Noncommunicable Diseases in the Western Pacific Region...Ms Marie Clem Carlos, Dr Han Tieru, Ms...

A Profile

Noncommunicable Diseasesin the Western Pacific Region

WHO Western Pacific RegionPUBLICATION

ISBN-13 978 92 9061 563 7

A Profile

Noncommunicable Diseasesin the Western Pacific Region

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.XLShttp://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

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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.


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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

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50

25

0

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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

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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

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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

Prev

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Women

Men

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Lao

Peop

le’s

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 dietPhysical

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







NCD surveillance, monitoring and evaluation Yes Diabetes No

Alcohol No


NCD cause-specific mortality Yes Physical inactivity 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





Physical inactivity ... ... ...





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








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


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"

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

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



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





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

Raised cholesterol 42.8 45.9 44.4 NCDs are estim

Noncommunicable Diseases in the Western Pacific Region...Ms Marie Clem Carlos, Dr Han Tieru, Ms...

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Transcript of Noncommunicable Diseases in the Western Pacific Region...Ms Marie Clem Carlos, Dr Han Tieru, Ms...