pmac2019synthesis 2019 02 03 (09.15) revised slide 3
TRANSCRIPT
SYNTHESIS Summary, Conclusion & Recommendations
3 February 2019
09:00-10:30
2
• Pre-conference: 29 – 31 January 2019 52 side meetings 6 field trips
• Main conference: 1 – 3 February 2019 3 keynote addresses 4 plenary sessions 15 parallel sessions 4 abstract sessions 6 special events 34 E-poster presentations 421 entries of World Art Contest
• Total registered participants 1,090 participants from 77 countries (F 52%, M 48%)
Conference programme structure
3
19 Plenary and parallel sessions 121 Moderators/speakers/panelists
Gender
OrganizationWHORegions
0
18
35
53
70
Female Male
67
54
N/A
PrivateSector
PublicSecofDevelopingcountry
PublicSecofDevelopedcountry
Bilat/MulDlat/InterAgency
UNAgency
NGO/CSO
Academic/ResearchInsDtute
0 13 25 38 50
48
20
14
12
9
9
3
6
0
13
25
38
50
AMR EUR WPR SEAR AFR EMR
2
1117
2228
41
Conference Summary and Synthesis
1. BACKGROUND1.1 Global commitment on NCDs
Politicaldeclarationofthe1st,2nd3rdHLMoftheGAonthepreventionandcontrolofNCDs(2011,2014,2018)
1.2 NCD situation • NCDscausethehighestburdenofdiseaseacrosstheworld,andyetfinancingofNCDpreventionandcontrolislargelyinadequate.
• NCDsarerootedinthesocial,economic,environmentalandcommercialdeterminantsofhealthandcannotbestoppedthroughindividualactionalone.
• Despiteavailabilityofscientificevidenceandcost-effectiveinterventions,implementationofhigh-levelcommitmentshasbeenslowinmanyLMICs.
Painful facts NCD causes 41 Million deaths of the 57 Million global deaths
Source:WHONCDcountryprofiles2018
NCD Countdown 2030 Collaborators Lancet 2018
78% of NCD deaths occurred in LMICs
•6.4litresofconsumption•11%ofglobaldeaths
28%ofadultsandhavenotdecreasedinthepast15years
Averageintakeof9-12grams
Attributedto>180,000globaldeaths
Killsmorethan7million
7millionprematuredeaths
22%ofadults
Nearlyquadrupledsince1980
650Millionobeseadults
Key fact: Risk factors, metabolic risk factors
2. Problem stream and root causes 2.1NCDs,riskfactorsandconsequences
• Influencedbyaseriesofcomplex,dynamicandintertwineddeterminantsrequiringeffectivemultisectoralactions
• Neglectedinparticularinhighburdenofcommunicablediseases.
• Emergingriskfactors:airpollution,climatechangecontributesignificantlytoNCD
2.2SocialdeterminantsofNCDs• Socialinequality;poverty,lackofeducation,unemployment
2.3 Commercial determinants of NCDs
• Unhealthycommoditiesindustryandharmfulcorporatepractices:powerful,deeppocket,unethicalmarketing–e.g.promotingunhealthyfoodstochildren,misleddiscourse
• Lobbyingbytrans-nationalcorporation,digitalmarketing,andinterferencesbyindustrytopolicymakers– Tobaccoindustrycigarettesaccountforaround2/3oftheillicitcigarettemarket,
industryresistsandinterfereswiththe“IllicitTradeProtocol”Litigationininternationalanddomestictrades
• PerceivedCOIbetweenregulators,governmentofficialsandindustries,regulatorycaptureandindustryfundedresearchandfoundationsuchasFoundationforaSmoke-FreeWorldwasfundedbyPMI
3. Challenges 3.1 Policy and implementation gaps
1. LackofinternationallylegallybindinginstrumentinregulatingNCDsriskfactors,exceptFCTC
2. Lowengagementofsocialandcommunity
3. Policyinertia:Lackofaccountabilitymechanism
4. Unethicalglobalfinancingsystems
1. Lackofpoliticalwillandleadership2. Weakgovernance:corruption,COI3. Poorprogressinclosingthe“know-dogaps”4. Lackofeffective,timelyM&Etoholdpartners
accountable5. Lackofmechanisms,infrastructure,resourcesto
facilitatepolicyadoptionandimplementation,especiallyinLMICs
6. Limitedinvestmentinhealth7. Inadequatemulti-sectoralaction8. Policyinertia:weakregulatorycapacities9. Lackofpolicycoherencebetweenpublichealth
goalsandeconomicgrowth10.Shorttenureofpoliticalleaders
Atgloballevels Atnationallevels
