REPORT OF THE GLOBAL SURVEY

ON THE PROGRESS IN NATIONAL

CHRONIC DISEASES PREVENTION
AND CONTROL
 2 3

WHO Library Cataloguing-in-Publication Data

Report of the global survey on the progress in national chronic diseases prevention
and control.
1. Chronic disease - prevention and control. 2. Chronic disease - economics.
3. Health policy - organization and administration. 4. Health surveys.
5. National health programs - organization and administration. 6. Financing,
Health. 7. Statistics. I.World Health Organization.
ISBN 978 92 4 159569 8 (NLM classification: WT 500)
TABLE OF CONTENTS

© World Health Organization 2007

All rights reserved. Publications of the World Health Organization can be
Acknowledgements 7
obtained from WHO Press, World Health Organization, 20 Avenue Appia,
1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857;
Abbreviations 9
e-mail: [email protected]). Requests for permission to reproduce or translate
WHO publications – whether for sale or for noncommercial distribution – should
Executive Summary 11
be addressed to WHO Press, at the above address (fax: +41 22 791 4806;
e-mail: [email protected]).
Introduction 15
The designations employed and the presentation of the material in this publication
do not imply the expression of any opinion whatsoever on the part of the World 1. Methods 16
Health Organization concerning the legal status of any country, territory, city 1.1 Data Collection and Data Entry 16
or area or of its authorities, or concerning the delimitation of its frontiers or 1.2 Data Imputation and Cleaning 17
boundaries. Dotted lines on maps represent approximate border lines for which 1.3 Data Analysis 17
there may not yet be full agreement.
The mention of specific companies or of certain manufacturers’ products does not 2. Quantitative Results 17
imply that they are endorsed or recommended by the World Health Organization 2.1 Response Rate 17
in preference to others of a similar nature that are not mentioned. Errors and 2.2 Focal Point, Unit/Department and Insitute 18
omissions excepted, the names of proprietary products are distinguished by initial 2.3 Act, Law, Legislation and Ministerial Decree 19
capital letters. 2.4 Policy, Strategy, Action Plan, Programme 20
All reasonable precautions have been taken by the World Health Organization 2.5 National Target 24
to verify the information contained in this publication. However, the published 2.6 Implementation of FCTC and DPAS 25
material is being distributed without warranty of any kind, either expressed or 2.7 National Health Reporting System, Survey
implied. The responsibility for the interpretation and use of the material lies with and Surveillance 26
the reader. In no event shall the World Health Organization be liable for damages 2.8 National Community-based Demonstration Programmes 30
arising from its use. 2.9 Protocols/Guidelines/Standards 33
Printed in France 2.10 Financial Resources 33
 4 5

3. Summary 37
3.1 Summary of Progress 37
3.2 Summaries by Risk Factor and Disease Groups 37

4. Qualitative Results 40
4.1 Ranking of NCD Prevention and Control
as a Priority for Action 40
4.2 Barriers and Constraints 42
4.3 Surveillance of Chronic Diseases Prevention and Control 43
4.4 Priority Areas of WHO Technical Support FOREWORD
for Chronic Disease Prevention and Control 44

5 Discussion and Conclusion 45

References 48

Annex 1 - Global Survey Questionnaire 49

Annex 2 - Explanation of Terms 62 The World Health Assembly (WHA) endorsed the Global Strategy for
Prevention and Control of Noncommunicable Diseases (NCDs) in May 2000. In
Annex 3 - Key Informant Questions 66 2001 and as a follow-up to the Global Strategy, WHO conducted a survey to
assess its Member States’ capacity to respond to NCDs, and to learn how best
Annex 4 - List of WHO Member States Responding to assist them. Since then, WHO has prompted actions targeted at NCDs, which
to the Global Survey 69 culminated in a series of vital WHO documents. The World Health Report 2002,
Reducing Risk, Promoting Healthy Life, raised awareness of risk factors. In 2003
and 2004, the WHA endorsed, respectively, the Framework Convention on Tobacco
Control (FCTC) and the WHO Global Strategy on Diet, Physical Activity and
Health (DPAS). In October 2005, the WHO Global Report on “Preventing chronic
diseases: a vital investment’’ was launched. This report makes the case for urgent
action to halt and turn back the growing threat of chronic diseases. WHO has at
all times been actively supporting partnerships and networking among Member
States committed to NCD prevention and control.
While the achievements made at country and global levels since 2000-2001
are encouraging, the NCD burden is predicted to grow unless more decisive
action is taken. In this context, the Department of Chronic Diseases and Health
Promotion at WHO Headquarters initiated a new wave of surveys whose
instruments included quantitative and qualitative components. Thanks to the
cooperation of the regional offices, all WHO regions were surveyed in 2005-2006
with the exception of the Western Pacific Region (WPR), where the Regional
Office had conducted a similar survey in 2004. A quantitative questionnaire
was mailed or emailed to Member States and responses were checked by WHO
regional offices. Later, in all WHO regions except the European Region (EUR),
key informant interviews were carried out aimed at collecting relevant qualitative
 6 7

information from a total of 26 countries across low income, lower-middle income

and upper-middle income classes.
The purpose of this report is to present the findings and conclusions of this
survey, with special regard to the progress being made in national chronic diseases
prevention and control by comparison with the previous one, and to examine the
implications for future action.
I would like to take this opportunity to express my appreciation to the survey
respondents from Member States, and to our colleagues at WHO representative
offices, regional offices and Headquarters who kindly gave their time and
assistance to this survey. The survey also benefited from the valuable contribution ACKNOWLEDGEMENTS
of the WHO Collaborating Centre on Chronic Diseases Policy at the Public Health
Agency of Canada.

Dr Catherine Le Galès-Camus This survey received strong support and cooperation from key persons in
Assistant Director-General the Member States and our colleagues at country offices, regional offices and
Noncommunicable Diseases and Mental Health Headquarters. Without their wholehearted assistance, it would not have been
possible to implement the survey.
Actively involved in this project during the planning and implementation
phases were our colleagues in the six WHO regional offices: Drs Antonio Filipe
Jr and Sidi Allel Louazani (AFRO), Lucimar Coser Cannon (AMRO), Oussama
Khatib (EMRO), Jill Farrington and Aushra Shatchkute (EURO), Jerzy Leowski
(SEARO), and Gauden Galea (WPRO). Their spirit of team work and partnership
is highly appreciated. Thanks should also be extended to all WHO country
counterparts who were involved in both the questionnaire filling exercise and the
key informant interviews.
Drs Robert Beaglehole and Colin Tukuitonga provided extensive comments
and inputs to the questionnaires and to subsequent drafts of the report prepared
by Drs Ruitai Shao and Bao Liu. Ms Barbara Legowski assisted in the finalization
of the report. Dr Juan Zhang provided assistance in interviewing key informants,
and Dr Lei Huang contributed to the drafts of the report. The support given by
colleagues in the Departments of Chronic Diseases and Health Promotion, Mental
Health and Substance Abuse, Nutrition for Health and Development, and Tobacco
Free Initiatives is gratefully acknowledged. Invaluable secretarial assistance was
provided throughout by Ms Hilda Muriuki. Ms Rebecca Harding was responsible
for the cover and lay-out design.
Finally, this survey also benefited greatly from the contributions of the WHO
collaborating centre on Chronic Diseases Policy at the Public Health Agency of
Canada. Special thanks are extended to Dr Sylvie Stachenko.
8 9

ABBREVIATIONS

AFR African Region

AMR American Region
CHP Chronic diseases and health promotion
CVDs Cardiovascular diseases
DPAS Global strategy on diet, physical activity and health
EMR Eastern Mediterranean Region
EUR European Region
FCTC Framework Convention on Tobacco Control
MOH Ministry of Health
NCDs Noncommunicable diseases
NCDPC Noncommunicable diseases prevention and control
NGO Non-governmental organization
PHC Primary health care
SEAR South-East Asia Region
WHO World Health Organization
WHR World Health Report
WPR Western Pacific Region
 11

EXECUTIVE SUMMARY

While achievements made at country and global levels since 2000-2001 are
encouraging, the NCD burden is predicted to grow unless much more decisive
action is taken. It is in this context that the Department of Chronic Diseases and
Health Promotion at WHO Headquarters has conducted a new survey with the
following objectives: to assess the capacity of national chronic disease prevention
and control in development, implementation of national policy, and action plan and
programmes; to promote sharing of information, experiences and best practices;
to identify constraints and needs of technical assistance; and to assist national
strategy and policy formulation, development, implementation and evaluation.
This report contains the results of these inquiries.
The survey had quantitative and qualitative components: a self-administered
questionnaire and key informant interviews. Five WHO regions were surveyed
in 2005-2006; in the Western Pacific Region (WPR), a questionnaire similar
to that administered in the other regions, was already completed in 2004 and
was reinforced by interviews in 2006. The global questionnaire had an overall
response rate of 69%, and was completed by 133 countries. A sub-set of 118
countries responded to both the first and later surveys, permitting an assessment
of progress. Progress is also reported for a group of 97 countries; these do not
include WPR because some questions were not in the WPR survey. In total, 26
key informants were interviewed from all regions except the European Region
(EUR).
In the group of 97 countries that excludes WPR, progress since 2000-2001 is
evident for a number of indicators: more countries have NCD units or departments
in their ministries of health, more have budgets specific to NCD policies, and more
have action plans for tobacco control, diabetes, heart disease and cancer. Across all
 12 13

Regions, national policies and programmes are most common for tobacco control, are less common for risk factors than for individual diseases, and they now exist
followed by nutrition/diet, cancer and diabetes. Policies for other risk factors and most often for diet (in 38% of countries) and smoking cessation (in 33%).
diseases are in place in between 20% and 35% of countries, depending on the With regard to the sources of financing for NCD prevention and control,
region. But despite the progress in policy development, key informants cautioned about 32% of countries on average identified international financial aid. The
that simply having a policy may suggest that the issue has high priority when, in proportion in EUR was lowest (16%). Very few countries reported taxation on
reality, implementation is often constrained by lack of financial resources. tobacco, alcohol and unhealthy food as sources of funding. As for taxes on alcohol,
As regards the FCTC and DPAS, 65% of respondents, excluding WPR, are the countries in EUR have the highest proportions (18%); while the countries in
contracting parties to the FCTC and 31% report a corresponding comprehensive AMR have the highest proportions of taxation on cigarettes (26%).
action plan. In the same group of countries, only 29 reported implementing DPAS Progress is apparent in the countries that responded to both surveys. However,
while 19 replied that they planned to do so. there are a number of key areas for action that are similar to those reported in
Among all respondents, 85% have now introduced tobacco control 2000-2001 and which re-emerge as priorities for WHO technical support to
legislation, an increase of 23% since 2000-2001. About 50% have no legislation Member States. These areas include advocacy, continuing assistance to countries
for alcohol control. The proportion of countries with food and nutrition legislation to strengthen surveillance systems, capacity building for the development,
has increased since 2000-2001, but it is unclear whether this concerns NCD implementation and evaluation of policies, action plans and programmes, and the
prevention and control, as opposed to food safety. creation of more channels, platforms and other occasions for sharing information
with best practice at different levels. In addition, regular global reviews should be
Compared to 2000-2001, more countries now include NCD information
encouraged in order to help WHO to measure the progress as well as to identify
in their annual health reporting systems but still only a small proportion
the Member States’ needs for technical support.
(26%) include risk factor data in these systems. More countries take account
of hypertension, diabetes and cancer in their surveillance systems but,
again, risk factors are less often included. However, between 2000-2005, all
responding countries carried out studies or surveys on risk factors, most often
for tobacco use (82%), and between 60% and 70% for overweight and obesity,
hypertension, diabetes, diet, physical activity and alcohol use. The frequency
of these studies is not known. Training for surveillance remains a barrier
according to key informants, and the challenge remains as to how to convert
the available data into strategic information that can influence policies and
mobilize resources for prevention.
On average, half of the 133 countries responding reported national targets
for NCD prevention and control. About 60% of them said that ministries of health
were involved in setting these targets, while some 40% of countries reported
the additional involvement of WHO, disease-specific associations, medical/
health professionals and academic institutions. Private citizens, community
organizations, specific population groups and consumer organizations played a
role in less than one-quarter of countries.
Across regions except WPR, almost half of the countries reported
demonstration programmes that apply an integrated approach to NCD prevention
and control, while 37% have such programmes specific to certain risk factors. In
about 35% of countries, the projects target children aged under 15 and adults aged
25-64 years. Most common are projects in schools.
Countries have made progress since 2000-2001 in making available and using
national protocols for dealing with hypertension, diabetes and cancer. Protocols
14 15

