WHO Department for Management of NCDs, Disability, Violence and Injury Prevention (NVI): Year in review
Saving lives through early diagnosis of cancer
In advance of World Cancer Day in February, WHO issued the Guide to cancer early diagnosis. This new tool highlights that delays in diagnosis often make treatment more complicated and costly and less successful. To save millions of lives, the guide indicates three actions: improve public awareness of different cancer symptoms and encourage people to seek care when these arise; invest in strengthening and equipping health services and training health workers so they can conduct accurate and timely diagnostics; and ensure people living with cancer can access safe and effective treatment, including pain relief, without incurring prohibitive personal or financial hardship. These actions will help policy-makers meet national targets tied to the SDGs. The impetus for this is timely as new figures indicate that more than 14 million people develop cancer every year, a figure which is projected to rise to over 21 million by 2030. Around 8.8 million people die from cancer annually, most of them in developing countries. The Guide to cancer early diagnosis has been downloaded nearly 23,000 times since its release, and is helping countries such as Sudan to enhance diagnostic pathways to reduce delays in care.
Assessing the emergency care system in Tunisia
Based on the findings of the WHO Emergency Care System Assessment, Tunisia developed priority actions aimed at strengthening its system. These were defined at a national meeting in January which convened emergency care providers from all levels of the nation’s health system. The WHO Emergency Care System Assessment helps policy-makers and planners evaluate the system, identify gaps and set priorities for addressing them. It has been conducted in nearly 30 countries; in 2017 this included Cameroon, Egypt, Myanmar, Pakistan, Tanzania, Uganda and Ukraine. The country action plans have generated a range of interventions ─ including basic emergency care training, implementation of triage and resuscitation protocols, development of clinical checklists, and establishment of standardized data collection and registries ─ improving outcomes from medical, surgical and obstetric emergencies. The Disease Control Priorities project estimates that nearly half of deaths and over a third of disability in developing countries could be addressed through effective emergency care.
“Rehabilitation 2030: a call for action" to strengthen rehabilitation in countries
Hosted on 6-7 February, Rehabilitation 2030, a global gathering of some 200 of the world's leading rehabilitation experts, concluded with a call for action to address the significant and ever-increasing need for rehabilitation services around the world. Participants pledged to support governments to enhance rehabilitation services by incorporating rehabilitation into universal health coverage. Specifically, they agreed to work towards building comprehensive service delivery models, a strong multidisciplinary workforce, expanded financing mechanisms and enhanced health information systems. During the meeting, WHO released Rehabilitation in health systems, a guide for health and other policy-makers, bringing to light these issues and highlighting the pressing need for assistive technologies like wheelchairs, eye glasses and hearing aids. Strong leadership and political support will underpin these efforts, which are considered a prerequisite to achieving SDG 3 on health.
Preventing drowning in the Philippines
Drowning takes the lives of approximately 5,800 people in the Philippines every year, of a total of 360,000 worldwide. Since 2015 WHO has supported drowning prevention projects in the Davao del Norte region of the Philippines. These were assessed by WHO colleagues during site visits in February. Throughout the year, work in the two target municipalities has continued to progress well, catalyzing a significant investment of financial and human resources from local government partners. The drowning prevention approaches being implemented, in line with the recommendations of WHO’s Global report on drowning, focus largely on the installation of barriers to wells and the doorways of homes which sit on or near water. Local government support has complemented this particular intervention with extended hours of day care for pre-school children, improvements in footbridges and offers of training in basic lifesaving.
Avoiding hearing loss by making sound investments
On World Hearing Day, 3 March, WHO joined partners in drawing attention to the economic impact of hearing loss. Around 360 million people worldwide have disabling hearing loss; 32 million of them are children. To mark the occasion, WHO released a new report, Global costs of unaddressed hearing loss and cost-effectiveness of interventions, estimating that lack of attention towards hearing loss poses an overall annual cost of 750 billion international dollars globally, including 67-107 billion international dollars to the health sector alone. Where strategies to prevent hearing loss are well-established, they have resulted in financial savings and significant return on investment. Cost-effective solutions include screening of newborn and school-aged children and adults above 50 years of age, reduction of noise exposure, early treatment of ear infections and provision of appropriate hearing devices. The report highlights that these interventions should be replicated wherever there is a need.
