5. WESTERN PACIFIC REGIONAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NCDs (2014–2020)

This is an excerpt of the "Western Pacific Regional Action Plan for the Prevention and Control of Noncommunicable Diseases (2014-2020)" (RAP NCD) which has been endorsed by the Member States of the Western Pacific Region of World Health Organization (WHO) in October 2013. The Regional plan is fully harmonized with the Global Action Plan for the Prevention and Control of Noncommunicable Diseases (2013-2020). The regional plan calls for a systematic approach to NCD prevention and control. The plan provides a road map and a menu of very cost-effective interventions for all Member States and other stakeholders, to take coordinated and coherent action at all levels to attain the nine voluntary global target by 2025. The original version of RAP NCD is downloadable from the website (http://www.wpro.who.int/noncommunicable_diseases/ WHO_NCD_RAP.pdf?ua=1). In addition, there are NCD tools in the WHO homepage (http://www.who.int/nmh/ncd-tools/en/).


Objectives and actions for Member States and WHO
The objectives of the Western Pacific Regional Action Plan for the Prevention andControl of Noncommunicable Diseases (2014-2020) are aligned with Global Action Plan for the Prevention andControl of Noncommunicable Diseases (2013-2020) for consistency and to help Member States adapt them to their national context.Recommended actions for Member States and WHO are provided by objectives.
In summary, the objectives are as follows: 1. To raise the priority accorded to the prevention and control of noncommunicable diseases in global, regional and national agendas and internationally agreed development goals, through strengthened international cooperation and advocacy.
2. To strengthen national capacity, leadership, governance, multisectoral action and partnerships to accelerate country response for the prevention and control of noncommunicable diseases.
3. To reduce modifiable risk factors for noncommunicable diseases and underlying social determinants through creation of health-promoting environments..

4.
To strengthen and orient health systems to address the prevention and control of noncommunicable diseases and the underlying social determinants through peoplecentred primary health care and universal health coverage.
5. To promote and support national capacity for high-quality research and development for the prevention and control of noncommunicable diseases.
6. To monitor the trends and determinants of noncommunicable diseases and evaluate progress in their prevention and control.

OBJECTIVE 1
To raise the priority accorded to the prevention and control of noncommunicable diseases in global, regional and national agendas and internationally agreed development goals, through strengthened international cooperation and advocacy.

Recommended actions for Member States
1. Strengthen advocacy for the implementation of the commitments of the Political Declaration of the High-level Meeting of the General Assembly on Non-communicable Disease Prevention and Control and secure sustained political commitment for action against NCDs.
2. Integrate NCDs into national strategic and development plans with special attention to social determinants of health and the health needs of vulnerable populations.
3. Promote universal health coverage as a means of prevention and control of NCDs.
4. Integrate prevention and control of NCDs into the United Nations Development Assistance Framework's design processes and implementation.
5. Advocate for adoption of the voluntary global NCD targets as national targets, as appropriate to the national context.

OBJECTIVE 2
To strengthen national capacity, leadership, governance, multisectoral action and partnerships to accelerate country response for the prevention and control of noncommunicable diseases.

Recommended actions for Member States
1. Develop or strengthen national multisectoral policies and plans for NCD prevention and control.
2. As appropriate to the national context, set up a national multisectoral mechanism, such as a high-level commission, agency or task force, for shared leadership, policy coherence (e.g.health and trade) and mutual accountability of different sectors of policy-making that have a bearing on NCDs.
3. Secure adequate, reliable and sustained resources for action against NCDs.

OBJECTIVE 3
To reduce modifiable risk factors for noncommunicable diseases and underlying social determinants through the creation of health-promoting environments.
Recommended actions for Member States ii increase availability, affordability and consumption of fruit and vegetables; iii replace trans fats with unsaturated fats; iv reduce saturated fatty acids in food and replace with unsaturated fatty acids; v reduce free and added sugars in food and non-alcoholic beverages; vi reduce portion size and energy density of foods in order to limit calories; and vii reduce the impact of marketing of foods and non-alcoholic beverages to children.
d. Promote the provision and availability of healthy food in all public institutions including schools, other educational institutions and workplaces.
e. Promote nutrition labelling for all pre-packaged foods.
a. Adopt and implement national guidelines on physical activity for health.
b. Develop policy measures to promote physical activity through activities of daily living, including through "active transport", recreation, leisure and sport.
c. Conduct public campaigns through mass media, social media and at the community level and social marketing initiatives to inform and motivate adults and young people about the benefits of physical activity and to facilitate healthy behaviours.
5. Create enabling environments through settings-based approaches.
a. Adopt settings-based approaches, such as cities, islands/villages, workplaces, schools, clinics and hospitals, to offer healthier dietary choices and to create enabling environments for physical activity, as well as make possible smoke-free environments.

