Noncommunicable Diseases in the Western Pacific Region · WHO Library Cataloguing in Publication...

A Profile

Noncommunicable Diseasesin the Western Pacific Region

WHO Western Pacific RegionPUBLICATION

ISBN-13 978 92 9061 563 7

A Profile


WHO Library Cataloguing in Publication Data

Noncommunicable diseases in the Western Pacific Region: a profile

1. Chronic diseases – prevention and control. 2. Data collection. 3. Registries.

I. World Health Organization Regional Office for the Western Pacific.

ISBN 978 92 9061 563 7 (NLM Classification: WT 500)

© World Health Organization 2012

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NoNcommuNicable Diseases iN the WesterN Pacific regioN: a Profile

Table of Contents

Preface 5

Summary 7

1. introduction 9

2. Burden of noncommunicable diseases 10

3. Risk factors for noncommunicable diseases 17

4. NCD country capacity 23

5. NCD country profiles 29

6. Key findings and recommendations 57

Annexes 59

Annex 1 - Regional Commitments on NCD 59

Annex 2 - Exploratory Notes on Country Estimates 63

Annex 3 - 2008 Comparable Estimates of NCD Mortality 68

Annex 4 - WHO STEPwise Surveillance for NCD Risk Factors 69

NoNcommuNicable Diseases iN the WesterN Pacific regioN: a Profile4

Acknowledgements

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

NoNcommuNicable Diseases iN the WesterN Pacific regioN: a Profile 5

Preface

Prevention and control of noncommunicable diseases (NCDs) are national, regional and global priorities. Despite progress, more needs to be done to address the burden and socioeconomic consequences of NCDs. Regional and global declarations in 2011 have reiterated the commitment of Member States to NCD prevention and control.

While efforts are ongoing to address the challenges of NCD prevention and control, a forceful response is required at the national and regional levels. Reliable and timely data are mandatory for the planning and evaluation of NCD programmes. However, setting up and maintaining surveillance systems can be difficult for low- and middle-income countries. Regardless, the NCD burden, in terms of mortality and risk factors, have to be kept under regular surveillance. Information on health system indicators and capacity are also critical for introducing and evaluating interventions. Policies in related domains such as trade, agriculture and marketing also need monitoring as they impact NCDs.

The political declaration of the United Nations High-level Meeting on Noncommunicable Diseases in September 2011 is a clear indication of the high level of commitment for NCD prevention and control worldwide. At the sixty-second session of the WHO Regional Committee for the Western Pacific, Member States discussed options for expanding and intensifying NCD prevention and control in the Region.

Given the huge burden and unacceptable rates of preventable premature morbidity and mortality from NCDs, we have to move towards time-bound targets with indicators and an accountability framework.

This regional profile, based on the WHO Global status report on noncommunicable diseases, will serve as a baseline for measuring the impact of our efforts in NCD prevention and control in the Western Pacific Region.

Let us continue to work together to prevent NCDs and promote health and development for all people of the Region.

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


Summary

This profile of noncommunicable diseases (NCDs) in the Western Pacific Region is based largely on the WHo Global status report on noncommunicable diseases published in 2011. Country-specific data are classified by income category to reflect the variations among countries in the Region and to serve as a baseline for further monitoring.

Mortality from NCDs is higher in low- and middle-income countries (LMIC) than in high-income countries (HIC). The gap between the two income groups is even more pronounced for NCD deaths below the age of 70 years. Efforts are also needed to strengthen mortality registration and certification systems in LMIC.

Disease registries are not widely available in the Region, making it difficult to assess morbidity. National-level data on cancer burden are available from GLOBOCAN 2008, and are presented in terms of incidence and mortality. Variations in the rate of breast and uterine cervical cancer in women are also highlighted. Diabetes prevalence is more than 10% in almost all the Pacific island countries.

Prevalence of risk factors is a pointer to the burden of NCDs. The wide variation in tobacco prevalence in the Region indicates that there is potential to reduce tobacco use in many countries. Obesity and lack of physical activity are serious issues in most countries and indicate a need for the promotion of healthy diets and physical activity through multisectoral actions. Alcohol consumption also shows wide variation. Raised blood pressure and blood cholesterol levels are uniformly high in the region. Population trends help to estimate the future burden of NCDs.

National capacity for assessment of NCD prevention and control were undertaken by WHO in 2004 and 2010. NCD country profiles, which include mortality, risk factors, and capacity to prevent and control NCDs, are presented for all Member States in the Region. Periodic evaluation can help countries to scale up NCD prevention and control.

This regional profile presents a situational analysis and can serve as a baseline for Member States to move towards time-bound targets.


1 Global status report on noncommunicable diseases. Geneva, WHO, 2011. Available online at http://www.who.int/chp/ncd_global_status_report/en/2 World Bank List of Economies. Washington, DC, The World Bank, 2011. Available online at http://siteresources.worldbank.org/DATASTATISTICS/Resources/CLASS.XLS

1. Introduction

Noncommunicable diseases (NCDs), principally cardiovascular diseases, cancer, diabetes and chronic respiratory diseases, impose a major and growing burden on health and development in the Western Pacific Region. NCDs are the leading causes of death and disability in the Region, responsible for 80% of all deaths in a region that is home to more than one quarter of the world’s population. Of particular concern is the high level of premature mortality from NCDs (deaths before 70 years of age) in several low- and middle-income countries (LMIC). There are indications that NCD-related morbidity and mortality will continue to rise if urgent measures are not taken.

The High-level Meeting of the General Assembly on the prevention and control of NCDs in September 2011 firmly placed NCD prevention and control as a global priority. Efforts are also ongoing at the regional and national levels to scale up NCD prevention and control. Regional commitments, particularly the Seoul Declaration and the Honiara Communiqué on the Pacific NCD Crisis (Annex 1), reflect the collective will to expand and intensify efforts for NCD prevention and control in the Region. One of the key ingredients for advancing the NCD agenda is to have an overview of the current NCD situation—mortality, morbidity, risk factors and country capacity.

The data and findings presented in the profile are mainly from the WHO Global status report on noncommunicable diseases released in 2011.1 The profile has four major sections: burden, risk factors, country capacity for NCD prevention and control, and NCD country profiles. All estimates were prepared by WHO, using multiple data sources and analytical methods (Annex 2).

The data are presented by country groupings—high-income countries (HIC) and low- and middle-income countries (LMIC)—as per the World Bank income categories as of July 2011.2 The NCD country profiles in Section 5, however, use the 2008 World Bank income categories.

There are many challenges in data collection and analysis in LMIC. Mortality registration is often weak, disease registries are suboptimal, and risk factor surveys are sporadic. National governments are responsible for leading and facilitating the collection of data and processing of information for action. Other groups such as academia and civil society are well positioned to support these efforts and use the data in innovative ways. The WHO STEPwise approach to surveillance of NCD risk factors (STEPS) has been adopted in some LMIC of the Region to measure trends, either as a stand alone format or incorporated into national health surveys.

WHO has been undertaking a major exercise in passive epidemiological surveillance, gathering published and unpublished data and information about key aspects of NCD globally. The findings in this profile are limited to the global comparisons. There is also a need to have better indicators to demonstrate the full information on the actual implementation of interventions.

This brief profile provides a baseline for measuring our efforts and encourages scaling up national surveillance frameworks for NCD prevention and control, especially in LMIC.

http://www.who.int/chp/ncd_global_status_report/en/

http://siteresources.worldbank.org/DATASTATISTICS/Resources/CLASS.XLS

http://siteresources.worldbank.org/DATASTATISTICS/Resources/CLASS.XLS


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2. Burden of noncommunicable diseases

MORtALIty

In 2008, more than a quarter of the 36 million deaths from NCDs worldwide were from the Western Pacific Region. Globally, NCD deaths are projected to increase by 15% between 2010 and 2020 (to 44 million deaths), with the highest numbers predicted in the Western Pacific (12.3 million deaths) and South-East Asia (10.4 million deaths) Regions.

Comparable estimates of NCD mortality for 2008—total NCD deaths, percentage of NCD deaths occurring under the age of 70, and age-standardized death rates per 100 000—are presented for each Member State of the Region in Annex 3.

Overall mortality from noncommunicable diseases

Figure 1 presents the age-standardized death rate from NCDs in the Region. The data are presented in ascending order of mortality rates in HIC and LMIC. There is a two- to three-fold difference in male NCD mortality rates between HIC and LMIC.

*Countries have a high degree of uncertainty because they are not based on national NCD mortality data. The estimates for these countries are based on a combination of country life tables, cause of death models, regional cause of death patterns, and WHO and UNAIDS programme estimates for some major causes of death (not including NCDs).

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

Figure 1. Age-standardized death rate (per 100 000) from NCD, Western Pacific Region, 2008


High Income

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Premature mortality from noncommunicable diseases

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

*Countries have a high degree of uncertainty because they are not based on national NCD mortality data. The estimates for these countries are based on a combination of country life tables, cause of death models, regional cause of death patterns, and WHO and UNAIDS programme estimates for some major causes of death (not including NCDs).


Figure 2. Percentage of all NCD deaths under age 70, Western Pacific Region, 2008


High Income

Age

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* Country data not available. Estimate based on a combination of country life tables, cause of death models, regional cause of death patterns, and WHO and UNAIDS programme estimates for some major causes (not including chronic diseases).


Figure 3. Age-standardized death rate (per 100 000) from cardiovascular disease and diabetes, Western Pacific Region, 2008

Cardiovascular disease and diabetes mellitus

Age-standardized death rates from cardiovascular disease and diabetes mellitus are provided in Figure 3. Substantial differences in mortality rates are seen between HIC and LMIC.


High Income

Age

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Cancer

Within the Region, cancer deaths make up one quarter of all NCD deaths. Variation in death rates across countries is presented in Figure 4.

* Country data not available. Estimate based on a combination of country life tables, cause of death models, regional cause of death patterns, and WHO and UNAIDS programme estimates for some major causes (not including chronic diseases).