Updating appropriate treatment options for people with diabetes
Based on the availability of new medicines, WHO is updating its recommendations on diabetes management. In March, the WHO Guidelines Development Group held an expert consultation in Geneva, during which the use of several new pharmacological agents in diabetes treatment was discussed, particularly in the context of low-resource settings. The recommendations from the meeting will be reflected in updated guidelines for policy-makers and practitioners as part of the WHO Package of Essential Noncommunicable (PEN) disease interventions for primary health care in low-resource settings. The Global report on diabetes, released by WHO on World Health Day in 2016, indicated that the number of people living with diabetes has almost quadrupled since 1980 to 422 million adults, with most living in developing countries. Factors driving this dramatic rise include overweight and obesity. Among the key recommendations from the report are that governments must help people with diabetes receive the treatment and care they need to manage their conditions, and that includes use of a small set of generic medicines. The new guidelines will be available in early 2018.
Ending violence against children in Uganda
In March, the Government of Uganda solicited the input of WHO, UNICEF, United States Centers for Disease Control and Prevention (US CDC) and a network of Ugandan NGOs to develop a national strategy for preventing violence against children. The strategy reflects what is known about the issue in the country and thinking around the most impactful ways to transform that knowledge into actions. This move was spearheaded by the Ugandan Ministries of Health and of Gender, Labour and Social Development. The strategy and related plan of action were informed by findings from the recent US CDC-UNICEF national survey of violence against children in Uganda, the provisional results of which show that in some districts up to 40% of adolescent girls and 17% of adolescent boys experienced sexual violence in the past year. It was also informed by the WHO-led technical package INSPIRE: seven strategies for ending violence against children. It calls for integrating violence prevention measures such as parent and caregiver support, life skills training, and income and economic empowerment into community-level HIV-prevention and response structures. WHO will continue to provide technical support for this work throughout 2018.
Making roads safe in Thailand
According to WHO estimates reflected in the Global status report on road safety 2015, more than 24,000 people lost their lives on the roads of Thailand in 2013. This figure raised the alarm, and the Government of Thailand has since taken several important steps towards safer roads. In 2017 these included enacting new laws based on best practice on drink-driving and seat-belt wearing and around licensing and penalties for drivers, among others. In addition, with respect to managing speed – a core of the safe system approach promoted by WHO – officials in 22 provinces reduced speed limits. WHO contributes to such achievements in Thailand through ongoing training and mentoring of lawyers and other decision-makers to help build their capacities to assess, develop and advocate for evidence-based laws and of journalists to improve their reporting on road safety and road safety laws with a focus on solutions. In April 2017, WHO launched an e-learning platform on road safety legislation to further build their capacities. Similar efforts are ongoing as part of the Bloomberg Initiative for Global Road Safety 2015-2019 in China, India, Philippines and Tanzania.
