18.02.13 NCD 6/10/1 - Info 1

NCD EG Flagship-B Project Concept mvi

EFFECTIVE AND EFFICIENT IMPLEMENTATION OF NATIONAL NCD PREVENTION STRATEGIES

NCD EG on Non-Communicable Diseases related to Lifestylesand Social and Work Environments
6th NCD EG meeting 21-22 February 2013
in Riga, Latvia /
Reference / NCD 6/10/1 - Info 1
Title / NCD EG Flagship –B
"RESULTS! EFFECTIVE AND EFFICIENT IMPLEMENTATION OF NATIONAL NCD PREVENTION STRATEGIES"
Project Work Package Draft
Submitted by / NCD EG Secretariat
Summary / Note
Requested action / For further elaboration at NCD-6 in Riga

NCD-5 MEETING NOTES ON Flagship-B project

NCD Flagship-B project Effective implementation of NCD prevention strategies in Baltic Sea region through transfer of best practices - regional partnership network

The working group consisted of Ms Anna Korotkova, Ms Elena Kirsanova, Ms Milda Andriūnaitė, Ms Andžela Slušnienė, Mr Marek Maciejowski (part time) and Mr Mikko Vienonen, who promised to act as rapporteur for the group.

·  The FP-B group started discussions from the draft listing the FP-B Work-packages and agreed that the updated list was an improvement to the previous version we had at NCD-4 in spring 2012.

·  The working group welcomed the meetings decision to put first implementation priority to FP-B. Provided that we do not abandon FP-A, but continue to look for funding opportunities there as well.

·  Ms Karolina Mackiewicz (Baltic Region Healthy Cities Association/ Turku/FIN) had had to leave the meeting before the FP-B workshop started, but she had proposed to send to us the latest (summer 2012) EU-project preparation format to which we would try to adapt the next version of our project draft proposal. However, we understand that every call of proposals will have their own specific format, but nevertheless it will be step forward and probably faster to make necessary changes to a recent EU project application format.

·  There was discussion as to what would be the realistic budget frame for FP-B WPs. Mikko Vienonen was of the opinion that our previous estimates had been over-optimistic (too high). Anna Korotkova disagreed saying that sufficient funding should be available. As a compromise we agreed that it very much depends on the funding facility and call for projects. We need to be flexible and pragmatic. The SPb/ Kalininsky district “Healthier People” pilot project gives some concrete idea of minimum funding without the peer-assessment component. In one project site the minimum budget would seem to be in the range of 250,000 Euro.

·  The working group reviewed the whole list of WPs (WP1 – WP6). Updates were made and will be visible in the next version to be finalized by the end of the year 2012.

·  The working group discussed in very practical manner the list of potentially participating countries. The countries included were Finland, Estonia, Germany, Latvia, Lithuania, Poland, Russian Federation (N-W Russia)

·  The working group discussed in very practical manner the list of potentially implementing agencies. In the next version we would need to be more critical and selective as to list only one (max 2) implementing lead-agencies per whole multi-country project, and implementing WP implementor per participating country.

·  The working group felt that the overall project concept is still valid, innovative and functional (as presently tested in SPb). There were some critical voices as to the peer-review assessment and “travelling seminars” for experts in the countries advising on strategic interventions. Previous experience has shown that such activity can be very expensive and there is a danger that the good suggestions are not penetrate into practical action on national levels. In other words, they are not “internalised” into country policies and not turned into action. This issue would need to be further discussed and reviewed.

Mr Mikko Vienonen as FP-B working group rapporteur would include the suggested changes into the project plan to be written on the new format.

EG on Non-Communicable Diseases related to Lifestyles and Social and Work Environments NCD EG

Northern Dimension Partnership in Public Health and Social Wellbeing (NDPHS)

e-mail:

GSM: +358-50-442 1877

RESULTS! EFFECTIVE AND EFFICIENT IMPLEMENTATION OF

NATIONAL NCD PREVENTION STRATEGIES[1]

PROBLEM STATEMENT

Non-communicable diseases (NCDs) represent one of the world’s major health challenges, both in terms of human suffering, as well as negative impact on socioeconomic development in all countries. Cardiovascular diseases are by far the leading killer, with more than 5 million deaths estimated to take place annually from these causes alone. By 2030, NCDs are estimated to contribute to 75% of global deaths, which means that NCDs are having even greater impact on all levels of health services, as well as health care costs as they are having today. As noted by Zsuzsanna Jakab (WHO Regional Director for Europe) at the conference on the prevention of non-communicable diseases in Budapest, Hungary in May 2011

tackling non-communicable diseases begins by acknowledging that they are linked by common determinants and opportunities for shared policy intervention. Almost 60% of the disease burden in the European region is attributable to 7 leading risk factors: high blood pressure, tobacco use, harmful use of alcohol, high blood cholesterol, overweight, low fruit and vegetable intake and physical inactivity. Evidence-based and cost-effective interventions exist to prevent and control NCDs at global, regional, national and local levels, but their implementation requires strong political commitment and interventions in all policies.