Figure 4. Age-standardized death rate (per 100 000) from cancer, Western Pacific Region, 2008


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

MORBIDIty

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

Cancer Morbidity data on cancer come from GLOBOCAN 2008,3 which provides comparable estimates on incidence and mortality of cancers worldwide in 2008. Figure 5 presents age-standardized cancer incidence in men and women and demonstrates the wide variation across countries.

Source: IARC Globocan 2008

Figure 5. Age-standardized incidence rate of cancer (all sites except non-melanoma skin cancer), Western Pacific Region, 2008


High Income

Age

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d ra

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Cervix

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100

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In women, breast and cervical cancer are among the leading causes of cancer deaths. The variation in incidence among countries is in large part a reflection of heterogeneous screening and early detection programmes throughout the Region in addition to the underlying differences in occurence (Figure 6).

Source: IARC Globocan 2008

Figure 6. Age-standardized incidence rate of breast and cervix uteri cancer, Western Pacific Region, 2008


High Income

Prev

alen

ce %


Women

Men

40

30

20

10

0

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Figure 7. Age-standardized prevalence of diabetes mellitus in adults aged 25+ years, comparable estimates, Western Pacific Region, 2008

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

Diabetes mellitus

Diabetes mellitus4 is an important marker of the burden of NCD in a population. It is the leading cause of renal failure in many populations. Figure 7 shows a marked variation in prevalence rates of diabetes in the Region, and very little difference in prevalence among men and women in most countries.


High Income

Prev

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Figure 8. Age-standardized prevalence of daily tobacco smoking in adults aged 15+ years, comparable country estimates, Western Pacific Region, 2008

3. Risk factors for noncommunicable diseases

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

BeHAvIOuRAL RIsk FACtORs

Tobacco use

Tobacco use is the leading cause of preventable deaths globally and within the Region. The percentage of men and women who smoke daily varies considerable by country, with rates ranging from less than 15% to 74% in men, and from under 2% to 62% in women (Figure 8). The variation in rates of tobacco use prevalence is a reflection of tobacco control efforts and indicates the huge potential for reducing rates further in countries.


High Income

Prev

alen

ce %


Women

Men

75

50

25

0

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and

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Figure 9. Age-standardized prevalence of insufficient physical activity in adults aged 15+ years, comparable country estimates, Western Pacific Region, 2008

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

unhealthy diet

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

Physical inactivity

Physical inactivity5 is variable across the Region, with prevalence rates ranging from 10% to 70% in men and women. Women tend to report more physical inactivity than men, especially in PIC (Figure 9).


High Income

Adu

lt ca

pita

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pur

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Figure 10. total adult (15+ years of age) per capita consumption of pure alcohol (litres) for both sexes, Western Pacific Region, 2008

Harmful use of alcohol

There is a high level of variation in alcohol consumption. Total adult per capita consumption of pure alcohol (litres) for both sexes is presented in Figure 10.


High Income

Prev

alen

ce %


Women

Men

75

50

25

0

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Figure 11. Age-standardized prevalence of obesity in adults aged 20+ years, comparable country estimates, Western Pacific Region, 2008

6 Overweight is defined as body mass index (BMI) ≥25 kg/m2 , while obesity as BMI ≥30 kg/m2.7 The World health report 2002: Reducing risks, promoting healthy life. Geneva, World Health Organization, 2002.8 Policy and action for cancer prevention. Food, nutrition, and physical activity: a global perspective. Washington, DC, World Cancer Research Fund/American Institute for Cancer Research, 2009.

MetABOLIC/PHysIOLOgIC RIsk FACtORs

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

Overweight and obesity

Overweight and obesity6 lead to adverse effects on blood pressure, cholesterol, triglycerides and insulin resistance. The risks of coronary heart disease, ischaemic stroke and type 2 diabetes mellitus increase steadily with increasing BMI. Raised BMI also increases the risk of cancer of the breast, colon/rectum, endometrium, kidney, oesophagus (adenocarcinoma) and pancreas.7,8

The prevalence of obesity among adults in the Region varies from under 5% to 75%. Women are more likely to be obese than men, especially in many PIC (Figure 11).


High Income

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Men

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Dem

ocra

tic R

epub

lic, t

he

Mon

golia

Cam

bodi

a

Mar

shal

l Isla

nds,

the

Naur

u

Repu

blic

ofKo

rea,

the Fiji


Figure 12. Age-standardized prevalence of raised blood pressure in adults aged 25+ years, comparable country estimates, Western Pacific Region, 2008

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

Raised blood pressure

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


High Income

Prev

alen

ce %


Women

Men

75

50

25

0

Japa

n

Aust

ralia

Sing

apor

e

New

Zeal

and

Cook

Isla

nds

Tong

a

Chin

a

Solo

mon

Isla

nds

Philip

pine

s

Micr

ones

ia,

the

Fede

rate

d St

ates

of

Sam

oa

Kirib

ati

Papu

a Ne

w G

uine

a

Mon

golia

Cam

bodi

a

Mar

shal

l Isla

nds,

the

Naur

u

Repu

blic

ofKo

rea,

the Fiji


Figure 13. Age-standardized prevalence of raised total cholesterol11 in adults aged 25 years, comparable country estimates, Western Pacific Region, 2008

10 Ezzati M et al. Selected major risk factors and global and regional burden of disease. The Lancet, 2002, 360:1347–1360.11 Raised cholesterol was defined, in these estimates, as 5.0 mmol/L or 190 mg/dl or higher.

Raised cholesterol

raised cholesterol10 increases the risk of heart disease and stroke. The prevalence of raised cholesterol is higher in HIC than LMIC. Uniformly high rates are observed in both men and women (Figure 13).


NCD POLICy AND PROgRAMMe INFRAstRuCtuReIndicator

2004 (n=27)

2010 (n=35)

Number of countries with national NCD entity (focal point, unit or department) 14 32

Number of countries with an allocated budget for NCD prevention and control 24 30

Number of countries with an integrated NCD policy, strategy and/or action plan 15 28

Number of countries with legislation (acts, laws, regulations, ministerial decrees, policies,plans, procedures, etc.) on:

Tobacco Control 22 29

Nutrition 17 23

Physical Activity 9 21

Alcohol Consumption 12 19

Diabetes 15 25

Number of countries completing at least one round of WHO STEPS survey 10 22

Number of countries with surveillance system that covers the following risk factors:

Tobacco Control 17 31

Alcohol Consumption 13 29

Unhealthy Diet 12 30

Physical Inactivity 12 27

Diabetes/Raised Blood Glucose 18 28

Hypertension/Raised Blood Pressure 17 29

Overweight and Obesity 15 30

Dyslipidaemia 10 25

Number of countries with clinical protocols, guidelines, standards for the treatment/managementof the following:

Hypertension 16 32

Diabetes Mellitus 18 33

Source: NCD country capacity survey data, WHO Western Pacific Regional Office, 2004 and 2010.

table 1. Comparison of country capacity indicators, Western Pacific Region, 2004 and 2010

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

COuNtRy CAPACIty suRveys: 2004 AND 2010

In the Region, twenty-seven countries and areas responded to the survey in 2004 and 35 responded in 2010. Table 1 shows the status of selected parameters in both years.

http://apps.who.int/ghodata/

http://apps.who.int/ghodata/


table 2. Dedicated NCD unit, integrated NCD policy, and policies on risk factors, Western Pacific Region, 2010

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

COuNtRy CAPACIty 2010

NCD unit and policies

Thirty-two of the 35 countries and areas that responded to the 2010 survey have a unit, branch or department in the Ministry of Health (or its equivalent) designated for NCD prevention and control. Twenty-eight have an integrated NCD policy, strategy and/or action plan and specific policies that address risk factors, most notably tobacco use.

Though structures and mechanisms vary, most countries and areas have a designated NCD unit and policies for NCD risk factor reduction (Table 2).

Country

Dedicated NCD office in Ministry of Health

IntegratedNCD Policy

Policy addressing specific risk factors

Alcohol unhealthy diet

Physical inactivity Tobacco

American Samoa Yes No No No No YesAustralia Yes Yes Yes Yes Yes YesBrunei Darussalam No No Yes Yes Yes YesCambodia Yes Yes Yes No* No* YesChina Yes No No Yes No NoCook islands Yes Yes No* No* No* YesFiji Yes Yes Yes Yes Yes YesFrench Polynesia Yes Yes Yes Yes Yes YesGuam Yes NoHong Kong (China) Yes Yes Yes Yes Yes YesJapan Yes Yes Yes Yes Yes YesKiribati Yes Yes Yes Yes Yes YesLao People’s Democratic Republic, the Yes Yes No* No* No* Yes

Macao (China) Yes No No Yes Yes YesMalaysia Yes Yes No Yes Yes YesMarshall Islands, the Yes Yes Yes No* No* YesMicronesia, the Federated States of Yes Yes Yes Yes Yes Yes

Mongolia Yes Yes Yes Yes Yes No*Nauru Yes Yes No* Yes Yes No*New Caledonia Yes Yes Yes Yes Yes YesNew Zealand No No Yes Yes Yes YesNiue Yes Yes Yes Yes Yes YesNorthern Mariana Islands, the Commonwealth of the Yes No Yes Yes Yes Yes

Palau Yes Yes No* Yes No* YesPapua New Guinea Yes Yes No* No* No*Philippines Yes Yes No* No* No* YesRepublic of Korea, the Yes Yes Yes Yes Yes YesSamoa Yes Yes No* Yes Yes YesSingapore Yes Yes Yes Yes Yes YesSolomon islands Yes Yes No* No* No* YesTokelau No Yes Yes Yes Yes YesTonga Yes Yes No* Yes No* No*Tuvalu Yes Yes No* No* No* YesVanuatu Yes Yes Yes Yes Yes YesViet Nam Yes Yes No No No Yes


Health reporting, information systems, monitoring and surveillance

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

table 3. surveillance data in national health reporting systems, Western Pacific Region, 2010

