WHO Global Forum IV on Chronic Disease Prevention and Control

Part 2: Records of Discussions

2.1: Policy Group Discussions

Participants provided policy feedback based on the following two questions. Responses are not in order of priority.

1. What do your countries/organizations/ networks/coalitions and alliances do well with respect to policy, i.e., enabling action through evidence-based advocacy?
   1. What are 2 or 3 actions that your countries/ organizations/networks/coalitions and alliances could do to improve what they do with respect to policy, i.e., enabling action through evidence-based advocacy?

1. What do your countries/ organizations/ networks/coalitions and alliances do well with respect to policy, i.e., enabling action through evidencebased advocacy?
   

• International Level: broad policies have been developed, e.g., FCTC, WHO Global Strategy on Diet, Physical Activity and Health, the Ottawa Charter.
• Policy making is done through a more consultative process now, e.g., in the UK where community involvement is key to policy development. Today many organizations and countries analyze why something Sdoesn't work and then adjust policies based on what is learned.
• Chronic disease is more integrated into a primary health care approach and national public health surveillance.
• The availability of data (e.g., NCD STEPwise) has strengthened evidence-based policy development and advocacy.
• Political commitment is increasingly combined with community effort.
• There is more emphasis today on using science and surveillance data as a basis for 25 WHO Global Forum IV on Chronic Disease Prevention and Control
• The strengthening of public health systems in some countries has had a positive effect.
• There is a need to strengthen across sectors, e.g., Ministries of Health, Agriculture and Transportation as well as Health.
• There needs to be support of NGO capacity.
• Linkages among public health and diseasebased organizations at the international level have improved.
• Policy has improved generally in terms of legislation and at community, schools and work sites.
• WHO contributes significantly by, e.g.,
  • providing international connectivity to promote chronic disease prevention policies as part of its global mandate
  • collecting evidence through demonstration databases
  • developing policy frameworks for chronic disease prevention and setting policies in broader health and social sector policies
  • developing materials for global advocacy
  • providing technical assistance for capacity building and program development.
• The Chronic Disease Prevention Alliance of Canada (CDPAC) combines the largest NGOs in an alliance that is developing a powerful voice for advocacy and fostering innovative thinking in civil society.
• The Canadian Intersectoral Healthy Living Network is a consortium of organizations working on integrated chronic disease prevention, health promotion and nutrition that facilitates networking for policy development and implementation.
• The International Council for Nurses builds capacity for nurses to participate in the national decision making processes and works with nurses to make their roles more proactive in chronic care and therefore chronic disease prevention.
• Heartfile is an NGO that has developed a national policy on chronic diseases in an integrated multi-stakeholder partnershipbased model that uses country-wide evidence to develop national policies and plans of action.
• The PAHO nutrition unit is advocating through governments to improve transportation policies that support physical activity, e.g., bike paths.
• WHO Collaborating Centres provide operational research to generate evidence for policy action.
• There is an improved process of policy development, starting with evidence, then advocacy, action planning and strategies.
• Advocacy is used to initiate consensus with stakeholders and get the attention of policy builders and to prioritize chronic disease prevention in the public health agenda.
• Formulation and initiation of policy development is being done well and easily; however, implementation and application of chronic disease policy is still weak.
• There is a growing recognition by many countries of the burden of chronic disease and the need for policies to address it.
• Networks show enthusiasm and commitment.
  
• Civil society groups are more active in advocacy.
• Canada has drawn attention to the determinants of health and set up frameworks and models for action, although implementation is problematic.
• Tanzania has developed guidelines for chronic disease prevention and control involving different sectors. Thail
• and is good at creating national level campaigns (e.g., physical activity), but less effective at the people/community level.
• In China, the government has asked each province to set up a unit to take responsibility for chronic disease prevention and control and to give resources to it. A long-term national strategy is being developed, 26 WHO Global Forum IV on Chronic Disease Prevention and Control including an action plan with financial support. A multisectoral cooperation committee has been set up for tobacco issues, working towards ratification of the FCTC and a national strategy for tobacco control. There is a wealth of experience at the provincial and local level with communitybased interventions. There are also food and nutrition guidelines as part of a national longterm strategy with a 10-20 year timeline.
• In Europe, cities exert local influence on national policy development related to implementation.

Developing Countries

• Developing countries such as Ghana are dealing with a double burden of disease related to both communicable and noncommunicable diseases, which poses different challenges, e.g.,
  • how do you use evidence of increased NCD to put resources into chronic disease prevention without taking away from communicable diseases?
  • how do you mobilize partners in multiple NGOs (such as World Bank, UNICEF, etc.) to move the agenda forward
  • who will put plans and resources in place to implement them?
  • how do we bring in partners from outside the health sector?
• Developing countries may not want to develop all encompassing policies on chronic disease prevention and control; they should focus on models for specific diseases (such as diabetes) that are an increasing priority.
• We need evidence of the burden of disease as well as about the effectiveness of interventions. It is difficult to assess the effectiveness of population-based interventions - the science is not sufficient to answer all the questions we have.
• There is a need to introduce changes in approaches by agencies in developing countries - CD and NCD can complement each other. 2. What are 2 or 3 actions that your countries/ organizations, networks, coalitions and alliances could do to improve what they do with respect to policy, i.e., enabling action through evidence-based advocacy?