Tobacco smoking leads the behavioural risk factors as a cause of death and disease in this region, but the European Region has also the highest alcohol intake in the world per person. Investing in prevention and improved control of non-communicable diseases would reduce premature death and preventable morbidity and disability and improve the quality of life and well-being of people and societies. No less than 86% of deaths and 77% of the disease burden in the WHO European Region are caused by this broad group of disorders, which are linked by common risk factors, underlying determinants and opportunities for intervention.

In Europe, there is good understanding of the wider societal approaches to addressing the non-communicable disease epidemic. There is strong collective experience on the use of price as an incentive or disincentive for behaviour, on the control of advertising of unhealthy goods, on the reduction of salt by reformulating food products and on the planning of urban environments to facilitate the use of active transport, among others. Healthy choices are easier when the fiscal, physical and policy environments make them the automatic choices.

Presently the international community, globally and in Europe, is in the process of scaling up actions against the epidemic of NCD. The national, regional and local strategies are being produced in the countries. However, their implementation and financing is threatened by numerous factors, e.g. lack of resources – financial, human, institutional, not realistic targets, lack of indicators and monitoring tools, insufficient dialogue between decision makers and public health practitioners. Those factors, together with the financial crisis and cuts in the public health budgets, do not support implementation of the strategies. The role of antagonist forces should not be underestimated either. For instance, tobacco and alcohol industry, fast-food chains, candy producers, agribusiness etc. make people use more their unhealthy products. Their lobbying power and marketing imagination has proven to be unexhaustable unda??? public health measures.

The First Global Ministerial Conference on Healthy Lifestyles and Non-communicable Disease Control, which was held in Moscow, 28-29 April 2011, emphasised that “prevention and control of NCDs requires leadership at all levels, and a wide range of multi-level, multi-sectoral measures aimed at the full spectrum of NCD determinants (from individual-level to structural) to create the necessary conditions for leading healthy lives. This includes promoting and supporting healthy lifestyles and choices, relevant legislation and policies; preventing and detecting disease a the earliest possible moment to minimize suffering and reduce costs; and provide patients with the best possible integrated health care throughout the lice cycle including empowerment, rehabilitation and palliation.

This project, "RESULTS! Effective and efficient implementation of national NCD prevention strategies", aims at addressing the above mentioned challenges by tackling the implementation gap of health strategies in the participating countries. It is evident that strategies and plans for cost-effective implementation exist, but it is seldom that the strategies includes budget and quantifiable targets, or country specific data/actions that would encourage to implement NCD prevention strategies on regional/local level.

This project facilitates effective and efficient implementation of NCD prevention strategies in the Northern Dimension area. The actions of this project support institutional capacity building and networking of key stakeholders so that they are better motivated and prepared for participating in decision making and policy formulation in the field of health and social protection, by practical interventions supported by necessary policy decisions. Moreover, the activities under this project promote local/regional governance, which needs to put the policy/strategy into practise and improve links between citizens and local/regional authorities and other stakeholders who need to understand the reasons behind them. The past experience has shown that formulating the strategy with all good intentions has been relatively easy. But the real challenge is to transform the plan into reality. Part of the "medicine" may not be popular among all (e.g. making alcohol and tobacco more expensive, restricting the liberties of smokers etc.).

Therefore, there is a need for action and the countries in the Northern Dimension area are committed to working together in order to improve their “management-of-change’’ on the local, regional and national levels. The estimated huge economic losses and burden to the societies provide an additional imperative but also an incentive to tackle this problem, as does the recognition of the short term commercial interest and profiteering trying to camouflage the long term losses to life and productivity.