*Population-based data

Country Mortality Cancer Registry Risk Factors

American Samoa No Yes Yes*Australia Yes* Yes* Yes*Brunei Darussalam Yes* Yes Yes*Cambodia Yes Yes NoChina Yes* Yes* YesCook islands Yes Yes* YesFiji Yes Yes* YesFrench Polynesia Yes Yes NoGuam Yes Yes* YesHong Kong (China) Yes* Yes* Yes*Japan Yes* Yes* YesKiribati Yes Yes* YesLao People’s Democratic Republic, the No Yes* YesMacao (China) Yes Yes YesMalaysia Yes Yes* Yes*Marshall Islands, the Yes Yes YesMicronesia, the Federated States of Yes Yes* YesMongolia Yes Yes* YesNauru Yes Yes* YesNew Caledonia Yes* Yes* YesNew Zealand Yes* Yes* Yes*Niue Yes Yes* YesNorthern Mariana Islands, the Commonwealth of the Yes Yes Yes

Palau Yes* Yes NoPapua New Guinea Yes* Yes* YesPhilippines Yes Yes* Yes*Republic of Korea, the Yes* Yes* Yes*Samoa Yes No NoSingapore Yes* Yes* Yes*Solomon islands No Yes NoTokelau Yes* Yes* YesTonga Yes Yes* YesTuvalu Yes No NoVanuatu Yes Yes* Yes*Viet Nam Yes Yes No


Health system capacity for NCD prevention, early detection, treatment and care within the primary health care system

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

Health promotion, partnerships and collaboration

Thirty-two of the 35 countries and areas reported engaging in partnerships to implement NCD activities (Table 5). Key stakeholders are nongovernmental organizations, the private sector, and non-health government ministries or departments.

A majority of countries and areas reported implementing fiscal interventions for NCD prevention and control (86%). About one third reported having established earmarking of taxes on substances such as tobacco and alcohol. Fifteen have regulations on the marketing of food to children, while nine have enforcement mechanisms.


Coun

try

/ A

rea

gui

delin

es/p

roto

cols

/sta

ndar

ds fo

r th

e m

gmt

of c

ondi

tion

s fo

r N

CDs

Hea

lth

care

sys

tem

fact

ors

affe

ctin

g N

CD m

anag

emen

t

Dia

bete

sH

yper

tens

ion

Ove

rwei

ght

and

obes

ity

Bloo

d lip

ids

Alc

ohol

de

pend

ence

Toba

cco

depe

nden

ceD

ieta

ry

coun

selin

g

Phys

ical

ac

tivi

ty

coun

selin

g

esse

ntia

l lis

t of

m

edic

ine

Hea

lth

insu

ranc

e co

vera

ge

Amer

ican

Sam

oaYe

sYe

sYe

sYe

sYe

sYe

sYe

sYe

sYe

sYe

sAu

stra

liaYe

sYe

sYe

sYe

sYe

sYe

sYe

sYe

sN

oYe

sBr

unei

Dar

ussa

lam

Yes

Yes

No

Yes

No

Yes

Yes

No

Yes

No

Cam

bodi

aYe

sYe

sN

oN

oN

oN

oYe

sYe

sYe

sN

oCh

ina

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Cook

isla

nds

Yes

Yes

Yes

No

No

No

Yes

Yes

Yes

No

Fiji

Yes

Yes

Yes

Yes

No

No

Yes

Yes

Yes

No

Fren

ch P

olyn

esia

Yes

Yes

Yes

Yes

No

No

No

Yes

Gua

m

Hon

g Ko

ng (C

hina

)Ye

sYe

sN

oYe

sYe

sYe

sYe

sYe

sYe

sYe

sJa

pan

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Kirib

ati

Yes

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

No

Lao

Peop

le’s

Dem

ocra

tic R

epub

lic, t

heYe

sYe

sN

oN

oN

oN

oYe

sYe

sM

acao

(Chi

na)

Yes

Yes

Yes

Yes

No

Yes

No

No

Yes

No

Mal

aysi

aYe

sYe

sYe

sYe

sN

oYe

sYe

sYe

sYe

sYe

sM

arsh

all I

slan

ds, t

heYe

sYe

sYe

sYe

sN

oN

oYe

sYe

sYe

sN

oM

icro

nesi

a, th

e Fe

dera

ted

Stat

es o

fYe

sYe

sYe

sYe

sYe

sYe

sYe

sYe

sYe

sYe

sM

ongo

liaYe

sYe

sN

oN

oYe

sYe

sYe

sYe

sYe

sYe

sN

auru

Yes

Yes

No

Yes

No

No

No

No

Yes

No

New

Cal

edon

iaYe

sYe

sYe

sYe

sYe

sYe

sYe

sN

oYe

sN

ew Z

eala

ndYe

sYe

sYe

sYe

sN

oYe

sYe

sYe

sYe

sYe

sN

iue

Yes

Yes

Yes

Yes

No

Yes

Yes

No

Yes

No

Nor

ther

n M

aria

na Is

land

s, th

e Co

mm

onw

ealth

of t

heYe

sYe

sN

oYe

sYe

sYe

sN

oYe

sYe

sPa

lau

Yes

Yes

Yes

Yes

Yes

Yes

No

No

Yes

No

Papu

a N

ew G

uine

aYe

sYe

sYe

sYe

sYe

sYe

sYe

sPh

ilipp

ines

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Repu

blic

of K

orea

, the

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Sam

oaYe

sYe

sYe

sN

oN

oN

oN

oYe

sN

oSi

ngap

ore

Yes

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

Solo

mon

isla

nds

Yes

No

No

No

No

Yes

Yes

Yes

Yes

No

Toke

lau

Yes

Yes

No

No

No

No

No

No

Yes

No

Tong

aYe

sYe

sN

oYe

sN

oN

oYe

sYe

sYe

sYe

sTu

valu

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

No

Vanu

atu

Yes

Yes

Yes

No

No

Yes

Yes

Yes

Yes

No

Viet

Nam

No

No

No

No

No

No

No

No

Yes

Yes

tabl

e 4.

H

ealt

h sy

stem

cap

acit

y fo

r N

CD p

reve

ntio

n, e

arly

det

ecti

on, t

reat

men

t an

d ca

re w

ithi

n th

e pr

imar

y he

alth

car

e sy

stem

,

Wes

tern

Pac

ific

Regi

on, 2

010


Coun

try

/ A

rea

Wit

h pa

rtne

rshi

ps /

co

llabo

rati

ons

key

stak

ehol

ders

Hea

lth

prom

otio

n in

itia

tive

sO

ther

g

over

nmen

t M

inis

trie

s (N

on-h

ealt

h)

Oth

er

inte

rnat

iona

l in

stit

utio

ns

Aca

dem

ia

and

rese

arch

ce

ntre

s

Ng

Os

/ co

mm

unit

y-ba

sed

orga

niza

tion

s /

civi

l soc

iety

Priv

ate

Sect

orFi

scal

in

terv

enti

ons

earm

arki

ng o

f ta

xes

Init

iati

ves

to

regu

late

food

m

arke

ting

to

child

ren

enfo

rcem

ent

of fo

od

mar

keti

ng

regu

lati

ons

Amer

ican

Sam

oaYe

sYe

sYe

sYe

sYe

sYe

sYe

sYe

sYe

sN

oN

o Au

stra

liaYe

sYe

sN

oN

oYe

sYe

sYe

sYe

sYe

sYe

sYe

sBr

unei

Dar

ussa

lam

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

Cam

bodi

aYe

sN

oYe

sYe

sYe

sYe

sYe

sYe

sN

oN

o N

o Ch

ina

No

Yes

No

No

No

Cook

isla

nds

Yes

Yes

Yes

No

No

Yes

Yes

Yes

No

No

No

Fiji

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Fren

ch P

olyn

esia

Yes

Yes

No

Yes

No

Yes

No

Yes

Yes

No

No

Gua

mYe

sYe

sN

oN

oYe

sYe

sYe

sYe

sYe

sYe

s N

o H

ong

Kong

(Chi

na)

Yes

Yes

No

No

Yes

Yes

Yes

Yes

No

No

No

Japa

nYe

sYe

sYe

sYe

sYe

sYe

sYe

sN

o

Yes

Yes

Kirib

ati

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

Lao

Peop

le’s

Dem

ocra

tic

Repu

blic

, the

No

Ye

sYe

s*M

acao

(Chi

na)

Yes

Yes

No

No

Yes

Yes

Yes

Yes

No

No

No

Mal

aysi

aYe

sYe

sYe

sYe

sYe

sYe

sYe

sYe

sN

oYe

sYe

s*M

arsh

all I

slan

ds, t

heYe

sYe

sN

oN

oN

oYe

sYe

sYe

sN

oN

o N

o M

icro

nesi

a, th

e Fe

dera

ted

Stat

es o

fYe

sYe

sYe

sYe

sYe

sYe

sYe

sYe

sN

oYe

sYe

sM

ongo

liaYe

sYe

sYe

sYe

sYe

sYe

sN

oYe

sYe

sN

o N

o N

auru

Yes

Yes

No

Yes

No

Yes

Yes

Yes

No

No

No

New

Cal

edon

iaYe

sYe

sN

oYe

sN

oYe

sYe

sYe

sYe

sYe

sYe

s*N

ew Z

eala

ndYe

sN

oN

oN

oYe

sYe

sYe

sYe

sN

oN

o N

o N

iue

Yes

Yes

No

No

No

Yes

Yes

Yes

No

No

No

Nor

ther

n M

aria

na Is

land

s, th

e Co

mm

onw

ealth

of t

heYe

sYe

sYe

sYe

sYe

sYe

sYe

sYe

sYe

sN

o N

o Pa

lau

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

No

No

No

Papu

a N

ew G

uine

aYe

sYe

sN

oYe

sN

oYe

sYe

sYe

s

Yes

Yes

Phili

ppin

esYe

sYe

sYe

sYe

sYe

sYe

sYe

sYe

sYe

sN

o N

o Re

publ

ic o

f Kor

ea, t

heN

o

Ye

sYe

sYe

sYe

sSa

moa

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Ye

sYe

sSi

ngap

ore

Yes

Yes

Yes

Yes

Yes

No

No

Yes

No

Yes

Yes*

Solo

mon

isla

nds

Yes

Yes

Yes

Yes

No

Yes

No

No

N

o N

o To

kela

uYe

sN

oYe

sYe

sN

oN

oN

oN

o

No

No

Tong

aYe

sYe

sYe

sYe

sYe

sYe

sYe

sYe

sN

oN

o N

o Tu

valu

Yes

Yes

Yes

Yes

No

Yes

No

Yes

No

Yes

Yes

Vanu

atu

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes*

Viet

Nam

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

No

No

No

tabl

e 5.