Recommended actions for WHO
1. Provide technical assistance to reduce modifiable risk factors through implementing the WHO FCTC and its guidelines, the WHO global strategies for addressing modifiable risk factors and other health-promoting policy options, including healthy workplace initiatives, health-promoting schools and health-sensitive urban development.
2. Develop tools for advocacy and support policy and programme implementation, including skills and capacity-building.
3. Advocate for engagement with local governments and settings to implement NCD prevention and control interventions.
4. Identify models and guidance for best practices in collaboration with other sectors and support their wider implementation.
5. Develop guidance for engagement with the labour sector on health promotion in the workplace and workers health.
6. Develop guidance for engagement with trade, finance and other relevant sectors.
To strengthen and orient health systems to address the prevention and control of noncommunicable diseases and the underlying social determinants through people-centred primary health care and universal health coverage.

Recommended actions for Member States
1. Highlight the importance of NCD prevention and control in universal health coverage.
2. Strengthen the role of primary and secondary health-care and referral systems in overall efforts to prevent, control and manage NCDs.h.provide multidrug therapy, including glycaemic control for diabetes mellitus for individuals who have had a heart attack or stroke, and to people at high risk (> 30%) of a cardiovascular event within 10 years; and i. aspirin therapy for acute myocardial infarction.
4. Shift from reliance on user fees levied on ill people to the protection provided by pooling and prepayment, with inclusion of NCD services.
5. Strengthen health workforce and institutional capabilities for the implementation of NCD prevention and control through patient-centred service models, multidisciplinary teams, quality-assurance measures and continuing education.
6. Expand access to community-based rehabilitation.

7.
Provide health-financing arrangements to cover NCD prevention, screening, management and control.
8. Improve access to palliative care and pain relief for patients with cancer and other life-threatening conditions as part of the continuum of care.

Recommended actions for WHO
1. Advocate for linkage of NCD prevention and control to universal health coverage.
2. Provide support, guidance and technical background to countries in integrating costeffective interventions for NCDs and their risk factors into health systems, including essential primary health-care packages.
3. Encourage countries to improve access to essential medicines and medical technologies, as part of universal health coverage through development of models, tools, and training.
4. Support the development of health-financing schemes that cover NCD prevention, screening, management and control.
5. Provide guidance for planning and development of human resources for health to respond to the NCD epidemic.
6. Develop training packages for implementation of WHO PEN and support actions towards strengthening capacity at different levels for health financing, essential medicines and technologies, and human resources for health.

7.
Assist countries to establish clinical-practice guidelines and develop the capacity to systematically assess new and emerging evidence.

OBJECTIVE 5
To promote and support national capacity for high-quality research and development for the prevention and control of noncommunicable diseases.

Recommended actions for Member States
1. Develop, implement and monitor a national NCD research agenda.
2. Undertake operational research to support, evaluate and assess relevant approaches for NCD prevention and control, particularly: a. coverage and access by vulnerable populations to NCD prevention and control services; b. costing and cost-effectiveness of NCD prevention and control; and c. social and economic impact of NCD control policies.

Recommended actions for WHO
1. Provide technical assistance and opportunities for collaboration that will strengthen national capacity for NCD-related research.
2. Promote sharing of intercountry research expertise and experience.
To monitor the trends and determinants of noncommunicable diseases and evaluate progress in their prevention and control.

Recommended actions for Member States
1. Adapt the set of voluntary global targets and indicators for 2025 for the prevention and control of NCDs, as appropriate to the national context, with reporting at regular intervals.
2. Develop or strengthen a national mechanism to coordinate surveillance and use data for action at local and national levels for NCD prevention and control.
3. Develop or strengthen mortality registration with up-to-date International Classification of Disease guidelines to generate reliable NCD mortality data.
4. Conduct periodic surveys to measure population levels of risk factors in adults and children at least once in five years, reporting all data by gender where possible.
6. Periodically assess health system capacity and national response to NCDs.

7.
Monitor policies and other instruments for NCD prevention and control and their implementation.

Recommended actions for WHO
1. Provide technical support for developing/strengthening national NCD surveillance framework.
2. Provide guidance on definitions, as appropriate, and on how indicators should be measured, collected, aggregated and reported, as well as the health information system requirements at the national level.4. Provide guidance and support for measuring population levels of salt consumption through appropriate tools and approaches.
5. Assist countries to conduct national capacity assessments for NCD prevention and control, through the provision of appropriate tools and training.
6. Assess regional progress in NCD prevention and control periodically.

