NDPHS_Strategy_NCD_Objective_3_drafting_team__draft_memo_dti_&_mvi
EG on Non-Communicable Diseases related to Lifestyles
and Social and Work Environments
Meeting of drafting team for 2014-2020 NDPHS Strategy’s Objective 3 “Strengthen prevention and reduce impact of non-communicable diseases (NCDs) through addressing lifestyle-related risk factors”
8 September 2014, time: 12:00 –16:00
Meeting venue: FCG (Finnish Consulting Group) premises
Address: Osmontie 34, 00601 Helsinki
Draft Memo of the Meeting
ReferenceTitle / Draft Memo
Submitted by / NCD EG Secretariat
Summary / Note / Draft memo of the meeting proceedings
Requested action / Adoption
Chair of NCD EG Mikko Vienonen opened the meeting. The agenda was adopted by the participants. The meeting was attended by: Mikko Vienonen (NCD EG Chair), Dmitry Titkov (NCD EG International Technical Advisor), Anna Korotkova (NCD EG member, FRIHOI of MoH of the RF), Marjatta Montonen (ASA EG member, THL/Finland), Piia Heliste (Aalto University/Northern Dimension Institute), Iveta Pudule (NCD EG member, Centre for Disease Prevention and Control/Latvia), Karolina Mackiewicz (NCD EG associated member, Baltic Region Healthy Cities Association).
First, Mikko referred to the primary goal of the meeting, which was to draft actions for the implementation of Objective 3 of 2014-2020 NDPHS Strategy formulated as “To strengthen prevention and reduce impact of non-communicable diseases (NCDs) through addressing lifestyle-related risk factors”. The work did not have to start from scratch as the first discussions took place back in June 2014 at the NCD EG-9 Meeting when a brain-storming exercise was held to collect ideas for possible actions related to Objective 3 and other NCD-associated objectives of the new NDPHS Strategy[1]. Later, in summer 2014, the pre-draft of the action plan for Objective 3 (NCD-related) was prepared by Mikko Vienonen, Karolina Mackiewicz and Dmitry Titkov. The document is available on the webpage of the meeting at http://www.ndphs.org/?mtgs,ncd_objective_drafting_team_meeting. It was underlined that this document presents just one vision and is open for revisions. Besides, it was remarked that the actions should be selected carefully, with consideration of available resources.
The Action Plan is compiled into the template, which was earlier proposed by the Strategy Working Group (SWG). As for the milestones, the draft should be submitted to the NDPHS Secretariat for comments by the 10th of October. Yet, the participants agreed that the drafting progress and draft action plans, if available, could already be demonstrated and discussed at the NDPHS EG Chairs and ITAs Meeting due on September 25 in Helsinki.
Marjatta Montonen from the ASA EG noted that the ASA EG has a similar vision on the drafting process. The route starts from establishing targets, then indicators for these targets, and then they see how to move towards the established targets. She told about what had already been done by the ASA EG in terms of the actions drafting.
So far, 4 ASA targets have been set:
1. To improve awareness on core NCD actions (thematic reports, policy recommendations, side events)
2. To improve knowledge on effective interventions (exchange of practices)
2.1. To mobilise and support municipalities
2.2. To disseminate best practices
2.3. To address cross-border challenges
3. To increase access to early interventions
4. To enhance the level of understanding (cannabis, drinking habit surveys).
The ASA EG did not go too ambitious and considered available resources in choosing possible indicators for action[2].
The NCD EG and ASA EG have at least two shared entry points: The NCD EG and ASA EG have at least two shared entry points: thematic NCD reports and side events with relevance to NCDs and their risk factors.
Although the drafting process is in many ways common between the NCD EG and ASA EG, yet the NCD EG followed the WHO voluntary targets and indicators when proposing expected results for the action plan on Objective 3 of the NDPHS Strategy. See in ANNEX Marjatta Montonen’s (ASA) useful “note for the file” summarising her views after this meeting.