H

ealt

h pr

omot

ion,

par

tner

ship

s, a

nd c

olla

bora

tion

, Wes

tern

Pac

ific

Regi

on, 2

010

Not

es: *

Yes=

Food

mar

ketin

g re

gula

tion

to c

hild

ren

is s

elf-r

egul

ated


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

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

http://www.who.int/nmh/countries/en/index.html


Australia

Income group: High

2008 estimates males females

Total NCD deaths (000s) 63.4 63.2

NCD deaths under age 60

(percent of all NCD deaths)

All NCDs 364.8 246.3

Cancers 140.8 92.9

Chronic respiratory diseases 25.6 15.5

Cardiovascular diseases and diabetes 136.3 88.6

2008 estimated prevalence (%) males females total

Current daily tobacco smoking 18.3 15.4 16.8

Physical inactivity 38.0 42.5 40.3


Raised blood pressure 41.1 32.0 36.4

Raised blood glucose 10.8 8.0 9.4

Overweight 68.2 59.3 63.7

Obesity 26.4 27.1 26.8

Raised cholesterol 55.9 58.9 57.4 NCDs are estimated to account for 90% of all deaths.

Country capacity to address and respond to NCDs

Has a Unit / Branch / Dept in MOH with responsibility for NCDs Yes

There is funding available for: Cardiovascular diseases No

NCD treatment and control Yes Cancer Yes

NCD prevention and health promotion Yes Chronic respiratory diseases No

NCD surveillance, monitoring and evaluation Yes Diabetes No

Alcohol Yes

National health reporting system includes: Unhealthy diet / Overweight / Obesity Yes

NCD cause-specific mortality Yes Physical inactivity Yes

NCD morbidity Yes Tobacco Yes

NCD risk factors Yes

Has a national, population-based cancer registry Yes

World Health Organization - NCD Country Profiles , 2011.

13.4

NCD mortality

9.2

Metabolic risk factor trends

Age-standardized death rate per 100 000

Behavioural risk factors

Metabolic risk factors

2010 total population: 22 268 384

Proportional mortality (% of total deaths, all ages)

Has an integrated or topic-specific policy / programme / action

plan which is currently operational for:

Number of tobacco (m)POWER measures

implemented at the highest level of achievement3/5

118

121

124

127

130

133

136

1980 1984 1988 1992 1996 2000 2004 2008

mm

Hg

4.8

5.0

5.2

5.4

5.6

5.8

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l

Mean fasting blood glucose

20

22

24

26

28

30

1980 1984 1988 1992 1996 2000 2004 2008

kg

/m2

Mean body mass index

5.0

5.2

5.4

5.6

5.8

6.0

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l

Mean total cholesterol

Males

Mean systolic blood pressure

Females

CVD

35%

Cancers

29%

Respiratory

diseases

6%

Other NCDs

17%

Injuries

6%

Diabetes

3%

Communicable,

maternal,

perinatal and

nutritional

conditions

4%


Brunei Darussalam

Income group: High





All NCDs 534.3 488.7

Cancers 97.0 98.1




Current daily tobacco smoking … … …

Physical inactivity ... ... ...


Raised blood pressure ... ... ...

Raised blood glucose ... ... ...

Overweight ... ... ...

Obesity ... ... ...

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


Has a Unit / Branch / Dept in MOH with responsibility for NCDs No


NCD treatment and control Yes Cancer No


NCD surveillance, monitoring and evaluation Yes Diabetes Yes

Alcohol Yes


NCD cause-specific mortality Yes Physical inactivity No


NCD risk factors No


… = no data available


41.4

NCD mortality

30.0





2010 total population: 398 920






116

120

124

128

132

136

1980 1984 1988 1992 1996 2000 2004 2008

mm

Hg

4.6

4.8

5.0

5.2

5.4

5.6

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


18

20

22

24

26

28

1980 1984 1988 1992 1996 2000 2004 2008

kg

/m2


4.6

4.8

5.0

5.2

5.4

5.6

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


Males


Females

CVD

33%

Cancers

16%

Diabetes

11%

Other NCDs

14%

Communicable,

maternal,

perinatal and

nutritional

conditions

10%

Injuries

8%

Respiratory

diseases

8%


Cambodia

Income group: Low





All NCDs 957.9 592.2

Cancers 144.9 90.0










Obesity 1.5 2.7 2.1




There is funding available for: Cardiovascular diseases Yes**

NCD treatment and control Yes Cancer Yes**


NCD surveillance, monitoring and evaluation Yes Diabetes Yes**

Alcohol Yes**

National health reporting system includes: Unhealthy diet / Overweight / Obesity Yes**

NCD cause-specific mortality Yes Physical inactivity Yes**

NCD morbidity Yes Tobacco Yes**

NCD risk factors No

Has a national, population-based cancer registry No

* The mortality estimates for this country have a high degree of uncertainty because they are not based ** = covered by integrated policy/programme/action plan

on any national NCD mortality data. The estimates are based on a combination of country life tables,

cause of death models, regional cause of death patterns, and WHO and UNAIDS program estimates

for some major causes of death (not including NCDs).


56.2

NCD mortality*

34.8






Proportional mortality (% of total deaths, all ages)*





110

112

114

116

118

120

122

124

1980 1984 1988 1992 1996 2000 2004 2008

mm

Hg

4.4

4.6

4.8

5.0

5.2

5.4

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


16

18

20

22

24

26

1980 1984 1988 1992 1996 2000 2004 2008

kg

/m2


3.8

4.0

4.2

4.4

4.6

4.8

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


Males


Females

CVD

21%

Cancers

7%

Other NCDs

11%

Communicable,

maternal,

perinatal and

nutritional

conditions

46%

Injuries

7%

Respiratory

diseases

5%

Diabetes

3%


China

Income group: Lower middle





All NCDs 665.2 495.2

Cancers 182.3 105.0










Obesity 4.7 6.7 5.7








Alcohol No



NCD morbidity Yes Tobacco No




2010 total population: 1 341 335 152






22.8

NCD mortality

17.4





119

121

123

125

127

129

1980 1984 1988 1992 1996 2000 2004 2008

mm

Hg

4.8

5.0

5.2

5.4

5.6

5.8

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


18

20

22

24

26

28

1980 1984 1988 1992 1996 2000 2004 2008

kg

/m2


4.0

4.2

4.4

4.6

4.8

5.0

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


Males


Females

CVD

38%

Cancers

21%

Respiratory

diseases

15%

Other NCDs

7%

Diabetes

2%

Communicable,

maternal,

perinatal and

nutritional

conditions

7%

Injuries

10%


Cook Islands

Income group: Upper middle





All NCDs 592.0 326.3

Cancers 58.6 57.4










Obesity 59.7 67.9 63.7








Alcohol Yes**






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








39.4

NCD mortality

30.6








Males


Females

CVD

37%

Cancers

10%Respiratory

diseases

7%

Other NCDs

15%

Injuries

7%Communicable,

maternal,

perinatal and

nutritional

conditions

19%

Diabetes

5%

1980 1984 1988 1992 1996 2000 2004 2008

No Data Available

1980 1984 1988 1992 1996 2000 2004 2008

No Data Available

1980 1984 1988 1992 1996 2000 2004 2008

No Data Available

1980 1984 1988 1992 1996 2000 2004 2008

No Data Available


Fiji






All NCDs 928.4 590.9

Cancers 106.2 121.6










Obesity 20.3 41.1 30.6








Alcohol Yes**















45.6

NCD mortality

38.0





120

122

124

126

128

130

1980 1984 1988 1992 1996 2000 2004 2008

mm

Hg

5.1

5.3

5.5

5.7

5.9

6.1

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


21

23

25

27

29

31

1980 1984 1988 1992 1996 2000 2004 2008

kg

/m2


4.4

4.6

4.8

5.0

5.2

5.4

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


Males


Females

CVD

42%

Cancers

12%

Other NCDs

13%

Injuries

5%Communicable,

maternal,

perinatal and

nutritional

conditions

18%

Respiratory

diseases

6%

Diabetes

4%


Japan

Income group: High





All NCDs 336.7 178.1

Cancers 150.5 76.6










Obesity 5.8 4.4 5.0








Alcohol Yes**














11.6

NCD mortality

7.0





124

126

128

130

132

134

136

138

1980 1984 1988 1992 1996 2000 2004 2008

mm

Hg

4.7

4.9

5.1

5.3

5.5

5.7

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


18

20

22

24

26

28

1980 1984 1988 1992 1996 2000 2004 2008

kg

/m2


4.4

4.6

4.8

5.0

5.2

5.4

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


Males


Females

CVD

32%

Cancers

31%

Respiratory

diseases

5%

Other NCDs

11%

Communicable,

maternal,

perinatal and

nutritional

conditions

14%

Diabetes

1%

Injuries

6%


Kiribati






All NCDs 832.4 548.3

Cancers 39.0 64.2










Obesity 37.7 53.8 46.0





NCD treatment and control No Cancer Yes**

NCD prevention and health promotion Yes Chronic respiratory diseases Yes**


Alcohol Yes**














66.5

NCD mortality

47.6








Males


Females

CVD

23%

Cancers

5%

Other NCDs

28%

Communicable,

maternal,

perinatal and

nutritional

conditions

29%

Diabetes

8%

Respiratory

diseases

4%

Injuries

3%

1980 1984 1988 1992 1996 2000 2004 2008

No Data Available

1980 1984 1988 1992 1996 2000 2004 2008

No Data Available

1980 1984 1988 1992 1996 2000 2004 2008

No Data Available

1980 1984 1988 1992 1996 2000 2004 2008

No Data Available


Lao People's Democratic Republic

Income group: Low





All NCDs 849.4 689.0

Cancers 145.4 111.1










Obesity 1.4 3.7 2.6




There is funding available for: Cardiovascular diseases DK

NCD treatment and control Yes Cancer DK

NCD prevention and health promotion Yes Chronic respiratory diseases DK

NCD surveillance, monitoring and evaluation Yes Diabetes DK

Alcohol DK

National health reporting system includes: Unhealthy diet / Overweight / Obesity DK