The project partnership represents the diversity of the region, different institutions (local authorities, ministries, public health institutes, NGOs, universities), with different organizations of the health systems. This partnership, being a ‘’test group’’ in Europe, provides a solid foundation to implement the proposed project that will focus on the “management-of-change’’ and promote more effective implementation of the NCD prevention strategies. Structures for leadership will be identified and analytical tools to measure the cost-effectiveness of health interventions will be provided. Moreover, evidence based experiences from the Northern Dimension area will be recognized. Finally, local decision-makers, parliamentarians and other stakeholders will be involved in the discussion on the implementation of the strategies and invited to help manage the change.

By taking the above actions, the project will facilitate the health policy debate in the Northern Dimension countries in a way that opens new perspectives and opportunities for national health policy implementation leading to health gain, and finding new ‘’win-win’’ opportunities for different stakeholders.

Moreover, the project will create operational links with the ongoing WHO-EURO NCD policy development building on Ottawa Charter 1987, Health in All Policies EU-2006, WHO-EURO Gaining Health – European Strategy for Prevention and Control of Non-Communicable Diseases 2006 and WHO 2008-2013 Action Plan for the Global Strategy for prevention and Control of Non-communicable Diseases. The European action Plan for the Prevention and Control of Noncommunicable Diseases was to be finalised in September 2011 in Baku, Azerbaijan.

The project supports the new WHO-Euro Health Strategy Health 2020 (under development), while at the same time learning from the experience of WHO, using its vast expertise on NCD issues and utilizing commitment of the national governments to tackle the NCD epidemic.

The following WHO-EURO documents will provide a solid basis for project implementation:

1.  Which are the known causes and consequences of obesity, and how can it be prevented? (WHO 2007)

2.  Addressing the socioeconomic determinants of healthy eating habits and physical activity levels among adolescents (WHO 2006)

3.  Country capacity for the prevention and control of noncommunicable diseases in the WHO European Region (preliminary report 2010)

4.  The Evaluation Partnership (2010). Evaluation of the European Platform for Action on Diet, Physical Activity and Health. Brussels, European Commission.

5.  Preventing chronic diseases: a vital investment. Geneva, World Health Organization (2005) (http://www.who.int/chp/chronic_disease_report/en)

6.  Report of the global survey on the progress in national chronic diseases prevention and control. Geneva, World Health Organization (2007) (http://www.who.int/chp/about/integrated_cd/en/index6.html)

7.  2008–2013 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases. Geneva, World Health Organization (2008) (http://www.who.int/nmh/publications/9789241597418/en/index.html)

8.  WHO report on the global tobacco epidemic. Geneva, World Health Organization (2009) (http://www.who.int/tobacco/mpower/2009/en/index.html).

9.  European Strategy for Tobacco Control. Copenhagen, WHO Regional Office for Europe (2002) (http://www.euro.who.int/__data/assets/pdf_file/0009/82386/E93103.pdf)

10.  Gaining health. The European Strategy for the Prevention and Control of Noncommunicable Diseases. Copenhagen, WHO Regional Office for Europe (2006) (http://www.euro.who.int/__data/assets/pdf_file/0009/82386/E93103.pdf)

11.  Framework for alcohol policy in the WHO European Region. Copenhagen, WHO Regional Office for Europe (2006) (http://www.euro.who.int/__data/assets/pdf_file/0009/82386/E93103.pdf).

12.  Steps to health. A European framework to promote physical activity for health. Copenhagen, WHO Regional Office for Europe (2007) (http://www.euro.who.int/__data/assets/pdf_file/0009/82386/E93103.pdf) .

13.  WHO European Action Plan for Food and Nutrition Policy 2007–2012. Copenhagen, WHO Regional Office for Europe (2007) (http://www.euro.who.int/__data/assets/pdf_file/0009/82386/E93103.pdf) .

14.  The Tallinn Charter: Health Systems for Health and Wealth. WHO European Ministerial Conference on Health Systems: “Health systems, health and wealth”. Copenhagen, WHO Regional Office for Europe (2008) (http://www.euro.who.int/__data/assets/pdf_file/0009/82386/E93103.pdf)

15.  Suhrcke Marc, Rocco Lorenzo, McKee Martin, Mazzuco Stefano, Urban Dieter, Steinherr Alfred (2007). Economic Consequences of Noncommunicable Diseases and Injuries in the Russian Federation. European Observatory on Health Systems and Policies.

16.  Lindström Bengt and Eriksson Monica (2010). The hitchhiker's Guide to Salutogenesis Salutogenic pathways to health promotion. Folkhälsan Research Centre, Health Promotion Research. Helsinki.