INTRODUCTION

The Global Strategy and Resolution WHA 53.14 requested WHO to provide
technical support and appropriate guidance to Member States in assessing their
needs, developing effective programmes and adapting their health systems
to respond to the NCD epidemic. Following the adoption of the Resolution
WHO conducted its first Global Survey on Assessment of National Capacity
for Noncommunicable Disease Prevention and Control: The Report of a Global
Survey (2001). The Survey was aimed at: assessing existing country capacity
in health policy, programmes and infrastructure to prevent, control and treat
NCD; identifying constraints and needs among Member States; setting priorities
for WHO technical support to Member States; and assisting them in planning,
implementing and evaluating their responses.
Since 2000, WHO has invoked various other instruments to prompt action
on NCD prevention and control. The 2002 World Health Report Reducing Risk,
Promoting Healthy Life focused on risk factors; in 2003, the World Health Assembly
(WHA) endorsed the Framework Convention on Tobacco Control (FCTC); and in
2004 WHO released the Global Strategy on Diet, Physical activity and Health
(DPAS). WHO has also supported partnerships and networking among Member
States by convening four global forums on NCD prevention and control since
2001, encouraging the development of policy observatories, and supporting new
and existing networks of national and demonstration level programmes aimed at
preventing and controlling NCDs.
Despite global successes since 2000 such as the FCTC and individual country
achievements, the risk factors and the NCD threat have been neglected in many
parts of the world, and the NCD burden is growing. Out of a projected total of
58 million deaths from all causes in 2005, WHO estimates that 35 million were
 16 17

due to NCDs. By 2015, unless there is significant decisive action, the estimate For the qualitative component, with the exception of EMR and EUR,
will increase to 41 million deaths. Low and middle income countries, where WHO HQ interviewers interacted with key informants using a semi-structured
80% of deaths are occurring, suffer the largest burden. Human and economic questionnaire, similar to that used in 2000-2001, and prepared notes. (See Annex
development on a global scale are threatened, as affected individuals lose quality 3 for the qualitative questionnaire.) The regional advisors for NCD recommended
of life, workforces are reduced by premature deaths, and economic losses are key informants to the WHO HQ research team on the basis of the informants’
experienced from household to national levels. knowledge of NCD situations in their respective countries, their English language
capacity and their technical background. Interviews were not conducted in EUR.
In 2005-2006, in order to assess progress in NCD prevention and control
Information was collected for 26 countries, from low income, lower middle income
capacity since 2000, and to re-examine the nature of WHO technical assistance
and higher middle income groupings. Most often, there was one key informant
that is most needed, the Department of Chronic Diseases and Health Promotion at
per country, interviewed during April, May, June or July of 2006. For the most
WHO Headquarters conducted a new survey, also with quantitative and qualitative
part, interviews occurred over the telephone.
components. With the cooperation of the regional offices, all WHO regions were
surveyed in 2005-2006 with the exception of WPR, where the regional office had The data and information collected were not validated by independent
conducted a similar survey in 2004. sources. Depending on the number of key informants interviewed in a region,
it may be possible to generalize their information to the region. But overall, the
The new survey had six core topics repeated from the 2000-2001 survey. interview information cannot be generalized across regions.
They covered: national focal points, units/departments and institutes; national
acts, laws, legislation, decrees; national policies, strategies, action plans and 1.2 Data Imputation and Cleaning
programmes; national health reporting systems, surveys and surveillance; Missing data from the quantitative survey were inferred after additional
protocols, guidelines and standards; and financial resources. Three topics were consultation with focal points at the WHO regional offices and with Member
new: demonstration programmes; national targets; and DPAS and FCTC. The States. In order for the final database to be sufficiently complete and accurate for
sections common to both surveys deal for the most part with NCD prevention and analysis, the WHO HQ team thoroughly cleaned all the variables in the dataset in
control. Treatment capacity was not assessed in the new survey to the extent that addition to the built-in check procedure of the data entry program.
it was in 2000-2001.
1.3 Data Analysis
This report presents the quantitative and qualitative findings from the new
survey. The progress made in the period between the two surveys is estimated Descriptive analysis is generally used for this first stage data analysis. STATA
for topics covered in both surveys, and the development of new capacities is 9 software was used for writing all the statistical programs for analysis.
reported.

2. QUANTITATIVE RESULTS

1. METHODS 2.1 Response Rate

In total, 133 countries from across WHO regions completed the quantitative
1.1 Data Collection and Data Entry questionnaire. Table 1.1 shows the numbers of respondents and non-respondents.
All regional offices were involved in coordinating data collection. They The overall response rate was 69% (133 respondents out of a total of 192
mailed or emailed the quantitative questionnaires to Member States and were Member States). The regional response rates varied from 55% in SEAR to 78%
the first to check the survey responses. (See Annex 1 for the quantitative in WPR.
questionnaire.) The WHO HQ survey team double checked the responses. These Table 1.2 showed that a sub-set of 118 countries responded to both the first
were then organized into a database using Epi-Info 6.04d and Excel 2003. The and latest surveys, permitting an assessment of progress. Progress is also reported
responses to the survey conducted in 2004 in WPR were combined with those for a group of 97 countries that excludes WPR, because some questions were not
from the other regions, which were collected in 2005-2006, to give a global in the WPR survey. In total, 26 key informants were interviewed from all regions
perspective. except EUR.
 18 19

Table 1.1 Response rates to the global survey, by WHO Region control institute; MOH unit or department refers to an administrative agency in
MOH for disease prevention and control or for prevention and control of chronic
Region Respondent Non-Respondent Total Response diseases; a national institute refers to a national public health institute or a
States States Rate (%) specialized institute for chronic disease prevention and control.
AFR 26 20 46 57
Findings
AMR 27 8 35 77
Table 2-1 showed that, among the 112 respondent countries (omitting WPR),
EMR 15 6 21 71
although 86% had focal points for chronic diseases prevention and control, only
EUR 38 14 52 73 about half of the states (49%) reported having national institutes for chronic
SEAR 6 5 11 55 disease prevention and control. Most responding states (79%) reported having a
WPR a
21 6 27 78 unit (or department) in the Ministry of Health for NCD and, as shown in Table 2-2
for all the five regions, in 2005~2006 this percentage was at least 24% higher than
Total 133 59 192 69
that in 2000~2001.
a
WPR data were collected in 2004.

Table 2-1 Percentage of countries establishing national focal point,

Table 1.2 Countries responding to the first survey in 2000-2001 and the second survey a MOH unit (or department), and an institute for chronic diseases prevention
in 2005-2006, and countries responding to both surveys and control, by WHO Region, 2005~2006

Countries responding to Region Focal point MOH Unit/ National institute

Region Countries Department
The first survey in The second survey responding to both
surveys AFR 89 81 39
2000-2001 in 2005-2006
AMR 78 82 41
AFR 39 26 24
EMR 87 87 40
AMR 33 27 24
EUR 87 74 66
EMR 17 15 13
SEAR 100 67 50
EUR 41 38 30
WPR NA NA NA
SEAR 10 6 6
Total 86 79 49
WPR 27 21 21
NA, no data available
Total 167 133 118

2.2 Focal Point, Unit / Department and Institute 2.3 Act, Law, Legislation and Ministerial Decree
National focal point, unit/department and institute National act, law, legislation and ministerial decree
for chronic diseases prevention and control for chronic diseases prevention and control
Table 2-1 and Table 2-2 report, by WHO region, on the availability of a national Table 3-1 and Table 3-2 report, by WHO region, on the existence of a national
focal point, national unit (or department) in the Ministry of Health (MOH), and a act, law, legislation and ministerial decree for NCD prevention and control. This
national institute for chronic disease prevention and control. A national focal point refers to nationally approved legal documents targeting prevention and control of
refers to the person responsible for prevention and control of chronic diseases in chronic diseases and risk factors; or to prevention and control of chronic diseases
MOH, in a national public health institute or in a chronic disease prevention and or related risk factors as part of the relevant legislation.
 20 21

Table 2-2 Percentage of countries establishing an MOH unit (or department) prevention and control of chronic diseases. A national policy for chronic disease
for chronic disease prevention and control prevention and control refers to a written document endorsed, in collaboration
with related sectors, by the country’s Ministry of Health, which includes a set
Region 2000~2001 2005~2006 of statements and decisions defining goals, priorities and main directions for
AFR 63 83 attaining these goals. The policy document may also include a strategy containing
AMR 63 83
main lines of action that are adopted to give effect to the policy.
EMR 62 92
EUR 60 83 Table 3-2 Percentage of countries having legislation for tobacco control,
SEAR 33 67 and food and nutrition in 2000~2001 and 2005~2006, by WHO Region
WPR NA NA
Tobacco control Food and nutrition
Total 60 84
Region 2000~2001 2005~2006 2000~2001 2005~2006
NA, no data available.
AFR 25 67 50 75

Findings AMR 58 71 67 83
EMR 69 92 69 85
Table 3-1 showed that out of the 133 respondent countries, 85%, 83%, 52%
and 23% reported having legislative instruments dealing respectively with tobacco EUR 80 100 80 100
control, food and nutrition, alcohol control and physical activity legislation related SEAR 67 100 83 100
to chronic disease prevention and control. In addition, the results in Table 3-2 WPRa 71 86 76 76
showed that the last five years saw 23% and 16% increases in the proportion
Total 61 84 70 86
of countries having legislation for tobacco control and for food and nutrition.
By contrast, the percentages of countries having legislation for alcohol control a
WPR data were collected in 2004.
and physical activity were on average much lower, with only around 25% of
respondent states having legislation for physical activity (Table 3-1). A national integrated programme refers to the country’s core public health
principles incorporated into a country action plan for chronic diseases prevention
Table 3-1 Percentage of countries having national act, law, legislation, ministerial decree and control through a concerted approach addressing the multidisciplinary range of
for chronic diseases prevention and control, by WHO Region, 2005~2006 issues within a prevention and health promotion framework across the broad range
of chronic diseases. A national integrated programme generally targets all major
Risk factors Total AFR AMR EMR EUR SEAR WPRa common risk factors common to main chronic diseases, and integrates primary,
Tobacco control 85 69 74 93 97 100 86 secondary and tertiary prevention, health promotion and disease prevention. It
Food and nutrition 83 73 82 80 92 100 76
may include programmes across sectors and disciplines and, rather than relying
on a disjointed set of small-scale projects, it will seek to harmonize and integrate
Alcohol control 52 35 59 60 74 33 24
actions within existing public health systems by incorporating contemporary
Physical activity 23 12 19 27 34 50 14
evidence-based concepts.
a
WPR data were collected in 2004.
Findings
Table 4-1 showed that the percentages of countries having a national health
2.4 Policy, Strategy, Action Plan, Programme policy and a strategy relevant to chronic disease prevention and control were
Table 4-1 and Table 4-2 report on the existence, by WHO region, of a national respectively 63% and 54% (except for WPR), while 64% of countries reported
policy, strategy and integrated programme for NCD prevention and control. A having a national integrated programme in all regions. As shown in Table 4-2,
national strategy means a long-term plan of action designed to achieve the goal of for the comparable 97 countries between 2000~2001 and 2005~2006, there was
 22 23