NCD cause-specific mortality No Physical inactivity DK

NCD morbidity No Tobacco No



* The mortality estimates for this country have a high degree of uncertainty because they are not based … = no data available

on any national NCD mortality data. The estimates are based on a combination of country life tables, DK = Country responded "don't know"










38.6

NCD mortality*

32.6





116

118

120

122

124

126

1980 1984 1988 1992 1996 2000 2004 2008

mm

Hg

4.6

4.8

5.0

5.2

5.4

5.6

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


16

18

20

22

24

26

1980 1984 1988 1992 1996 2000 2004 2008

kg

/m2


4.0

4.2

4.4

4.6

4.8

5.0

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


Males


Females

CVD

24%

Cancers

9%

Injuries

10%

Respiratory

diseases

7%

Diabetes

1%Other NCDs

8%

Communicable,

maternal,

perinatal and

nutritional

conditions

41%


Malaysia






All NCDs 605.7 436.5

Cancers 118.8 89.9










Obesity 10.4 17.6 14.0








Alcohol No















33.7

NCD mortality

26.3





120

122

124

126

128

130

1980 1984 1988 1992 1996 2000 2004 2008

mm

Hg

5.0

5.2

5.4

5.6

5.8

6.0

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


18

20

22

24

26

28

1980 1984 1988 1992 1996 2000 2004 2008

kg

/m2


4.4

4.6

4.8

5.0

5.2

5.4

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


Males


Females

CVD

32%

Cancers

15%

Respiratory

diseases

7%

Other NCDs

11%

Communicable,

maternal,

perinatal and

nutritional

conditions

24%

Injuries

9%

Diabetes

2%


Marshall Islands






All NCDs 1280.1 1316.0

Cancers 100.7 129.0










Obesity 37.9 52.4 45.4







NCD surveillance, monitoring and evaluation No Diabetes Yes

Alcohol Yes**

















52.2

NCD mortality*

42.8








Males


Females

CVD

40%

Respiratory

diseases

7%

Other NCDs

14%

Communicable,

maternal,

perinatal and

nutritional

conditions

22%

Cancers

7%Diabetes

5%

Injuries

5%

1980 1984 1988 1992 1996 2000 2004 2008

No Data Available

1980 1984 1988 1992 1996 2000 2004 2008

No Data Available

1980 1984 1988 1992 1996 2000 2004 2008

No Data Available

1980 1984 1988 1992 1996 2000 2004 2008

No Data Available


Micronesia (Federated States of)






All NCDs 753.7 622.8

Cancers 79.3 90.1










Obesity 28.1 53.2 40.6








Alcohol Yes**

















38.8

NCD mortality*

37.0





118

120

122

124

126

128

130

132

1980 1984 1988 1992 1996 2000 2004 2008

mm

Hg

5.2

5.4

5.6

5.8

6.0

6.2

6.4

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


22

24

26

28

30

32

1980 1984 1988 1992 1996 2000 2004 2008

kg

/m2


4.2

4.4

4.6

4.8

5.0

5.2

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


Males


Females

CVD

35%

Cancers

8%Other NCDs

14%

Communicable,

maternal,

perinatal and

nutritional

conditions

28%

Injuries

5%

Diabetes

4%

Respiratory

diseases

6%


Mongolia






All NCDs 867.7 569.0

Cancers 259.5 166.4










Obesity 10.4 18.3 14.4








Alcohol Yes**

















48.0

NCD mortality*

35.4





124

126

128

130

132

134

1980 1984 1988 1992 1996 2000 2004 2008

mm

Hg

4.8

5.0

5.2

5.4

5.6

5.8

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


20

22

24

26

28

30

1980 1984 1988 1992 1996 2000 2004 2008

kg

/m2


4.4

4.6

4.8

5.0

5.2

5.4

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


Males


Females

CVD

37%

Cancers

21%

Communicable,

maternal,

perinatal and

nutritional

conditions

14%

Injuries

13%

Other NCDs

12%

Diabetes

0%

Respiratory

diseases

3%


Nauru






All NCDs 1367.4 845.5

Cancers 114.7 190.6










Obesity 67.7 74.4 71.1








Alcohol Yes**














54.0

NCD mortality

48.5








Males


Females

CVD

40%

Cancers

9%

Injuries

11%

Communicable,

maternal,

perinatal and

nutritional

conditions

19%

Other NCDs

12%

Respiratory

diseases

5%

Diabetes

4%

1980 1984 1988 1992 1996 2000 2004 2008

No Data Available

1980 1984 1988 1992 1996 2000 2004 2008

No Data Available

1980 1984 1988 1992 1996 2000 2004 2008

No Data Available

1980 1984 1988 1992 1996 2000 2004 2008

No Data Available


New Zealand

Income group: High





All NCDs 410.7 285.1

Cancers 149.1 110.8










Obesity 27.3 29.3 28.3



Has a Unit / Branch / Dept in MOH with responsibility for NCDs No

There is funding available for: Cardiovascular diseases Yes



NCD surveillance, monitoring and evaluation Yes Diabetes Yes

Alcohol Yes








14.1

NCD mortality

11.1











120

124

128

132

136

1980 1984 1988 1992 1996 2000 2004 2008

mm

Hg

4.9

5.1

5.3

5.5

5.7

5.9

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


22

24

26

28

30

32

1980 1984 1988 1992 1996 2000 2004 2008

kg

/m2


5.0

5.2

5.4

5.6

5.8

6.0

6.2

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


Males


Females

CVD

37%

Cancers

29%

Other NCDs

15%

Respiratory

diseases

7%

Diabetes

3%

Injuries

6%

Communicable,

maternal,

perinatal and

nutritional

conditions

3%


Niue






All NCDs 790.3 314.6

Cancers 79.7 80.5




Current daily tobacco smoking … … …





Overweight … … …

Obesity … … …





NCD treatment and control No Cancer DK

NCD prevention and health promotion Yes Chronic respiratory diseases DK

NCD surveillance, monitoring and evaluation No Diabetes Yes**

Alcohol Yes**








DK = Country responded "don't know"








45.6

NCD mortality

21.3








Males


Females

CVD

36%

Cancers

11%Respiratory

diseases

7%

Other NCDs

13%

Injuries

8%

Communicable,

maternal,

perinatal and

nutritional

conditions

21%

Diabetes

4%

1980 1984 1988 1992 1996 2000 2004 2008

No Data Available

1980 1984 1988 1992 1996 2000 2004 2008

No Data Available

1980 1984 1988 1992 1996 2000 2004 2008

No Data Available

1980 1984 1988 1992 1996 2000 2004 2008

No Data Available


Palau






All NCDs 777.3 413.7

Cancers 91.4 105.3





Physical inactivity … … …




Overweight ... ... ...

Obesity ... ... ...







NCD surveillance, monitoring and evaluation No Diabetes Yes**

Alcohol Yes**



NCD morbidity No Tobacco Yes**

NCD risk factors No



on any national NCD mortality data. The estimates are based on a combination of country life tables, ** = covered by integrated policy/programme/action plan










43.6

NCD mortality*

38.1








Males


Females

CVD

38%

Cancers

13%

Other NCDs

13%

Communicable,

maternal,

perinatal and

nutritional

conditions

20%

Respiratory

diseases

6%

Diabetes

4%

Injuries

6%

1980 1984 1988 1992 1996 2000 2004 2008

No Data Available

1980 1984 1988 1992 1996 2000 2004 2008

No Data Available

1980 1984 1988 1992 1996 2000 2004 2008

No Data Available

1980 1984 1988 1992 1996 2000 2004 2008

No Data Available


Papua New Guinea






All NCDs 836.9 664.7

Cancers 151.8 106.9










Obesity 11.7 20.6 16.2








Alcohol Yes**





Has a national, population-based cancer registry DK


on any national NCD mortality data. The estimates are based on a combination of country life tables, DK = Country responded "don't know"










