

Tunisia

%

Future burden of chronic diseases will reflect accumulation of risk

Global Chronic Disease Burden1990-202019902020 (baseline scenario)(by disease group in developing countries)

Prevalence of diabetes mellitus in adults (>20 years) in 2000 and projections for 2030%

and impact on the long-term emergence of health inequalitiesSmoking prevalence among men in Chennai (India) by education levels

Chart4

64

58

42

21

Smoking prevalence %

Education

Smoking prevalence (%)

Sheet1

Education levelSmoking prevalence %

illiterate64

< 6 years58

6-12 years42

> 12 years21

Sheet1

0

0

0

0

Smoking prevalence %

Education

Smoking prevalence (%)

Sheet2

Sheet3

Economic Impact

Costs to the economy: TobaccoTobacco has many negative economic impacts: Health care costs

Fires: Annual cost of fires caused by smoking is US$27 billionAbsenteeism: In the US, smokers take of an average of 6.16 sick days per year compared with 3.86 of people who have never smoked; in 1994, it costs Telecom Australia $16.5 million in costs of loss of time off workCumulative costs on the workplace: In the USA, workplace smoking costs $47 billion every year.Trash collection: 20% of all trash collected in the US is cigarette buttsSource: Mackay and Eriksen, 2002

Country

Health care costs attributable to tobacco, latest available estimates, US$

Australia

$6 billion

Canada

$1.6 billion

China

$3.5 billion

Germany

$14.7 billion

New Zealand

$84 million

Philippines

$600 million

South Africa

$1 billion

UK

$2.25 billion

USA

$76 billion

Economic costs of diet-related chronic diseases in China & India

"The following report on cardiovascular disease estimates that 6 million years of potentially productive life are lost in China each year because of heart disease and stroke. Thus, countries experience the economic impact of these cardiovascular disorders far beyond the health portfolio, including in industry and commerce, in households and in communities."

Jeffrey SachsA Race Against Time: The Challenge Of Cardiovascular Disease In Developing Economies The Earth Institute and Mailman School of Public Health, Columbia University, New York (2004)Chronic diseases impact national economies and pose risks for private foreign investors

Economic growth is an underlying determinant of chronic diseases

Unhealthy consumption - development and policy optionsHighPrevalence ofunhealthy consumptionSocio-economic DevelopmentDesired pathHighLowObserved pattern

Overweight-plus-obesity Prevalence in Women 20-49 by Gross National Income

Risk factors are being transmitted by globalisation...

TradeTrade of cigarettes out of and into the United States

Foreign Direct Investment (FDI)SectorFood/Beverage Retail (Food & Drink)AlcoholTobaccoCorporationHutchinson Whampoa LimitedNestle SAUnileverDiageoProctor & GambleCoca-Cola CompanyMcDonaldsDanone Group SA

Carrefour SAWal-Mart StoresRoyal Ahold NVDiageoPhillip MorrisBATHome economyHong KongSwitzerlandUK/NetherlandsUKUSAUSAUSAFranceFranceUSANetherlandsUKUSAUKForeign Assets (rank) US$ billion40.9 (17)33.1 (21)30.5 (25)19.7 (47)17.3 (58)17.1 (59)12.8 (79)11.4 (86)

29.3 (29)26.3 (24)19.9 (44)19.7 (47)19.3 (49)10.4 (92)Foreign employment53 478223,000204,00060 00043 38126 000251,00088,000235 894303 000183 851

60 00039,00059 000Foreign assets, sales and employment of tobacco, alcohol, food, retail companies in the worlds largest 100 TNCs, 2001, ranked by foreign assets (US$ billion) Source: UNCTAD, 200311 automobile and 10 pharmaceutical companies are also amongst the top 100 TNCs

Marketing

UrbanisationEstimated projected urban and rural populations in the world, 1950-2030

Urbanisation, lifestyles and chronic diseases Tobacco useObesityPhysical activityRisk factors and trends

Unhealthy consumption patterns threaten sustainable developmentUnhealthy consumptionLack of physical activityHigh-fat dietsTobacco useSome associated impact on sustainable developmentMore motorised transport;increased vehicular pollution;destroyed landscapes and citiesGrain for animals not humans;animal husbandry erodes fragile farmlandDeforestation,pesticide residues

Interventions exist and are cost effective but

Many impediments to progress...