a 28% increase in the percentage of countries having a national policy relevant A national programme refers to a set of comprehensive goals and objectives
to chronic diseases prevention and control. The Table also showed that, when within the framework of national chronic disease prevention and control, which
compared with AMR, EMR and EUR, for AFR there was a persisting low rate of translate into programme goals and objectives that are consistent with the chosen
issuance of national policy relevant to chronic diseases prevention and control, intervention strategies; the programme also develops from these a blueprint of
while SEAR significantly improved on its shortfall over the past five years. how the intervention activities will operate and how to evaluate the results.
Findings
Table 4-1 Percentage of countries having national policy, strategy, and integrated programme Among the respondent countries, generally, the proportions of countries
relevant to chronic diseases prevention and control, by WHO Region, 2005~2006 having specific risk factor related national health policy (action plan, programme)
for tobacco control and nutrition/diet were in general higher than those of countries
Total AFR AMR EMR EUR SEAR WPRa having a specific national policy directly targeting chronic disease. But this is
National policy 63 39 70 67 74 50 NA not the case for risk factors like physical activity and alcohol control (Table 5,
Table 6-1, Table 7).
National strategy 54 31 63 53 63 50 NA
National integrated 64 39 63 67 74 50 76
Table 6-2 showed that, although the current percentages of countries having
programmes a specific national action plan for tobacco control, diabetes, heart diseases and
cancer were consistently much higher than those reported in the 2000~2001
NA, no data available.
a
WPR data were collected in 2004.
survey, the corresponding percentages for AFR in both surveys were much lower
than for the other four regions. And when compared with the other regions, AFR
achieved much less progress in these action plans except for tobacco control
Table 4-2 Percentage of countries having national policy relevant to chronic diseases and cancer. For instance, in AFR the percentage having a specific national heart
prevention and control in 2000~2001 and 2005~2006, by WHO Region disease action plan remained the same over the last five years, while AMR, EMR,
EUR and SEAR increased by 17%, 15%, 13% and 17%, respectively.
Region 2000~2001 2005~2006
AFR 17 46
Table 5 Percentage of countries having a specific national policy for chronic diseases
AMR 42 75
prevention and control, by WHO Region, 2005~2006
EMR 69 77
EUR 57 83 Risk factors & Diseases Total AFR AMR EMR EUR SEAR WPRa
SEAR 17 67 Tobacco control 56 39 48 73 74 67 38
WPR NA NA Nutritional/diet 50 46 56 33 63 67 33
Total 42 70 Physical activity 29 12 26 33 50 33 10
NA, no data available.
Alcohol control 28 12 26 13 50 33 19
Hypertension 30 23 37 47 40 NA 10
Diabetes 41 27 44 60 53 NA 29
Table 5, Table 6-1, Table 6-2 and Table 7 report on the existence of a national Heart diseases 34 8 33 47 53 NA NA
action plan and a programme for NCD prevention and control by WHO region.
Stroke 24 8 22 13 45 NA NA
A national action plan is a scheme, prepared according to policy and strategic
directions and with defined activities, to generate a set of products/targets in order Cancer 41 23 41 60 61 17 24
to achieve the desired goals. The action plan should identify who does what (type Chronic respiratory disease 20 4 22 33 34 NA 5
of activities and people responsible for implementation), when (time frame), how Other chronic disease 24 15 26 20 26 50 NA
and for how much (resource). It should ideally have an inherent mechanism for NA, no data available.
monitoring and evaluation. a
WPR data were collected in 200.
 24 25

Table 6-1 Percentage of countries having a specific national action planfor chronic prevention and control (or for risk factors such as tobacco use, unhealthy diet
diseases prevention and control, by WHO Region, 2005~2006 and physical inactivity, and health determinants such as environment, lifestyles,
socio-economic levels etc).
Risk factors & Diseases Total AFR AMR EMR EUR SEAR WPR
Tobacco control 66 39 63 80 76 100 NA Table 7 Percentage of countries having specific national programmes for chronic diseases
Nutritional/diet 48 35 52 33 61 50 NA prevention and control, by WHO Region, 2005~2006
Physical activity 32 12 37 27 42 50 NA
Risk factors & Diseases Total AFR AMR EMR EUR SEAR WPRa
Alcohol control 30 19 22 13 47 33 NA
Tobacco control 54 31 41 67 66 100 57
Hypertension 35 19 48 47 32 33 NA
Nutritional/diet 50 42 56 47 53 33 57
Diabetes 54 27 63 60 61 67 NA
Physical activity 32 8 22 20 45 33 57
Heart diseases 46 12 48 53 61 50 NA Alcohol control 32 12 30 7 45 33 52
Stroke 20 4 26 13 26 33 NA Hypertension 42 23 52 40 42 33 57
Cancer 60 35 59 67 68 100 NA Diabetes 48 23 59 60 53 17 57
Chronic respiratory disease 18 4 15 33 24 17 NA Heart diseases 38 15 33 53 53 33 NA
Other chronic disease 24 27 26 27 21 17 NA Stroke 25 12 26 13 37 33 NA
NA, no data available. Cancer 47 19 48 60 61 33 48
Chronic respiratory disease 21 8 26 27 26 0 NA
Table 6-2 Percentage of countries having a specific national action plan for tobacco control, Other chronic disease 21 19 19 7 26 33 NA
diabetes, heart diseases, and cancer in 2000~2001 and 2005~2006, by WHO Region
NA, no data available.
a
WPR data were collected in 2004.
Tobacco control Diabetes Heart disease Cancer
2000~ 2005~ 2000~ 2005~ 2000~ 2005~ 2000~ 2005~
Findings
Region 2001 2006 2001 2006 2001 2006 2001 2006
Half of the 133 respondent countries reported having national targets for
AFR 17 38 17 25 13 13 21 33
chronic disease prevention and control, but the percentages varied widely from
AMR 29 63 46 63 29 46 50 58 region to region.
EMR 54 85 46 69 54 69 54 77 As shown in Table 8-2, among the respondent states, the proportion of
EUR 37 77 53 67 57 70 60 77 countries having sectors/organizations involved in national target-setting ranged
SEAR 67 100 50 67 33 50 83 100 widely from the reported 19% for the involvement of “other ministries” to the
highest percentage of 62% for the Ministry of Health. The percentage of countries
WPR NA NA NA NA NA NA NA NA
reporting the Ministry of Finance’s involvement in national target-setting varied
Total 34 66 41 56 37 49 49 63 from 5% in WPR to 32% and 33% in EUR and EMR.
NA, no data available.
2.6 Implementation of FCTC and DPAS
Table 9 reports on the status of FCTC and DPAS implementation. FCTC
2.5 National Target
refers to the national action plan or work plan for implementing the Framework
Table 8-1 and Table 8-2 report on the availability of national targets Convention on Tobacco Control (FCTC), adopted by WHA 56 in May 2003.
for NCD prevention and control. A national target refers to the setting of DPAS refers to the Global Strategy on Diet, Physical Activity and Health (DPAS),
quantitative output, impact, outcomes or health indicators for chronic diseases endorsed by WHA 57 in May 2004.
 26 27

Table 8-1 Percentage of countries having national targets for chronic disease prevention Table 8-2 Organizations involved in setting a national target for chronic diseases
and control, by WHO Region, 2005~2006 prevention and control (percentages), by WHO Region, 2005~2006

Region National targets Organizations Total AFR AMR EMR EUR SEAR WPRa
AFR 23 Ministry of Health 62 42 56 80 79 50 52
AMR 48 Ministry of Education 31 23 26 47 50 33 0
EMR 60 Ministry of Finance 21 15 19 33 32 17 5
EUR 71 Other Ministries 19 15 11 20 29 33 10
SEAR 33 Subnational government 20 4 15 13 34 33 NA
WPR a
52 World Health Organization 42 39 41 67 50 50 14
Total 51 National NGO 37 27 26 40 50 33 NA
a
WPR data were collected in 2004.
Citizen or community 24 19 22 13 34 17 NA
representatives
Associations for specific 21 19 19 20 32 33 5
Findings population groups
Among the 112 respondent countries in AFR, AMR, EMR, EUR and SEAR, Consumer Organizations 16 15 7 7 32 17 5
65% became contracting parties to the WHO’s FCTC, and 31% already have Medical/Health 39 19 48 20 58 50 29
implemented an action plan for FCTC. As regards DPAS, 26% of 112 countries Professional Associations
had implemented DPAS, 17% had plans to do so, and 27% had established a Disease-specific 41 27 44 47 58 33 24
mechanism for discussion /interaction between national authorities and private Associations
sector interests related to DPAS. Currently no country has implemented DPAS International Nongovern- 17 15 7 20 26 17 10
in the EMR’s 15 respondent countries, but three reported having plans to do mental Organizations
so. Table 9 also showed that, out of 112 respondent countries, slightly over
Other Bilateral/Multilateral 13 8 15 13 18 33 0
one quarter had established a mechanism for discussion/interaction between Organizations
national authorities and the private sector.
Academic institutions 39 19 41 27 58 33 NA

2.7 National health Reporting System, Survey and Surveillance Others 12 8 15 7 16 0 NA

Table 10-1, Table 10-2, Table 11, Table 12-1 and Table 12-2 report on the NA, no data available.
a
WPR data were collected in 2004.
availability of a national health reporting system, survey and surveillance in
respect of NCD and related risk factors. A health reporting system includes
annual health reports of the MOH which contain data on national capacity, Findings
human resources, demographic aspects, health expenditure and health Table 10-1 showed that the proportion of countries having an established
indicators. Morbidity information may include incidence or prevalence data health information system covering chronic diseases and major risk factors
from disease registries, hospital admissions or discharge data. A national ranged from 60% in EMR to 84% in EUR and 100% in SEAR. And out of
survey (with either fixed or unfixed time intervals) will examine the main 112 countries from AFR, AMR, EMR, EUR and SEAR, around 93% had
chronic diseases, or the major risk factors common to chronic diseases. included chronic diseases in the annual health report system. Regarding the
National surveillance refers to information on risk factors, chronic diseases data included in the annual health report system, 26% reported having full
and their determinants, used to permit which is a continuous analysis, coverage across risk factors, cause-specific mortality and morbidity. This
interpretation and feed-back of systematically collected data using a survey Table also showed that approximately 68% among 133 respondent countries
or regular registration. had a routine or regular surveillance system for chronic diseases in all
 28 29

regions. And although WPR enjoyed the highest rate (86%) for establishing Table 10-1 Health information system covering chronic diseases
a routine chronic disease surveillance system, fewer than half of countries in and major risk factors, by WHO Region, 2005~2006
AFR did so.
Channels of collecting Total AFR AMR EMR EUR SEAR WPRa
information on risk factors
and chronic diseases
Table 9 Percentage of countries implementing FCTC and DPAS,
by WHO Region, 2005~2006 Health information system 77 73 74 60 84 100 NA
covering chronic diseases
and major risk factors
Total AFR AMR EMR EUR SEAR WPR
Inclusion of chronic 93 100 96 73 92 100 NA
Contracting party to the WHO 65 65 52 80 66 83 NA diseases in the annual
FCTC health report system
Implementation action plan 31 27 30 47 24 67 NA Data included in the annual
of FCTC health report system
Implementation of DPAS 26 8 26 0 45 50 NA – Cause-specific mortality 12 8 22 27 3 0 NA
Plans for the implementation 17 15 19 20 13 33 NA – Risk factors/Cause- 26 8 22 13 45 33 NA
of DPAS specific mortality/
morbidity
Mechanism for discussion/ 27 8 30 27 34 50 NA
– Cause-specific mortality/ 35 46 44 13 32 17 NA
interaction between national
morbidity
authorities and private
sector interests related to Routine or regular 68 46 67 53 76 83 86
the DPAS surveillance system

NA, no data available. NA, no data available.

a
WPR data were collected in 2004.

Table 10-2 showed the progress made in including chronic diseases in the Table 10-2 Percentage of countries having included chronic diseases in annual health
annual health reporting system and in establishing a routine surveillance system reporting system and surveillance system in 2000~2001 and 2005~2006, by WHO Region
for chronic disease. For the best comparable 97 countries of the two surveys
conducted in 2000~2001 and in 2005~2006 (except WPR), in general a 14% Region Inclusion of chronic diseases Routine surveillance system
increase was found for the inclusion of chronic diseases in the annual health in the annual health for chronic disease
reporting system. As regards data included in the surveillance system, among reporting system
118 countries there was a 12% increase (from 60% in 2000~2001 to 72% in 2000~2001 2005~2006 2000~2001 2005~2006
2005~2006) in countries reported to have included risk factors, cause-specific
AFR 96 100 29 50
mortality and morbidity.
AMR 75 96 54 67
Table 11 showed that during the period 2000-2005, among 112 respondent EMR 46 77 54 62
countries from AFR, AMR, EMR, EUR and SEAR, the proportion of countries EUR 93 97 77 87
having conducted national/provincial surveys or studies on such risk factors as
SEAR 67 100 67 83
tobacco use, unhealthy diet, physical inactivity and alcohol consumption stood at
WPRa NA NA 81 86
82%, 63%, 62% and 61% respectively. The percentage of countries reported as
having national/provincial studies/surveys covering risk factors and diseases varied Total 81 95 60 72
widely from 29% for chronic respiratory diseases to 82% for tobacco control. a
WPR data were collected in 2004.
 30 31

Table 11 Percentage of countries having national/provincial studies/surveys during 2000- source of public and professional inspiration. Large or national programmes based
2005, by WHO Region on the experience of the demonstration areas can then be launched.

