WHO Global Forum IV on Chronic Disease Prevention and Control

Opening Session: A Global Context

Dr. David Butler-Jones, Canada's recently appointed Chief Public Health Officer, convened the Forum by welcoming participants and noting the wide range of perspectives on chronic disease prevention and control among the 27 nations represented in the room.

Dr. Jong-Wook Lee, Director General, World Health Organization, began his remarks by noting that with chronic diseases now accounting for 60% of deaths, there is an urgent need for more effective approaches to prevention and control. He acknowledged the role of the Global Forum in making major steps towards meeting this need and thanked Canada for hosting this 4th Forum and continuing its substantial impact in this area. Dr. Lee mentioned the benefits of strong Canadian support for the WHO Framework Convention on Tobacco Control, which is close to coming into force, and for the WHO Global Strategies for

Noncommunicable Diseases and Diet, Physical Activity and Health. He also noted the importance of the Millenium Development Goals and that chronic disease prevention and control must be an integral part of every health system.

Dr. Lee stressed the importance of immediate action. The World Health Assembly has adapted landmark strategies on tobacco, diet and physical activity. There is an unprecedented opportunity to move ahead through effective cooperation among all sectors involved. In closing, Dr. Lee commented that the WHO is fully committed to chronic disease prevention and control and expressed his strong hope that ministers of health and other policy makers would support immediate action in this area.

Hon. Ujjal Dosanjh, Minister of Health, Canada, brought greetings from the Prime Minister of Canada. He emphasized that chronic diseases represent one of the major global health challenges of our time, taking a devastating toll both on the health of societies and on their economies. The recent establishment of the Public Health Agency of Canada and the appointment of the Chief Public Health Officer puts chronic disease prevention and control at the core of the public health system in Canada. Canada also has two decades of experience related to such issues as diabetes and tobacco control and is committed to aggressively promoting a chronic diseases prevention and healthy living agenda.

Hon. Dosanjh noted key areas of Canadian collaboration with WHO, including support of the FCTC, the development of new international health regulations and effective policy and programme interventions for noncommunicable diseases. Hon. Dosanjh also highlighted Canada's investment of $500K for the WHO Collaborating Centre on Chronic Disease Policy, as well as hosting the International Cancer Control Conference in Vancouver in 2005. In closing, Hon. Dosanjh took the opportunity to signal increased efforts to work with WHO regarding chronic disease by tasking Canadian officials with developing a framework for future cooperation related to this important issue.

Hon. Dr. Jorge José Santos Pereira Solla, State Secretary for Health, Deputy Minister of Health, Brazil, provided an overview of the current situation in Brazil, which has seen changes in its population strategy and the pattern of morbidity and mortality through increased urbanization and an aging population. Dr. Solla explained that the Global Strategy on Diet, Physical Activity and Health has been supported by Brazil's Ministry of Health as a significant opportunity to develop and implement an effective line of action to reduce death and improve quality of life. Of particular interest is the national programme for pharmaceuticals that involves 23,000 physicians, nurses and 200,000 community health agents working in family health. It is expected that this programme and its associated database will help to improve prevention and contribute to effective surveillance and control for noncommunicable diseases. In closing, Dr. Solla reinforced his message that chronic disease prevention and control is one of the priorities of the public health system in Brazil.

Dr. Maria del Rocio Saenz Madrigal, Senior Minister of Health, Costa Rica, welcomed participants to the Global Forum IV. She noted that noncommunicable diseases are the most serious problem for governments in this century- once diagnosed they become a daily, ongoing concern for the individual, the community and health services. She emphasized the need for intersectoral strategies to improve quality of life, with special attention to risk factors in the poorest members of the population. Dr. Madrigal recognized that primary health care requires an economic commitment and emphasized the importance of the Millenium Development Goals, information systems and the public policy observatories as strategies for implementation.

Dr. Butler Jones closed the opening session by quoting Benjamin Disraeli: The health of the public is the foundation upon which rests the happiness of the people and the welfare of the state. He encouraged Forum participants to work together in support of global public health to find effective strategies to prevent and control noncommunicable diseases that dramatically shorten the lives of people across the world.

Keynote Presentations

Dr. Catherine Le Galès-Camus, Assistant Director General, Noncommunicable Diseases and Mental Health, WHO, introduced the keynote presentations by noting the urgent situation related to noncommunicable diseases and how action by Forum participants is essential to drive the chronic disease prevention and control agenda throughout the world.

