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Adaptation & Implementation

… BE IT FURTHER RESOLVED, that the Policy on NCDs shall include benchmarks for ending the Regional State of Health Emergency; … BE IT FURTHER RESOLVED , that the Policy shall provide clear justification for its goals, including clear, accurate and referenced data on NCDs and their impact ;

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Adaptation & Implementation

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  1. … BE IT FURTHER RESOLVED, that the Policy on NCDs shall include benchmarks for ending the Regional State of Health Emergency; … BE IT FURTHER RESOLVED, that the Policy shall provide clear justification for its goals, including clear, accurate and referenced data on NCDs and their impact ; … BE IT FURTHER RESOLVED, that the Regional approach to NCDs shall integrate effectively with other regional, national and local NCD policies and plans;

  2. NCD Surveillance & Monitoring Framework & Plans Regional Bodies & Mechanisms for Control of NCDs Adults Illness (hypertension, diabetes, cholesterol, lung & vascular disease) Outcomes Stroke, dialysis, heart attacks, cancer, amputations, hospitalizations, death Youth Risks (obesity, tobacco, alcohol) Adults Risks Primary Care Environments Hospital Services Policies (Laws, regs, school, govt agency, church, traditional leader policies) Health Education & Promotion Clinical Services Advocacy Adaptation & Implementation APIL, MCIS, TradLeaders, Religious Leaders USAPI Health Professional Associations Ministers, Secretaries, Directors of Health

  3. NCD Burden- Impact of Interventions Sources: Franks P, et. al. JAMA, 27(6):737-741. 1993. McGinnis J, et. al. Health Affairs. 21(2) 2002

  4. Timeline, USAPI Regional NCD Response, 2010-14

  5. THE COMMITMENT: Fifteen Essential Policies for Reversing the Epidemic of Non-Communicable Diseases in PIHOA jurisdictions Risk Factor: Tobacco  Commitment 1: Increase taxes on tobacco products (to extent needed to offset costs)* Commitment 2: Pass and enforce model comprehensive smoke-free air acts * Commitment 3: Restrict all forms of tobacco product advertising* Commitment 4: Establish and sustain tobacco cessation programs Risk Factor: Alcohol  Commitment 5: Restrict all forms of alcohol advertising* Commitment 6: Restrict access to alcohol* Commitment 7: Increase taxes on alcohol (to extent needed to offset costs)* Risk Factor: Poor Nutrition  Commitment 8: Implement policies that reduce salt consumption* Commitment 9: Implement policies that reduce sugar consumption Commitment 10: Implement policies that reduce fat consumption* Commitment 11: Implement policies that promote breastfeeding Commitment 12: Implement policies that promote local foods Risk Factor: Lack of Physical Activity  Commitment 13: Develop the built environment to promote physical activity Commitment 14: Promote physical activity in the work place [reconsider] Commitment 15: Promote physical activity in the schools *WHO “Best Buys”

  6. NCD Policy Toolkit

  7. Regional Road Map • for Ending the Epidemic of Non-Communicable Diseases • In the United States Affiliated Pacific Islands • Version 9 • Updated May 22, 2013 • 1

  8. NCD Surveillance & Monitoring Framework & Plans Mechanisms for Control of NCDs Adults Illness (hypertension, diabetes, cholesterol, lung & vascular disease) Outcomes Stroke, dialysis, heart attacks, cancer, amputations, hospitalizations, death Youth Risks (obesity, tobacco, alcohol) Adults Risks Primary Care Environments Hospital Services Policies (Laws, regs, school, govt agency, church, traditional leader policies) Health Education & Promotion Clinical Services Legislators, Exec Branch, Schools,Relig & Trad Leaders Advocacy Clinical Guidelines, Chronic care delivery systems (WHO PEN, JNC, ADA, etc.) NCD Policy Tool Kit (model laws, regs, policies) Adaptation & Implementation Health Leadership Council Roadmap NCD Policy Commitment Package (includes WHO “Best Buys”) USAPI Professional Associations Ministers, Secretaries, Directors of Health

  9. Guam- Youth Tobacco Use Synar Amendment started Cigarette tax increased DMHSA cessation started Natasha Act passed 4 major decreases: 1999, 2003, 2005, 2007 By: Dr. Annette David, SPW & DMHSA PEACE

  10. ↓= Improved (rate decreased) N= No change ↑= Worse (rate increased) Blank= Not enough data

  11. Out of 144 measurements: 14=improved, 15=worse, 33=no change, 82=not enough data

  12. Take Home Messages • Some progress, especially tobacco and alcohol • Need to do much better overall • Many gaps in surveillance picture, because: At jurisdiction level- > No clear delegation of responsibility at jurisdiction level > Lack of NCD surveillance plans at jurisdiction level At regional level- > Surveillance activities initiated by variety of TA agencies > Very long turn-around time for analysis of some surveys > Vital stats problems

  13. Addressing the Gaps- Jurisdiction Level > Clear identification of surveillance teams in your jurisdiction > Nominate members to attend May Palau EpiTech Workshop (or hold similar activity in your jurisdiction) - Jurisdiction-level NCD Surveillance Plan - Technical work to harmonize CDC with WHO stuff - Credited Epi course delivery > Encourage/require enrollment of team members in EpiTech certificate program (for credit!)

  14. NCD SURVEILLANCE STYLES- Your Choices: CDC- BRFSS - Comparisons with US - Fits well with CDC/HP2020 • Stable external funding • Good analysis support • Flexible • Telephone survey • Does not fit as well with MANA • Not as good for Pacific comparisons BOTH • Comparisons with both US and Pacific • More burden on Depts of Health • Survey fatigue • Difficult to monitor trends WHO- NCD STEPS - Comparisons across Pacific - Fits well with MANA - Face-to-face survey -Does not fit as easily with CDC programs/HP2020 -Costs to come from country budgets -Analysis support not completely established -Not very flexible

  15. NCD SURVEILLANCE STYLES (Creating another choice) Harmonizing WHO with CDC Styles - Adapt BRFSS (and YRBS) to meet WHO needs as well as US program needs - physical measures - fit with new WHO NCD Surveillance Framework - Secretariats to work more closely to harmonize technical assistance

  16. Addressing the Gaps- PIHOA Board • Communique to CDC NCDPHP to request: > Assist to provide Epi TA/place epidemiologist in region > BRFSS & YRBS funding support > Adapt BRFSS and YRBS > Help support delivery of EpiTech and Pacific FETP • Asking WHO to assist with harmonization of BRFSS & YRBS, and harmonizing TA > ? Formal communique

  17. Regional Surveillance TA Entities SAMHSA • Behav Health Brisbane Accord Group • Vital stats HIV-STI TB, Etc,etc. PHIN (Public Health Information Network) - HIS planning PPHSN (Pacific Public Health Surveillance Network) - Outbreak prone diseases Counterparts Frameworks Training program Surveillance plans Off-island trips Counterparts Frameworks Training program Surveillance plans Off-island trips Counterparts Frameworks Training program Surveillance plans Off-island trips

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