Risk factors & diseases Total AFR AMR EMR EUR SEAR WPR
Table 12-1 The coverage of the chronic disease surveillance system,
Tobacco use 82 73 82 80 87 100 NA by WHO Region, 2005~2006
Unhealthy diet 63 35 67 47 84 83 NA
Physical activity 62 31 63 53 82 83 NA Risk factors & Diseases Total AFR AMR EMR EUR SEAR WPRa
Alcohol consumption 61 35 70 20 84 83 NA Tobacco use 41 27 22 40 50 83 52
Hypertension 66 50 67 67 74 83 NA Unhealthy diet 36 19 22 40 47 67 43
Diabetes 66 42 74 73 71 83 NA Physical activity 35 15 26 47 40 67 43
Overweight and obesity 68 42 74 60 82 83 NA Alcohol consumption 34 23 22 7 50 83 38
Raised blood glucose 51 35 59 60 50 67 NA Diabetes (Elevated blood 59 50 59 47 61 50 81
Raised blood pressure 57 35 63 60 63 83 NA glucose)
Dyslipidaemia 42 23 48 60 42 50 NA Hypertension (Elevated blood 58 50 59 53 50 100 71
pressure)
Heart diseases 39 12 52 33 53 33 NA
Overweight and obesity 38 23 33 40 42 67 48
Stroke 33 8 44 20 47 33 NA
(Body Mass Index)
Cancer 46 19 48 47 63 50 NA
Dyslipidaemia (Cholesterol) 26 8 26 33 29 33 33
Chronic respiratory diseases 29 12 26 27 45 17 NA Heart diseases 43 35 41 20 58 50 NA
NA, no data available. Stroke 35 31 33 13 45 50 NA
Cancer 64 50 59 40 76 67 76
Table 12-1 indicated the coverage of the chronic disease surveillance system. Chronic respiratory diseases 33 27 33 20 45 17 NA
Out of 133 respondent countries, less than two-fifths covered the major risk factors
NA, no data available.
such as tobacco use, unhealthy diet, physical activity and alcohol consumption. The a
WPR data were collected in 2004.
results showed that the proportion of countries covering diabetes, hypertension,
heart diseases and cancer in their chronic disease surveillance system was higher
Table 12-2 The coverage of the chronic disease surveillance system
than those which included risk factors such as tobacco control, unhealthy diet,
in 2000~2001 and 2005~2006, by WHO Region
physical inactivity and alcohol consumption. Table 12-2 indicated that the last
five years saw 24%, 20% and 15% increases respectively in the proportion of Hypertension Diabetes Cancer
countries reported as covering hypertension, diabetes and cancer in their chronic
disease surveillance system. Region 2000~2001 2005~2006 2000~2001 2005~2006 2000~2001 2005~2006
AFR 25 54 25 54 29 54
2.8 National Community-based Demonstration Programmes AMR 42 58 42 58 42 58
Table 13, Table 14 and Table 15 report on the existence of national EMR 46 62 46 54 46 54
community-based demonstration programmes and their target population and EUR 27 53 47 67 70 87
settings. A national community-based demonstration programme is one which SEAR 50 100 33 50 50 67
addresses issues relevant to chronic disease prevention and major risk factors; WPR a
52 71 62 81 71 76
applies existing knowledge to put into practice effective prevention at community
level; examines different methods of disease prevention and health promotion; Total 37 61 43 63 53 68
evaluates their feasibility; and validates their effect to show how they can be a a
WPR data were collected in 2004.
 32 33

Findings 2.9 Protocols /Guidelines /Standards

Table 13 showed that among 112 countries, 47% had established a National protocols/guidelines/standards
demonstration programme for integrated chronic disease prevention and
for chronic diseases and conditions
control, and 38% had a demonstration programme for tackling specific risk
factors. Table 16-1 and Table 16-2 report on the availability of national protocols/
guidelines/ standards for chronic diseases and conditions. These refer to
Table 14 and Table 15 dealt with the population groups and settings
prevention, treatment or management services that deal with an already existing
targeted by the countries’ demonstration programme for prevention and control
chronic disease or with risk factors, and aim to treat and control the condition,
of chronic diseases. Out of 112 countries, 35% had a demonstration project
prevent complications, and improve outcomes and quality of life of patients.
for under 15s, and the corresponding percentages were 26% for 15-24 years,
35% for 25-64 adults, 26% for elderly (aged 65 and over), and 31% for women.
As expected, among the 112 respondent countries, those whose demonstration Table 15 Percentage of countries having a demonstration project for settings,
project targeted schools (47%) had the highest proportion among all the listed by WHO Region, 2005~2006
settings.
Settings Total AFR AMR EMR EUR SEAR WPR
Workplace 35 12 37 20 55 33 NA
Table 13 Percentage of countries having a national demonstration programme
for chronic diseases and/or health promotion, by WHO Region, 2005~2006 School 47 27 44 33 68 50 NA
Hospital and clinic 37 27 33 27 50 33 NA
Integrated and/or Specific Total AFR AMR EMR EUR SEAR WPR Community 39 23 37 27 58 33 NA
risk factors Family 24 15 22 20 34 17 NA
Integrated NCD prevention 47 19 44 47 66 67 NA Others 12 8 11 0 21 0 NA
and control
NA, no data available.
Tackling specific risk 38 19 41 27 53 33 NA
factors
NA, no data available. Findings
Table 16-1 showed that among the 118 countries for which the data were
available, nearly half or over had the national protocols/guidelines/standards
Table 14 Percentage of countries having a demonstration project for chronic diseases such as hypertension, diabetes, heart diseases and
for population groups, by WHO Region, 2005~2006 cancer, while 30% or less had the corresponding materials for weight control
and physical activity. Table 16-2 showed that the last five years saw 17%,
Population groups Total AFR AMR EMR EUR SEAR WPR 17% and 13% increases in the proportion of countries reported as having
Children under 15 35 23 33 20 55 0 NA national protocols/guidelines/standards for hypertension, diabetes and cancer,
15-24 years 26 19 26 13 37 17 NA
respectively.
Adults, 25-64 years 35 23 30 27 50 33 NA
2.10 Financial Resources
Elderly, 65 years 26 19 30 27 29 17 NA
and over Table 17, Table 18 and Table 19 report on the availability of financial
Women 31 27 30 20 42 17 NA resources for national chronic prevention and control. Financial resources
refer to governmental budget allocation as well as to other sources of
Others 6 4 4 7 11 0 NA financial support for prevention and control in any of the chronic diseases
NA, no data available. components.
 34 35

Table 16-1 Percentage of countries having national protocols/guidelines/standards Findings

for chronic diseases and conditions, by WHO Region, 2005~2006
Among the 112 respondent countries, Table 17 showed that overall 68% had
Risk factors and Diseases Total AFR AMR EMR EUR SEAR WPR a specific allocated resources or a dedicated budget for implementing a national
policy or strategy for chronic diseases prevention and control. The corresponding
Hypertension 74 54 78 80 79 67 81 percentages for AFR, AMR, EMR, EUR and SEAR were 58%, 63%, 77%, 73%
Diabetes 78 58 82 93 82 83 81 and 83%, respectively.
Heart diseases 49 23 44 47 74 33 48 For the comparable 97 countries of the two surveys conducted in 2000~2001
Stroke/cardiovascular 38 15 37 13 61 33 48 and 2005~2006, Table 17 further showed that there was a 29% increase in the
accident proportion of countries having specific budget for a national policy or strategy in
Cancer 69 50 78 60 82 67 67 chronic disease prevention and control.
Chronic respiratory 35 15 30 33 55 17 NA For the specific chronic disease components listed in Table 18, the proportions
diseases of countries having dedicated budgets were 54% for cancer, 53% for diabetes,
Smoking cessation 33 12 30 27 53 33 NA
50% for tobacco use, 49% for nutrition/diet, but only 32% for physical activity,
for alcohol consumption and for obesity control.
Weight control 26 4 22 20 47 17 NA
Table 19 reported on the sources of financial support for chronic disease
Diet 38 15 52 27 47 33 NA
prevention and control. Around two-fifths among the 112 respondent countries
Physical activity 30 19 26 20 45 17 NA (except WPR) reported the existence of unspecific resources of financial budget
Other chronic 21 12 30 13 26 0 NA for chronic diseases prevention and control. But the financial situation varied
diseases/NCD across the six concerned regions. For instance, in AMR and EUR, unspecific
resources of financial budget are dominant as compared to those relatively
NA, no data available.
a
WPR data were collected in 2004. preferable and more stable methods of raising fund such as taxation. When
compared with EUR, international financial aid played a more important role in
the other five regions.
Table 16-2 Percentage of countries having national protocols/guidelines/standards
for chronic diseases and conditions in 2000~2001 and 2005~2006,
by WHO Region Table 17 Percentage of countries having a specific budget for the implementation
of national policy or strategy for chronic disease prevention and control
Hypertension Diabetes Cancer in 2000~2001 and 2005~2006, by WHO Region
2000~ 2005~ 2000~ 2005~ 2000~ 2005~
Region 2001 2006 2001 2006 2001 2006 Region 2000~2001 2005~2006
AFR 50 54 46 58 38 46 AFR 33 58
AMR 58 79 63 79 75 79 AMR 29 63
EMR 62 85 54 92 54 69 EMR 31 77
EUR 70 87 80 87 73 90 EUR 50 73
SEAR 33 67 33 83 33 67 SEAR 67 83
WPRa 62 81 67 81 48 67 WPR NA NA
Total 59 76 62 79 58 71 Total 39 68
a
WPR data were collected in 2004. NA, no data available.
 36 37

Table 18 Percentage of countries having specific/dedicated budgets for the following 3. SUMMARY
chronic diseases components, by WHO Region, 2005~2006
3.1 Summary of Progress
Risk factors and diseases Total AFR AMR EMR EUR SEAR WPRa
Progress is apparent in the group of 118 countries that responded to both
Tobacco use 50 31 41 53 55 50 71 surveys. The proportion with a national act, law, legislation or ministerial decree
Nutrition/diet 49 50 48 27 55 33 57 for tobacco control increased from 61% to 84%, varying from 67% in the
Physical activity 32 15 37 13 37 17 57 African Region to 100% in the European and South-East Asian regions. The
proportion with a national act, law, legislation or ministerial decree for food
Alcohol consumption 32 23 30 7 45 0 48
and nutrition related to chronic diseases prevention and control increased from
Obesity 32 12 37 13 37 17 57 70% to 86%. The existence of budgets specific to NCD increased from 39% of
Hypertension 45 31 48 47 42 17 71 countries to 68%. In a group of 97 countries that excludes WPR, the proportion
Diabetes 53 35 52 60 55 33 71 with a national policy for chronic diseases prevention and control rose from 42%
to 70% between the two surveys, varying from 46% in the Africa Region to 83%
Heart diseases 41 23 44 40 53 33 NA
in the European Region. The proportion with an NCD unit or department in the
Stroke 30 23 41 13 32 33 NA Ministry of Health increased from 60% to 84%. In 2005, 64% of all 133 countries
Cancer 54 31 52 53 68 50 62 reported having a national integrated programme for prevention and control of
Chronic respiratory 26 15 33 33 26 17 NA
chronic diseases.
diseases
3.2 Summaries by Risk Factor and Disease Groups
NA, no data available.
a
WPR data were collected in 2004. Below, findings are organized by risk factor and disease groups, summarizing
data derived from across the tables in the previous section.
Table 19 Percentage of countries having the following financial sources for chronic
diseases prevention and control, by WHO Region, 2005~2006
3.2.1 Tobacco
Among all 133 respondents, 85% reported having a tobacco control act,
Financial resources Total AFR AMR EMR EUR SEAR WPRa law, legislation or ministerial decree. Since 2000-2001, for the 118 countries that
Increase tax on cigarette 17 4 26 7 21 17 24 responded to both surveys, there has been a 23% increase in the existence of
these instruments and almost double the number of countries with tobacco control
Increase tax on alcohol 11 4 15 0 18 17 10
action plans, now standing at 65%. Again excluding WPR, 65% of respondents are
Increase tax on unhealthy 1 4 0 0 0 0 0 contracting parties to the FCTC, and 31% report a corresponding comprehensive
imported food action plan. The extent to which there is overlap in the two sections of the survey
International financial 32 31 33 27 16 33 62 asking about tobacco action plans is not known, nor is the nature of the legislation
aids reported, nor the stage reached by any action plan.
Fund raising activities 17 15 11 13 24 0 19 Between 2000 and 2005, 82% of respondents (WPR excluded) said that
Donations from health 18 15 22 13 21 0 19 populations were surveyed for tobacco use while 41% (WPR inclusive) reported
interested private routine surveillance. The surveys could have been at national or sub-national
groups levels. Smoking cessation guidelines are said to be available in one-third of
Unspecific resources 39 31 52 33 45 0 NA countries.
of financial budget
Dedicated budgets for tobacco control were reported in 50% of countries and
Others 24 19 22 20 26 50 NA 17% on average said that cigarette tax is contributing to financing NCD prevention
NA, no data available and control initiatives. For the latter, the proportions were highest in AMR (26%),
a
WPR data were collected in 2004.. WPR (24%) and EUR (21%).
 38 39