49.1

NCD mortality*

48.4





108

110

112

114

116

118

120

122

1980 1984 1988 1992 1996 2000 2004 2008

mm

Hg

5.1

5.3

5.5

5.7

5.9

6.1

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


18

20

22

24

26

28

1980 1984 1988 1992 1996 2000 2004 2008

kg

/m2


4.0

4.2

4.4

4.6

4.8

5.0

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


Males


Females

CVD

21%

Cancers

8%

Communicable,

maternal,

perinatal and

nutritional

conditions

47%

Injuries

9%

Other NCDs

8%

Respiratory

diseases

5%

Diabetes

2%


Philippines






All NCDs 711.6 482.8

Cancers 98.6 74.6










Obesity 4.6 8.0 6.3








Alcohol Yes**














44.4

NCD mortality

35.6





118

120

122

124

126

128

1980 1984 1988 1992 1996 2000 2004 2008

mm

Hg

4.6

4.8

5.0

5.2

5.4

5.6

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


18

20

22

24

26

28

1980 1984 1988 1992 1996 2000 2004 2008

kg

/m2


4.2

4.4

4.6

4.8

5.0

5.2

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


Males


Females

CVD

30%

Cancers

10%

Communicable,

maternal,

perinatal and

nutritional

conditions

30%

Other NCDs

13%

Respiratory

diseases

5%

Diabetes

4%

Injuries

8%


Republic of Korea

Income group: High





All NCDs 465.0 246.8

Cancers 190.5 77.1










Obesity 7.2 8.3 7.7








Alcohol Yes**















24.2

NCD mortality

12.5





117

119

121

123

125

127

1980 1984 1988 1992 1996 2000 2004 2008

mm

Hg

4.9

5.1

5.3

5.5

5.7

5.9

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


18

20

22

24

26

28

1980 1984 1988 1992 1996 2000 2004 2008

kg

/m2


4.2

4.4

4.6

4.8

5.0

5.2

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


Males


Females

CVD

29%

Cancers

30%

Diabetes

5%

Other NCDs

13%

Injuries

12%

Respiratory

diseases

5%

Communicable,

maternal,

perinatal and

nutritional

conditions

6%


Samoa






All NCDs 772.1 583.2

Cancers 68.5 40.2










Obesity 43.6 65.5 54.1








Alcohol No



NCD morbidity Yes Tobacco No

NCD risk factors No


* The mortality estimates for this country have a high degree of uncertainty because they are not based











36.1

NCD mortality*

27.7





118

120

122

124

126

128

130

132

1980 1984 1988 1992 1996 2000 2004 2008

mm

Hg

5.0

5.3

5.6

5.9

6.2

6.5

6.8

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


24

26

28

30

32

34

1980 1984 1988 1992 1996 2000 2004 2008

kg

/m2


4.0

4.2

4.4

4.6

4.8

5.0

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


Males


Females

CVD

37%

Cancers

6%Respiratory

diseases

7%

Diabetes

5%

Other NCDs

15%

Communicable,

maternal,

perinatal and

nutritional

conditions

25%

Injuries

5%


Singapore

Income group: High





All NCDs 372.1 238.8

Cancers 141.6 90.9










Obesity 7.0 7.1 7.1








Alcohol Yes**















24.4

NCD mortality

18.9





120

122

124

126

128

130

1980 1984 1988 1992 1996 2000 2004 2008

mm

Hg

5.0

5.2

5.4

5.6

5.8

6.0

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


18

20

22

24

26

28

1980 1984 1988 1992 1996 2000 2004 2008

kg

/m2


4.6

4.8

5.0

5.2

5.4

5.6

5.8

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


Males


Females

CVD

33%

Cancers

30%

Other NCDs

9%

Respiratory

diseases

4%

Diabetes

3%

Injuries

5%

Communicable,

maternal,

perinatal and

nutritional

conditions

16%


Solomon Islands






All NCDs 709.7 524.3

Cancers 85.9 85.9










Obesity 22.6 37.7 30.0








Alcohol No

National health reporting system includes: Unhealthy diet / Overweight / Obesity No

NCD cause-specific mortality No Physical inactivity No

NCD morbidity No Tobacco No

NCD risk factors No


* The mortality estimates for this country have a high degree of uncertainty because they are not based











38.8

NCD mortality*

38.7





115

117

119

121

123

125

1980 1984 1988 1992 1996 2000 2004 2008

mm

Hg

5.1

5.3

5.5

5.7

5.9

6.1

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


22

24

26

28

30

32

1980 1984 1988 1992 1996 2000 2004 2008

kg

/m2


4.0

4.2

4.4

4.6

4.8

5.0

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


Males


Females

CVD

29%

Cancers

10%

Respiratory

diseases

5%Other NCDs

12%

Communicable,

maternal,

perinatal and

nutritional

conditions

35%

Injuries

5%

Diabetes

4%


Tonga






All NCDs 649.3 672.6

Cancers 67.4 93.9










Obesity 46.6 68.5 57.6








Alcohol Yes**














25.6

NCD mortality

35.1





117

119

121

123

125

127

129

131

1980 1984 1988 1992 1996 2000 2004 2008

mm

Hg

5.3

5.5

5.7

5.9

6.1

6.3

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


25

27

29

31

33

35

1980 1984 1988 1992 1996 2000 2004 2008

kg

/m2


4.4

4.6

4.8

5.0

5.2

5.4

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


Males


Females

CVD

38%

Respiratory

diseases

7%

Other NCDs

15%

Cancers

9%Diabetes

5%

Communicable,

maternal,

perinatal and

nutritional

conditions

22%

Injuries

4%


Tuvalu






All NCDs 992.3 991.9

Cancers 106.9 153.8









Overweight … … …

Obesity … … …








Alcohol No




NCD risk factors No










36.6

NCD mortality

37.0








Males


Females

CVD

38%

Cancers

10%Respiratory

diseases

6%

Other NCDs

15%

Diabetes

5%

Communicable,

maternal,

perinatal and

nutritional

conditions

21%

Injuries

5%

1980 1984 1988 1992 1996 2000 2004 2008

No Data Available

1980 1984 1988 1992 1996 2000 2004 2008

No Data Available

1980 1984 1988 1992 1996 2000 2004 2008

No Data Available

1980 1984 1988 1992 1996 2000 2004 2008

No Data Available


Vanuatu






All NCDs 767.8 576.8

Cancers 94.7 94.3










Obesity 21.0 34.2 27.5








Alcohol Yes**







on any national NCD mortality data. The estimates are based on a combination of country life tables, ** = covered by integrated policy/programme/action plan










37.9

NCD mortality*

42.0





122

124

126

128

130

132

134

1980 1984 1988 1992 1996 2000 2004 2008

mm

Hg

4.4

4.6

4.8

5.0

5.2

5.4

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


20

22

24

26

28

30

1980 1984 1988 1992 1996 2000 2004 2008

kg

/m2


4.2

4.4

4.6

4.8

5.0

5.2

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


Males


Females

CVD

36%

Cancers

12%Respiratory

diseases

6%

Other NCDs

13%

Diabetes

4%

Communicable,

maternal,

perinatal and

nutritional

conditions

24%

Injuries

5%


Viet Nam

Income group: Low





All NCDs 687.2 508.2

Cancers 137.3 94.3










Obesity 1.2 2.1 1.7






NCD prevention and health promotion Yes Chronic respiratory diseases Yes


Alcohol No




NCD risk factors No











26.4

NCD mortality

19.4





116

118

120

122

124

126

1980 1984 1988 1992 1996 2000 2004 2008

mm

Hg

4.6

4.8

5.0

5.2

5.4

5.6

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


16

18

20

22

24

26

1980 1984 1988 1992 1996 2000 2004 2008

kg

/m2


4.0

4.2

4.4

4.6

4.8

5.0

1980 1984 1988 1992 1996 2000 2004 2008

mm

ol/l


Males


Females

CVD

40%

Cancers

14%

Respiratory

diseases

8%

Other NCDs

10%

Diabetes

3%

Communicable,

maternal,

perinatal and

nutritional

conditions

16%

Injuries

9%


6. key findings and recommendations

NCDs are a major public health problem in all countries of the Region. Age-standardized death rates show a wide variation among countries, indicating a large potential for reducing NCD mortality. The high proportion of NCD deaths among people under 70 years in LMIC is of concern. Cause-specific mortality data, with International Classification of Diseases (ICD) coding, are required for monitoring NCD mortality and serve as unbiased indicators of the effectiveness of the overall NCD prevention and control programme. Mortality registration and certification should be strengthened, especially in LMIC, as it is an important basis for implementing and monitoring NCD programmes, as well as for assessing other health programmes.

There is a two- to three-fold variation in cancer incidence in the Region. HIC have managed to reduce the incidence of cervical cancer through screening, early detection and prompt management. Population-based disease registries are available for cancer in many HIC. However, there are many challenges in establishing population-based disease registries in LMIC; hospital-based registries offer an entry point prior to coverage of a defined catchment population.

Trends in NCD risk factors serve as indicators of the effectiveness of risk reduction programmes. Collection of comparable data in a periodic manner is essential for measuring trends between and within countries. WHO STEPS offers a standardized approach that can be adopted by countries.

WHO has proposed a framework for a national NCD surveillance scheme with three major components as given in Box 1.

Box 1. Framework for national NCD surveillance

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

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

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


There has been substantial progress in the overall country capacity for NCD prevention and management in the Region. The profile has not gone into an analytical approach as the data on country capacity were limited to availability of policies and programmes and did not include detailed information on implementation.

Interventions to prevent NCDs on a population-wide basis are not only feasible but also cost-effective. Low-cost solutions can work anywhere to reduce the major risk factors for NCDs. While many interventions may be cost-effective, some are considered “best buys”—actions that should be undertaken immediately to produce accelerated results in terms of lives saved, diseases prevented and heavy costs avoided. A set of best buys and cost-effective interventions from the Global status report on noncommunicable diseases 2010, as listed below, can be considered as priority interventions.

Best buys include:

• protecting people from tobacco smoke and banning smoking in public places;• warning about the dangers of tobacco use;• enforcing bans on tobacco advertising, promotion and sponsorship;• raising taxes on tobacco;• restricting access to retailed alcohol;• enforcing bans on alcohol advertising;• raising taxes on alcohol;• reducing salt intake and salt content of food;• replacing trans-fat in food with polyunsaturated fat; and• promoting public awareness about diet and physical activity, including through mass media.

Cost-effective approaches in individual health care interventions include:

• counselling and multidrug therapy, including glycaemic control for diabetes for people older than 30 years with a 10-year risk of fatal or nonfatal cardiovascular events;

• aspirin therapy for acute myocardial infarction;• screening for cervical cancer, once at age 40, followed by removal of any discovered cancerous

lesion;• early case finding for breast cancer through biennial screening with mammography (for

women aged 50–70 years) and treatment of all stages;• early detection of colorectal and oral cancer; and• treatment of persistent asthma with inhaled corticosteroids and beta-2 agonists.