Pervasive mythsGlobal economic development will improve all health conditionsChronic diseases result from freely adopted risksChronic diseases are diseases of the elderlyChronic diseases are diseases of affluenceBenefits of chronic disease control accrue only to the individualInfectious disease models are applicable to chronic diseasesWe can wait till infectious diseases are controlled

Screening and treating patients in the health sector is a cost effective prevention strategy

Weak capacityPercentage of countries with specific capacity indicators for NCD prevention and control

Chart1

13218131315

374030274150

595653505056

595150435462

443850755678

585240686464

NCD policy

NCD plan

CVD plan

Tobacco control plan

Diabetes control plan

Cancer control plan

WHO Region

Percent of countries with policies/plans

Chart2

43

41

35

39

43

48

All

National policies and plans

Percentage of countries with policies/plans

Chart3

2833394348506269

Information about NCDs in the national annual health reporting system

NCD prevention and control initiatives not integrated into the primary health care systems.

Special budget line for NCDs

NCD policy

No surveillance systems for major NCDs.

National survey on hypertension prevalece

Dedicated unit for NCD prevention and control,

National diabetes prevention guidelines

Indicator of NCD prevention and control capacity

Percentage of countries reporting

Chart4

28

33

39

43

48

50

62

69

Percentage of countries

Sheet1

Percentage of countries reporting the existence of national policies and plans for NCD prevention and control

AFRAMREMREURSEARWPRAll

NCD policy13375959445843

NCD plan21405651385241

CVD plan8305350504035

Tobacco control plan13275043756839

Diabetes control plan13415054566443

Cancer control plan15505662786448

Sum83225324319341346

Source: Alwan, table 2 page 22

All

NCD policy43

NCD plan41

CVD plan35

Tobacco control plan39

Diabetes control plan43

Cancer control plan48

Percentage of countries

Information about NCDs in the national annual health reporting system28

NCD prevention and control initiatives not integrated into the primary health care systems.33

Special budget line for NCDs39

NCD policy43

No surveillance systems for major NCDs.48

National survey on hypertension prevalence50

Dedicated unit for NCD prevention and control62

National diabetes prevention guidelines69

Sheet2

Sheet3

Powerful interests block progress

attack WHO... discredit key individualscontain, neutralize, reorient WHOWHO...the leading enemytobacco company activities revealed in WHO inquiry

World Bank and Regional Development BanksNo comprehensive policy on chronic disease(though currently developing a policy note)WB Health, Nutrition and Population strategy paper recognises impact of chronic disease on poor populations (eight of the existing 31 PRSPs include chronic diseases or risk factors in their action/expenditure plans or monitoring/evaluation indicators)RDBs have health sector strategies(but concentrate on communicable diseases)

International DonorsIncreased health support by donors mostly directed towards HIV/AIDS, not chronic diseases

Current status of key playersHeads of StateG8 - Health is the key to prosperity;" "poor health drives poverty. Mobilization of resources for Global Fund in 2001. No commitment to chronic diseases.G77 - no focus on chronic diseases but recent support for the FCTC. Critical of the draft Global Strategy on Diet, Health and Physical ActivityHealth MinistriesInadequate capacity and budget for chronic diseases in most countriesWHO

NCD resolutions and global strategies agendas since 1956NCD cluster established at HQ in 1998 and capacity later developed at regions, but commitment not followed by funding

Budgetary allocation and expenditure within WHO HQ to leading chronic and communicable diseases relative to DALYs attributed to leading chronic and communicable diseases, for the biennium 1/1/00 - 31/12/01ONLY US$ 0.25 ALLOCATED TO LEADING CHRONIC DISEASES PER DEATH WITHIN WHO OPERATING BUDGET COMPARED WITH $14 FOR LEADING COMMUNICABLE DISEASES

Policy of theAfrican Development Bank GroupThe Bank does not currently have any specific policy or guidelines to address non-communicable diseases.