Piia Heliste from the Northern Dimension Institute (NDI) (coordinator Aalto University/Finland) informed about interests of cooperation, which primarily go down to data collection and research, with the aim of commercialising the final products of project-based cooperation action. The NDI is likely not a partner for such activities as exchange of practices, yet is very much interested in participating in development projects. While the NDI does not have a list of pursued operations/activities, the participants were eager to learn closely about the areas of the NDI and, possibly, about the possibility to highlight the health and social aspects on the NDI’s website.
Anna Korotokova took the floor to share her vision about the drafting process. According to her, firstly, the actions can be clearly divided into the country level and community (regional and local) level. The interventions themselves could be more concentrated on such areas as: 1) policy education, lobbying, awareness raising, 2) flagship projects, 3) seminars and trainings, 4) best practices, 5) research, 6) information and communication technology. Anna noted that the Northwest Russia is rather advanced if compared to many other regions of Russia, and in many ways this position is ensured by close cooperation and sharing experiences with countries and regions of the Northern Dimension area. Therefore the capital of the Northern Dimension is in the high technology in health and wellbeing, and the best practices gained in the Northern Dimension area should be used as an asset. Secondly, when considering the ND in the WHO EURO context, we should keep in mind the country cooperation strategies the European Office of the WHO develops based on country’s specific priorities. And the task of the NDPHS is to lobby interests and priorities of the ND area, the way Finland pushes forward the Health-in-All-Policies approach. Thirdly, Anna reminded that we deal with public health, not care, and the actions should in the first place be oriented on promotion of public health.
Anna’s concluding remark concerned the practice of dissemination of technology in Russia. The prerequisite for effective dissemination is availability of a signed “Country Cooperation Strategies” between ministries of health and the WHO-EURO, which gives a biannual framework for public health priorities and action in the countries. NDPHS/NCD action should take these into account and seek synergies together with WHO-EURO which is also our member organization. After national health authorities have adopted new approaches, their dissemination to regions is more likely to take place, for instance through projects.
In the next part of the meeting the participants went through the actions set forth in the pre-draft Action Plan for Objective 3 of the NDPHS Strategy.
1. Thematic Report
The Thematic Report can be done by country or by risk factor. The content of the Thematic Report can be based on information from a self-assessment survey, similar to the WHO EURO Country Assessment Guide, about what has been done or under implementation. The collected information could then be summarised to give a picture of the situation in the ND area. In addition, success stories could be compiled as an annex to the Thematic Report. The group felt that annual reporting would be too frequent and that an optimal interval for producing the Thematic Report would be two years. This means that a Thematic NCD-report is planned to be produced in 2015 and 2017.
2. Potential Years of Life Lost (PYLL) analysis
The PYLL indicator was approved as the indicator of the NDPHS performance within the EU Strategy in the Baltic Sea Region (EUSBSR) and therefore should be measured for, at least, reporting aims. At the moment the PYLL is measured by the OECD, yet some of the ND Member States are missing from reporting system. They are RF, Latvia and Lithuania, which are not yet full members of OECD. However, they are in the process to become members. We need to find out from OECD at what point they will start reporting also these countries. Mikko also referred to the benefits the PYLL analysis can give to decision-makers at all levels for prioritising interventions in the public health and social wellbeing sectors. The group discussed the importance to be in contact with national institutes of Public Health and also WHO in order to motivate them in systematic use and reporting of PYLL, which is easily calculated from normal death registry data. Facilitating and systematizing this process would also be an important process indicator for monitoring our impact. It needs to be noted that PYLL is not meant to substitute for other WHO recommended NCD-indicators related to mortality, morbidity and prevalence of unhealthy lifestyle risk behaviour such as harmful use of alcohol, use of tobacco, unhealthy diet, and lack of physical activity.
3. Support for Health-in-All-Policies (HiAP) at local level
It was suggested engaging locations with poor NCD data into the action as it would give bigger chances for improvements and funds appropriation.
4. Implementation of best practices for prevention of obesity and overweight among school-aged children
The proposed action is project-based and envisages close work together with the PPHS EG, as the school healthcare is part of the primary healthcare system. This is a question to be raised at the meeting of the PPHS-related objective of the NDPHS Strategy on 24-25 September in Riga.