Given the health and economic burden caused by NCDs and the urgent need to scale up action and monitor progress, countries should move towards time-bound targets and improved monitoring frameworks for NCD prevention and control.


Annexes

ANNex 1 - RegIONAL COMMItMeNts ON NCD

seOuL DeCLARAtION ON NONCOMMuNICABLe DIseAse PReveNtION AND CONtROL IN tHe WesteRN PACIFIC RegION

18 March 2011

Recognizing the serious and rapidly increasing adverse impact of noncommunicable diseases (NCD), including cardiovascular diseases, cancers, diabetes and chronic respiratory diseases, on individuals, families, communities, health systems and national economies, and the high prevalence of the major risk factors, the countries and areas of the WHO Western Pacific Region participating at the Regional High-level Meeting on Scaling Up Multisectoral Action for Noncommunicable Disease Prevention and Control, declare their commitment to:

(1) provide strong and sustained high-level political support for NCD prevention and control to reduce premature NCD death and disability and health inequalities;

(2) ensure a supportive multisectoral whole-of-government policy environment across all levels of government and a coordinating mechanism to mainstream the response to NCD involving all stakeholders, including civil society and, where appropriate, the private sector to protect health over commercial and other vested interests and to ensure that healthy choices are the easiest choices;

(3) reduce the common modifiable NCD risk factors (tobacco use; diets high in saturated fats and trans-fats, salt and sugar; the harmful use of alcohol; and physical inactivity); and• in line with the WHO global and regional action plans and using the full range of

mechanisms including legislation, regulation, fiscal measures and healthy public policies and, in particular, accelerate the full implementation of the WHO Framework Convention on Tobacco Control; and

• by addressing the social determinants of health and by leveraging the power of local governments and civil society actions;

(4) strengthen and integrate health systems, based on primary health care to ensure that NCD prevention and control is part of a funded coherent, balanced, realistic and comprehensive health planning process that is financially feasible and to:• deliver services for NCD and their risk factors utilizing team-based care and the most

appropriate professional health care for the patient’s needs, including affordable and cost-effective drugs and technologies to support evidence-based priority interventions; and

• work towards continuity of quality care from prevention to palliation across all components of health systems and promote a people-centred approach;

(5) prioritize human and financial resources and infrastructure to ensure equitable coverage of complementary priority evidence-based NCD prevention and control interventions, including resource mobilization through innovative financing mechanisms; and

(6) provide integrated but practical monitoring and accountability systems based on strengthened health information systems and a small number of quantified and timed targets and indicators to assess progress nationally to be reported publicly and to the United Nations General Assembly and other appropriate forums.


In support of these commitments, participating countries and areas request the global community, through the UN High-level Meeting on the Prevention and Control of Noncommunicable Diseases, to act in a coordinated way to facilitate global and national multisectoral actions by:

(1) raising the priority of NCD on their agendas;(2) strengthening synergies between NCD programmes and other development priorities,

including the Millennium Development Goals and the future global development agenda; and

(3) mobilizing additional resources and supporting innovative approaches to financing NCD prevention and control.


HONIARA COMMuNIQuÉ ON tHe PACIFIC NONCOMMuNICABLe DIseAse CRIsIs9th Meeting of Ministers of Health for the Pacific Island Countries

30 June 2011

Ministers of Health for the Pacific island countries are gravely concerned that the rapid increase in the incidence and prevalence of noncommunicable disease (NCD) in the Pacific island countries and areas over the past decade is responsible for up to 75% of all deaths and a similar percentage of long-term illness and disability, and declared at their 9th Meeting in Honiara, Solomon Islands, on 28–30 June 2011 that the Pacific island countries and areas are in an NCD crisis requiring urgent attention.

Pacific island countries and areas are in crisis due to an epidemic of noncommunicable disease (NCD) such as heart disease, cancer and diabetes. The burden of NCD in the region is already extremely high, causing up to 75% of deaths and much long-term illness and disability. Our prevalence of NCD risk factors are among the highest in the world—up to three of every four adults are obese and up to four of every five adults smoke—meaning that without real action things will only get worse.

The Pacific NCD crisis is not just a concern for the health of our people. It drains limited national budgets, reduces worker productivity, separates families, and robs communities of leadership and wisdom, as adults suffer long-term illness and die early. While adult NCD rates continue to rise, the next generation—more overweight and less active than any other Pacific generation in history—is the tsunami of the future. High childhood obesity rates in the Pacific, if left unchecked, suggest that a true health catastrophe is just a generation away.

There is hope, however. There has been some early progress in the fight against NCD, and effective actions are available across a spectrum ranging from prevention to early detection and treatment. But what is missing is a sense of urgency in the region, and the recognition among Pacific island countries and areas that a whole-of-government and whole-of-society approach is needed to tackle this health and development crisis.

There is a great opportunity this year with the United Nations General Assembly holding a High-level Meeting on the Prevention and Control of Noncommunicable Diseases from 19–20 September 2011 in New York. In the lead-up to this meeting, there have already been a number of key regional and global meetings that have considered the NCD crisis. The resulting Nadi Statement and Moscow Declaration made important recommendations on ways forward and this communiqué builds on those important initiatives. We have an opportunity to address this crisis if we act now.

Recognizing the fundamental importance of the upcoming United Nations High-level Meeting in tackling this crisis at the global level, and the need for the outcomes of this meeting to reflect Pacific realities, we call on the outcome document of the High-level Meeting to include the following:

• recognize NCD as a crisis in the Pacific to be addressed with the utmost urgency; • address the need for better information and guidance on cost-effective interventions in

resource-limited settings;• initiate and sustain effective action across the life-course; • ensure sustainable resourcing for NCD prevention, treatment and control;


• adopt a small number of global and publicly reported targets for NCD that can be adapted to national context; and

• initiate multisectoral action at the international level to complement national level action, and make an explicit expectation that international organizations will work together in a coordinated way to tackle NCD.

And in support of these recommendations, consistent with the Pacific Plan endorsed by the leaders of the Pacific Islands Forum at their October 2005 meeting and in support of our goal of Healthy Islands, we, the Ministers of Health for the Pacific island countries and areas, declare our commitment to the following critical actions:

(1) provide strong and sustained leadership and support for NCD prevention and control; (2) lead the advocacy for a whole-of-government and whole-of-society response and a coordinating

mechanism to mainstream the response to NCD; (3) ensure implementation of evidence-based initiatives to reduce the common modifiable NCD risk

factors across the life-course, and address the social determinants of health, including leveraging the power of local government and civil society, with a focus on interventions across the life-course;

(4) strengthen health systems, based on primary health care, to ensure that effective NCD prevention and control is funded and part of a coherent, balanced, realistic and comprehensive programme of health services as reflected in a costed national health plan;

(5) ensure monitoring and accountability systems are in place, along with a small number of quantified and timed national targets, with progress to be reported publicly; and

(6) fully implement the WHO Framework Convention on Tobacco Control as a critical step in reducing the impact of tobacco use on the prevalence of NCD.

Recognizing that many of the factors underlying this pandemic are outside the control of the health sector, and that as a result a whole-of-government, whole-of-society and whole-of- region response is needed, we also call on the Pacific Forum Leaders to give the highest priority to NCD, and to lead and champion tackling the crisis in the Pacific by:

(1) declaring NCD as a health and development crisis;(2) driving a whole-of-government and whole-of-society response involving all sectors;(3) integrating NCD prevention and control into national development agendas; (4) mobilizing additional resources locally and internationally to support the fight against NCD;(5) setting national targets for NCD and regularly and publicly reporting results;(6) calling on all Council of Regional Organizations in the Pacific (CROP) agencies and regional

health agencies to play an active part in a coordinated regional response to the crisis, and to report back every two years to Pacific Islands Forum Leaders on actions and progress;

(7) considering setting an ambitious regional tobacco elimination target, inspired by (8) New Zealand’s smoke-free by 2025 goal; and (9) championing the cause of prevention and control of this NCD epidemic.


ANNex 2 - exPLORAtORy NOtes ON COuNtRy estIMAtes

Mortality

Age- and sex-specific all-cause mortality rates were estimated for the year 2008 for the 193 WHO Member States from revised life tables, published in World Health Statistics 2011. Total deaths by age and sex were estimated for each country by applying these death rates to the estimated resident populations prepared by the United Nations Population Division in its 2008 revision. To calculate causes of death for countries with complete or incomplete death registration data, vital registration data were used to estimate deaths by cause. Death registration data from 1980 up to 2008 (if available) were used to project recent trends for specific causes, and these trend estimates were used to estimate the cause distribution for 2008. Adjustments for deaths due to HIV, drug use disorders, war and natural disasters were based on other sources of information using similar data sources and methods as previous estimates.

For countries without any nationally representative data, cause-specific estimates of deaths for children under age 5 were estimated as described by Black et al. For ages five years and over, previous estimated distributions of deaths by cause were projected forward from 2004 to 2008, excluding human immunodeficiency virus (HIV), war and natural disasters. Detailed proportional cause distributions within the three broad groups were based on death registration data from within each region. Further information on these methods is available from WHO. Specific causes were further adjusted on the basis of epidemiological evidence from registries, verbal autopsy studies, disease surveillance systems and analyses from WHO technical programmes. Cause-specific estimates for HIV, tuberculosis and malaria deaths for 2008 were derived from previously published WHO estimates. Country-specific estimates of maternal mortality and cause-specific maternal mortality were based on the recent estimates for 2008 together with an analysis of regional cause patterns.

Risk factors

The crude adjusted estimates presented are based on aggregated data provided by countries to WHO or obtained through a review of published and unpublished literature. The inclusion criteria for estimation analysis stipulated that data had to come from a random sample of the general population, with clearly indicated survey methods (including sample sizes) and risk factor definition.