Source: Philibert Afrika, Director Operations Policies and Review, ADBG, personal communication, February 2003

Current status of key playersGlobal NGO'sNGO's focused support for chronic diseases not mobilised, although the Framework Convention Alliance supporting FCTC was effectiveHealth and development initiativesMDGs exclude chronic diseasesUNFPA does not include chronic diseases or risk factors in strategy on population and developmentUNICEF's goal setting program, "A World Fit for Children," excludes reference to risk factors for chronic diseases amongst children.World Summit of Sustainable Development does refer to chronic diseasesBusiness & investment communityInvestment analysts warn that chronic disease risk factors are risky investmentsSuperficial CSR initiativesSome new business markets emerging(Continued)

Current status of key players(Continued)MediaChronic diseases not perceived or reported as global health problems by broadcast or print news sources while acute infections are sensationalizedResearch journalsPre-eminent medical journals do not publish content that accurately reflects global burden of disease

New data on research output 1990-3 versus 2000-3

Chart1

2921213

412262215

00000

01001

12885

00000

361266

612313514

00000

1714920

210281435

00000

518143033

3561935357

00000

11545288105

44170233149258

00000

30178180283229

40488672445763

00000

2114183305180

43359358357310

00000

55365336654471

282650634837854

Tobacco

CVD

Obesity

Cancer

Diabetes

Countries

Sheet1

TobaccoCVDObesityCancerDiab

RegionP 1990-1993% TPP 2000 -2003% TPP 1990-1993% TPP 2000 -2003% TPP 1990-1993% TPP 2000 -2003% TPP 1990-1993% TPP 2000 -2003% TPP 1990-1993% TPP 2000 -2003% TPP 1990-1993% TPP 2000 -2003% TP

Africa22.8241.0891.41120.8820.34261.56121.06221.56131.5150.84

Americas66.06256.78274.231098.03416.961398.34907.961309.21546.241508.41

Asia1111.114411.92548.4517012.53528.8323313.99887.7914910.5510512.1325814.47

Australasia55.05359.49182.82614.5142.38935.58302.65533.75333.81573.2

China33.361.6360.94120.8810.17311.86262.3352.4860.69140.79

Europe3030.34010.8417827.8648835.9618030.5667240.3328325.0444531.5222926.4476342.79

India11.0120.5471.1100.74142.38281.6890.8140.99202.31351.96

South Africa0010.2710.1620.150080.480080.5710.1250.28

United Kingdom2121.214311.6514122.0735926.468314.0935821.4930526.9935725.2818020.7931017.39

USA5555.5628276.4236557.1265047.933657.0563438.0665457.8883759.2847154.3985447.9

Total papers99369

Obesity

RegionP 1990-1993% TPP 2000 -2003% TP

Africa20.34261.56

Americas416.961398.34

Asia528.8323313.99

Australasia142.38935.58

China10.17311.86

Europe18030.5667240.33

India142.38281.68

South Africa0080.48

United Kingdom8314.0935821.49

USA33657.0563438.06

Total papers5891666

Cancer

RegionP 1990-1993% TPP 2000 -2003% TP

Africa121.06221.56

Americas907.961309.21

Asia887.7914910.55


China262.3352.48

Europe28325.0444531.52

India90.8140.99

South Africa0080.57


USA65457.8883759.28

Total papers11301412

Diabetes

RegionP 1990-1993% TPP 2000 -2003% TP

Africa131.5150.84

Americas546.241508.41

Asia10512.1325814.47


China60.69140.79

Europe22926.4476342.79

India202.31351.96

South Africa10.1250.28


USA47154.3985447.9

Total papers8661783

CVD

RegionP 1990-1993% TPP 2000 -2003% TP

Africa91.41120.88

Americas274.231098.03

Asia548.4517012.53


China60.94120.88

Europe17827.8648835.96

India71.1100.74

South Africa10.1620.15


USA36557.1265047.9

Total papers6391357

test graphs

Tobacco 90-93Tobacco 00-03CVD 90-93CVD 00-03Obesity 90-93Obesity 00-03Cancer 90-93Cancer 00-03Diab 90-93Diab 00-03Tobacco 90-93Tobacco 00-03CVD 90-93CVD 00-03Obesity 90-93Obesity 00-03Cancer 90-93Cancer 00-03Diab 90-93Diab 00-03

RegionRegion

Africa240912022612221315Africa2.821.0801.410.880.341.561.061.561.50.84

Americas6250271090411399013054150Americas6.066.7804.238.036.968.347.969.216.248.41

Asia114405417005223388149105258Asia11.1111.9208.4512.538.8313.997.7910.5512.1314.47

Australasia535018610149330533357Australasia5.059.4902.824.52.385.582.653.753.813.2