3.2.2 Diet and Physical Activity 3.2.5 Diabetes

Twenty-nine countries, excluding those in WPR, reported implementation The proportion of countries with national action plans for diabetes rose from
of DPAS while another 19 said they had plans to implement the Strategy. 41% in 2000-2001 to 56% in 2005-2006. The existence of protocols, standards
86% of respondents to both surveys reported the existence of legislation and guidelines for treatment and control was reported by 79% of countries, up
related to food and nutrition, up from 70% in 2000-2001. However, at that from the 62% found in the first WHO survey. In the most recent survey, about 53%
time, legislation was most often concerned with food safety and sanitation, so of countries reported budgets dedicated to diabetes. Surveillance for diabetes also
whether any new legislation is targeting NCD prevention and control issues is rose, occurring now in 63% of countries compared to 43% in 2000-2001.
unknown. Around 50% of countries indicated the existence of nutrition/diet
3.2.6 Dyslipidaemia
policies, action plans and/or programmes, with 49% of countries reporting a
dedicated budget. Across regions, 42% of countries (excluding WPR) reported national or sub-
national surveys of dyslipidaemia, and almost 26% (including WPR) reported
23% of all respondents indicated that there is national legislation concerning
routine surveillance.
physical activity, the nature of which was not stated. Between one-quarter and
one-third of respondents reported national policies, action plans and programmes 3.2.7 Cancer
for physical activity, with 32% having dedicated budgets.
In the latest survey, 41% of countries reported national policies on cancer and 47%
About 60% of countries reported that national or sub-national surveys were have national cancer programmes. Since 2000-2001, in five regions (excluding WPR),
conducted between 2000 and 2005 to determine dietary and physical activity the proportion of countries with national cancer action plans rose by 14%, reaching
habits. Routine surveillance of diet, physical activity and overweight/obesity was 63% in 2005-2006. 54% of all reporting countries now have budgets dedicated to
reported by just over one-third of countries. National protocols, guidelines or cancer. 46% of countries reported having surveys for cancer between 2000 and 2005,
standards were said to be available in 38% of countries for healthy diet, in 30% and 64% reported routine surveillance (including WPR). Among the 118 countries
for physical activity, and in 26% for weight control. From among all reporting that responded to both WHO surveys, the proportion that reported the availability of
countries, only one in AFR uses taxes on unhealthy imported foods as a source of cancer treatment protocols, standards or guidelines rose from 58% to 71%.
financing for NCD prevention and control.
3.2.8 Heart Disease and Stroke
3.2.3 Alcohol Among countries that responded to both WHO surveys, excluding WPR,
On average 52% of responding countries reported the existence of legislation the proportion with national action plans for heart disease rose from 37% to 49%
targeting alcohol control. In about 30% of countries, there are national policies, and about 40% now have dedicated budgets. Plans for stroke were not surveyed
action plans and programmes for alcohol control, with a similar proportion having in 2000-2001. But in the most recent survey, again excluding WPR, between 20%
dedicated budgets. In 61% of countries, people at national or sub-national levels and 25% of countries reported a national policy, action plan and/or programme
had been surveyed on their alcohol consumption between 2000 and 2005 while for stroke and 30% have dedicated budgets. (The discrepancy is not explained.)
in 34% of countries, alcohol consumption is part of routine surveillance. On About one-third of countries reported having national policies and/or
average, 11% of respondents said that taxes on alcohol are a source of revenue for programmes for heart disease in 2005-2006. Around 40% of countries reported
NCD prevention and control. national surveys or surveillance of heart disease; for stroke, it was about one-third
of countries. Almost 50% of all reporting countries now have protocols, standards
3.2.4 Hypertension
or guidelines for treating heart disease and around 40% have them for stroke.
Approximately 30% to 40% of countries reported national policies, action
plans and/or programmes dealing with hypertension. Protocols, standards or 3.2.9 Chronic Respiratory Disease
guidelines for treatment exist in 76% of 118 countries, up from 59% in 2000- Around 20% of responding countries reported the existence of national
2001. Almost 45% of countries have dedicated budgets. Populations at national policies, action plans and/or programmes for chronic respiratory disease; 35%
or sub-national levels have been surveyed for hypertension between 2000-2005 in said there are protocols, standards or guidelines for treatment and 26% reported
two-thirds of reporting countries, excluding WPR. Among 118 countries across dedicated budgets. Surveying for chronic respiratory disease between 2000 and
all regions, routine surveillance of hypertension increased from 37% to 61% since 2005 was reported by 29% of countries while one-third are said to have routine
2000-2001. surveillance for these conditions.
 40 41

4. QUALITATIVE RESULTS Table 21 Ranking of chronic non-communicable disease prevention and control as a
priority for action
Key informants in 26 countries participated in interviews. They were located
in low, lower-middle and upper-middle income countries, in all regions except Rank Key informants
EUR, as shown in Table 20.
High 15
Medium 11
Table 20 Key Informant Countries in 2005~2006 Survey Low 0

Region Countries Where a medium rank was assigned, key informants explained that a
AFR Namibia, Uganda, Nigeria government may assign a high priority to the NCD issue in terms of intent, but
AMR Brazil, Chile, Trinidad and Tobago, the priority in reality – in terms of response to NCD – is medium. Health system
funds are largely consumed by necessary treatment and care services. In some
Mexico
cases, the double burden of disease is constraining an effective approach to prevent
EMR Bahrain, Egypt, Jordan, Lebanon, Oman, Syrian
and control NCD. Such policies may be in place but key informants expressed
Arab Republic, Sudan
concerns about implementation, and said that policies are not comprehensive of
SEAR India, Thailand
all the issues they are to address, and lack the instruments to be effective. Some
WPR Cambodia, Fiji, Micronesia, Mongolia, Philippines, WHO-assisted biennial health plans do not identify NCD as a priority. Health
Samoa, Solomon, Tonga, Vanuatu, Viet Nam promotion in general is a high priority and preventing NCD falls under that
initiative. For some countries, advocates for NCD prevention feel that they have
to “compete” with the communicable diseases issue which has a high priority,
There were slight variations in the topics explored in each region to
particularly among rural and peasant populations. High risk of NCD disease is
accommodate the specific information needs of the NCD regional advisors. All seen to reside within middle-class and wealthy populations, who are better able
the interviews delivered information about the following core topics: to access (and are expected to access) health care systems once they are affected.
1) The priority assigned to NCD prevention and control. Mentioned also are situations where a country may have a number of separate
2) The major barriers and constraints to the development and implementation conditions or risk factor strategies in place and ongoing. For example to prevent
of policies and programmes for NCD prevention and control. cancer and diabetes, and to deal with risk factors such as tobacco. But overall,
NCD is not given a high priority, despite data on high mortality and morbidity
3) The nature and extent of surveillance of major chronic diseases and risk
rates. The public and governments are alarmed by NCD rates but mortality data
factor exposure.
are proving to be insufficient to mobilize government spending decisions. There
4) The priority areas for WHO technical support. remains a big gap between the awareness of the NCD problem and the government
decision to respond.
4.1 Ranking of NCD Prevention and Control as a Priority for Action
Key informants also noted that there is uncertainty as to how best to
Table 21 shows that 15 key informants ranked NCD prevention and control take action. NCD prevention and control is a complex issue, and health care
as a high priority in their countries while 11 considered it a medium priority. infrastructures are not being developed to respond with prevention, in some cases
Where it was a high priority, key informants spoke of strong governmental being of relatively small scale to begin with. Planning and finance ministries in
commitment. Recent evidence of the NCD burden such as rising injury rates, government argue a need to hold back the allocation or reallocation of scarce
the high prevalence of diabetes mellitus and cardiovascular diseases, and recent funds on the basis of a lack of evidence on what policies are working in which
public media reports was identified as having contributed to governments placing situations. Some opponents even argue that preventing NCD is an individual’s
high priority on NCD policy development. responsibility and not a population-level issue.
 42 43

The continuing influence of the tobacco industry on government decisions was capacity within some primary care services for health professionals to absorb
also mentioned. Policies and action plans that are in place do not comprehensively new activities to deal with risk factors and generally with NCD prevention, both
control tobacco; thus, pricing policy keeps cigarettes still affordable to low-income in terms of their time and the availability of health system funds to compensate
earners among whom high smoking rates prevail. them for their interventions.
4.2 Barriers and Constraints Knowledge/skills/tools as a barrier was related also to the capacity and
competencies of two bodies of people – the front-line of health professionals,
Key informants ranked a list of barriers and constraints, shown in Table 22.
with reference to their training to provide interventions in their respective settings
The lack of financial resources or their total lack was the number one barrier
that prevent and control NCD; and the health policy-makers. For the latter group,
to NCD prevention policy implementation in twelve (12) instances, and human
resources were the top barrier in seven (7). Information systems and public key informants characterized the knowledge barrier as related to the design of
health policy were the next most often cited barriers, followed by health care new policies or strategies that serve to coordinate existing disease- and risk
infrastructure, and finally knowledge/skills/tools. Essential drugs and equipment factor-specific initiatives, and at the same time to join up the actions of health and
were not among the top barriers or constraints to NCD action. non-health government departments. The difficulty of shifting the government’s
perspective from a vertical orientation of strategies to horizontal collaboration
was acknowledged.
Table 22 Key Informant Ranking of Barriers and Constraints
Key informants characterized health information systems as being typically
limited to being institution-based, with hospitals and other treatment centres being
Barriers and Constraints Total that Assigned First Priority the source of NCD mortality data and sometimes morbidity data. Key informants
financial resources 12 also indicated a knowledge gap on the part of public health professionals as to
how to use data most effectively to persuade more government action to prevent
human resources 7
and control NCD.
information systems 5
Also raised was the issue of how to translate the intentions of national policy
public health policy 5
into action at the local levels, where the responsibilities and infrastructures for
health care infrastructure 1 policy implementation, such as they are, are often located. In some cases, local
knowledge/skills/tools 1 structures with health and social services mandates that are currently providing
essential drugs and equipment 0 services have not been certain how to proceed. They understand that taking an
integrated approach calls, for example, for increasing and diversifying local
coalitions and partners and engaging new sectors, but how to start and who is to
In the interviews, key informants linked the lack of financial resources to play what role is not clear.
implement NCD prevention and control interventions to a number of circumstances.
Many were mentioned in section 4.1 above in the explanations of why NCD
4.3 Surveillance of Chronic Disease Prevention and Control and
prevention is not given high priority by governments. To these were added the Risk Factors
lack of awareness by the general public of NCD rates in terms of mortality and Eleven key informants mentioned an active survey of conditions and risk
morbidity, and the lack of knowledge that the risk factors underlying major NCD factors in their countries, including hypertension, diabetes and mental disorders,
are modifiable. There is little “room” in the public’s attention for NCD prevention and diet, weight, alcohol use, tobacco use and physical activity. Most NCD and
given the high profile in the media of such communicable disease concerns as risk factor surveys have been conducted since 2002, some at national levels, others
HIV and bird flu, and of access to health care services. Key informants recognize in regions. Seven key informants mentioned that the WHO STEPwise approach to
that the potential advocacy of the public is missing, a factor that contributes to the chronic disease risk factor surveillance, or a modified approach, is being applied
relatively low levels of funding that governments are willing to allocate to NCD or that preparations are underway, for example the training of interviewers. The
prevention. lowest income countries in the sample reported no NCD or risk factor surveys. In
Human resources as a constraint to NCD intervention were related to health one case, a shortfall of US $65,000 was said to be holding back application of the
care infrastructure. Key informants said that there is limited or non-existent STEPwise approach.
 44 45

4.4 Priority Areas of WHO Technical Support for Chronic Disease Also mentioned was assistance with the reorientation and training of health
Prevention and Control promotion and disease prevention professionals to deal with NCDs, since their
traditional emphasis has been on communicable diseases.
Key informants assigned first priority for WHO assistance most often to the
area of policy, action plan and programme development. WHO help with disease
surveillance and training were the next highest priorities.