Proposed actions for international partners
1. International cooperation and capacity strengthening: e. Support WHO in establishing the global coordination mechanism where stakeholders -including nongovernmental organizations, professional associations, academia, research institutions and private sector -can contribute and take concerted action against NCDs.
f. Support the United Nations funds, programmes and agencies to collaborate through an agreed division of labour.A provisional list with examples of a collaborative division of tasks and responsibilities for United Nations funds, programmes and agencies is under development and will be appended to this action plan once finalized.

Resource mobilization for the prevention and control of NCDs:
a. Facilitate the mobilization of adequate, predictable and sustained financial resources and the necessary human and technical resources.
b. Support and be part of the social movement to support collaborative implementation of the global and regional action plans and to promote health and equity in relation to the prevention and control of NCDs.

Monitoring and reporting progress
Monitoring and reporting of the Western Pacific Regional Action Plan for the Prevention and Control of Noncommunicable Diseases (2014-2020) will be fully aligned with the proposed monitoring of the Global Action Plan for the Prevention and Control of Noncommunicable Diseases (2013-2020) to harmonize the efforts (Annex 3).WHO is in the process of developing appropriate action plan indicators to monitor progress of implementation of the Global Action Plan for the Prevention and Control of Noncommunicable Diseases (2013Diseases ( -2020)).These indicators, based on feasibility, current availability of data and capability of application across the six objectives of the global action plan, will be used to assess the progress made in 2016, 2018 and 2021.
Reports on progress achieved in attaining the nine global voluntary targets will be submitted in 2016, 2021 and 2026.
WHO will also update Appendix 3 (menu of policy options) of the global action plan, which appears as Annex 1 of the regional action plan, as appropriate, to be considered through the Executive Board, by the World Health Assembly, in the light of new scientific evidence.
There are many other conditions of public health importance that are associated with the four main NCDs -cardiovascular diseases, cancers, diabetes and chronic respiratory diseases.The other conditions include: 1. other NCDs -renal, endocrinal, neurological, haematological, hepatic, gastroenterological, musculoskeletal, skin and oral diseases; 2. mental disorders; 3. disabilities, including blindness and deafness; and 4. violence and injuries.
Some of these conditions are the subject of other WHO strategies and World Health Assembly resolutions.NCDs and their risk factors are also linked to communicable diseases, maternal and child health, reproductive health, ageing, and social, environmental and occupational determinants of health.The Western Pacific Regional Action Plan for the Prevention andControl of Noncommunicable Diseases (2014-2020) will explore potential synergies between NCDs and interrelated conditions to maximize opportunities and efficiencies for mutual benefit.

HEALTHY CITIES AND SETTINGS
Healthy Cities is a priority initiative of the Western Pacific Region.As one of the WHO regions with very rapid urbanization, cities in the Region offer a platform for NCD prevention and control.
City governments are well placed to provide multisectoral interventions."Eat smart" restaurants and schools, environmentally sustainable and healthy urban transport, walking and cycling paths, healthier street foods and smoke-free cities are examples of innovative approaches for NCD prevention and control in cities of the Region.Healthy cities and settings, such as schools and workplaces, will have an emphasis on the implementation of the regional action plan.
Subnational focus is a related area and there will be new pathways to work at provincial and district levels.

HEALTHY ISLANDS
Healthy Islands is an ideal envisioned in 1995 at the first Meeting of the Ministers of Health for the Pacific Island Countries on Yanuca Island, Fiji.That vision has served as a unifying theme for health protection and health promotion in the Pacific and reflects the comprehensive and integrated approach to health that is a hallmark of WHO in the Western Pacific Region.One of the recurring themes within Healthy Islands is the predominant and growing burden of NCDs, which have become a crisis in the Pacific island countries and areas.Efforts for prevention and control will be enhanced accordingly to the local context.

HEALTHY AGEING
The Region is experiencing a rapid and profound demographic transition, whose successful management poses a significant challenge.With respect to NCDs and healthy ageing, prevention of NCDs will increase the number and proportion of people who experience healthy ageing, and avoid high health-care costs and even higher indirect costs in older age groups.Otherwise, health costs will outstrip pensions and cause financial catastrophe for a large segment of the population, especially older women, who face greater financial insecurity.The ageing and health agenda in the Region encompasses a range of actions, including promoting healthy ageing across the life-course, developing age-friendly health systems to address the health needs of older people, strengthening the evidence base, and promoting the right of older people to good health.