China36061201312635614China3.31.6300.940.880.171.862.32.480.690.79

Europe304001784880180672283445229763Europe30.310.84027.8635.9630.5640.3325.0431.5226.4442.79

India120710014289142035India1.010.5401.10.742.381.680.80.992.311.96

South Africa010120080815South Africa00.2700.160.1500.4800.570.120.28

United Kingdom21430141359083358305357180310United Kingdom21.2111.65022.0726.4614.0921.4926.9925.2820.7917.39

USA5528203656500336634654837471854USA55.5676.42057.1247.957.0538.0657.8859.2854.3947.9

test graphs

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Africa

Americas

Asia

Australasia

China

Europe

India

South Africa

United Kingdom

USA

final charts

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USA

United Kingdom

South Africa

India

Europe

China

Australasia

Asia

Africa

Sheet3

Sheet3

2921213

412262215

00000

01001

12885

00000

361266

612313514

00000

1714920

210281435

00000

518143033

3561935357

00000

11545288105

44170233149258

00000

30178180283229

40488672445763

00000

2114183305180

43359358357310

00000

55365336654471

282650634837854

Tobacco

CVD

Obesity

Cancer

Diabetes

Countries

2.821.410.341.061.5

1.080.881.561.560.84

00000

00.16000.12

0.270.150.480.570.28

00000

3.30.940.172.30.69

1.630.881.862.480.79

00000

1.011.12.380.82.31

0.540.741.680.991.96

00000

5.052.822.382.653.81

9.494.55.583.753.2

00000

11.118.458.837.7912.13

11.9212.5313.9910.5514.47

00000

30.327.8630.5625.0426.44

10.8435.9640.3331.5242.79

00000

21.2122.0714.0926.9920.79

11.6526.4621.4925.2817.39

00000

55.5657.1257.0557.8854.39

76.4247.938.0659.2847.9

Tobacco

CVD

Obesity

Cancer

Diabetes

Regions

Percent

55.5621.2130.311.115.051.013.302.82

76.4211.6510.8411.929.490.541.630.271.08

000000000

57.1222.0727.868.452.821.10.940.161.41

47.926.4635.9612.534.50.740.880.150.88

000000000

57.0514.0930.568.832.382.380.1700.34

38.0621.4940.3313.995.581.681.860.481.56

000000000

57.8826.9925.047.792.650.82.301.06

59.2825.2831.5210.553.750.992.480.571.56

000000000

54.3920.7926.4412.133.812.310.690.121.5

47.917.3942.7914.473.21.960.790.280.84

000000000

USA

United Kingdom

Europe

Asia

Australasia

India

China

South Africa

Africa

Chronic disease

Percent

2921213

412262215

00000

518143033

3561935357

00000

11545288105

44170233149258

00000

30178180283229

40488672445763

00000

2114183305180

43359358357310

00000

55365336654471

282650634837854

Tobacco

CVD

Obesity

Cancer

Diabetes

Countries

TobaccoCVDObesityCancerDiabetes

Region

Africa (1990-93)2921213

Africa (2000-03)412262215

00000

South Africa (1990-93)01001

South Africa (2000-03)12885

00000

China (1990-93)361266

China (2000-03)612313514

00000

India (1990-93)1714920

India (2000-03)210281435

00000

Australasia (1990-93)518143033

Australasia (2000-03)3561935357

00000

Asia (1990-93)11545288105

Asia (2000-03)44170233149258

00000

Europe (1990-93)30178180283229

Europe (2000-03)40488672445763

00000

United Kingdom (1990-93)2114183305180

United Kingdom (2000-03)43359358357310

00000

USA (1990-93)55365336654471

USA (2000-03)282650634837854

Tobacco 90-93Tobacco 00-03CVD 90-93CVD 00-03Obesity 90-93Obesity 00-03Cancer 90-93Cancer 00-03Diab 90-93Diab 00-03

Region

Africa

Americas6.066.784.238.036.968.347.969.216.248.41

Europe30.310.8427.8635.9630.5640.3325.0431.5226.4442.79

United Kingdom21.2111.6522.0726.4614.0921.4926.9925.2820.7917.39

USA55.5676.4257.1247.957.0538.0657.8859.2854.3947.9

TobaccoCVDObesityCancerDiabetesTobacco 1990-93CVD 1990-93Obesity 1990-93Cancer 1990-93Diabetes 1990-93

