Guatemala

1. COSTA RICA Guatemala Honduras El Salvador Nicaragua Costa Rica Panamá Costa Rica 51.200Km

2. COSTA RICA Population: 4,600,000 (four million six hundred thousand) Life expectancy: 79 years old Social Security coverage: 90% of population Margarita Claramunt Ministry of Health National coordinator of Non Communicable Disease (NCD

3. Fiveprinciple causes of mortality in Costa Rica Ministry of Health, 2011

4. BIOLOGICAL RISK FACTORS ECNT OF NCD IN COSTA RICA, 2010 Overweight and obesity in adults Total 62% , men 58,4 % women 65, 8% Hipertention in adults 37,8 % CCSS Overweight children< 5 años 8,1% ENN 2009 Diabetes en adultos 10,5 % CCSS Overweight and obesity in adolescentes 21,0%, ENN 2009

5. BEHAVIOURAL RISK FACTORS ECNT OF NCD IN COSTA RICA, 2010 Fruits and vegetables consumption (>o= 5 portions per day ) Total 22,3% Adult smokers of tobacco Total 14%, Smoking teenagers of tobacco Total 8,9 % Low physical activity in adults 50 % MEN 38% WOMEN 63% Low physical activity in Adolescentes 72% EGA

6. Some main achievements in Costa Rica in tackling NCDs and their risk factors • Law antitbacco and regulation • Food regulation in student cafeterias • Elimination of trans fats in processed foods • Food guide diffusion • Food security Policy and National Plan 2011-2021 • National Plan in Physical Activity 2011-2021 • National Plan to reduce consmption of salt sodium 2011-2021

7. Interventiontoimprove NCD in healthcaresystem IMPROVEMENT OF THE QUALITY OF ATTENTION IN HIPERTENTION AND DIABETIC PATIENTS • CROSS SECTION METHODOLOGY • Establish national standards to measure quality attention using indicators and instruments in different phases: diagnosis, process and results. • Elaboration of Guidelines in Hipertention and Diabetes

8. Results of theevaluation in healthservices Net • Equipments badly calibrated in 3 levels of attention (local, regional and national) • Lack of knowledges of health professionals in the levels of hypertention and diabetes • Lack of knowledges in the correct measurement of the arterial pressure • by doctors and nurses • Lack of information to the patients on the management of their disease ACTIONS • Implementation of a Plan toimprovethequalityattention of thepatients • Calibration of equipmentsevery 6 months in publichealthservices • Training tohealthprofessional in measuringthe arterial pressure • and knowledge of thehypertentionlevels and diabetes levels • - Groupmethodology of innovative nutritional education

9. Multisectorial interventionto reduce riskfactors in NCD Food regulation in school cafeteria Decree of Ministry of Education and Ministry of Health (2012) to regulate saturated fat, sugar, sodium and calories of food that is offered in school cafeterias Results • Foodindustrystartedto reduce fat, sugar and sodium in someprocessedfood • Training tosupervisors of cafeterias in schools • Information, education and communicationtostudents, teachers,parents and • educationcommunityabouthealthyfood and foodthatisnotallowedbecause • of itshighcontent in sugar, salt and fat. • No evaluationyetaboutnutritionalhabitsbutis in process.

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