European Region makes huge gains in NCD response, but needs faster progress
The WHO European Region’s response to noncommunicable diseases (NCDs) has brought it on track to achieve some of the global Sustainable Development Goals (SDGs), Global Monitoring Framework on NCDs and Health 2020 targets, notably reducing premature mortality and hypertension. These results are set out in the latest edition of the annual Monitoring noncommunicable disease commitments in Europe, launched at the WHO Global Conference on enhancing policy coherence to prevent and control NCDs in Montevideo, Uruguay, on 18–20 October.
The report shows that because of the rapid decline in premature deaths related to NCDs, the Region is likely to achieve SDG target 3.4 to reduce premature mortality from NCDs by one third by 2030 earlier than 2030, and will most probably exceed it significantly.
The report also highlights, however, that tobacco use and alcohol consumption are declining too slowly, and prevalence of overweight and obesity is rising rapidly, so the targets in those areas are unlikely to be achieved. Robust assessment of other selected targets – such as salt reduction, physical activity and access to essential medicines and technologies – is currently not possible owing to limited comparable data.
Monitoring progress in policy implementation
The annual publication reports on the progress made in the WHO European Region in the fight against NCDs. Each edition focuses on a different topic: this year’s theme is progress towards implementation of “best buys”– highly effective, low-cost interventions – for the governance, surveillance and prevention of NCDs: the so-called “progress monitoring indicators”.
The report demonstrates that implementation of progress monitoring indicators has improved significantly over the last two years in the Region. Between 2015 and 2017 the proportion of full implementation of indicators in countries increased on average from 34% to 42%; Bulgaria, Turkey and the United Kingdom have the highest share of fully implemented indicators in 2017. The proportion of at least partial implementation of indicators increased from 69% to 76%.
The effort to implement the most effective policy interventions, along with the major decline in mortality, opens an opportunity to accelerate achievement in all countries, irrespective of income levels. It allows countries with a higher burden to hasten their progress by applying good practices from the experience of other countries in the Region that overcame similar challenges decades ago.
Inequalities in premature deaths
The evidence shows that large inequalities in premature mortality levels remain between and within countries, and reveals strong gender inequity: most premature deaths occur among men and are caused by cardiovascular diseases.
Recognizing this, countries have identified a gender-sensitive approach: masculinities and hypertension management in primary health care are two important areas of action to further accelerate the decline in premature mortality. Preliminary analyses indicate that eliminating excess male and cardiovascular disease mortality would reduce absolute inequalities between countries by approximately 50% and contribute substantially to Health 2020 and SDG targets.
Dr Zsuzsanna Jakab, the WHO Regional Director for Europe, presenting the report about the Region’s progress at the Global Conference, emphasized the need for Member States to continue making timely interventions. “Although the WHO European Region as a whole has achieved substantial progress in reducing premature mortality from NCDs, there is no time for complacency. Governments need to act resolutely and implement the ‘best buys’ that have a rapid effect on mortality, such as controlling the price, availability and marketing of tobacco and alcohol.”
Gaps in surveillance of NCD risk factors
Surveillance of NCD risk factors has improved significantly in the eastern part of the WHO European Region in the last two years, thanks to a generous grant from the Government of the Russian Federation and efforts by the WHO European Office for the Prevention and Control of NCDs in Moscow, Russian Federation.
It is nevertheless worrying that it is not currently possible definitively to assess indicators on physical activity, salt intake, drug therapy and counselling to prevent heart attacks and strokes, and availability of affordable basic technologies and essential medicines. Implementation of health examination surveys is also declining in the Region and even some of the wealthiest countries in the world are not currently conducting such surveys, leading to a lack of data for monitoring trends.
Countries have a lot more to do to achieve the health targets within the SDGs. “In order to accelerate progress we need to engage the whole of society in the implementation of multisectoral solutions, with participatory governance for health,” said Dr Gauden Galea, Director of the Division of NCDs and Promoting Health through the Life-course at WHO/Europe. “Strengthening health systems’ response to NCDs is the key to achieving universal health coverage in the Region, but our work needs to go beyond that and tackle the root causes – the social, economic, environmental and commercial determinants of health. This will lead to improved health outcomes and reduced inequalities, and will contribute to the sustainability of universal health coverage in the Region.”