5. DISCUSSION AND CONCLUSION

Table 23 Key Informant Ranking of Areas for WHO Technical Support
The fact that there are some common topics in WHO’s first and latest surveys
of country capacities for NCD prevention and control has made it possible to
Areas for WHO Technical Support Total that assigned First Priority estimate the progress made in the period between the two surveys. Equally
Policy, action plans and programme development 6 important is an assessment of country responses in the context of the directions
Assistance with disease surveillance 5 that WHO has encouraged since the first survey. Prominent among them for NCD
prevention and control, compared to the context in 2000-2001, is the increased
Training for human resource development 5
emphasis by WHO on upstream action that targets the main risk factors common to
Establishing demonstration programmes 4 several NCDs, and clarifies the nature of integrated approaches to deal with them.
International collaboration and networking 3 FCTC exemplifies an integrated approach, being a comprehensive regulatory
Assistance with risk factor surveillance 3 strategy that implicates health and non-health sectors as well as public and private
sectors to respond to a population health threat. The Global Strategy on Diet,
Physical Activity and Health is another broad-ranging approach, challenging
Key informants pointed to different entry points as regards where to begin countries to use various instruments across sectors to address two risk factors
with WHO technical support. What can be considered a bottom-up approach was simultaneously.
mentioned, starting with assistance with demonstration projects or pilots, for Reporting first on progress made since 2000-2001, there is an increase in
these to become the basis for survey design and implementation and to learn more the proportion of countries reporting policies, action plans and programmes that
about population-based interventions, then followed by assistance with policy intend to prevent and control the major risk factors and NCD. However, even
development to scale up to comprehensive national programmes. with more initiatives apparent, and even with a high priority assigned to NCD
prevention, several key informants believe that, in their countries, decisive
A top-down approach was also suggested, asking for stronger international
implementation remains a challenge. Their number one barrier to NCD prevention
collaboration with WHO, using its high profile to support national efforts to
policy implementation is the lack of financial resources. There continues to be a
advocate NCD prevention and have it placed on the political agenda, to increase the
knowledge gap within governments and in the general public about the extent of
potential for resources to be mobilized and to make it genuinely a top priority.
the NCD burden and the fact that risk factors are modifiable at a population level.
Key informants indicated that knowing the policies and interventions that It is clear that a key area for WHO technical assistance, as was reported in 2000-
are considered good practice in other countries and situations would give an 2001, is still advocacy. WHO can better use its high profile to persuade the general
insight into how to proceed with initiatives in their own countries. They suggested public, governments and, where relevant, donor agencies to mobilize sufficient
that WHO compile good practices and create the platforms where they can be resources for NCD prevention interventions to achieve the preventive dose.
exchanged. Furthermore, some countries want assistance with tailoring the Health budgets around the world are being strained to cover necessary
international guidelines and good practices that are available into policies and treatment and care of existing NCD cases and, in some countries, of the double
programmes that are relevant and feasible in their contexts and applicable at their burden of communicable diseases. The public understandably defends health
local levels, where several programmes may already exist. They know that the next care. Given that several risk factors to NCD are modifiable and are the products
steps involve building coalitions and new partnerships at national and local levels, of global industries, WHO intervention with industry at the global level reduces
and want assistance in how to build trust and design the integrating mechanisms the pressure on Member States to mobilize, on their own, the national public
needed to move forward with the various players. awareness and the extent of public demand needed to effectively control or
 46 47

eliminate NCD risk factors at the population level. Furthermore, WHO can create Even with more countries reporting the existence of protocols for dealing
more instruments similar to FCTC to deal with diet, physical activity and other with risk factors and disease management since 2000-2001, key informants
major risk factors, so as to support and leverage country efforts in implementing continue to ask for assistance in assessing their feasibility and appropriateness for
DPAS and other strategies that are emerging. their local contexts and capacities, and then in training primary care professionals
A top priority for technical assistance from WHO continues to be policy, to use them.
action plan and programme development. An interpretation of what might appear Technical assistance and training are also needed with regard to preparing
as a contradiction – the request for assistance with NCD prevention-related policy information that will be strategic in capturing the attention of policy makers.
while countries have actually made progress in this regard – is that the nature of WHO can assist public health professionals to frame the NCD burden in, for
the assistance with policies and plans has to do with their implementation and how example, economic and sustainable human development terms, using the research
to better design policies to make them more effective. WHO can help with policy and methods that have been developed since 2000-2001. WHO can also give more
development by training policy makers while advocating policy formulation support to training and dissemination of health impact assessment methods among
processes that define key aspects of implementation necessary for a policy to public health professionals, enabling them to point out the potential population
“have legs” from the outset. For example, specifying within an NCD prevention health effects of policies being proposed by non-health sectors and making them
policy declaration the sources and amounts of resources to be available, along with better advocates for healthy public policies.
identifying the general structures and mechanisms through which interventions With regard to the sources of financing for NCD prevention and control,
are to be delivered, would greatly improve the chances that the results intended by about 32% of countries on average identified international financial aid. The
policies, plans and programmes will indeed be realized. Where several initiatives proportion in EUR was lowest (16%). Very few countries reported taxation on
are in place, key informants also indicated a need for assistance in determining tobacco, alcohol and unhealthy food as sources of funding. As for taxes on alcohol,
how to coordinate or join up efforts in order to bring about a degree of integration the countries in EUR have the highest proportions (18%); while the countries in
specific to their political, social and economic realities. AMR have the highest proportions of taxation on cigarettes (26%).
An area for WHO assistance that emerged was that WHO should create While progress is apparent in the countries that responded to both surveys,
more channels, platforms and other occasions for dialogue among Member States a number of key areas still call for action, and these are similar to those that were
to encourage them to be outward looking, to exchange their experiences with reported in 2000-2001. These key areas also re-emerge as priorities for WHO
NCD prevention and control policies, plans, programmes and protocols in an technical support to Member States. They can be summarized as:
environment with peers, to review what is being done and to consider options – Advocacy, with a continuing need for WHO to persuade the general
on how to move forward. WHO can also compile and disseminate examples of public, governments and donor agencies to mobilize sufficient resources
what is being done. Given the diversity of country situations and contexts for for NCD prevention;
NCD prevention, and the huge range in country capacities to respond, WHO can
encourage research to deliver case studies that profile leadership in applying good – Member States still require assistance in strengthening their surveillance
practices relevant to countries by income group. The demonstration programmes systems;
identified in the current survey are potential case studies, as are FCTC and DPAS – Strengthening capacity in developing, implementing and evaluating
action plans. national policies, action plans and programmes for chronic disease
The number of countries reporting risk factor surveys and surveillance has prevention and control;
increased since 2000-2001 but the frequency is not known. Collecting reliable data – Creating more channels, platforms and other occasions for dialogue at
on the major risk factors on a regular basis needs emphasis and support to produce global and regional level and among Member States.
the trends that can inform policy and action plan development and evaluation and, Finally, regular global reviews should be encouraged, not only to help WHO
above all, can support advocacy. Key informants indicate that WHO technical to measure the progress made but also to identify the Member States’ needs for
assistance continues to be needed for training and evaluation of surveillance technical support.
and survey systems for NCD risk factors, disease prevalence and cause-specific
mortality. WHO can also encourage, assist with and profile research on the
relationship between risk factor exposure and NCD prevalence and socioeconomic
determinants, thus broadening the adoption of the equity agenda.
 48 49

REFERENCES ANNEX 1
1. WHA51.18. A Global Strategy for the Prevention and Control of
Noncommunicable Diseases. Resolution of the 51st World Health Assembly.
GLOBAL SURVEY QUESTIONNAIRE
Geneva, World Health Organization, 20 May 1998.
2. WHA53.17. Prevention and Control of Noncommunicable Diseases. National Chronic Diseases Prevention and Control Questionnaire
Report of the Director General. 53rd World Health Assembly. Geneva, World
Health Organization, 20 May 1998. Thank you for agreeing to complete this questionnaire. We really appreciate
3. The World Health Report 2002: Reducing risks, promoting healthy life. your efforts.
Geneva, World Health Organization, October 2002. The objectives of the WHO global survey are to assess the capacity of national
4. WHO Framework Convention on Tobacco Control. Geneva, World chronic disease prevention and control in development, and implementation
Health Organization, May 2003. of national policy, and action plan and programmes, to promote sharing of
information, experiences and best practices, to identify constraints and needs and
5. WHA51.17. Global Strategy on Diet, Physical Activity and Health.
to assist national strategy and policy formulation, development, implementation
Geneva. May 22, 2004. Resolution of the 57th World Health Assembly. Geneva,
and evaluation of programmes.
World Health Organization, 20 May 1998.
The last WHO global survey to assess national capacity for chronic diseases /
6. Preventing chronic diseases: a vital investment. Geneva, World Health
NCD prevention and control was carried out in 2001. Those results are available
Organization, October 2005.
from: http://whqlibdoc.who.int/hq/2001/WHO_MNC_01.2.pdf. The results from
7. Alwan A, Maclean D, Mandil A. Assessment of national capacity for the analysis of this 2005 survey will be made available through the WHO website
noncommunicable disease prevention and control: the report of a global survey. with links to relevant policy documents for each country, where these exist. To
Geneva, World Health Organization, 2001. enhance quality of data collection, some countries may be contacted for further
8. Microsoft Corporation. Microsoft Excel 2003. Redmond, Washington: information on receipt of questionnaire.
Microsoft Corporation, 2003.
COUNTRY NAME: _________________________________________________
9. Centers for Disease Control and Prevention. Epi Info: version 6.04d.
This is a current profile of the chronic disease prevention and control in this
Atlanta, Georgia: Centers for Disease Control and Prevention, 2001.
country/territory.
10. Stata Corporation. Stata statistical software: release 9.0. College Station, We understand that it will be used in a global analytic report.
Texas: Stata Corporation, 2005.
NAME OF PRINCIPAL PERSON FILLING IN THE QUESTIONNAIRE:
Surname: _____________________ First Name: _____________________
DESIGNATION /TITLE: __________________________________________

CONTACT DETAILS: Please provide contact details in case further

information or clarification is needed.
Address: ________________________________________________________
Tel: _______________________________ Fax: _______________________
Email: __________________________________________________________

SIGNATURE: ______________________
DATE OF COMPLETION: ** 14-Aug-07 (dd/mm/yyyy)
 50 51