WOMEN'S AND CHILDREN'S HEALTH
The Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Noncommunicable Diseases and the Regional Committee for the Western Pacific in resolution WPR/RC62.R2 state that women's and children's health is inextricably linked with NCDs and that the promotion of health through the life-course is important for both maternal and child health and NCDs.As mortality from infectious diseases and related to childbirth decrease, NCDs represent an increasing cause of death and disability among women and children.Cervical cancer, the second most common type of cancer among women, is rising, and 80% of cases occur in developing countries.Most deaths occur in the prime of life.NCDs can have an intergenerational effect as NCDs prior to and during pregnancy can result in suboptimal newborn health, including prematurity and low birth weight.In the long run, these are associated with increased NCDs.In particular, strengthening the implementation of the International Code of Marketing of Breast-milk Substitutes and the WHO Global Strategy for Infant and Young Child Feeding are important to promote, protect and support breastfeeding, including exclusive breastfeeding for six months, continued breastfeeding until two years and above, and complementary feeding from six months onwards.Breastfeeding not only reduces susceptibility to infections and the risk of undernutrition, but also reduces the risk of obesity and NCDs across the life-course.

MENTAL DISORDERS
Since mental disorders are an important cause of morbidity and contribute to the global NCD burden, equitable access to effective programmes and health-care interventions is needed.Mental disorders affect, and are affected by, other NCDs.Mental disorders can be a precursor or consequence of NCDs, or the result of interactive effects.For example, there is evidence that depression predisposes people to developing heart attacks and, conversely, heart attacks increase the likelihood of depression.Risk factors of NCDs, such as sedentary behaviour and the harmful use of alcohol, also link NCDs with mental disorders.Characteristics of economically underprivileged population segments, such as little schooling, lower social class and unemployment, are shared by mental disorders as well as NCDs.Despite these strong connections, evidence indicates that mental health disorders in patients with NCDs and NCDs in patients with mental disorders are often overlooked.

DISABILITIES AND REHABILITATION
Approximately 15% of the population experiences disability, and the increase in NCDs is having a profound effect on disability trends.For example, NCDs are estimated to account for about two thirds of all years lived with disability in low-and middle-income countries.NCD-related disability, such as amputation, blindness or paralysis, puts significant demands on social welfare and health systems, impacts productivity and impoverishes families.Rehabilitation needs to be a key health strategy in NCD programmes to address risk factors, for example obesity and physical inactivity, as well as loss of function due to NCDs, such as paralysis due to stroke or amputation due to diabetes.Access to rehabilitation services can decrease the effects and consequences of disease, hasten discharge from hospital and improve health and the quality of life.

3.
Provide technical support to: a. strengthen vital registration, b. measure population levels of risk factors using WHO tools, c. strengthen cancer registration.
1. Provide technical assistance to raise public awareness about the links between NCDs and sustainable development including integration of the prevention and control of NCDs into national health and development planning processes and the United Nations Development Assistance Framework.Strategically advocate for action on NCDs and adoption of global targets at the highest levels of political leadership in countries and among United Nations funds, programmes and agencies; development partners; donors; and regional bodies, such as the Association of Southeast Asian Nations (ASEAN), the Asian Development Bank (ADB), Asia-Pacific Economic Cooperation (APEC), the Organisation for Economic Co-operation and Development (OECD) and the Secretariat of the Pacific Community (SPC).
3. Enhance access to essential NCD interventions through a defined service package, such as adapting the WHO Package of Essential Noncommunicable Disease Interventions (PEN) in the primary health-care system, and through appropriate referrals, as part of universal health coverage: a. scale up early detection and coverage and prioritize very cost-effective, highimpact interventions to address behavioural risk factors; b. provide counselling and patient education, including the provision of brief advice for tobacco cessation and reducing harmful use of alcohol; c. assess, manage and treat risk factors and link with family and community-based approaches for lifestyle modification; d. refer people at high risk of disease and complications; e. prevent liver cancer through hepatitis B immunization as part of the Expanded Programme on Immunization;f.preventcervical cancer through cost-effective screening methods, such as visual inspection with acetic acid [VIA] and/or Pap smear (cervical cytology), linked with timely treatment of pre-cancerous lesions;g.secondary prevention of rheumatic fever and rheumatic heart disease; Support national authorities to create enabling environments for implementing evidence-based multisectoral action, in other words by reducing modifiable risk factors of NCDs through health-promoting policies in agriculture, education, labour, sports, food, trade, transport and urban planning, by implementing existing international conventions in the areas of environment and labour, and by strengthening health financing for universal health coverage.c.Strengthen international cooperation within the framework of North-South, South-South and triangular cooperation, in support of national, regional and global plans for the prevention and control of NCDs, and among other things through the exchange of best practices and research findings in the areas of health promotion, legislation, regulation, monitoring and evaluation and health systems strengthening, strengthening of institutional capacity, training of health personnel, development of appropriate health-care infrastructure and diagnostics, and by promoting the development and dissemination of appropriate, affordable and sustainable transfer of technology on mutually agreed terms and the production of affordable, safe, effective and quality medicines and vaccines, medical technologies and information and electronic communication technologies (eHealth) and the use of mobile and wireless devices (mHealth).