Adjustments were made for the following factors so that the same indicator could be reported for a standard year (in this case 2008) in all countries: standard risk factor definition; standard set of age groups for reporting; standard reporting year, and representativeness of population. Using regression modelling techniques, crude adjusted rates were produced for each indicator. Additionally, means for each of the four metabolic indicators were also estimated for the years 1980-2009. These means are presented in the risk factor trend graphs. Uncertainty in the estimates was analysed by taking into account sampling error and uncertainty due to statistical modelling. Further detailed information on the methods and data sources used to produce these estimates is available from WHO.


Prevalence estimates for the year 2008 are given for the following behavioural and metabolic risk factors:

• Current daily tobacco smoking: the percentage of the population aged 15+ years who currently smoke tobacco on a daily basis.

• Physical inactivity: the percentage of the population aged 15+ years engaging in less than 30 minutes of moderate activity per week or less than 3 times 20 minutes of vigorous activity per week, or the equivalent.

• Raised blood pressure: the percentage of the population aged 25+ years having systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥90 mmHg or on medication to lower blood pressure.

• Raised blood glucose: the percentage of the population aged 25+ years having a fasting plasma glucose value ≥ 7.0 mmol/L (126 mg/dl) or on medication for raised blood glucose.

• Overweight: the percentage of the population aged 20+ years having a body mass index (BMI) ≥ 25 kg/m2.

• Obesity: the percentage of the population aged 20+ years having a body mass index (BMI) ≥ 30 kg/m2.

• Raised cholesterol: the percentage of the population aged 25+ years having a total cholesterol value ≥ 5.0 mmol/L (190 mg/dl).

Country Capacity survey

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

the questionnaire is composed of 5 domains and is discussed briefly below.

Public Health InfrastructureThis domain queried countries about having a designated NCD unit/branch/department within the Ministry of Health (or its equivalent), the designated unit’s responsibilities, and the existence of an established budget allocation to sustain this unit’s operations.

Status of NCD Policies, Strategies and Action PlansThis section queried countries about the existence of integrated NCD policies/strategies and action plans and the inclusion of key components in the policies/strategies/action plans as well as separate policies for individual risk factors. The questionnaire also asked about the availability of budgetary resources to implement the policies/strategies/action plans.


Health Reporting/Information Systems, Monitoring and SurveillanceThis section of the assessment questionnaire queried countries about the inclusion of NCD-related data into national health reporting mechanisms, the existence of NCD registries, and the conduct of risk factor surveys.Health System Capacity for NCD Prevention, Early Detection, Treatment and Care within the Primary Health Care SystemThis section queried countries on the integration of the various components of the spectrum of NCD-related health interventions into the primary health care system and factors within the health care system affecting the management of NCDs.

Health Promotion, Partnerships, and CollaborationThis section covers the health promotion initiatives, partnerships and collaboration related to NCDs. These include the mechanisms for partnership, the stakeholders, and the content areas of these collaborations.

Country Profiles

The 2010 population estimates from the most recent United Nations Population Division World Population Prospects are reported in each profile. For income category, the 2008 World Bank income categories are reported.

In addition to the methods as stated under Country Capacity Survey above, information about the MPOWER package of six evidence-based tobacco control measures was included in the country profiles. To help countries fulfil their WHO FCTC obligations, WHO, in 2008, introduced the MPOWER that are proven to reduce tobacco use. MPOWER refers to M: Monitoring tobacco use and prevention policies; P: Protecting people from tobacco smoke; O: Offering help to quit tobacco use; W: Warning about the dangers of tobacco; E: Enforcing bans on tobacco advertising, promotion and sponsorship; and R: Raising taxes on tobacco. Each measure reflects one or more provisions of the WHO FCTC, and the package of six measures is an important entry point for scaling up efforts to reduce the demand for tobacco.

The NCD profile includes an assessment of progress in countries to implement only the POWER measures. (W focussed on Health Warnings only). Data for assessing the progress of Member States against the POWER measures were gathered by WHO from various country-level sources. These included original tobacco control legislation documents, detailed information on cessation services, mass media campaigns, cigarette prices and tobacco-related tax and revenues.

The final data for each country were sent to the respective government for review and signoff. In cases where national authorities explicitly did not approve the data, this is noted in the WHO Report on the Global Tobacco Epidemic, 2011.

Using these data, countries were then assessed at the highest level of achievement if they met the best-practice criteria for each POWER measure. A full description of these criteria can be found in the WHO Report on the Global Tobacco Epidemic, 2011 (13). For each of the POWER measures, countries were allocated a score of 1 if they were assessed by WHO as having attained the highest level of achievement, else a score of 0. This means that each individual country score is out of a total of 5 with a minimum of 0/5 to a maximum of 5/5.


Cancer

Method used to estimate incidence cases and deaths by country in GLOBOCAN

Member States Incidence Mortality

Australia National incidence rates (1986-2005) projected to 2008 and applied to 2008 population. The numbers were scaled to the estimated total number of new cancer cases by sex provided by the Australian Institute of Health and Welfare for 2008.

National mortality rates (1985-2004, source WHO) projected to 2008 and applied to 2008 population.

Brunei Darussalam Local incidence data and national mortality data: incidence was estimated from national mortality by modelling, using incidence mortality ratios derived from recorded data in local cancer registries in neighbouring countries

Local incidence data and national mortality data: incidence was estimated from national mortality by modelling, using incidence mortality ratios derived from recorded data in local cancer registries in neighbouring countries

Cambodia Frequency data: age/sex specific incidence rates for all cancers were partitioned using data on relative frequency of different cancers (by age and sex) obtained from local source.

No data: the number of cancer deaths was estimated from incidence estimates and site specific survival, provided by neighbouring countries.

China Local incidence data and national mortality data: incidence was estimated from national mortality by modelling, using incidence mortality ratios derived from recorded data in country-specific cancer registries.

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

Fiji National incidence rates observed in the Fiji Cancer Registry (1991-1999) were applied to the 2008 population

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

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

National mortality data: recorded mortality in 2008.

Korea, Republic of National incidence rates (2000-2007) projected to 2008 (except for thyroid cancer for which incidence rates for 2007 were applied to 2008 population).

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

Lao People’s Democratic Republic

Simple mean of rates observed in the cancer registries of Khon Kaen and Chiang Mai (Thailand).

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

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



Mongolia National incidence data: reliable estimates of the national incidence in 2008.

National mortality data: recorded mortality in 2008.

New Zealand National incidence rates (1986-2005) projected to 2008 and applied to the 2008 population

National mortality rates (1986-2005, source WHO) projected to 2008 and applied to the 2008 population.

Papua New Guinea Frequency data: age/sex specific incidence rates for all cancers were partitioned using data on relative frequency of different cancers (by age and sex).

No data: the number of cancer deaths was estimated from incidence estimates and site specific survival, estimated by the GDP method.

Philippines Local incidence data and national mortality data: incidence was estimated from national mortality by modelling, using incidence mortality ratios derived from recorded data in local cancer registries in neighbouring countries.


Samoa National incidence rates (1981-1987) applied to the population (2008).

Estimated incidence for 2008 was converted to mortality using mortality incidence ratios obtained by the aggregation of data from French Polynesia and Guam.

Singapore National incidence data: incidence rates projected to 2008

National mortality data: mortality rates projected to 2008

Solomon islands No data: Incidence was estimated as the simple mean of the country-specific estimates for Fiji and Vanuatu.

No data: the number of cancer deaths was estimated from incidence estimates and site specific survival, estimated by the GDP method.

Vanuatu Mortality rates (1998-2002, provided by cancer registry) applied to the population (2008)


Viet Nam Local incidence data and national mortality data: incidence was estimated from national mortality by modelling, using incidence mortality ratios derived from recorded data in local cancer registries in neighbouring countries



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508.

294

.345

.529

8.2

2008

AN

Nex

3 -

200

8 CO

MPA

RABL

e es

tIM

Ates

OF

NCD

MO

RtA

LIty

Not

e: C

ount

ries

with

ast

eris

k ha

ve fi

gure

s w

ith a

hig

h de

gree

of u

ncer

tain

ty b

ecau

se th

ey a

re n

ot b

ased

on

any

natio

nal N

CD

mor

talit

y da

ta. T

he e

stim

ates

for t

hese

cou

ntrie

s ar

e ba

sed

on a

com

bina

tion

of c

ount

ry li

fe ta

bles

, ca

use

of d

eath

mod

els,

regi

onal

cau

se o

f dea

th p

atte

rns,

and

WH

O a

nd U

NA

IDS

pro

gram

me

estim

ates

for s

ome

maj

or c

ause

s of

dea

th (n

ot in

clud

ing

NC

Ds)

.


ANNex 4 - WHO stePwise suRveILLANCe FOR NCD RIsk FACtORs

No. Country Coverage survey period

1 American Samoa National 2004

2 Cambodia National 2010

3 China National 2004, 2007, 2010

4 Cook islands National 2004

5 Fiji National 2002

6 Kiribati National 2004-06

7 Lao People’s Democratic Republic, the Subnational (Vientiane) 2008

8 Malaysia National 2005-06

9 Marshall Islands, the National 2002

10 Micronesia, the Federated States of Subnational (Pohnpei) 2002, 2006, 2008

11 Mongolia National 2005 & 2009

12 Nauru National 2004

13 Palau National 2011-12 (ongoing)

14 Papua New Guinea Subnational (Capital, Manus, Gulf, Madang, Simbu)

2007-08

15 Philippines National 2003-04, 2008

16 Samoa National 2002

17 Solomon islands Subnational 2005-06

18 Tokelau National 2005

19 Tonga National 2004

20 Tuvalu National 2006-07

21 Vanuatu National 2011

22 Viet Nam Subnational(3 surveys) 2005

A Profile


WHO Western Pacific RegionPUBLICATION

ISBN-13 978 92 9061 563 7

Noncommunicable Diseases in the Western Pacific Region · WHO Library Cataloguing in Publication...

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Transcript of Noncommunicable Diseases in the Western Pacific Region · WHO Library Cataloguing in Publication...