Note: A3 Are there national institutes for public health or chronic disease
1. This questionnaire is accompanied by two documents to assist you in prevention and control – or equivalent (Other)?
completing the questionnaire: the Preamble which explains the background Yes ® No ® Other ®
to this survey, and the Objectives, Terms and Definitions.
If Yes, please provide us with the name and website of the institute, where
2. If you have any difficulty or need to discuss this in any way, please contact this exists:
WHO Regional Office for**********; Dr *******, WHO/***** at
***@****** for ***** Region;
B. National Act, Law, Legislation, Ministerial Decree for Chronic Diseases
3. We prefer that you complete the questionnaire in an electronic version.
Prevention and Control
Further copies of the form are available at from your Regional counterpart,
the WHO Headquarters focal point ([email protected]) or the WHO website These are nationally approved act, law, legislation or ministerial decree for
(http://www.who.int). prevention and control of chronic diseases.
4. Some of the questions require that you provide supplementary material
B1 Does your country have Tick box, Type Year, Title and website
(e.g. documents, reports and published papers). We would prefer to receive
an act, law, legislation, if yes (or PDF file), if exists
an electronic copy of each (WORD, PDF etc) and the website where the
ministerial decrees
document is located. If electronic version is unavailable, please send
developed on the
two hard (paper) copies of each. If the original document is in another following areas
language, we would be grateful to receive a short abstract in English.
a. Tobacco control ** ®
5. We recommend that you discuss this questionnaire with the relevant
®
people or focal points at the national level prior to completion to ensure
as full a response as possible. ®
b. Food and nutrition ®
A. National Focal Point, Unit/department, and Institute • Specific food product ®
e.g. fat consumption,
A1 Is/are there a focal point(s) for overall prevention and control of chronic salt control
diseases in the Ministry of Health and /or in your Organization?
• Settings: school, ®
Yes ® No ® workplace
If yes, please give contact details of lead person as follows: c. Alcohol control ** ®
Surname: .................................... First Name: .......................................... d. Physical activity ®
Designation /Title: ...................... Unit /Department: ................................ e. Any other regulatory ®
instruments of
Address: ........................................................................................................ relevance to Chronic
Tel: .............................................. Fax: ...................................................... disease prevention
Email: ............................................................................................................ and control? (please
indicate)
A2 Is there a unit (or department) for prevention and control of chronic
Any other comments you wish to add regarding section B?: .........................
diseases in the Ministry of Health?
.................................................................................................................................
Yes ® No ® .................................................................................................................................
If Yes, what is the total Number of staff: .................................................................................................................................
 52 53

C. Policy, Strategy, Action Plan, Programme C4 Does your country have If yes, Year, Title (original and English)
individual national please and website (or PDF file), if exists
These are nationally approved policies, strategies, action plans, programmes for
policies developed on tick
the prevention and control of chronic diseases.
the following areas
.
a. Tobacco Control ®
C1 Does your country have a national health policy relevant to chronic
diseases prevention and control? b. Nutrition/diet ®
Yes ® No ® c. Physical Activity ®
If yes, please give: Effective Year: ........ Title (original and English): .... d. Alcohol Control ®
....................................website (or PDF file), if exists: ............................. e. Hypertension ®
Please provide hard (paper) copy, if electronic version does not exist. f. Diabetes ®
C2 Does your country have a national health strategy relevant to g. Heart Diseases ®
prevention and control of chronic diseases? h. Stroke ®
Yes ® No ® i. Cancer ®
If yes, please give: Effective Year: ........ Title (original and English): .... j. Chronic respiratory ®
....................................website (or PDF file), if exists: ............................. disease
Please provide hard (paper) copy, if electronic version does not exist. k. Other chronic disease/ ®
C3 Does your country have national integrated programmes for chronic NCD of importance in
diseases prevention and control which cover all or some of the your country
major risk factors (tobacco use, nutrition, physical inactivity, alcohol C5 Does your country have If yes, Year, Title (original and English)
consumption), or main chronic diseases (heart diseases, stroke, cancer, individual national please and website (or PDF file), if exists
chronic respiratory diseases, hypertension, diabetes)? action plans developed on tick
Yes ® No ® the following areas
If yes, please give details: a. Tobacco Control ®
Effective Year: ....... Title (original and English): .................................. b. Nutrition/diet ®
...............................website (or PDF file), if exists: .................................. c. Physical Activity ®
Please provide hard (paper) copy, if electronic version does not exist. d. Alcohol Control ®
e. Hypertension ®
f. Diabetes ®
g. Heart Diseases ®
h. Stroke ®
i. Cancer ®
j. Chronic respiratory ®
disease
k. Other chronic disease/ ®
NCD of importance in
your country
 54 55

C6 Does your country have If yes, Year, Title (original and English) D2 Which organizations were involved in setting population targets for
individual national please and website (or PDF file), if exists chronic disease prevention and control? (Please tick)
programmes developed on tick Ministry of Health ® Associations for ®
the following areas specific population
a. Tobacco Control ® groups e.g. Men’s,
b. Nutrition/diet ® Women’s or Youth
Organizations
c. Physical Activity ®
Ministry of Education ® Consumer ®
d. Alcohol Control ® Organizations
e. Hypertension ® Ministry of Finance ® Medical /Health ®
f. Diabetes ® professional
g. Heart Diseases ® Associations
h. Stroke ® Other Ministries (Specify) ® Disease-specific ®
Associations e.g.
i. Cancer ® Cancer Society,
j. Chronic respiratory ® Diabetes Associations
disease Subnational Government ® International ®
k. Other chronic disease/ ® Nongovernmental
NCD of importance in Organizations
your country World Health Organization ® Other Bilateral/ ®
C7. Are there any relevant policies / plans in preparation? multilateral
Organizations
Yes ® No ®
If yes, please give details ............................................................................... National nongovernmental ® Academic institutions ®
Organizations
Any other comments you wish to add regarding section C?: .........................
Citizen or community ® Others (please ®
.................................................................................................................................
representatives specify)
.................................................................................................................................
Any other comments you wish to add regarding section C?: .........................
D. National Target .................................................................................................................................

D1 Please complete the table below on the areas of chronic disease or E. Implementation of the Framework Convention on Tobacco Control
major risk factors where National targets for prevention and control (FCTC) and the Global Strategy on Diet, Physical activity and Health(DPAS)
have been set.
E1. Has your country become a contracting Party to the WHO FCTC?
Area/aspect of chronic diseases (or National targets
Yes ® No ®
risk factors, health determinants)
If Yes, does your country have an action plan for the implementation of the FCT,
in addition to any Tobacco Control action plan already mentioned in section C?
Yes ® No ®
If Yes, please provide us with a copy of the document or Web site and
electronic file (in word, PDF).
 56 57

E2. Are there aspects of FCTC implementation you need assistance with F2 During the past 5 years (2000-2005), were national/provincial studies/
from WHO? surveys carried out on: (Please tick)
Yes ® No ®
Tobacco use ® Raised blood glucose ®
E3. Does your country implement the DPAS?
Yes ® No ® Unhealthy diet ® Raised blood pressure ®

If Not, Does your country have plans for the implementation of the DPAS? Physical inactivity ® Dyslipidaemia ®
Alcohol consumption ® Heart diseases ®
Yes ® No ®
Hypertension ® Stroke ®
If Yes, please provide us with links to the website where the plans is the and
the electronic copy (word, PDF, etc), or provide us with a hard copy. Diabetes ® Cancer ®
E4. Does your country have a mechanism in place for discussion/interaction Overweight and obesity ® Chronic respiratory diseases ®
between national authorities and private sector interests related to the F3 Does your country have a routine or regular surveillance system for
DPAS? chronic diseases/risk factors?
Yes ® No ® Yes ® No ®
If yes, what is the mechanism? If Yes, please state:
E5. Are there aspects of DPAS implementation you need assistance with • the year initiated date last completed:
from WHO? • the periodicity age groups covered:
Yes ® No ® and provide us with a Web site and electronic file (in word, PDF)of the
most recent report
F. National health reporting system, survey and surveillance F4 Which of the following chronic diseases/risk factors does your
country’s chronic disease surveillance system cover? (Please tick)
National health reporting system refers to annual or regular health report Tobacco use ® Overweight and obesity (Body ®
system of MOH; Survey refers to regular, fixed or unfixed time interval national Mass Index)
health survey; Surveillance refers to the ongoing monitoring and reporting/
analysis of chronic disease/risk factors, morbidity and mortality due to chronic Unhealthy diet e.g. ® Dyslipidaemia (cholesterol) ®
disease in a population. low fruit and vegetable
intake
F1 a. Does your country have a health information system in which chronic Physical inactivity ® Heart diseases ®
disease and major risk factors are part of system? Alcohol consumption ® Stroke ®
Yes ® No ® If yes,
Diabetes (Elevated ® Cancer ®
b. Are chronic diseases included in the annual health report system? blood glucose)
Yes ® No ® If yes,
Hypertension (Elevated ® Chronic respiratory diseases ®
c. Please specify the data included: blood pressure)
1) Risk factors ® 2) Cause-specific mortality ® 3) Morbidity ®
F5. Has the WHO Stepwise approach to surveillance for risk factors been
d. How are the results made available e.g. website?
implemented in your country?
e. How has the information been used for decision-making or policy- Yes ® No ®
making?
Any other comments you wish to add regarding section F?: .........................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
 58 59

G. National community-based demonstration programme for chronic G4 Does your country have health promotion and chronic Yes No
disease prevention and/or health promotion disease prevention and control demonstration project(s) for
individual settings?
Refers to national demonstration community-based chronic disease prevention (Please tick all that apply).
and control and/or health promotion programmes targeting major risk factors, group
of population or settings. Please provide a website and electronic evaluation report, if
these exist?
G1 Does your country have health promotion and chronic Yes No Workplace ® ®
disease prevention and control demonstration site(s) for ® ® School ® ®
integrated chronic disease prevention and control?
Hospital and clinics ® ®
If yes, what?
Community ® ®
Please provide a website and electronic evaluation report, if
these exist? Family ® ®

G2 Does your country have health promotion and chronic Yes No Others(please indicate) ® ®
disease prevention and control demonstration site(s) for ® ® Any other comments you wish to add regarding section G?: ........................
tackling individual risk factors? .................................................................................................................................
If yes, what? .................................................................................................................................
.................................................................................................................................
Please provide a website and electronic evaluation report, if
these exist?
G3 Does your country have health promotion and chronic Yes No
disease prevention and control demonstration project(s) for
individual population groups?
(Please tick all that apply).
Please provide a website and electronic evaluation report, if
these exist?
Children 15 years and Under ® ®
Young People and Adolescents, 15 –24 years ® ®
Adults, 25 – 64 years ® ®
Elderly, 65 years and over ® ®
Women ® ®
Others (please indicate) ® ®
 60 61

H. National Protocols/Guidelines/Standards for Chronic Diseases and I. Financial Resources

Conditions Specific budgetary and other financial resources allocated for chronic disease
Refers to the prevention, treatment or management services that deal with an prevention and control.
already existing noncommunicable disease or risk factor aiming to prevent, treat I1 Has your country allocated specific resources or a dedicated Yes No
and control the condition, prevent complications, improve outcomes and quality budget for implementation of a national policy or strategy
of life of the patients. for the prevention and control of chronic diseases?
H1 Does your country have national protocols/ Tick box, Type I2 Does your country allocate specific/dedicated budgets for Yes No
guidelines/standards developed and implemented if yes prevention and control in any of the following chronic
for the prevention, treatment or management of diseases components?
the following chronic diseases or risk factors? a. Tobacco use ® ®
If yes, please provide a website and electronic b. Nutrition/diet ® ®
document, if these exist?
c. Physical activity ® ®
a. Hypertension ®
d. Alcohol consumption ® ®
b. Diabetes Mellitus ®
e. Obesity ® ®
c. Heart diseases ®
f. Hypertension ® ®
d. Stroke/CVA (Cardiovascular Accident) ®
g. Diabetes Mellitus ® ®
e. Cancer ®
h. Heart diseases ® ®
f. Chronic Respiratory Diseases ®
i. Stroke ® ®
g. Smoking Cessation ®
j. Cancer ® ®
h. Weight Control ®
k. Chronic respiratory diseases ® ®
i. Dietary ®
I3 What is the source of financial support for chronic diseases prevention
j. Physical activity ® and control? (Please tick). Government appropriation from:
k. Other chronic diseases /NCD of importance in ® Increase tax on Cigarette ®
your country
Fund Raising Activities ®
Any other comments you wish to add regarding section H?: ........................ Increase tax on Alcohol ®
.................................................................................................................................
................................................................................................................................. Donations from Health Interested Private Groups ®
................................................................................................................................. Increase Tax on unhealthy imported food ®
Unspecific resources of financial budget ®
International Financial Aids ®
Others (please indicate) ®
Any other comments you wish to add regarding section I?: ..........................
.................................................................................................................................
.................................................................................................................................

THANK YOU FOR COMPLETING THIS QUESTIONNAIRE

 62 63

ANNEX 2 Copies of documents

Copies of strategies, policies, action plans and guidelines can be in local
EXPLANATION OF TERMS languages but please provide an abstract in English, if another language is used.
Please provide links to the website(s) where the documents are located and attach
electronic files (Word, PDF, etc), or provide hard copies. Effective year refers to
OBJECTIVES, TERMS AND DEFINITIONS year that policy, legislation or thing in question takes effect.