3.2 Evidence gaps • Lackofpoliticaleconomyanalysisinpublichealtharena
• Lackofpolicyevaluationandassessment– inholisticapproach– onhealthoutcomes(suchastaxation,SSBtax)
• Limitedevidenceonemerginghealthrisks(pollution,climatechanges)
• LimitedevidenceinLMICs
4. Solutions and role of actors
4.1Actionsbyglobalactorsa.Globalgovernanceregimes
•Internationalagreements:–LearningfromFCTC,UNmemberstatescannegotiateforFCAC,FCFS–Ithelpsfostercoherentpoliciesandregulatorymeasuresagainstindustryinterferences
•GlobalNCDsframework–ContinuouslyreviewandimplementGlobalFrameworkswhichpromotesmulti-sectoralcollaborationsandfosterimpacts
–Strengthenaccountabilityacrossallstakeholders:health,non-health,publicandprivate,atcountry,regional,andgloballevels
4. Solutions and role of actors (continue)
b.Globalfinancingmechanisms• FillthefundinggapsforNCDsimplementationinparticularinLIC
• AlignDevelopmentAssistanceforHealthwithcountries’NCDpreventionandcontrolplansandimproveeffectivenessandefficiencyofODApool
• IntegrateNCDintoexistingfinancingmechanismsandexplorenewinnovativefinancingsourcesandmodelsthroughbilateral&multilateralcooperation(e.g.catalytictrustfundforNCD)
• Regionaltobaccotaxharmonizationcanreducecrossbordersmuggling;shiftingprofitsoutofhigher-taxjurisdictionandtaxevasion
4.2Actionsbynationalactorsa.Improvegovernanceandleadership
• Strategicleadership,prioritizehealthinpublicsectorbudgetandresourceallocationforNCD
• Greaterpolicycoherencethroughwhole-of-governmentandhealth-in-all-policiesapproaches
• Strengthengoodgovernance,transparency,accountability,regulatoryandenforcementcapacities,improvelegalcapacities
4.2Actionsbynationalactorsa.Improvegovernanceandleadership(cont.)
• Paradigmshift:beyondthehealthsector– Fromhealthsystemstosystemsforhealth;– Fromsurvivalandtreatingdiseasestoenablingpeopletolivehealthylives
• Implementthecost-effective,affordableinterventions,goodpractices,andWHO16best-buys
• Strengthenleadership– Establisheffectivemulti-stakeholderandmulti-sectoralcoordinationmechanismsatthehighestleveltoensurethewholeofgovernment,wholeofsocietyapproach
Source:YikYingTeo
• AdequatefundingforimplementationofNCDactionplan,multi-sectoralaction
• Mobilizingadditionalfund:introducepro-healthtaxes
Source:Dr.JohannaBirckmayer
4.2 Actions by national actorsb. Address financing gaps
4.2 Actions by national actorsb. Address financing gaps(cont.)
• Prioritization:explicitcriteriatoprioritizebudgetsforpreventionandpromotion
• Providerpayment:designproviderpaymenttosupportcontinuumofcare;utilizepaymentinformationtoinformserviceprovision– Shiftingfrompayingindividualservicecontacttosupportcarecoordination
4.2 Actions by national actorsc. Improve implementation capacities
• Reforminghealthdeliverysystemstorespondtodemographicandepidemiologictransitions
• Improvehealthsystemsresponse• EnsurediagnosticandessentialmedicinesforNCDand
mentalhealthavailableatPHClevel• StrengthenFCTCimplementationinparticularinLMIC
– Legislatione.g.plainpackaging– effectiveenforcementandimplementation
• Implement16bestbuysinlinewithcountrycontext– Singapore’sWaronDiabetes:NationalpoliciesonNCDpreventionguidedbyglobalintelligence
SSB interventions – evidence base
Source:YikYingTeo(PS2.2)
4.2 Actions by national actors d. A whole of society approach
• Politicaleconomylens• UsingUniversalHealthCoveragelens• ExampleofSingaporeandPhilippines:Whole-of-GovernmentandWhole-of-Nationstrategy
4.2 Actions by national actors d. A whole of society approach (cont.)
• Collaborationandpartnership:–Empowerandstrengthenthecapacityofcivilsociety:synergieswithothersocialmovemente.g.climatechangeandenvironment
–PublicPrivatePartnershipsmustengagetherightmembersfromthestartandmanageofCOIi.e.MOH,MOF,civilsocietyetc.
d. A whole of society approach(cont.)