Hon. Dr. Carolyn Bennett, Canadian Minister of State (Public Health) noted that public health is undergoing a renaissance that includes not only infectious diseases but chronic diseases as well. She also noted the importance of applying the four "C"s of collaboration, cooperation, communication and clarity to best practices across jurisdictions to develop an effective "what-when-how" strategy based not on a shopping list of needs but on real, measurable, meaningful goals.

Dr. Bennett commented on the wealth of perspectives, information sharing and creativity that can result from the diverse experiences among country representatives in the Forum. She encouraged strategies focusing on common risk factors and also emphasized the important contribution of research in achieving the Millenium Development Goals.

Dr. Catherine Le Galès-Camus made the point that governments and the public must be reminded that we are faced with a global epidemic of chronic diseases that will have catastrophic social and economic impact in both rich and low income countries. Increasingly, chronic diseases are an obstacle both to development and to realization of the Millenium Development Goals.

Dr. Le Galès-Camus outlined the following four points that she hoped would be discussed at the Forum:

1. Strengthen efforts to take an integrated approach, e.g., common risk factors, diet, tobacco; national strategies must emphasize prevention
2. Enable cooperation at the international level
3. Act quickly on public health issues by targeting individuals at risk and implementing a general programme for overall national populations
4. Contribute to the development of national capacity through policies, strategies and actions, e.g., at the national level through public health institutes to help policy and decision makers and provide training programs and policies in line with the most recent research.

In closing, Dr. Le Galès-Camus noted that WHO recognizes the double burden of developing countries, which must deal with both communicable and chronic diseases. WHO is redoubling its efforts in chronic disease prevention and control, but what is needed now are resources and a strong commitment from Ministries of Health to ensure we have a coordinated approach. The Global Forum is a framework to enable this to happen.

Dr. Joxel Garcia, Deputy Director, Pan-American Health Organization, echoed his copresenters' comments related to the global epidemic of chronic diseases and the need for a multisectoral approach to combat this epidemic. Although public health officials are acting to address these issues, the needs far outstrip the resources available to counteract them. Given the seriousness of the chronic disease challenge, Dr. Garcia emphasized the importance of bringing in as many influential people as possible to have an impact on chronic disease prevention and control, in particular industry, colleges, universities, policy makers, education and government. In closing, Dr. Garcia mentioned the epidemic of diabetes among Latino children in California, where for the first time in history, Latino parents will be burying their children.

In closing the keynote presentations, Dr. Le Galès- Camus thanked speakers and noted that it was now time for participants to get down to work to ensure the success of the Forum.

Forum Overview

Dr. Robert Beaglehole, Director, Department of Chronic Diseases and Health Promotion, World Health Organization, noted that it is an exciting and important time for public health, especially in Canada where as a result of SARS chronic diseases are now firmly on the agenda.

Dr. Beaglehole gave a brief update on discussions at the Regional Advisers meeting held November 3, which focused on how to best develop a truly global implementation plan for the Global Strategy on Diet, Physical Activity and Health. This was the second advisers' meeting in six months-an indication of the WHO commitment to strong leadership in this area. Dr. Beaglehole also mentioned the Global Report "Chronic Diseases-A Vital Investment" that will be published next year to make the case for investment and interventions that are affordable and effective. This report will provide STEPwise guidance for integrated national plans and set a quantitative goal for preventing deaths by 2015.

Dr. Sylvie Stachenko, Director General, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, introduced the three Forum themes of policy, participation and planning, commenting on the importance of intersectoral approaches to addressing these themes in an integrated manner that recognizes their interdependence. She emphasized the importance of the wealth of diversity at the Forum from many backgrounds and countries, and that the Forum was designed to be both a good learning experience and a venue for action planning.

Dr. Stachenko acknowledged participants who, like herself, had attended all previous Forums: Dr. Ruitai Shao (WHO), Dr. Sylvia Robles and Dr. Lucimar Coser Cannon (PAHO), Dr. Sania Nishtar (Heartfile, Pakistan), Dr. Janet Voute (World Heart Federation), Dr. Jerzy Leowski (SEARO) and Dr. Srinath Reddy (WHO Collaborating Centre, India).

Thematic Presentations

WHO Regional Advisers were invited to present thematic updates on their activities and to propose challenges to the meeting in relation to chronic disease prevention and control. The following presentations were made:

At the Forum, participants were provided with An Overview of Regional Networks as well as a copy of Forum presentations on a CD-ROM. Summaries of updates can be found in Part 1 of the Annex to this Document: "Forum Outputs and Resources".

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