5. Better non-communicable outcomes: challenges and opportunities for health systems at national level
The proposed action calls for close links with the PPHS EG, ASA EG and OSH TG. Besides, the action requires involvement of national ministries and support from the WHO EURO. The assessment to the used could be revised to get a “light” scorecard with the parts of the survey which would be interesting to the ND area. In the beginning the trial could be done within a few countries/regions, and then benefits of the exercise could be demonstrated to others.
Additionally the group made note of the NDPHS Action Plan and Strategy drafting process in general:
The Objectives of the new NDPHS Strategy relate explicitly to the current structure of the EGs and TGs. Yet, it is unknown what the new structure will be starting from next year 2015. This uncertainty may create much confusion in future. For instance, if there would not be an NCD EG at all, who would become responsible for Objective 3? Finland has been the sponsor of NCD-EG since 2010 (and for its predecessor SIHLWA 2006 – 2010). But so far only), AMR (objective 2/Sweden), ASA (objective 4/ Norway), PPHS (Objective 5 PHC/Sweden and Prison health/Russia), and OSH (objective 6/ Finland) have some indication that a sponsor could be found. Objective 1 (HIV/AIDS & associated infections) and Objective 3 (NCD/ lifestyles) have remained “orphans” and risk the action plans to remain without an implementing executive organ. As NCD, ASA and OSH (objectives 3,4, and 6) all relate with preventable NCD morbidity and mortality, and social ill-being due to unhealthy lifestyles and conditions, one option could be to enhance their cooperation by establishing a “HEALTHY LIFESTYLE-CONSORTIUM connecting these 3 EGs for instance organizing at least once per year their meetings at the same time in the same place. We recommend to the new NDPHS Strategy Consultant to seriously and urgently consider these organizational structures and importance to have active participation in every EG from all partner countries. NCD planning team felt that this had been the weakest link in our work during the last 4 years,
All the countries should be committed to appoint representatives to all newly established expert groups.
The NDPHS database of projects needs improvements as there is no reference to projects’ final products (deliverables, final reports, etc.)
Before the closure of the meeting it was agreed to make amendments to the draft Action plan before the meeting of drafting team of the PPHS-related Objective, i.e. 24 September. The memo of the meeting will also be prepared presently and distributed to the participants of the meeting.
The meeting was announced closed.
1
NDPHS_Strategy_NCD_Objective_3_drafting_team__draft_memo_dti_&_mvi
Annex 1
Brief summary of the main points of interest to ASA EG
Prepared by Marjatta Montonen, member of ASA EG / THL, Finland
· The template for suggesting results and indicators for the Action Plan seems to be open for different interpretations. EG NCD has focused on distal impact indicators whereas the EG ASA ad-hoc drafting meeting was looking at the short and medium term outcomes and intermediate indicators.
· Even though the instruction is to develop a work plan without perpetuating the current structure of EGs/TGs it could be useful to convey to the CSR our own views of what kind of structure would be useful in the future, given that we are closest to the concrete work to be done.
· While EG NCD’s work mainly concerns Objective 3, EG ASA’s interests relate to Objectives 3 and 4 both.
· Therefore EG ASA or its tasks cannot be integrated into EG NCD.
· There is however clear synergy to be derived from cooperation between ASA and NCD, notably as regards drawing decision makers’ attention to the need to address NCD risk factors (for example organizing jointly a “high level” event) and as regards monitoring progress.
· The NCD reports planned by EG NCD (planned activity #1) would be the main instrument for monitoring progress. EH ASA’s area of action only covers alcohol and tobacco, so it would clearly be for EG NCD to take the lead in producing an overall report. This is one of the tasks for which EG NCD is needed also in the future.
· The NDPHS area NCD report (planned activity #1) could be produced bi-annually (rather than yearly). It could combine basic NCD monitoring data (provided by the WHO) with a score card of core interventions and services (following the WHO Barcelona model) and (in the years between reports) it could be complemented with selections of “success stories”.
· The implementation of the Barcelona assessment model (planned activity #5) could be divided into two steps: 1) “quick and dirty” score card exercise by the partnership itself; 2) proper expert assessments in countries that are interested and able to provide the funding.
· PYLL indicators (planned activity #2) with breakdown across the major NCDs – preferably also identifying the contribution of alcohol and tobacco – would be useful for EG ASA too. The key question is where to find the funding.