70th World health assembly addresses NCDs, cancer and deafness and hearing loss
On 31 May, the 70th World Health Assembly:
- Adopted a resolution endorsing an updated list of evidence-based and cost-effective interventions for the prevention and control of some of the world's leading killers: cardiovascular diseases, cancer, diabetes and chronic respiratory diseases. The list of interventions, featured as Appendix 3 of the WHO Global action plan for the prevention and control of noncommunicable diseases 2013-2020, was revised based on new data and evidence. From a total of 88 proposed interventions, the update contains 16 interventions which are considered the most cost-effective and feasible for implementation. Among them are offering drug therapy and counselling to those who have had a heart attack or stroke; vaccinating girls aged 9-13 years against human papillomavirus; and screening women aged 30-49 years for cervical cancer. As countries prepare for the next High-level Meeting of the UN General Assembly on the Prevention and Control of NCDs in 2018, the list of interventions will help them to plan and show progress towards achieving the SDG target of reducing premature mortality from NCDs by one third by 2030. http://apps.who.int/gb/ebwha/pdf_files/EB140/B140_R7-en.pdf
- Adopted a resolution for the first time in 12 years on cancer prevention and control, calling on governments to implement a national cancer control plan with a focus on equity and access; reduce risks for cancer through strategies such as imposing higher taxes on tobacco and alcohol; ensure early diagnosis and accessible, affordable and high-quality care; and develop the appropriate competencies and skills of their workforces. The resolution also invites development of a global report on cancer featuring evidence-based, policy-oriented guidance for scaling up cancer prevention and control. As a first step towards its development, WHO and its International Agency for Research on Cancer hosted an expert consultation in early September during which participants concluded the need for an inclusive, visionary report that would set the cancer agenda for the next decade. The general content and structure of the report was defined. The report is expected to be released in 2019. http://apps.who.int/gb/ebwha/pdf_files/WHA70/A70_ACONF9-en.pdf
- Adopted a resolution on the prevention of deafness and hearing loss. Half of all cases of hearing loss can be prevented through public health measures. Integrating strategies for ear and hearing care within the framework of primary health care systems underpins such efforts. The resolution calls for training programmes to build human resource capacities; screening programmes for early identification; accessible, high-quality, affordable hearing devices; and regulations for the control of noise in various settings. A stakeholders’ consultation to define next steps on several of these actions was held in July. This includes developing tools and standards related to the Make Listening Safe initiative, preparing a global report on hearing and undertaking global advocacy through World Hearing Day.. http://apps.who.int/gb/ebwha/pdf_files/WHA70/A70_34-en.pdf
WHO releases new guidance to prevent drowning
Launched during a high-level forum on drowning prevention hosted by Bloomberg Philanthropies in New York on 2 May, Preventing drowning: an implementation guide provides concrete guidance for programme managers for conducting situation assessments and implementing effective drowning prevention strategies. The implementation guide, which features case studies showing real world application, builds on the recommendations of the first Global report on drowning released by WHO in 2014. The event also served as the occasion for Bloomberg Philanthropies to announce a further US$ 25 million to support drowning prevention activities from 2018-2022.
Furthering progress towards achieving the SDGs with the SaveLIVES technical package
In the context of the Fourth UN Global Road Safety Week, 8-14 May, WHO launched SaveLIVES: a road safety technical package. Each year, more than 1.25 million people die as a result of road traffic crashes and as many as 50 million people are injured. Road traffic crashes are the leading cause of death among people aged 15-29 years. The package of 6 strategies and 22 interventions offers an evidence-based inventory focused on Speed management, Leadership, Infrastructure design and improvement, Vehicle safety standards, Enforcement of traffic laws and post-crash Survival (SaveLIVES). The Fourth UN Global Road Safety Week itself was celebrated worldwide under the banner "Save Lives: #Slow Down". Around 1000 events took place in at least 125 countries drawing attention to the dangers of excessive and inappropriate speed and highlighting the urgent measures needed. These included “Slow Down Days” in a number of cities. In the context of the UN Week, WHO also released the brochure Managing speed, documenting that speed contributes to 1 in 3 road traffic fatalities worldwide. Such efforts help to further achievement of SDG targets 3.6 and 11.2.
WHO Global Ambassador for NCDs, Michael R. Bloomberg, launches Partnership for Healthy Cities
On 16 May, as part of his philanthropic giving, Michael R. Bloomberg launched the Partnership for Healthy Cities, a prestigious global network of more than 50 cities committed to saving lives by preventing NCDs and injuries. The initiative premises that with the majority of the world’s population now living in urban settings, cities and their leaders are uniquely positioned to transform the fight against these leading killers by implementing evidence-based policies to reduce exposure to risks. Along with Vital Strategies, WHO is providing technical support to the effort to help cities implement one of 10 interventions, among them creating walkable, bikeable, liveable streets; reducing drink-driving and speeding, and increasing seat-belt and helmet use. Effective policies at the city level will help achieve the SDGs by 2030, by improving health and creating safer, more sustainable cities. Bloomberg Philanthropies has committed US$ 5 million to the activity in the form of seed grants. Cities also have access to a global network of mayors to improve the sharing of good practices. The achievements and lessons learned from the Partnership will be showcased in 2018.