All Levels

• Advocate, advocate, advocate and raise awareness. Many countries do not feel that chronic disease prevention is on the political agenda yet. In particular, we need more evidence-based advocacy with respect to diet, physical activity and health. There is not as big a need for evidence in tobacco.

"Let's not preach to the choir; we need to focus on the unconverted."

Country Level

• Develop a strong economic rationale for country benefits related to chronic disease prevention. However, instead of talking about cost savings (which won't work), tie the rationale to quality of life issues, productivity and to the dependency ratio.
  
• Develop national committees on tobacco control and national planning.
• Establish processes and structures to implement strategies based on and/or integrated with existing structures.
• Develop better tools for (a) policy impact assessment, (b) health impact assessment of policies put forward by other parts of government, and (c) marketing the impact of successful policies.
• Provide country-specific evidence to advocate and influence policy development.
• Develop differential strategies that aim to improve access to care, e.g., equipping disadvantaged groups with the information they require to address their health issues. This approach requires strategies that are contextualized to suit the needs of those at risk in terms of social issues.
• Analyze existing agricultural, trade and transportation policies to learn what works and what doesn't.
• Look at health insurance benefits for medication. 27 WHO Global Forum IV on Chronic Disease Prevention and Control
• Develop a health equity policy that enshrines health as a basic human right.
• Change health professionals' curriculum and education so that they are more aware of population-based prevention and the determinants of health.
• Develop models for interdisciplinary training and approaches to building capacity in integrated ways so that ultimately we can infiltrate systems.
• Support public education as a precursor to policy change, including more research on linkages between education and change.
• Encourage more cross-talk and interaction between chronic disease approaches to surveillance and integrated risk factor approaches.
• Recognize that policy and advocacy are multidimensional, including
  • epidemiological data
  • political/interest groups
  • economic externalities, e.g., productive losses
  • rights based access
  • health as a human right
  • emotional impact on women, poor people, children's future health.
    
• Make strategies more implementable at the country level, e.g., - FCTC: Develop structures such as a ministers' committee at the national level. Have a strong consultation process; build coalitions that involve NGOs, government agencies, enforcement; develop clear action plans that focus on resource mobilization. Put in place a monitoring mechanism. - WHO Global Strategy on Diet, Physical Activity and Health: Include physical activity at the country level. Consider alcohol as an additional strategy both in-region and in-country. Put in place an action plan with defined targets, objectives and a timetable for implementation. Develop high level advocacy at every level, including where there is resistance.
• Develop a combined multi-stakeholder governance mechanism.
• Foster capacity development at the local level and enhance sustained capacity development at the country level.
• 
• Start with the determinants, not the disease.
• Address power struggles among sectors.
• Focus more on how we can work together and not as much on differences. Acknowledge the importance of customizing various approaches to different stakeholders and situations. Establish when to use approaches and for whom, e.g., high risk vs. population approaches or a combined approach; disease prevention vs. health promotion or a combined approach. Recognize similarities between chronic disease prevention and health promotion.
• Bring the legislators on board: ultimately, on some issues, we need high level decision makers to create the legislation required to support our key values.
• Through organizations such as WHO and the World Bank, strengthen the commitment of the international community to send a strong signal that there is a link between health and poverty to support action at the country level.
• Establish partnerships with sectors outside health, e.g., agriculture, finance.
• Prioritize chronic disease prevention and control in national health agendas and subsequently allocate both human and financial resources.
• Improve existing policies on nutrition and food, transportation, etc., to re-orient them to chronic disease prevention and control.
• Collect better information and improve the information base through surveys and surveillance.
• Tie the talk to action, e.g.,
  • move from demonstration of the importance of the determinants of health to addressing them
  • communicate with different departments when developing health policies and ensure they consider the impact of their own policies on health
  • relate interventions to poverty reduction strategies
  • use social marketing principles in chronic disease prevention and intervention
• Start some activities for health screening for employees, involving trade unions.

Organizational Level

• Involve regulatory bodies to ensure their potential contributions are realized.
• Regarding the WHO: avoid a compartmentalized approach to policy around chronic diseases: "integration" is a term that is over-used but under-done. Strengthen high level advocacy for policy development and the capacity for identifying and addressing priorities.
• Develop better research methodologies and value other dimensions of decision making.
• Have international organizations advocate at high political level for policy formulation and by sharing country experiences within networks.
• 
• Have international organizations coordinate, communicate and streamline a concerted policy, plan and approach to prevent conflicting positions among organizations.
• Ensure that national organizations critically review evidence and use evidence better in policy development.

Network Level

• Establish a multisectoral approach at the network level, which tends to be inwardlooking.
• Foster sharing among networks to ensure the same multisectoral approach is used at the member country level.
• Assist with the development of national goals and intersectoral targets for chronic disease prevention and control.
• Share experiences more frequently and communicate more regularly among networks.
• Network with the media. Communicate with the public through language and approaches that they will understand, e.g., not just complex statistics but plain language.
• Ensure that network members share experiences to support country development rather than keeping it "in the club." Coalition/Alliance Level
• Regarding the WHO, FCTC and other documents: clarify and better define roles of each partner and make them more actionoriented - currently everyone seems to be doing the same thing.
• Advocate for mobilization of resources to chronic disease prevention and control, including raising awareness.
• Explore opportunities for combined funding mechanisms with other programs, e.g., HIV/AIDS.
• Ensure better coordination and collaboration for an integrated approach.
• Create multi-sectoral partnerships.

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