International and Canadian Perspectives on Integrated Chronic

Disease Prevention

Dr. Sylvie StachenkoDirector General, Centre for Chronic

Disease Prevention and Control

2

Global NCD Picture

3

Global NCD Burden

4

5

Risk Factors and Global Burden of Disease

Selected Risk Factor

% E.U. DALY’s

% Global DALY’s

Tobacco 9% 3%

Alcohol 8.4% 3.5%

Hypertension NA 1.4%

Physical Inactivity 1.4% 1%

Ref: Global Burden of Disease 1990; Murray and Lopez

6

Key Issues

Burden: large and increasing

Risks: few and modifiable communicated globally cluster in time among the poor

Interventions: effective but underused

Health Systems: transform to meet new challenges

7

Milestones for World Health Assembly Resolution of 2000

Building the Evidence-base

Comprehensive Community Cardiovascular Control Programs (CCCCP) – 1974

MONICA (CVD prevention initiative, 1980’s)

INTERHEALTH + CINDI (1985)

8

Good Health(reducing NCD)

Promotion Prevention Health Care

- Determinants of Health- Lifestyle programmes- Mental Health

- Models of Chronic Care

Bridging Agent - CINDI

Monitoring and Evaluation

9

The CINDI Approach Integration

Commonality of risk factors for major NCD Systems approach to delivery Partnerships

Demonstrations Focal point for development of know-how

Dissemination. . .

Canadian Heart Health Initiative (CHHI – 1987)

10

The Global NCD StrategyFocus on Integration

WHA endorsed framework for the integrated prevention and control of NCD’s – May 2000

However…Member State capacities pose challenges for supporting an integrated NCD agenda

11

Ref: Assessment of National Capacity for Noncommunicable Disease Prevention and Control. WHO 2002

12

13

14

Ref: Assessment of National Capacity for Noncommunicable Disease Prevention and Control. WHO 2002

15

Impetus for Integration International Level

Networks of national programmes and integrated community based NCD prevention and control initiatives CINDI (Euro), CARMEN (Amro), NANDI (Afro), INDRIA (Searo), EMEN (Emro), WPRO

Global Forum of community based networks Focus on 4 priority NCD

CVD, cancer, diabetes, chronic respiratory disease Taking stock of existing integrated comprehensive

programs across the world Research and training in policy

16

17

Impetus for IntegrationNational Assets

Canadian Heart Health Initiative Observatory of community-based

comprehensive programs 311 projects in 10 provinces, 35 community level

programs Development of tools and methodologies

Process evaluation Partnership and linkage model

International, national, provincial, and community Public, private, and voluntary sector

18

19

20

Canadian Heart Health Initiative Lessons Learned

Long time-frame and sustainable funding needed…visible output requires visible input

‘Preventive dose’ not achieved…’scaling up’

Focus mainly on community mobilization, public health - health care system not fully mobilized…sustainability

Link up with other targeted prevention initiatives and combine strategies whenever possible (CHHI, Diabetes, Canadian Strategy on Cancer Control…)

21

Impetus for Integration National Assets

National Alliances Chronic Disease Prevention Alliance Coalition on Enhancing Preventive Practices

of Health Professionals

Provincial Alliances Several provinces moving toward integrated

NCD strategy (MB, BC, NS, AB)

22

Strategic Opportunities Romanow Commission:“What relative share of governments’ investments in health should be focused on prevention of illness and injury, promotion of good health habits, treatment of illnesses or “healthy” public policy to address the socio-economic and other inequalities that lead to ill health?”

Large funding streams: Tobacco, Diabetes, Primary Care Fund

Research (CIHR)

Federal provincial advisory committees

ACPH

ACHI

23

CCDPC Role

1. Knowledge Generation and Dissemination

2. Policy development

3. Surveillance expertise

4. International (CINDI Canada and WHO Collaborating Centre on NCD policy)

24

Towards Integration - Challenges Need to create an Observatory function and database of best

practices for integrated approaches

Integrated evaluation framework

Dissemination through effective usage of IT and other mechanisms (e.g. G-8 Heart Health Telematics Project)

Intersectoral collaboration

New alliances between public health and clinicians

Comprehensive approach to chronic disease across the continuum of care

Integrate in the population health agenda

. . .

A National Strategy for integrated chronic disease prevention…