Strengthening rehabilitation services in Botswana
With technical support from WHO, the Ministry of Health and Wellness of Botswana conducted a comprehensive rehabilitation situation assessment with a view to strengthening rehabilitation services in the country. Using newly developed tools for rehabilitation system situation assessment which are currently being piloted, the Government identified strengths and weaknesses of the system and priorities that need to addressed, including development of a specialist rehabilitation facility to deliver comprehensive rehabilitation services. Based on the findings and recommendations of the assessment, conducted from 24 April-5 May, WHO assisted the Ministry in September to draft its first national rehabilitation policy and strategic plan and establish its first specialist rehabilitation facility to be opened in Francistown in 2018.
141st Meeting of the WHO Executive Board addresses rheumatic heart disease
On 1 June, the WHO Executive Board discussed a draft resolution on rheumatic heart disease, an illness caused by damage to the heart valves and heart muscle from the inflammation and scarring caused by rheumatic fever. Rheumatic heart disease affects at least 33 million people and causes over 300,000 deaths annually. Among the priority activities for Member States outlined in the resolution are to accelerate multisectoral efforts to reduce poverty, a key determinant of the disease burden; implement and resource programmes in endemic countries; build the capacities of the primary health care workforce; and ensure the timely and reliable access to technologies and medicines. With regard to the latter, international stakeholders, including private sector entities, are key. The draft resolution is to be further discussed in the World Health Assembly in May 2018.
Measuring disability in Cameroon
In June, a report was finalized reflecting the findings of the World Bank and WHO Model Disability Survey (MDS) in Bankim, Cameroon. The MDS collects detailed information on the lives of people with disability – their impairments, related health conditions, and environmental factors that limit their activities and restrict their full participation in society. In Bankim, the MDS indicated that the rate of severe disability in the district is nearly 13% for men and nearly 14% for women, with 60% of people with severe disability reporting difficulties in accessing the toilets in their own homes, schools, workplaces or public transport. The FAIRMED Foundation, which initiated and carried out the survey in 2016, will use the results to guide its work. In 2017, the MDS was also conducted nationwide in the Philippines and Qatar as well as piloted in Panama; Balochistan, Pakistan; and Dubai, United Arab Emirates. WHO helps by providing technical support for the training of interviewers, the analysis of data and the preparation of final reports. The MDS can lead to profound changes in a country. In Chile, the first country to implement the MDS nationally, policies and laws linked to mental health, labour and transport have been updated as a result. The MDS is also used to monitor progress towards fulfillment of the SDGs and implementation of the Convention on the Rights of Persons with Disabilities.
Preventing and managing NCDs in Timor-Leste
On 28 July during the country’s first National Health Day, H.E. the Prime Minister of Timor-Leste released the Package of essential noncommunicable disease interventions (PEN) in Timor-Leste. Adapted with WHO support from the global WHO PEN package, this national version, approved by the Honourable Minister of Health, identifies priority actions including equipping health facilities with a dedicated team of health workers, offering diagnostic services and providing essential medicines. These actions are among those identified in the global WHO Package of essential noncommunicable (PEN) disease interventions for primary health care in low-resource settings, which offers a prioritized set of cost-effective interventions that can be delivered to an acceptable quality of care, even in settings with limited resources. Such measures are considered useful building blocks for enhancing a nation’s overall primary health care system.
Managing cardiovascular diseases in Nepal
In August the Ministry of Health of Nepal held a training for 20 healthcare providers from 2 pilot districts on the basic principles of the WHO Package of Essential Noncommunicable (PEN) disease interventions for primary health care in low-resource settings. The training included a session on the WHO HEARTS technical package for cardiovascular disease management in primary health care, in particular the package’s module on systems monitoring. The aim of the HEARTS technical package is to improve clinical preventive services in primary health care using highly effective, scalable, sustainable and proven interventions. It uses a protocol-driven approach to simplify, standardize and support the scaling-up of integrated CVD management. As a result of the training in Nepal, and with technical support from WHO, registers and other relevant forms related to NCD management, including CVD management, were modified to ensure alignment with the HEARTS technical package. These modifications will be rolled out by the Ministry of Health in Kailali and Ilam Districts in 2018.