Objectives Respondent group

This survey aims at assessing the current national capacity in health policy, If information for different sections of the questionnaire is managed by a
strategy, action plan and programmes for prevention and control of chronic different person or different ministries in countries, it is advised to convene the
diseases, in order to: people responsible in order to prepare the response.
(1) Assess progress of national chronic diseases prevention and control; Definitions
(2) Share information, experiences and best practices;
1. National Focal Point, Unit/Department, Institute:
(3) Identify constraints and needs;
i. National focal point: refers to the person responsible for prevention and
(4) Assist in the formulation, implementation and evaluation of policy, control of chronic diseases in MsOH, in a national public health institute
strategy and action plan in countries. or chronic disease prevention and control institute;
Terms ii. Unit or department: refers to a unit or department in MsOH for disease
prevention and control or prevention and control of chronic diseases;
In order to assure standardization in responding to the questionnaire, it is
essential that the respondent reviews the following terms and definitions before iii. Institute: refers to a national public health institute or chronic disease
attempting to complete the questionnaire: prevention and control institute.

Chronic Diseases (Noncommunicable Diseases) 2. National Act, Law, Legislation, Ministerial Decree:
In this questionnaire, the terms “chronic diseases” and “noncommunicable i. Refers to nationally approved acts, laws, legislation, ministerial decrees
diseases” are considered synonymous. This questionnaire primarily focuses on targeting prevention and control of chronic diseases and risk factors; or
four prominent chronic diseases, which are given a high priority by the WHO prevention and control of chronic diseases or related risk factors as part of
Global Strategy for Noncommunicable Diseases Prevention and Control. legislations concerned.
These four diseases are, cardiovascular diseases, cancer, diabetes, and chronic ii. Tobacco legislation: This deals with legal provisions for tobacco control
respiratory diseases. Cardiovascular disease include heart disease and stroke including information on health hazards from different tobacco products,
(cerebrovascular accidents); cancer includes malignant tumors of organs such as passive smoking, protection of children, and different laws for tobacco
brain, lung, prostate, breast but also leukaemias and lymphomas; diabetes refers prevention, cessation, taxation, and distribution of tax revenues.
to diabetes mellitus; and chronic respiratory diseases includes chronic obstructive
pulmonary disease (COPD) and asthma. iii. Food and nutrition legislation: Deals with legal provisions for food and
nutrition, including manufacturing, labelling, quality assurance standards,
Chronic Disease Prevention and Control (CDPC) food protection regulation, etc. In this questionnaire, the food and/or
For the purpose of this questionnaire, CDPC includes all activities related to sur- nutrition legislation is related to chronic diseases prevention and control,
veillance, prevention and management of the four chronic diseases mentioned above. or chronic diseases prevention and control is part of its concerns.

Risk Factors 3. National Policy, Strategy, Action Plan/Programme:

Refers to the major risk factors common to the four chronic diseases namely: i. Strategy: Refers to the national strategy that includes a long term plan
tobacco use, unhealthy diet, physical inactivity, alcohol consumption, elevated of action designed to achieve the goal of prevention and control of chronic
blood pressure and blood glucose, overweight and obesity, and dyslipidaemia. diseases.
 64 65

ii. Policy: In the context of the Chronic Disease Prevention and Control, 5. National health reporting system, survey and surveillance:
policy means consensus among relevant partners on issues to be addressed i Annual health reporting system: This includes the annual health reports
and on approaches or strategies to be used in doing so. Therefore, a of the MOH, containing data on national capacity, human resources,
national policy for chronic disease prevention and control refers to a demographic data, health expenditure, health indicators. Morbidity
written document endorsed, in collaboration with related sectors, by the information many include incidence or prevalence data from disease
country’s Ministry of Health (MOH), which includes a set of statements registries, hospital admission or discharge data.
and decisions defining goals, priorities and main directions for attaining
these goals. The policy document may also include a strategy containing ii National survey: Refers to national fixed or unfixed time interval survey
main lines of action that are adopted to give effect to the policy. on the main chronic diseases, or major risk factors common to chronic
diseases.
iii. National integrated action plan (NIAP): Refers to the countries
iii Surveillance: Refers to information on risk factors, chronic diseases
core public health principles incorporated into country action plan for
and their determinants, which is a continuous analysis, interpretation
chronic diseases prevention and control through a concerted approach to
and feed-back of systematically-collected data using survey or regular
addressing the multidisciplinary range of issues within a prevention and
registration.
health promotion framework across the broad range of chronic diseases.
NIAP targets all major common risk factors common to main chronic 6. National community-based demonstration programmes for chronic
diseases, and integrate primary, secondary and tertiary prevention, health disease prevention and/or health promotion:
promotion and diseases prevention, and programmes across sectors and
Refers to national community-based demonstration programmes that address
disciplines through, rather than rely on, a disjointed set of small scale
issues relevant to chronic disease prevention and major risk factors; apply
projects through a set of actions, harmonizing actions, integrating actions
existing knowledge to practice effective prevention at community level;
with existing public health systems by incorporating contemporary
examine different methods of disease prevention and health promotion;
evidence-based concepts into this approach.
evaluate their feasibility; and validate their effect and how they can be a
iv. National action plan: This is a scheme, prepared according to policy and source of public and professional inspiration. Large or national programmes
strategic directions, and defining activities, to generate products/targets based on experience of the demonstration areas can be launched.
set to achieve the desired goals. The plan should identify who does what
(type of activities and people responsible for implementation), when 7. Implementation of FCTC and DPAS:
(time frame), how and for how much (resource). It should ideally have an Refers to the national action plan or work plan for implementation of the
inherent mechanism for monitoring and evaluation. Framework Convention on Tobacco Control (FCTC) adopted by WHA 56
v. National programmes: Refers to the understanding of the national in May 2003, and the Global Strategy for Diet, Physical Activity and Health
overall goal and objectives within the framework of national chronic (DPAS) endorsed by WHA 57 in May 2004.
disease prevention and control, translate these into programme goals and
8. National Protocols/Guidelines/Standards for Chronic Diseases and
objectives that are consistent with the intervention strategies and from
Conditions:
these develop a blueprint of how the intervention activities will operate
and evaluate the results. Refers to prevention, treatment or management services that deal with an
already existing chronic disease or risk factors aiming to treat and control
vi. Capacity: The ability to perform appropriate tasks effectively, efficiently
the condition, prevent complications, improve outcomes and quality of life
and sustainably (at national level) of patients.
4. National Target: 9. Financial Resources:
Refers to setting of quantitative output, impact, outcomes or health indicators Refers to specific chronic disease prevention or risk factors intervention
for chronic diseases prevention and control (or risk factors such as tobacco and budget allocation for prevention and control in any of the chronic
use, unhealthy diet and physical inactivity, and health determinants such as diseases components and the source of financial support for chronic diseases
environment, lifestyles, socio-economics etc). prevention and control.
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ANNEX 3 4. In the survey mentioned above, your country indicated that it had national
programmes/projects in the area of chronic diseases prevention and control.
In a few words could you describe the nature and extent of these programmes/
KEY INFORMANT QUESTIONS projects?
Interviewer comments:
Interview Questions Regarding Chronic Diseases Prevention and 5. In the survey mentioned above, your country indicated that there was
Control for Key Informants legislation in place regarding tobacco control and food and nutrition. In a
few words could you describe the nature and extent of this legislation?
Date:
Member State:
Tobacco:
Key Informant:
Food and Nutrition:
1. How would you rank NCD prevention and control as a priority for action
Interviewer comments:
given the present health status of your country’s population and the capacity
of your health system? 6. In the survey mentioned above, your country indicated that there was a
surveillance system (or register) for chronic diseases. In a few words could
low median high
you indicate the nature and extent of this system?
Interviewer comments: Chronic diseases Population-based Institution-based
2. What do you think are the major constraints or barriers (top 3) to the develop- Hypertension
ment and implementation of policies and programmes for chronic diseases
Diabetes
prevention and control in your country? (rank in order all that apply).
Heart diseases
a) Public health policy
Stroke
b) Fiscal resources
Cancer
c) Human resources Chronic respiratory diseases
d) Information systems
e) Health care infrastructure Interviewer comments:
f) Essential drugs and equipment 7. In the survey mentioned above, your country indicated that there was a
g) Knowledge/skills/tools surveillance system that included surveillance for some of the chronic
diseases risk factors namely ……………… . In a few words please indicate
h) Other
the nature and extent of these systems?
Interviewer comments:
3. In the survey conducted in 2005 by WHO entitled “ The Global Survey on Risk factors Population-based Institution-based
Progress of National Chronic Disease Prevention and Control “, your country Tobacco use
indicated that it had an official policy or plans in the area of chronic diseases
Unhealthy diet
prevention and control. In a few words could you describe the nature and
extent of the policy or plans or programmes? Physical inactivity

1) Policies Alcohol consumption

Overweight and obesity
2) Action plans
 68 69

Risk factors Population-based Institution-based ANNEX 4

Raised blood glucose
Raised blood pressure LIST OF WHO MEMBER STATES RESPONDING TO
Dyslipidaemia THE GLOBAL SURVEY

Interviewer comments:
8. In the survey mentioned above, your country indicated that there were chronic AFRICAN REGION Zimbabwe
disease prevention and control programmes integrated with the primary Angola
health care system. In a few words could you describe the nature of these
programmes and explain what the term “integrated” means in this context? Benin REGION OF THE
Cameroon AMERICAS
Interviewer comments: Cape Verde Antigua and Barbuda
9. Implementation of the WHO Global Strategy on Diet, Physical Activity and Congo Argentina
Health (DPAS): Bahamas
Côte d’Ivoire
1) In the survey mentioned above, your country defined the mechanism in Barbados
place for discussion/interaction between national authorities and private Democratic Republic of the
sector interests related to the DPAS. In a few words could you please Congo Belize
indicate the nature and extent of this mechanism? Eritrea Bolivia
2) Are there aspects of DPAS implementation for which you need assistance Ethiopia Brazil
from WHO?
Gabon Chile
10. What do you think should be the major priority areas for WHO technical
Ghana Colombia
support for chronic diseases prevention and control for your country? (Rank
in order all that apply). Kenya Costa Rica
a) Training for human resource development Madagascar Cuba
b) Establishing demonstration programmes Malawi Dominican Republic
c) Policy, action plans and programmes development for chronic diseases Mali Ecuador
prevention and control Mauritania El Salvador
d) Assistance with chronic diseases surveillance Mauritius Guatemala
e) Assistance with risk factor surveillance Namibia Guyana
f) International collaboration and networking Niger Haiti
g) Other Sao Tome and Principe Jamaica

Interviewer comments: Seychelles Mexico

Swaziland Nicaragua
Uganda Panama
United Republic of Tanzania Paraguay
Zambia Peru
 70 71

Suriname Cyprus United Kingdom of Great Tuvalu

Trinidad and Tobago Britain and Northern Ireland Vanuatu
Czech Republic
Uruguay Uzbekistan Viet Nam
Denmark
Venezuela (Bolivarian Estonia
Republic of ) SOUTH EAST REGION
Finland
Bangladesh
Georgia
EASTERN India
MEDITERRANEAN Greece
Indonesia
REGION Hungary
Myanmar
Afghanistan Ireland
Nepal
Bahrain Israel Sri Lanka
Egypt Italy
Iran (Islamic Republic of)
Kazakhstan WESTERN PACIFIC
Jordan REGION
Latvia
Lebanon Australia
Lithuania
Libyan Arab Jamahiriya Brunei Darussalam
Montenegro
Morocco China (People’s Republic of)
Netherlands
Oman Cook Islands
Poland
Pakistan Fiji
Portugal
Saudi Arabia Japan
Republic of Moldova
Sudan Lao People’s Democratic
Syrian Arab Republic Romania Republic
Tunisia Russian Federation Malaysia
Yemen Serbia Micronesia (Federated States of)
Slovakia Mongolia
EUROPEAN REGION Slovenia Niue
Albania Spain Palau (Republic of)
Andorra Sweden Philippines
Armenia Switzerland Republic of Korea
Belarus Tajikistan Samoa
Belgium The former Yugoslav Republic Singapore
Bulgaria of Macedonia Solomon Islands
Croatia Turkey Tonga