RegionTobacco 2000-03CVD 2000-03Obesity 2000-03Cancer 2000-03Diabetes 2000-03

Africa (1990-93)2.821.410.341.061.5

Africa (2000-03)1.080.881.561.560.84Africa

00000South Africa

South Africa (1990-93)00.16000.12China

South Africa (2000-03)0.270.150.480.570.28India

00000Australasia

China (1990-93)3.30.940.172.30.69Asia

China (2000-03)1.630.881.862.480.79Europe

00000United Kingdom

India (1990-93)1.011.12.380.82.31USA

India (2000-03)0.540.741.680.991.96

00000

Australasia (1990-93)5.052.822.382.653.81

Australasia (2000-03)9.494.55.583.753.2

00000

Asia (1990-93)11.118.458.837.7912.13

Asia (2000-03)11.9212.5313.9910.5514.47

00000

Europe (1990-93)30.327.8630.5625.0426.44

Europe (2000-03)10.8435.9640.3331.5242.79

00000

United Kingdom (1990-93)21.2122.0714.0926.9920.79

United Kingdom (2000-03)11.6526.4621.4925.2817.39

00000

USA (1990-93)55.5657.1257.0557.8854.39

USA (2000-03)76.4247.938.0659.2847.9

2921213

412262215

00000

01001

12885

00000

361266

612313514

00000

1714920

210281435

00000

518143033

3561935357

00000

11545288105

44170233149258

00000

30178180283229

40488672445763

00000

2114183305180

43359358357310

00000

55365336654471

282650634837854

Tobacco

CVD

Obesity

Cancer

Diabetes

Countries

00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

Tobacco

CVD

Obesity

Cancer

Diabetes

Regions

Percent

What's new about the rationale for action?New epidemiological data: China as a pressing exampleFocus on upstream macroeconomic determinants: chronic diseases spread by globalization (FDI focus), concentrated by urbanizationSynthesis of economic impacts: past studies and support of new initiativesLinks made with sustainable developmentAssessment of WHO resolutions and fundingReview of stakeholder response to chronic diseasesNew financial data on funding of chronic diseasesNew data on research output on chronic diseases

but none of this has to be inevitable

Towards a new strategy for chronic diseases of lifestyleVisionTargets and objectivesBetter quality and years of healthy lifeReduce disparitiesTargets achievable at a stretch for prevalence by age, sex, classCosted and budgeted

New terminologyNCDs-cant catch it, cant communicate itChronic-lifelong, slow onset, seriousLifestyle-chosen risks and behaviour

Summary of changes for WHOFromSporadic advocacy Do it all aloneToHigh level advocacyWork through and with partnersSole impact on governmentsFull range-from schools to neglect of higher order leversInfluence markets, governments & NGOsUpstream health promotionAll diseases separatelyChronic care systems and effective secondary preventionRowingSteering, leading

New roles for key playersGovernmentsNGOs, consumer groups Investment/PensionsCoherent chronic disease programmes & policies across all key sectorsadvocacy: leadership, long-term viewRules and incentives for healthier investmentGlobal networks of influence (Globalink for chronic diseases)Local services: health promotion and careAnalysis of major trends and need for corporate changeDevelop incentives for market changesIndustryDonorsNew models beyond treatment must prioritize healthChanges in products , marketing and researchFinancial support that matches burden and preventive potentialUN and related familyPlacing chronic diseases on development agendaScreen for chronic disease impacts access sectors

Proposed WHO actionsEffective communication and advocacy Global governance for chronic disease controlSupport innovative "up-stream" strategies for prevention-and implement the FCTC and the Global Strategy on diet, physical activity and healthEnhance financial, human, institutional resource capacity Strengthen health systems for chronic disease controlStrengthen the evidence base, evaluate impactUse scenarios to develop targets

Overall, HIV/AIDS is the leading cause of death in adults aged 1559. Ischaemic heart disease is the leading cause of death at older agesNote that 30% of deaths in developing countries occur in young adults this vast premature adult mortality is a major public health concernFigure 53:A different pattern is apparent for the urban population of Beijing, China. Mean total cholesterol has been increasing in both men and women since 1983. This cholesterol pattern predicts the increase in heart disease and stroke now being reported from Beijing.

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© World Health Organization [2004] Cambridge International Health Leadership Programme; April, 25 th 2004 WHO long-term strategy for prevention and control