Taking first steps towards preparation of the World report on vision
During a side event held at the 70th World Health Assembly in May, Member States called for development of a global report to provide the evidence on which to call for accelerated action on vision. An estimated 253 million people around the world live with vision impairment, 36 million of whom are blind. Chronic eye diseases are the main cause of vision loss. For its first meeting in August, the Editorial Committee for the Word report on vision provided advice on the proposed report structure, the scope of background papers and the process for the report’s development. The Editorial Committee also discussed the theme issue on vision for the Bulletin of the World Health Organization, for which the call for papers was subsequently announced in October. Next steps in the development of the Word report on vision include commissioning background papers to inform the first draft, which will go for consultation in early 2018.
New programme set to scale-up prevention and control of cardiovascular diseases (CVDs)
CVDs are the number one cause of death globally: more people die annually from CVDs than from any other cause. An estimated 17.7 million people died from CVDs in 2015, representing 31% of all global deaths. On 12 September, a new initiative was launched - Resolve to Save Lives - the first to be funded by three leading philanthropies, namely Bloomberg Philanthropies, Chan Zuckerberg Initiative and Bill & Melinda Gates Foundation. The initiative aims to save more than 100 million lives by preventing heart attacks and strokes and will help countries close life-threatening gaps in epidemic preparedness. Backed by US$ 225 million, the initiative's CVD component will seek increased control of blood pressure, reductions in dietary sodium intake and elimination of artificial trans-fat. WHO is using its convening power to facilitate the preparatory phase of the project in China, India and Thailand and finalizing a series of related technical manuals, in line with its own Global HEARTS initiative.
Preventing violence in schools in El Salvador
In September, the Government of El Salvador invited WHO to join a national policy dialogue on schools-based violence prevention. Participants reviewed the global evidence on what works and identified how the evidence can best be used to shape national policy. A high-level satellite session attended by the Minister of Education of El Salvador and the Vice Ministers of Education from Guatemala and Honduras was held to launch a formal statement highlighting the three countries’ commitment to strengthening schools-based violence prevention. In recent months WHO has collaborated closely with the technical team in charge of drafting El Salvador’s national policy, and will provide ongoing support for its implementation. This work is part of a broader drive by WHO, UNESCO and UNICEF to advance schools-based violence prevention, which in the coming year will result in publication of a manual on the topic, as well as national policy dialogues in other countries.
Supporting education for children who are blind in Tajikistan
During a technical support mission to Tajikistan in July, WHO was made aware of a critical shortage in the special paper used for Braille texts in schools in Tajikistan. The special paper had been lacking for more than ten years, and as a result, the Braille texts had become so worn they were no longer usable, hampering the learning of students. In collaboration with the Ministry of Health and Social Protection and the National Association of the Blind, WHO conducted a needs assessment, raised funds from the Italian Society for the Blind and sourced the paper. On 19 September a ceremony marked the official hand over of 4.5 tonnes of paper worth € 150,000. The event was presided over by the Deputy Minister of Health and Social Protection and involved colleagues from this ministry as well as the Ministry of Education, the National Association of the Blind and WHO. It is expected that the two-year supply of special paper will help over 1,000 children who are blind, enabling them to learn with their peers.
8th Meeting on Milestones of a Global Campaign for Violence Prevention documents progress
Hosted by the Government and the Public Health Agency of Canada on 19-20 October, WHO’s 8th Milestones Meeting convened around 250 participants from some 50 countries. Globally, 470,000 people are victims of homicide every year. Hundreds of millions more people suffer non-fatal forms of violence. Violence contributes to leading causes of death such as cancer, heart disease and HIV/AIDS, because victims are at an increased risk of adopting behaviours such as smoking, alcohol and drug misuse and unsafe sex. Meeting participants documented recent progress on implementing proven violence prevention policies and programmes, which will help to achieve the SDG violence-related targets. They agreed on the need to better communicate with policy-makers and the public regarding the wealth of existing knowledge about what works to prevent violence. A new tool released by WHO during the meeting will support such efforts, namely "Violence Info", a global interactive knowledge platform of scientific findings about violence. WHO also issued Clinical guidelines for responding to sexual abuse of children and adolescents. It is estimated that 18% of girls and 8% of boys worldwide have experienced sexual abuse. This new guidance aims to help health care providers identify such abuse; provide an empathetic response when children and adolescents disclose, or show signs of, abuse; and help connect survivors to services beyond health.