• Publicawarenessandimprovehealthliteracy– RaiseawarenessaboutthepublichealthburdencausedbyNCDs&therelationshipbetweenNCDs,povertyandsocialandeconomicdevelopment
• Changingenvironmentsincludingphysical,economic,digitalandsocialisthemostpromiseforchangingbehaviorinthepopulations.
Source:PairojS.
e. Information system• Addressevidenceandinformationgaps,highlightcaseNCDhealthandeconomicburden
• Supportevidencedbasedsocialmovementandpolicyadvocacy
• De-normalizationandcorrectingmisinformationthroughinvolvementofhealth,non-healthsectors,publicmedia,civilsociety
• Investinginimplementationresearchanduseofinformationforpolicymonitoring
4.3 Actions by Community
• Civilengagement&socialmobilizationtodrivepoliticalactions.
• EngagingpeoplelivingwithNCDintheresponses• BuildingalliancesandcoalitionforNCDatthecommunitylevele.g.Healthycitymovement
• SriLanka:establishcommunityinfrastructuresformanagementandcontrolofNCDs– EstablishHealthyLifestyleCentresin2011– Launchofwellwomenclinicsin1996
4.4 Actions by Individual
• UKexperiencesonChangeforlife—App,empoweringconsumers
• ApplicationofNUDGEtheoryincombinationwithCHOICEarchitecturetoinfluenceindividualbehaviourinfavourofhealthychoices
PMAC2019–healthymeeting• SetglobalandnationalnormandstandardofhealthyandactivemeetingHealthierFoodand
Nutrition• Varietyofgrains• Fruitsandvegetables• Waterasdefault• Alcohol-andtobacco
free• Lessuseofplastic
Physicallyactive
• Standingzoneduringmeeting
• Activebreaks• Activezone
Mentalpleasantenvironment
• Massage• Meditation
Lead Rapporteur and Rapporteur Coordinator
Dr.KatieDainNCDAlliance
Prof.TeoYikYingNationalUniversityofSingapore
Dr.TeaCollinsWorldHealthOrganization
Dr.VirojTangcharoensathienInternationalHealthPolicyProgram
RAPPORTEURCOORDINATOR
Dr.WalaipornPatcharanarumol
Dr.WarisaPanichkriangkai
OranaChandrasiri PayaoPhonsuk
LEADRAPPORTEUR
PMAC2019 Session RapporteursAbdelJamal Disangcopan Abila DerrickBary Akiko Fukui Alia Luz Anond Kulthanmanusorn Ayodele Akinnawo BawiMang Lian Bhurinud Salakij Biniam Getachew Carmeneza DosSantosMonteiro Charuttaporn Jitpeera Chayanis KositamongkolChen Cynthia Chhorvann Chhea Elisabeth Listyani Fonthip WatcharapornHathairat Kosiyaporn Jaruayporn Srisasalux Jessica Beagley Jin Xu Jintana Jankhotkaew Jiraluck Nontarak Jurairat Phromjai Kamolthip Chanvised Kaori Oohara Khanitta Seaiew Khanuengnij Yueayai Khunjira Udomaksorn Korapat MayurasakornKrittiya Sasipuminrit
Milin Sakornsin Nanoot Mathurapote Naoki Yanagisawa Napat Pattawattananon Nattadhanai Rajatanavin Nattanicha Pangkariya Nichakul Pisitpayat Nicolas Rosemberg Nimali Widanapathirana Niyadar Impetch Nootchawon Boonruangkitinandha Noppakun Thammatacharee Noppawan Piaseu Nucharapon LiangruenromNurKhaulah Fadzil Nutkamon Luesomboon NyiNyi Zayar Ong Suan Orratai Waleewong Panupong Tantirat Patinya Srisai Patiphak Namahoot Pawena Narasri Pensom Jumriangrit PhatthanawilaiInmai Pitikhun Setapura Piyawan Kanan Quinten Lataire RachaneekornManeesiri Rachel Archer
Ratchaporn Congprasert Rui Liu Rungsun Munkong Sarayuth Khuntha Shaheda Viriyathorn Shiqi Wang Sigit Arifwidodo Silvana PerezLeonQuinoso Sininard Wangdee Sirinard Nipaphorn Sopit Nasueb Suchunya Aungkulanon Sumithra KrishnamurthyReddiar Suphanat Wongsanuphat Suphanna Krongthaeo Taishi Matsumoto Takuya Nakashima Tharani Loganathan Thitiporn Sukeaw Thitirat Wongkeaw ThuyenHoangMyNguyen Voramon Agrasuta Wakako Takeda Waraporn Suwanwela Watinee Kunpuek Wattana Masunglong Wilailak Saengsri Woranan Witthayapipopsakul Ye YuShwe Yuki Inoue Yumiko Miyashita Yun Wang