Assessing achievements in preventing and managing NCDs in South Africa
In October a checklist for evaluating national action plans to prevent and control NCDs was developed by WHO and shared with the National Department of Health of South Africa. This simple tool, which is currently being finalized, will support countries to assess their plans to ensure they are realistic, complete and cover the various facets that need to be addressed. The tool is currently being used at national and subnational levels. In addition to helping the National Department of Health to determine the extent to which its plan for the period 2013-2017 has been implemented, it is also aiding in identifying gaps, which will inform the next national action plan which is currently under development.
Governments reach consensus on a comprehensive set of global road safety targets
On 21 November in a historic move, Member States, represented by senior officials from health, transport, interior, police and other sectors, concluded work on a comprehensive set of 12 global road safety targets to measure progress. The performance targets align with the five pillars of the Global Plan for the Decade of Action for Road Safety 2011-2020: road safety management, safer roads and mobility, safer vehicles, safer road users, and post-crash response. These targets will provide a framework to guide the focus and scale of national road safety activities that are needed in order to meet the SDGs. In the coming months, WHO will work with Member States and other UN agencies to develop a set of indicators to facilitate measurement of the new targets.
Members convene for General Meeting of the Global Alliance Against Respiratory Diseases
The 2017 General Meeting of the Global Alliance Against Respiratory Diseases (GARD) was attended by more than 80 GARD participants. Members identified strategies to raise awareness about chronic respiratory diseases globally and scale-up implementation of related programmes. Recommendations to improve surveillance, prevention, management, research and advocacy were endorsed by the General Assembly. Air pollution and its effects on chronic respiratory diseases were highlighted in a special session organized jointly with the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA). GARD demonstration projects such as the Practical Approach to Care Kit (PACK) for primary health care and the Allergic Rhinitis and its Impact on Asthma (ARIA) initiative are being successfully implemented in several countries and expanded to others. Members agreed to enlarge GARD and ensure constructive links with Ministries of Health to reduce the burden of chronic respiratory diseases globally.
Enhancing ear and hearing care services in China
In November 2017, the National Health and Family Planning Commission of China organized a policy discussion drawing attention to effective strategies for the prevention of deafness and hearing loss. An estimated 298 million people in China live with hearing loss. The Government’s recent efforts to address the issue at national and regional levels dovetail with the actions called for in the World Health Assembly resolution adopted in May. Among recent initiatives taken include hearing screening for all newborn babies, and, in collaboration with the China Disabled Persons’ Forum, provision of hearing aids and cochlear implants to those who need them amid an expansion of rehabilitation services in many parts of the country. WHO has supported these activities by providing technical guidance and materials linked to its Make Listening Safe campaign which promotes safe listening practices and other topics such as childhood hearing loss.
Global network of road safety legislators advocates for stronger legislation
Strengthening laws and their enforcement are key to road safety in all countries. Through the Bloomberg Initiative for Global Road Safety 2015-2019, WHO has worked with lawmakers in several countries, and together with the Towards Zero Foundation, has established the Global Network of Road Safety Legislators. The Annual Council Meeting of the Global Network was held on 12-13 December. Participants included lawmakers from Australia, Czech Republic, Egypt, Luxembourg, Moldova, Philippines, Tanzania, Thailand, Ukraine, and United Kingdom. At a pre-meeting, experts from WHO, Global New Car Assessment Programme, International Road Assessment Programme and the FIA Foundation offered models of impactful road safety initiatives that could be adopted in their countries. During the meeting itself, Members of Parliament presented progress from their respective countries, and, as a network, they defined next steps for the years ahead. This includes sending a delegation of Members of Parliament to the next discussion on road safety in the UN General Assembly, mobilizing for the Fifth UN Global Road Safety Week, promoting a new road safety target for 2030, and engaging with groups such as the Inter-Parliamentary Union and the Commonwealth Parliamentary Association.